PRISUTNOST BAKTERIJA Legionella pneumophila U TOPLOJ VODOVODNOJ VODI U OVISNOSTI O EKOLOŠKIM ČIMBENICIMA

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1 Izvorni znanstveni članak Original Scientific Paper UDK : : Primljeno (Received): ; Prihvaćeno (Accepted): PRISUTNOST BAKTERIJA Legionella pneumophila U TOPLOJ VODOVODNOJ VODI U OVISNOSTI O EKOLOŠKIM ČIMBENICIMA Anita Rakić, dipl. ing. kem. Nastavni zavod za javno zdravstvo Splitsko-dalmatinske županije Vukovarska 46, Split anita.rakic@st.t-com.hr Prof. dr. sc. Jelena Perić, dipl. ing. kem. Kemijsko-tehnološki fakultet Sveučilišta u Splitu Teslina 10, Split Prof. dr. sc. Nives Štambuk-Giljanović, dipl. ing. kem. Nastavni zavod za javno zdravstvo Splitsko-dalmatinske županije Vukovarska 46, Split Medicinski fakultet Sveučilišta u Splitu Šoltanska 2, Split Cilj ovoga rada bio je procijeniti ekološke čimbenike (temperatura, slobodni rezidualni klor, teški metali) koji utječu na prisutnost L. pneumophila u toploj vodovodnoj vodi. U 153 uzorka tople vode ispitana je prisutnost L. pneumophila, kao i utjecaj ekoloških čimbenika na njihovu prisutnost u vodi. L. pneumophila je dokazana u 24,8% ispitivanih uzoraka. Koncentracije željeza veće su u uzorcima u kojima je nađena L. pneumophila uspoređujući ih s uzorcima u kojima nije bila prisutna, dok su povišene vrijednosti temperatura u negativnoj korelaciji s prisustvom L. pneumophila. Nije dokazana statistički značajna povezanost cinka (z = 0,855; p = 0,392), mangana (z = 0,283; p = 0,777), bakra (z = 1,66; p = 0,097) i slobodnog rezidualnog klora (z = 0,458; p = 0,648) s prisustvom L. pneumophila. Istraživanje potvrđuje postavku o povezanosti ekoloških čimbenika, o prisutnosti bakterija L. pneumophila u toploj vodi vodovodnog sustava. Ključne riječi: vodovodna voda, biofilm, Legionella pneumophila, kultivacija, teški metali, atomska apsorpcijska spektrofotometrija 1

2 1. UVOD Bakterije iz porodice Legionellaceae prisutne su u okolišu. Za razliku od drugih patogenih organizama, bakterije iz roda Legionella spp. prirodno se nalaze u vodnom ekosustavu, uključujući u to površinsku (Palmer i sur., 1993.) i podzemnu vodu (Lieberman i sur., 1994.). Njihova je sveprisutnost u prirodi uzrokovana njihovom sposobnošću preživljavanja u vodi pri različitim uvjetima, uključujući u to temperaturu od 15 do 60 C i ph od 5,0 do 8,5 (Nguyen i sur., 1991.). Ljudi se zaraze udišući vodeni aerosol u kojemu se nalaze legionele (Taylor i sur., 2009.). Prvo objavljeno izvješće o Legionella spp., koja se prenosi dovodom vode za piće, uključivalo je pacijente koji su se zarazili u bolnici (Tobin i sur., 1981.). Poznato je više od 40 vrsta iz roda Legionella spp. (Legionella pneumophila i dr.), i više od 60 seroskupina. Do danas je otkriveno 14 seroskupina vrste Legionella pneumophila. Legioneloze su bolesti najčešće uzrokovane vrstom Legionella pneumophila, seroskupine 1. Ljudske djelatnosti i prirodne pojave izravno utječu na nastanak, opstanak i razvitak bioaerosola. Nastanak bioaerosola, prijenos i preživljavanje mikroorganizama u zraku složeni je proces na koji utječu različiti fizikalno-kemijski čimbenici. U radu Tiefenbrunnera i sur. (1993.) proučavan je utjecaj koncentracije teških metala na prisutnost L. pneumophila i mikobakterija u vodoopskrbnom sustavu. Tada je utvrđeno da određeni ioni usporavaju razvitak L. pneumophila, ali ne i mikobakterija, u toplovodnim sustavima. Također je istraživan utjecaj iona bakra i srebra na mikrobiološku kakvoću tople vode. Rezultati su pokazali da navedeni ioni imaju baktericidni učinak i da vodovodne cijevi izrađene od bakra usporavaju rast L. pneumophila (Kusnetsov i sur., 2001.). Slika 1. Vodovodna cijev kao kemijsko biološki reaktor - uzdužni presjek cijevi (U.S. EPA, 2008.). Prisutnost L. pneumophila dokazana je na