Resumen Objetivo: Analizar el estado y la influencia de la variabilidad climática en la calidad del agua de un sistema de abastecimiento para consumo humano en San José, Costa Rica, captado en cuatro microcuencas del cantón Vásquez de Coronado, en el periodo 2017-2018, para brindar recomendaciones al operador y promover la protección de la población abastecida Métodos: Estudio descriptivo de los parámetros de calidad básicos de agua para consumo humano (Escherichia coli, coliformes fecales, turbidez, conductividad, pH, color, temperatura y cloro residual). Los análisis se realizaron siguiendo el Standard Methods for the Examination of Water and Wastewater. Se delimitaron las zonas de captación utilizando sistemas de información geográfica. Se utilizó estadística descriptiva e inferencial para describir la calidad del agua y su variabilidad espacial y estacional. Resultados: La concentración de coliformes fecales en el agua superficial fue > 103 NMP/100 mL y la turbidez >5 UTN en el 76% de las muestras. En la red de distribución se encontraron concentraciones de cloro residual y turbidez (>5 UTN) por encima de los límites recomendados para agua de consumo humano. Se encontró diferencias significativas en todos los parámetros básicos de calidad de agua entre las distintas zonas de captación (p<0,05 en todos los casos), así como entre épocas climáticas por zona de captación. Conclusión: Estos resultados indican que se está utilizando agua de calidad inadecuada para uso y consumo humano, por lo cual se recomienda un monitoreo intensivo y sectorizado de las fuentes para localizar puntos de contaminación.

Abstract Objective: Analyze the water quality and the influence of the climatic variability in supply system for the human consume in San José, Costa Rica, in four catchment areas in Vasquez of Coronado in the period 2017-2018 to give recommendations to the operator and promote the protection of the supplied population. Methods: Descriptive study of the basic parameters of the drinking water (Escherichia coli, fecal coliforms, turbidity, conductivity, pH, color, temperature, and residual chlorine). The analyses were done following Standard Methods for the examination of Water and Wastewater. The catchment areas were delimited using geographic information systems (GIS). Descriptive and inferential statistic was used to describe the water quality, spatial and seasonal variability. Results: The concentration of fecal coliforms in the catchment areas was >10 3 NMP/100 mL and the turbidity >5 UTN in 76% of the samples. In the distribution system were found concentrations of the residual chlorine and turbidity (>5 UTN) above according to recommended limits for drinking water in the country. The results showed significant differences in all of the basic parameters of the water quality between catchment areas (p<0, 05 in all cases) and between climatic periods for catchment areas. Conclusion: These results indicate that water of inadequate quality is being used for human use and consumption, for which reason intensive and sectorized source monitoring is recommended to locate contamination points.

Abstract In Latin America, the disease burden of shigellosis is found to coexist with the rapid and rampant spread of resistance to commonly used antibiotics. The molecular basis of antibiotic resistance lies within genetic elements such as plasmids, transposons, integrons, genomic islands, etc., which are found in the bacterial genome. Integrons are known to acquire, exchange, and express genes within gene cassettes and it is hypothesized that they play a significant role in the transmission of multidrug resistance genes in several Gram-negative bacteria including Shigella. A few studies have described antibiotic resistance genes and integrons among multidrug resistant Shigella isolates found in Latin America. For example, in Brazil, Bolivia, Chile, Costa Rica and Peru, class 1 and class 2 integrons have been detected among multidrug resistant strains of Shigella; this phenomenon is more frequently observed in S. flexneri isolates that are resistant to trimethoprim, sulfamethoxazole, streptomycin, ampicillin, chloramphenicol, and tetracycline. The gene cassette sul2, which is frequently detected in Shigella strains resistant to the sulfonamides, suggests that the sulfonamide-resistant phenotype can be explained by the presence of the sul2 genes independent of the integron class detected. It is to be noted that sul3 was negative in all isolates analyzed in these studies.The high frequency of sulfonamide (as encoded by sul2) and trimethoprim resistance is likely to be a result of the recurrent use of trimethoprim sulfamethoxazole as a popular regimen for the treatment of shigellosis. The observed resistance profiles of Shigella strains confirm that ampicillin and trimethoprim-sulfamethoxazole are ineffective as therapeutic options. In-depth information regarding antibiotic resistance mechanism in this pathogen is needed in order to develop suitable intervention strategies. There is a pressing need for regional and local antimicrobial resistance profiling of Shigella to be included as a part of the public health strategy.

La contaminación fecal de las aguas superficiales es un problema importante para la salud pública, dada la transmisión de microorganismos patógenos. Se estima que las poblaciones ubicadas cerca de costas, ríos o lagos con elevada contaminación fecal, tienen mayor riesgo de desarrollar enfermedades infecciosas gastrointestinales. En esta investigación se analizó durante un año, la contaminación fecal en las aguas superficiales de la microcuenca del río Purires, ubicada en una zona de alta densidad poblacional en Costa Rica. En el 100% de las muestras se detectó contaminación fecal, siendo el punto de muestreo 3 el que mostró los niveles más altos, en promedio 2,2 x 10(4) Número Más Probable(NMP)/100()mL. Aunque los puntos 1 y 2 presentaron menor contaminación fecal, en promedio 6,4 x 10² NMP/100 mL y 6,3 x 10³ NMP/100 mL respectivamente, estos valores indican también mala calidad de las aguas. Con estos resultados se pretende llamar la atención sobre la problemática ambiental de alta contaminación fecal en las aguas superficiales de esta microcuenca. Esta información es un insumo para desarrollar acciones de control sobre las fuentes de contaminación que afectan la calidad de las aguas y por ende, la salud de las poblaciones ubicadas en su cercanía.

