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      Fungal Contaminants in Drinking Water Regulation? A Tale of Ecology, Exposure, Purification and Clinical Relevance

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          Abstract

          Microbiological drinking water safety is traditionally monitored mainly by bacterial parameters that indicate faecal contamination. These parameters correlate with gastro-intestinal illness, despite the fact that viral agents, resulting from faecal contamination, are usually the cause. This leaves behind microbes that can cause illness other than gastro-intestinal and several emerging pathogens, disregarding non-endemic microbial contaminants and those with recent pathogenic activity reported. This white paper focuses on one group of contaminants known to cause allergies, opportunistic infections and intoxications: Fungi. It presents a review on their occurrence, ecology and physiology. Additionally, factors contributing to their presence in water distribution systems, as well as their effect on water quality are discussed. Presence of opportunistic and pathogenic fungi in drinking water can pose a health risk to consumers due to daily contact with water, via several exposure points, such as drinking and showering. The clinical relevance and influence on human health of the most common fungal contaminants in drinking water is discussed. Our goal with this paper is to place fungal contaminants on the roadmap of evidence based and emerging threats for drinking water quality safety regulations.

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          Most cited references222

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          Guidelines for Drinking Water Quality

          (2011)
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            Fusarium infections in immunocompromised patients.

            Fusarium species cause a broad spectrum of infections in humans, including superficial, locally invasive, and disseminated infections. The clinical form of fusariosis depends largely on the immune status of the host and the portal of entry, with superficial and localized disease occurring mostly in immunocompetent patients and invasive and disseminated disease affecting immunocompromised patients. Risk factors for severe fusariosis include prolonged neutropenia and T-cell immunodeficiency, especially in hematopoietic stem cell transplant recipients with severe graft-versus-host disease. The most frequent presentation of disseminated fusariosis is a combination of characteristic cutaneous lesions and positive blood cultures, with or without lung or sinus involvement. The prognosis is poor and is determined largely by degree of immunosuppression and extent of infection, with virtually a 100% death rate among persistently neutropenic patients with disseminated disease. These infections may be clinically suspected on the basis of a constellation of clinical and laboratory findings, which should lead to prompt therapy. Treatment options include the lipid formulations of amphotericin B, voriconazole, and posaconazole. Prevention of fusarial infection among high-risk patients should be considered.
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              Aspergillus flavus: human pathogen, allergen and mycotoxin producer.

              Aspergillus infections have grown in importance in the last years. However, most of the studies have focused on Aspergillus fumigatus, the most prevalent species in the genus. In certain locales and hospitals, Aspergillus flavus is more common in air than A. fumigatus, for unclear reasons. After A. fumigatus, A. flavus is the second leading cause of invasive aspergillosis and it is the most common cause of superficial infection. Experimental invasive infections in mice show A. flavus to be 100-fold more virulent than A. fumigatus in terms of inoculum required. Particularly common clinical syndromes associated with A. flavus include chronic granulomatous sinusitis, keratitis, cutaneous aspergillosis, wound infections and osteomyelitis following trauma and inoculation. Outbreaks associated with A. flavus appear to be associated with single or closely related strains, in contrast to those associated with A. fumigatus. In addition, A. flavus produces aflatoxins, the most toxic and potent hepatocarcinogenic natural compounds ever characterized. Accurate species identification within Aspergillus flavus complex remains difficult due to overlapping morphological and biochemical characteristics, and much taxonomic and population genetics work is necessary to better understand the species and related species. The flavus complex currently includes 23 species or varieties, including two sexual species, Petromyces alliaceus and P. albertensis. The genome of the highly related Aspergillus oryzae is completed and available; that of A. flavus in the final stages of annotation. Our understanding of A. flavus lags far behind that of A. fumigatus. Studies of the genomics, taxonomy, population genetics, pathogenicity, allergenicity and antifungal susceptibility of A. flavus are all required.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                13 June 2017
                June 2017
                : 14
                : 6
                : 636
                Affiliations
                [1 ]Department of Biology, Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, 1000 Ljubljana, Slovenia; nina.gunde-cimerman@ 123456bf.uni-lj.si
                [2 ]Department of Water Hygiene, National Public Health Center, Albert Flórián út 2-6, H-1097 Budapest, Hungary; vargha.marta@ 123456oki.antsz.hu
                [3 ]Department of Biology, University of Veterinary Medicine, István utca 2, H-1078 Budapest, Hungary; zsofi.tischner@ 123456gmail.com
                [4 ]Department of Air Hygiene and Aerobiology, National Public Health Center, Albert Flórián út 2-6, H-1097 Budapest, Hungary; magyar.donat@ 123456gmail.com
                [5 ]Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal; cristina.verissimo@ 123456insa.min-saude.pt (C.V.); raquel.sabino@ 123456insa.min-saude.pt (R.S.)
                [6 ]GIAS, ESTeSL—Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; carla.viegas@ 123456estesl.ipl.pt
                [7 ]Molecular Mycology Research Laboratory, Centre for Infectious Disease and Microbiology, Sydney Medical School, Westmead Hospital, Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Level 4, Room 0.4.04, 176 Hawkesbury Road, Westmead, NSW 2145, Australia; wieland.meyer@ 123456sydney.edu.au
                [8 ]Department of Environmental Health, National Institute of Health Doutor Ricardo Jorge, Av. Padre Cruz, 1649-016 Lisboa, Portugal
                Author notes
                Article
                ijerph-14-00636
                10.3390/ijerph14060636
                5486322
                79c73737-daba-4d96-8197-e7c0b60ec7e8
                © 2017 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 03 May 2017
                : 08 June 2017
                Categories
                Perspective

                Public health
                drinking water,fungi,fungal contaminants,aspergillus,in water,candida,moulds,molds,mycotoxins
                Public health
                drinking water, fungi, fungal contaminants, aspergillus, in water, candida, moulds, molds, mycotoxins

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