različitim mjestima unutar vodoopskrbnog sustava kao što su: rashladni tornjevi, spremnici s vrućom vodom, glave tuša, ovlaživači zraka, pri čemu se onečišćuje vodovodna voda i okolni zrak (Varvara Mouchtouri i sur., 2010.). Također mogu kolonizirati i uređaje za zagrijavanje, hlađenje i ovlaživanje zraka (Ropac i sur., 2003.). Distribucijski sustav za pitku vodu može se promatrati kao vrlo složeni kemijsko-biološki reaktor (Bargellini i sur., 2011.; Farhet i sur., 2011.) u kojem se zbiva cijeli niz reakcija u vodenoj fazi i na granici faza čvrsto-tekuće-plinovito. Uslijed korozije povećava se u vodi koncentracija teških metala u obliku različitih topljivih specija ili se dijelom talože na stjenkama cijevi i armatura kao teško topljive soli (Bargellini i sur., 2011.). Ovi procesi, uz povišenu temperaturu, mogu favorizirati stvaranje nakupina mikroorganizama u obliku biofilmova na unutrašnjim stjenkama cijevi (slika 1). Fluktuacija protoka i tlaka, temperature, te dinamika korištenja vode i armatura su neki od čimbenika koji mogu prouzročiti promjene kakvoće vode u vodoopskrbnoj mreži, posebice u sustavima opskrbe toplom vodom (Wullings i sur., 2011.; Shelton i sur., 1994.; Rogers i sur., 1994.). U tim se sustavima L. pneumophila nalazi najčešće u biofilmovima pa se zato ona može razmnožavati i opstati. Biofilmove se može opisati kao mikroorganizme i njihove izvanstanične proizvode povezane s podlogom (Ta i sur., 1995.). Biofilmovi su veoma postojani, udruženi s različitim bakterijama u vodnim ekosustavima kao što su: Klebsiella, Pseudomonas, Legionella, Mycobacterium, Escherichia coli i drugim mikroorganizmima kao što su protozoe (amebe), nametnici (paraziti) i crijevni virusi (enterovirusi) (Lau i Ashbolt, 2009.). Mikroorganizmi u biofilmovima često su otporni na biocide i teško ih je odstraniti, osobito s teško pristupačnih mjesta (rubovi cijevi, T-profili vodovodnih cijevi, hrapave površine u vodovodnim cijevima). Izvori kontaminacije u cjevovodima pitke vode mogu biti i mali ili ne korišteni dijelovi vodovodnog sustava, područja gdje vlada stajaća voda u udubljenjima unutrašnjih površina cijevi (Lin i sur., 1998.). Prisutnost biofilma na površinama vodovodnih cijevi utječe na ponovno onečišćenje vode nakon dezinfekcije, a dolazi i do mikrokorozije unutar metalnih cijevi ispod sloja biofilma, što utječe na promjene u kakvoći vode (Williams i Braun-Howland, 2003.). Različiti sojevi bakterija su klinički ispitani na određene koncentracije klorovih pripravaka, a rezultati pokazuju da je L. pneumophila mnogo otpornija nego što su koliformne bakterije (Habich i sur., 1988.). Istraživanje Kuchta i sur. (1983.) pokazalo je da L. pneumophila može preživjeti pri niskoj koncentraciji klora razmjerno dugo vremena. Ta je spoznaja dovela do zaključka da viša ph-vrijednost, niža temperatura i manji sadržaj klora mogu pogodovati duljemu preživljavanju L. pneumophila. Cunliffe i sur. (1990.) i Borella i sur. (2004.) su ispitivali prisutnost metala u uzorcima tople vode neophodnih za rast bakterija L. pneumophila. Dokazano je da se neki metali ponašaju kao inhibitori rasta, a da neki potiču povećanje rasta L. pneumophila. 2

3 Cilj ovoga rada bio je identificirati potencijalne ekološke čimbenike koji utječu na kolonizaciju bakterija L. pneumophila u vodovodnim sustavima, i na taj način preventivno utjecati na smanjenje rizika od pojave legionarske bolesti u objektima od javnog značaja. L. pneumophila seroskupine 1 i seroskupina Broj bakterija izražava se kao broj jedinica koje formiraju kolonije (engl. Colony Forming Units-CFU) u 1 L uzorka. 