Occurrence of Pathogens in Distribution and Marketing Municipal Sludges (1988)
EPA Pathogen list from Part 503 (1989)


20.    Toxoplasma gondii -------------------------------Toxoplasmosis

Meningitis, Most people who become infected with Toxoplasma are not aware of it. Some people who have
toxoplasmosis may feel as if they have the "flu" with swollen lymph glands or muscle aches and pains that last for a
month or more. Severe toxoplasmosis, causing damage to the brain, eyes, or other organs, can develop from an acute
Toxoplasma infection or one that had occurred earlier in life and is now reactivated. Severe cases are more likely in
individuals who have weak immune systems, though occasionally, even persons with healthy immune systems may
experience eye damage from toxoplasmosis. Symptoms of ocular toxoplasmosis can include reduced vision, blurred
vision, pain (often with bright light), redness of the eye, and sometimes tearing. Ophthalmologists sometimes prescribe
medicine to treat active disease. Whether or not medication is recommended depends on the size of the eye lesion, the
location, and the characteristics of the lesion (acute active, versus chronic not progressing). An opthamologist may
provide the best care for ocular toxoplasmosis. Most infants who are infected while still in the womb have no symptoms
at birth, but they may develop symptoms later in life. A small percentage of infected newborns have serious eye or brain
damage at birth.

Clinical manifestations may mimic those of other opportunistic infections. Necrotizing encephalitis, pneumonitis, and
myocarditis are the most common autopsy findings. The most frequent clinical findings reflect involvement of these 3
organ systems, although disseminated toxoplasmosis is being described with increasing frequency. Incidence of
toxoplasmic encephalitis in patients with AIDS is correlated directly with the presence of antitoxoplasmal antibodies. In
patients with AIDS, CNS involvement is the most common manifestation, ranging from nonspecific, generalized symptoms
to focal findings such as headache, altered levels of consciousness, motor impairment, and seizures.
Pulmonary involvement is the second most common manifestation. Clinically, patients may appear to have tuberculosis
or infection with Pneumocystis carinii.

Most often, you won't know that you've contracted toxoplasmosis, although some people may develop signs and
symptoms similar to those of the flu or mononucleosis, such as:
Body aches, Swollen lymph nodes, Fever, Fatigue, Occasionally, a sore throat.

The risk and severity of your baby's infection often depends on when in your pregnancy you were infected. Your baby is
most at risk of toxoplasmosis if you become infected in the third trimester and least at risk if you become infected during
the first trimester. On the other hand, the earlier in your pregnancy infection occurs, the more serious the outcome for
your baby. Many early infections end in stillbirth or miscarriage, and children who do survive are likely to be born with
serious problems, such as:
An unusually large head caused by excess accumulation in the brain of the clear fluid surrounding the brain and spinal
cord (cerebrospinal fluid), a condition known medically as hydrocephalus
An enlarged liver and spleen
Yellowing of the skin and whites of the eyes (jaundice)
Severe eye infections
Children born to mothers infected during the second trimester, when the possibility of transmission is greater, also may
be born with serious problems, although only a small number of babies who have toxoplasmosis show signs of the
disease at birth. Instead, the majority of infected newborns — mainly those whose mothers were infected during the last
three months of pregnancy (third trimester) — don't develop signs and symptoms of the disease until they're in their 20s
or 30s. Those signs and symptoms include:
Hearing loss
Mental retardation
Serious eye infections that may lead to blindness

21.     Balantidium  -------------------------------------- Balantidiasis

Common symptoms of Balantidiasis include chronic diarrhea, occasional dysentery (diarrhea with passage of blood or
mucus), nausea, foul breath, colitis (inflammation of the colon), abdominal pain, weight loss, deep intestinal ulcerations,
and possibly perforation of the intestine. Left untreated, it is reported to have a case fatality rate of 30%. Dysentery due
to hemorrhaging (bleeding) can lead to shock and death.