Fecal contamination of the superficial waters is an important public health problem due to the presence of pathogenic microorganisms- It has been estimated that populations located close to coasts, rivers of lakes with an elevated fecal contamination have a higher risk of developing communicable gastrointestinal diseases. This investigation analyzed the fecal contamination of the superficial waters of the microbasin of the Rio Purires, located in a highly populated area of Costa Rica. Fecal contamination was detected in 100% of the samples, and sample point 3 was the one that showed the highest levels, with an average of 2.2 x 10(4) Most Probable Number (MPN)/100mL. Even thought points 1 and 2 presented a lower fecal contamination, an average of 6.4 x 10² MPN/100mL and 6.3 x 10³ MPN/100mL, respectively, these values also indicate low quality water. With these results we intend to alert regarding the problem of a high fecal contamination of superficial waters of this microbasin. This information is an input for developing control actions over the contamination sources which compromise the quality of water and, therefore, the health of the populations located in its vicinity.

Se analizó la calidad microbiológica en 37 muestras de lechuga variedad criolla (Lactuca sativa var. Capitata L.) de distintos intermediarios en las provincias de San José y Cartago, en Costa Rica. Las muestras se recolectaron mediante muestreo no probabilístico por selección intencional. Se cuantificó Escherichia coli (NMP/g) como indicador de contaminación fecal y se determinó la presencia de patógenos específicos (Shigella y Salmonella), por cultivo y por PCR-Múltiple. En el 65% de las muestras analizadas se detectó E. coli, aunque no se encontró Shigella ni Salmonella por PCR-Múltiple o cultivo. Una posible explicación es que los niveles de contaminación de Shigella y Salmonella están por debajo de los límites de detección de ambos métodos (menos de 10(4) UFC/g para Shigella y menos de 10² UFC/g para Salmonella). Estos resultados establecen una base importante para continuar con este tema de investigación y analizar otras fuentes de transmisión de Shigella y Salmonella, dado que ambos patógenos son frecuentes en la región.

The microbiological quality of 37 lettuce samples of the creole variety (Lactuca sativa var. Capitata L.) obtained from different intermediaries at the provinces of San José and Cartago, in Costa Rica was analyzed. The samples were collected through a non-probabilistic sampling with intentional selection. Escherichia coli (NMP/g) was quantified as indicator of fecal contamination and the presence of specific pathogens (Shigella and Salmonella) was determined by culture and Multiplex-PCR. In 65% of the samples analyzed we detected E. coli, even though we did not find Shigella or Salmonella by Multiplex-PCR or culture. A possible explanation is that the Shigella or Salmonella contamination levels may have been under the detection limits for both methods (less than 10(4) CFU/g for Shigella, and less than 10² CFU/g for Salmonella). These results establish an important basis for continuing with this research subject and analyzing other sources of transmission of Shigella and Salmonella contamination, since both pathogens are frequent in the region.

A Multiplex Polymerase Chain Reaction (PCR) assay to be used as an alternative to the conventional culture method in detecting Shigella and enteroinvasive Escherichia coli (EIEC) virulence genes ipaH and ial in lettuce was developed. Efficacy and rapidity of the molecular method were determined as compared to the conventional culture. Lettuce samples were inoculated with different Shigella flexneri concentrations (from 10 CFU/ml to 10(7) CFU/ml). DNA was extracted directly from lettuce after inoculation (direct-PCR) and after an enrichment step (enrichment PCR). Multiplex PCR detection limit was 10(4) CFU/ml, diagnostic sensitivity and specificity were 100% accurate. An internal amplification control (IAC) of 100 bp was used in order to avoid false negative results. This method produced results in 1 to 2 days while the conventional culture method required 5 to 6 days. Also, the culture method detection limit was 10(6) CFU/ml, diagnostic sensitivity was 53% and diagnostic specificity was 100%. In this study a Multiplex PCR method for detection of virulence genes in Shigella and EIEC was shown to be effective in terms of diagnostic sensitivity, detection limit and amount of time as compared to Shigella conventional culture.