2. MATERIJALI I METODE RADA 2.1. Prikupljanje uzoraka Od siječnja do prosinca 2011., ukupno je prikupljeno 153 uzorka tople vode iz vodoopskrbnog sustava (slika 2). Na mjestu uzimanja uzorka, za svaki uzorak određen je slobodni rezidualni klor hladne vode i temperatura tople vode. Uzorci vode (1 L) bili su uzeti u sterilnim, polietilenskim bocama, u koje se prije steriliziranja, dodalo 0,1 ml standardne otopine natrijeva tiosulfata, koncentracije 0,1 mol/l. Nakon uzorkovanja uzorci su pohranjeni i preneseni u prijenosnom hladioniku u laboratorij za mikrobiološku i kemijsku analizu u najkraćem mogućem roku. Slika 3: BCYE AGAR s kolonijama L. pneumophila. Tablica 1. Sastav BCYE agara. SASTAV (g/l) kvaščev ekstrakt 10,0 ACES (N-2-acetamido-2-aminoetan sulfonska kiselina) 5,0 aktivni ugljen 2,0 agar 15,0 željezov pirosulfat 0,25 cistein hidroklorid 0,4 vancomycin 0,001 colistin IU Slika 2: Vodoopskrbni sustav,, označena mjesta uzorkovanja Bakteriološka analiza Bakteriološka analiza uzoraka izvršena je nakon dostave uzoraka u laboratorij, a najdulje 24 sata nakon uzorkovanja. Uzgoj i identifikacija L. pneumophila provodila se prema normi ISO Mikroflora u uzorku vodovodne vode koncentrira se membranskom filtracijom kroz filtar promjera pora 0,20 µm (Millipore). Poslije se filtar sterilnom ezom ostruže i pomiješa s 10 ml uzorka. Zatim se 100 µl uzorka nasije na selektivnu GVPC podlogu i inkubira 7 dana pri 36±1 C. Nakon inkubacije, morfološki karakteristične kolonije potrebno je subkultivirati na BCYE i BCY agaru. BCYE agar (ph = 6,9±0,2) je selektivna podloga (slika 3) koja omogućava rast Gram-negativnih bakterija iz roda Legionella spp. (tablica 1). Inkubacija se odvija pri 36±1 C najmanje 2 dana. Poslije 2 dana provjeri se porast na BCYE i BCY agaru. Ako su kolonije narasle samo na BCYE agaru, a ne i na BCY agaru, to je potvrda da se radi o L. pneumophila. Za potvrdni test koristi se test aglutinacije (Legionella Latex Test, Oxoid). Test omogućuje odvojeno prepoznavanje 2.3. Fizikalne i kemijske analize Temperatura i slobodni rezidualni klor određuju se za vrijeme prikupljanja uzoraka termometrijski i spektrometrijski s umjerenim aparatima. Koncentracija željeza, mangana, cinka, bakra, određuje se na atomskom apsorpcijskom spektrofotometru, Z-2000 (HITACHI) koristeći grafitne kivete. Valne duljine za mjerenje absorbancije su: za željezo 248,3 nm, za mangan: 279,6 nm, za cink: 213,9 nm i za bakar: 324,8 nm. Uzorci u kojima su određivani spomenuti metali bili su zakiseljeni s 0,5 ml 65% HNO 3 (Merck) u 50 ml uzorka. 3. REZULTATI I RASPRAVA Obrađeno je 153 uzorka tople vode, a ispitivani su sljedeći pokazatelji kakvoće vode: fizikalni (temperatura), mikrobiološki (L. pneumophila) i kemijski (slobodni rezidualni klor, koncentracije željeza, mangana, cinka i bakra). Rezultati su protumačeni na razini značajnosti p < 0,05, a za statističku analizu korišten je Mann-Whitney test. Vrijednosti z i p su statističke veličine koje su dobivene iz Mann-Whitney testa. 3

4 Tablica 2. Prikaz medijana (min.-maks.) fizikalno-kemijskih pokazatelja i L. pneumophila tijekom analiziranog razdoblja (N=153) u uzorcima tople vode. Parametar L. pneumophila odsutna L. pneumophila prisutna A = statistički značajna razlika temperatura ( C) 53,8 (41,0-66,1) 47,9 (38,5-61,7) A da slobodni rezidualni klor Cl 2 (mg/l) 0,2 (0,1-0,3) 0,2 (0,2-0,3) ne Fe (mg/l) 0,05 (0-0,471) 0,08 (0,02-0,23) A da Zn (mg/l) 0,128 (0,01-0,5267) 0,0908 (0,0002-0,4206) ne Cu (mg/l) 0,00814 (0-0,101) 0,0052 (0-0,1395) ne Mn (mg/l) 0,013 (0, ,038) 0,014 (0, ,64) ne Bakterijske kolonije L. pneumophila, koje se razvijaju na BCYE agaru, jesu svjetlucavo-bijele, konveksne/okrugle i imaju cjeloviti rub (Kalenić i sur., 2001.). Utvrđeno je da su u 38 od 153 (24,8%) uzoraka prisutne morfološki karakteristične kolonije L. pneumophila. Prosječni broj L. pneumophila u pozitivnim uzorcima bio je 2800 CFU/L. Pri tomu je najviše 8400 CFU/L nađeno u jednomu uzorku, a najniže 500 CFU/L također u jednomu uzorku. Prisutnost