Hyaluronidase is produced by this organism, which may enhance its ability to invade the mucosa.  Pneumonia has been
described in patients with cancer-related immunosuppressant.  Diarrhea (watery, bloody, mucoid)
Nausea, Vomiting, Abdominal pain, Anorexia, Weight loss, Headache, Mild colitis, More severe and marked fluid loss
(resembling amebic dysentery),
Patients may present with abdominal tenderness and, in cases with prolonged diarrhea,
signs of dehydration. May cause severe colitis with peritonitis

Invasive balantidiasis presented as chronic colitis and lung involvement, weakness, anemia,
chronic colitis and inflammatory polyposis of the rectum and sigmoid colon and an intrapulmonary mass,

Balantidiasis is transmitted primarily by eating food or drinking water that has been contaminated by human or animal
feces containing B. coli cysts. In the digestive tract, the cysts are transported to the intestine where the walls of the cysts
are broken open by digestive secretions, releasing the mobile trophozoites. Once released within the intestine, the
trophozoites multiply by feeding on intestinal bacteria or by invading the lining of the large intestine. Within the lining of
the large intestine, the trophozoites secrete a substance that destroys intestinal tissue and creates sores (ulcers) or
The most common symptoms of balantidiasis are chronic diarrhea or severe colitis with abdominal cramps, pain, and
bloody stools. Complications may include intestinal perforation in which the intestinal wall becomes torn, but the
organisms do not spread to other parts of the body in the blood stream.

Infection of colon characterized by diarrhea or dysentery; accompanied by abdominal colic, tenesmus, nausea, and
vomiting with bloody and mucoid stools, Cysts survive for long periods in the environment, CONTAINMENT
REQUIREMENTS: Biosafety level 2 practices are recommended for activities involving infectious stages of the parasite

22.     Entamoeba histolyca, ---------------------------- Amebic dysentery

Gastroenteritis, mild diarrhea to severe dysentery may occur. Extraintestinal infections include liver abscesses. The
motile trophozoite feeds on bacteria and tissue, reproduces, colonizes the lumen and the mucosa of the large intestine,
and sometimes invades tissues and organs, Some trophozoites in the colonic lumen become cysts that are excreted with
stool. E. histolytica trophozoites adhere to and kill colonic epithelial cells and PMNs and can cause dysentery with blood
and mucus. They also secrete proteases that degrade the extracellular matrix and permit invasion into the intestine wall
and beyond. Trophozoites can spread via the portal circulation and cause necrotic liver abscesses. Infection may
spread by direct extension from the liver or through the bloodstream to the lungs, brain, and other organs.

Symptoms that occur with tissue invasion include intermittent diarrhea and constipation, flatulence, and cramping
abdominal pain. Tenderness over the liver or ascending colon may occur, and stools may contain mucus and blood.

Amebic dysentery common in the tropics, presents with episodes of frequent semiliquid stools that often contain blood,
mucus, and live trophozoites. Abdominal findings range from mild tenderness to frank abdominal pain, with high fevers
and toxic systemic symptoms. Abdominal tenderness frequently accompanies amebic colitis. Between relapses,
symptoms diminish to recurrent cramps and loose or very soft stools, but emaciation and anemia may develop.
Symptoms suggestive of appendicitis may occur. Surgery in such cases may result in peritoneal spread of amebas.

Chronic amebic infection can mimic inflammatory bowel disease and presents as intermittent nondysenteric diarrhea with
abdominal pain, mucus, flatulence, and weight loss. Chronic infection may also present as tender, palpable masses or
annular lesions (amebomas) in the cecum and ascending colon that resemble carcinomas.

Extraintestinal disease originates from infection in the colon and can involve any organ, but a liver abscess, usually
single and in the right lobe, is the most common. It can present in patients without prior symptoms, is more common in
men than in women (7:1 to 9:1), and may develop insidiously. Symptoms include pain or discomfort over the liver, which
is occasionally referred to the right shoulder; intermittent fever; sweats; chills; nausea; vomiting; weakness; and weight
loss. Jaundice is unusual and low grade when present. The abscess may perforate into the subphrenic space, right
pleural cavity, right lung, or other adjacent organs. Skin lesions are occasionally observed, especially around the
perineum and buttocks in chronic infection, and may also occur in traumatic or operative wounds.

Nondysenteric amebiasis may be misdiagnosed as irritable bowel syndrome, regional enteritis, or diverticulitis. Amebic
dysentery may be confused with shigellosis, salmonellosis, schistosomiasis, or ulcerative colitis.

23.    Giardia lambia ------------------------------------  Giardiasis

Some organisms transform into environmentally resistant cysts that are spread by the fecal-oral route, resistant to
routine levels of chlorination, watery malodorous diarrhea, abdominal cramps and distention, flatulence and eructation,
intermittent nausea, epigastric discomfort, and sometimes low-grade malaise and anorexia. significant weight loss in
severe cases, causes failure to thrive in children. (Merck)

24.     Crytosporidium-----------------------------------  Gastroenteritis

Onset is acute, with profuse watery diarrhea, abdominal cramping, and, less commonly, nausea, anorexia, fever, and
malaise. No drugs have been found that kill Cryptosporidium in people with diarrhea. (Merck)