Se analizó la presencia de parásitos intestinales en muestras de heces de 350 niños, de una población de 1.563 niños de hasta cinco años de edad, de la comunidad urbano marginal de Los Cuadros de Goicoechea, San José, Costa Rica, durante los años 2003 y 2004. El diseño del muestreo fue aleatorio simple, para un tamaño de muestra de 350 y nivel de confianza del 95%. Las muestras se recolectaron mediante visitas a los hogares. Se obtuvo una muestra de heces de cada niño; no se repitieron muestras. La detección de parásitos se realizó mediante un examen directo (salina, lugol), concentrado de Ritchie (formol-éter) y tinción modificada de Zielh Neelsen. Las muestras fueron analizadas por profesionales de laboratorio. Del total de muestras 210 fueron positivas por al menos un parásito, protozoarios y helmintos intestinales, lo que representó una prevalencia total del 60%. Los resultados mostraron la presencia de Giardia intestinalis en el 18,2%; Entamoeba histolytica/E dispar en el 15,7%; Ascaris lumbricoides en el 15,4% y Trichuris 0,8% y Entamoeba coli en el 9,7% de los casos. Los mismos claramente revelan la existencia de un problema en dicha comunidad y dejan al descubierto la necesidad de desarrollar estrategias de educación sanitaria, prevención y tratamiento, a fin de mejorar las condiciones de salud de estas personas y evitar la transmisión de agentes patógenos.

To analyze the presence of intestinal parasites, there has been developed a study with a 95% of confidence level at the urban-marginal community of Los Cuadros, Goicoechea, San José, Costa Rica, during the years 2003 and 2004, using a sample random of 350 children up to 5 years of age, from whom faecal samples were collected by visits home by home. The stool samples were analyzed to detect intestinal parasites through a direct exam (saline and iodine solutions), sedimentation of formalin-ether (Ritchie) and Zielh Neelsen modified. From the 350 stool samples, 210 (60%) were positive showing at least one parasite, protozoa and helminths, which represented a 60% prevalence. The results showed the presence of Giardia intestinalis (18.2%); Entamoeba histolytica/E dispar (15.7%); Ascaris lumbricoides (15.4%); Entamoeba coli (9.7%) and Trichuris (0.8%). The present study clearly showes that intestinal parasites represent a serious problem in this community. Therefore, sanitary education, prevention and treatment strategies are necessary to improve people health condition in this community.

En julio del 2001, un brote de diarrea asociado a transmisión hídrica afectó a más de 7000 personas residentes en el área urbana de San José. Desde su inicio se especuló sobre el papel de Shigella spp., como uno de los posibles agentes etiológicos del mismo, por lo que el objetivo de este estudio fue determinar la presencia de esta bacteria en los casos de diarrea atendidos en una de las clínicas ubicadas en el área del brote y demostrar que Shigella spp. es un agente importante de diarrea en nuestro país asociado a la transmisión hídrica, particularmente por la baja dosis infectante y alta virulencia. Para este fin, se analizaron especimenes fecales de 49 pacientes con diarrea que acudieron a la clínica de Alajuelita, del 17 al 31 de julio del 2001. Se obtuvo 16 aislamientos de Shigella spp (34,7%), 15 correspondieron a Shigella sonnei en tanto que solamente uno a Shigella flexneri. Los grupos etáreos más afectados fueron niños menores de 10 años y personas mayores de 60 años. El patrón de sensibilidad a los antibióticos de las cepas aisladas mostró resistencia a 8 de los 11 antibióticos probados: trimetoprim/sulfametoxazole, tetraciclina, ampicilina, eritromicina, cloranfenicol, cefalotina, amikacina y amoxicilina; y sensibilidad a norfloxacina, ciprofloxacina y gentamicina. No fue posible aislar Shigella spp. de las muestras de agua. Los resultados sugieren que este medio de transmisión estuvo relacionado con el brote de diarrea. El presente estudio demuestra la importancia de Shigella spp. como causa de diarrea sobre todo en niños pequeños, adultos mayores y su frecuente asociación a brotes relacionados con agua contaminada. Los resultados también sugieren que el tratamiento contra la shigelosis debería incluir información acerca de los perfiles de resistencia a los antibióticos y de la necesidad de más investigación sobre vías de transmisión por agua y alimentos en la prevención de este tipo de brotes

During July of 2001, a diarrheal outbreak affected more than 7000 individuals in the urban area of San José. Even though the origen of the outbreak was not found, faecal pollution of the drinking water from the metropolitan aqueduct it is suspected. The objetive of the study was to determinate the presence of Shigella spp., as a possible aetiological agent of the outbreak. Samples were collected during two weeks (july 17th to 31st). Sixteen Shigella isolates were obtained out of 49 patients with diarrhoea (34,7%), 15 of the isolates were Shigella sonnei and 1 corresponded to Shigella flexneri. The most affected age groups were children under 10 and people older than 60. The antibiotic susceptibility pattern of the Shigella isolates showed that they were resistant to eigth of the antibiotics: trimethoprim/sulfamethoxazole, tetracycline, ampicillin, eritromicine, chloramphenicol, cephalotin, amikacine and amoxicillin. They were sensitive to norfloxacin, ciprofloxacin and gentamicin. Althought it was not possible to isolate Shigella directly from water, the results highly suggest this pathogen to be the aetiological agent of the outbreak. This study demonstrates the import role of Shigella spp. as cause of diarrhea affecting mainly small children and elderly people and its frequent association to outbreaks related to drinking water. This study also suggests that guidelines for treatment of shigellosis should include information on the antibiotic resistance pattern and further studies regarding the routes of transmission by water and food, will be required for strategies of prevention of such outbreaks