L. pneumophila nije dopuštena Pravilnikom o zdravstvenoj ispravnosti vode za piće. Iz istraživanja provedenog u Italiji (Borella i sur., 1999) utvrđeno je da je L. pneumophila glavni uzročnik za 80-90% svih legionarskih bolesti. U tablici 2 prikazani su čimbenici opasnosti koji mogu utjecati na prisutnost L. pneumophila te su prikazani medijanom minimuma i maksimuma. Iz dobivenih vrijednosti vidljivo je da nema statistički značajne povezanosti koncentracije Zn (z = 0,855; p = 0,392), koncentracije Mn (z = 0,283; p = 0,777) i koncentracije Cu (z = 1,66; p = 0,097) s prisustvom L. pneumophila u uzorcima vode. Najviše dopuštene koncentracije metala u vodi definirane su u Pravilniku o zdravstvenoj ispravnosti vode za piće, a iznose: Fe = 0,2 mg/l, Zn = 3 mg/l, Cu = 2 mg/l, Mn = 0,05 mg/l. Medijan koncentracije Fe je veći u uzorcima vode u kojima je nađena L. pneumophila uspoređujući je s uzorcima u kojima je nije bilo (z = 2,3; p = 0,021). U istraživanju koje je provedeno u Njemačkoj dokazan je pozitivan odnos između koncentracije željeza, protozoa i bakterija L. pneumophila (Habich i sur., 1988.). Temperatura vode je dodatni čimbenik koji utječe na opstanak i razmnožavanje stanica L. pneumophila, a temperatura između C pogodna je za preživljavanje ovih bakterija (Mathys i sur., 2008.). Dokazano je da se L. pneumophila ubrzano razmnožava pri temperaturi nižoj od 42 C, a mjerljivi usporeni rast počinje pri temperaturi višoj od 50 C (Katz and Hammel, 1987.). Našim mjerenjima je dokazano da je u uzorcima vode, gdje su izolirane bakterije L. pneumophila, vrijednosti temperature u temperaturnom rasponu (od 38,5 C do 61,7 C) i da je medijan temperature u tim uzorcima niži, 47,9 C, u odnosu na uzorke u kojima nije prisutna L. Pneumophila, gdje je vrijednost medijana temperature 53,8 C. Dakle, medijan temperature u uzorcima kod kojih nije izolirana L. pneumophila je za 5,9 C veći u odnosu na uzorke u kojima je nađena (z = 5,0; p = <0,001). Dokazano je da je L. pneumophila izolirana iz vode koja je bila klorirana i iz one vode koja to nije bila. To dokazuje da klor koji se koristi za dezinfekciju vode ne uništava niti usporava rast i razmnožavanje L. pneumophila. Do sličnih zaključaka došli su i talijanski istraživači (Borella i sur., 2000.). Istraživanjem se došlo do spoznaje da je koncentracija slobodnoga rezidualnog klora od 0,2 do 0,3 mg/l u uzorcima vode s dokazanom L. pneumophila. U tim je uzorcima medijan koncentracije slobodnoga rezidualnog klora 0,2 mg/l. Trebalo bi odstraniti čimbenike koji potiču razmnožavanje i utječu na opstanak bakterija iz roda L. pneumophila i time smanjiti pojavu legioneloza. Stoga se preporučuje razvijanje programa za tehničko održavanje vodoopskrbnih sustava, rashladnih tornjeva, mikrobiološka kontrola vode kao i održavanje temperature hladne vode ispod 20 C, odnosno tople vode iznad 50 C (WHO, 2007.). 4. ZAKLJUČAK U ovome radu je ispitan utjecaj fizikalno-kemijskih pokazatelja na prisutnost bakterija L. pneumophila u uzorcima tople vodovodne vode. Utvrđeno je da je medijan koncentracije željeza (0,08 mg/l) veći u uzorcima vode u kojima je dokazana prisutnost L. pneumophila u odnosu na uzorke u kojima je nema (0,05 mg/l). Također je dokazana povezanost vrijednosti temperature s prisutnosti L. pneumophila u vodi i to da je medijan temperature niži (47,9 C) u odnosu na uzorke u kojima nije dokazana njihova prisutnost (53,8 C). Istraživanja u ovom radu potvrđuju hipotezu o povezanosti ekoloških čimbenika rizika i prisutnosti L. pneumophila u toploj vodi vodovodnih sustava. Obzirom na patogenost bakterija iz roda L. pneumophila, potrebna su daljnja istraživanja o učinkovitosti obrade vode, kao i o uzrocima promjena kakvoće vode unutar vodoopskrbnog sustava u svrhu osiguravanja higijenske ispravnosti vode i zaštite ljudskog zdravlja. 4

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(1981.): Legionnaires disease: further evidence to implicate water storage and distribution systems as sources. Clin Res Ed. 6263, U.S. EPA (2008.): Water Distribution System Analysis:Field Studies, Modeling and Management. A Reference Guide for Utilities,.Washington, USA. Varvara Mouchtouri A., Goutziana G., Kremastinou J., Hadjichristodoulou C. (2010.): Legionella species colonization in cooling towers: Risk factors and assessment of control Measures. Am J Infect Control, 38, WHO (2007.): Legionella and the Prevention of Legionellosis. World Health Organization, Geneva, Switzerland. Williams M.W., Braun-Howland E.B. (2003.): Growth of Escherichia coli in model distribution system biofilms exposed to hypochlorous acid or monochloramine. Appl Environ Microbiol, 69, Wullings Bart A., Bakker G., van der Kooij D. (2011.): Concentration and Diversity of Uncultured Legionella spp. in Two Unchlorinated Drinking Water Supplies with Different Concentrations of Natural Organic Matter. Appl. Environ. Microbiol., 77(2),

6 PRESENCE OF BACTERIA Legionella pneumophila IN WARM TAP WATER IN RELATION TO ECOLOGICAL FACTORS Abstract. The aim of this paper is to assess whether ecological factors (temperature, free residual chlorine, heavy metals) influence the presence of L. pneumophila in warm tap water. In 153 samples of warm water, the presence of L. Pneumophila and the influence of ecological factors on its presence in water was tested. L. pneumophila was confirmed in 24.8% analyzed samples. Iron concentrations are higher in the samples in which L. pneumophila was found when compared to the samples where it was not present, whereas increased temperature values are negatively correlated with the presence of L. pneumophila. A statistically significant relation between zinc (z = 0.855; p = 0.392), manganese (z = 0.283; p = 0.777), copper (z = 1.66; p = 0.097) and free residual chlorine (z = 0.458; p = 0.648) and the presence of L. Pneumophila was not proven. The investigation confirms the assumption about exstence of a connection between ecological factors and the presence of bacteria L. Pneumophila in warm tap water. Key words: tap water, biofilm, Legionella pneumophila, cultivation, heavy metals, atomic absorption spectrophotometry Anwesenheit von Bakterien Legionella pneumophila im warmen Leitungswasser in Abhängigkeit von Umweltfaktoren Zusammenfassung. Das Ziel dieses Beitrags war es, die Umweltfaktoren (Temperatur, freies Restchlor, Schwermetalle) einzuschätzen, die die Anwesenheit von L. pneumophila im warmen Leitungswasser beeinflussen. 153 Proben vom warmen Leitungswasser wurden auf die Anwesenheit von L. pneumophila geprüft, und der Einfluss von Umweltfaktoren auf die Anwesenheit von L. pneumophila im Wasser wurde auch geprüft. L. pneumophila wurde in 24,8% der geprüften Proben nachgewiesen. Die Eisenkonzentrationen waren höher in den Proben, in denen L. pneumophila nachgewiesen wurde im Vergleich zu den Proben, in denen L. pneumophila nicht anwesend war, während zwischen den erhöhten Temperaturwerten und der Anwesenheit von L. pneumophila eine negative Korrelation gefunden wurde. Eine statistisch signifikante Korrelation zwischen Zink (z = 0,855; p = 0,392), Mangan (z = 0,283; p = 0,777), Kupfer (z = 1,66; p = 0,097) bzw. freiem Restchlor (z = 0,458; p = 0,648) und der Anwesenheit von L. pneumophila konnte nicht nachgewiesen werden. Die Untersuchung bestätigt die Annahme über die Korrelation zwischen den Umweltfaktoren und der Anwesenheit von Bakterien L. pneumophila im warmen Leitungswasser. Schlüsselwörter: Leitungswasser, Biofilm, Legionella pneumophila, Kultivierung, Schwermetalle, Atomabsorptionsspektrometrie 6

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