A day on the water is always great fun.  But no surface water is ever entirely safe. There are waterborne organisms that can cause illness or even death. Be sure you are aware of the potential dangers and take precautions to stay safe.

Primary amebic meningoencephalitis (PAM)

Although this is a rare disease, it is caused by an amoeba that is common in all untreated surface water. For most, coming in contact with the amoeba is harmless. In rare instances, it may be fatal.

Naegleria fowleri is an amoeba present in all fresh surface water and soil. It thrives in low levels of freshwater that is warmer than 80 degrees Fahrenheit and is stagnant or slow-moving. When water containing the organism is forced into the nasal passages - usually from diving or jumping into water, or from water skiing and similar activities, the amoeba can cause a condition called Primary Amebic Meningoencephalitis or PAM.

The PAM infection occurs when the amoeba makes its way through the nasal passage into the brain and spinal cord, destroying brain tissue. Often mistaken for the flu or meningitis, symptoms of the infection include severe headache, high fever, stiff neck, nausea, vomiting, seizures and hallucinations as the condition worsens. There are currently no known treatments for the infection that is usually fatal. Those infected usually succumb to the disease within a week.

PAM cannot be spread through drinking water or person to person. Swimming pools and hot tubs that are properly cleaned, maintained and chlorinated are generally safe, as is saltwater.

Although the number of confirmed PAM cases is low - affecting about one to three people a year in Texas - research is ongoing. The Texas Department of Health recommends that people avoid stagnant or polluted water and take “No Swimming” signs seriously.

Officials recommend that those taking part in warm, fresh water-related activities use nose clips or hold their noses shut while jumping into water or doing other activities where untreated water might get forced up the nose. With the amoeba often found in soil, it is best to avoid stirring up underwater sediment. If infection is suspected, emergency medical care should be sought immediately.

Because PAM is rare, doctors might not consider the presence of this amoeba when attempting to diagnose the cause of the illness. If you or someone you know is exhibiting flu-like symptoms and has been in or around a lake, river or swimming hole, let your doctor know.  If the illness is caught early enough, treatment may be possible.

There were 34 known cases of PAM in Texas between 1962 and 2015, according to the National Centers for Disease Control and Prevention. The Texas Department of Health confirmed two cases of PAM in Texas in 2015. Most cases occurred in young males, ages 9 – 12, with a history of exposure to surface water during warm summer months. 

Of those who have contracted the disease, there are three known survivors since 1962, including Kali Hardig of Arkansas, who was infected in 2013.

E. coli

Escherichia coli, commonly known as E. coli, is a bacteria normally found in the intestines of humans and other warm-blooded animals. It can pollute water bodies and other areas through contact with waste or feces.

Researchers have found contact with some forms of the bacteria can cause gastrointestinal illnesses, with symptoms such as nausea, vomiting, severe diarrhea and abdominal cramps. Healthy adults usually recover from infection within a week, but young children and older adults can develop a life-threatening form of kidney failure called hemolytic uremic syndrome (HUS).

Public water treatment systems are designed to kill the bacteria. Well treated and maintained swimming pools are also safe. However, one can become infected by accidentally swallowing untreated lake or stream water while swimming, or by drinking untreated water when camping, hiking or participating in other outdoor activities. The illness can also spread through contaminated foods.

Currently, there are no treatments to cure the infection or relieve symptoms. Getting rest and drinking plenty of fluids is the best option for most people. Those sick with E.coli should avoid anti-diarrheal medications. These slow the digestive system, preventing the body from ridding itself of toxins.

Giardiasis
Giardiasis is an infection of the small intestine caused by single-celled parasites called giardia. Found worldwide, especially in areas with poor sanitation and unsafe water, the parasite typically infects through exposure to fecal matter through contaminated water or food. Symptoms, which usually begin about a week after infection, include diarrhea, nausea and abdominal cramps.

Giardiasis is one of the most common causes of waterborne disease in the United States. Infections can last up to six weeks, but intestinal problems can continue longer. Though there are drugs used to combat the parasites, they do not work with everyone. Efforts should instead be focused on prevention.

Cryptosporidium
Another potentially hazardous contaminant is cryptosporidium, a microscopic parasite that lives in intestines of warm blooded animals, including humans, and is passed with waste. In healthy people, the parasite can cause illness with symptoms including diarrhea, vomiting, fever and dehydration among others. Cryptosporidium can prove deadly for those with weakened immune systems. The parasite is very resistant to chlorine-based disinfectants and boiling is considered the most effective way of killing it.

Symptoms may last for up to two weeks, though they may occasionally recur for up to a month. Some infected people may have no symptoms. Like giardia, cryptosporidium is a common cause of U.S. waterborne illness. Also like giardia, these parasites are hearty and avoiding them is the best defense.

Prevention
When it comes to waterborne organisms, prevention is the key. Here are some suggestions from the Centers for Disease Control and Prevention to avoid getting sick or spreading a waterborne illness:

• When swimming, jumping into water or waterskiing and other similar activities, use nose clips or something else to prevent untreated water from being forced up your nose.
• Avoid stagnant water and obey "No Swimming" signs.
• Also when in the water, be careful to avoid accidentally swallowing untreated water.
• If you get thirsty while hiking, camping or doing any other activity around a stream, lake or other source of untreated water, boil the water before ingesting or using it to wash foods to be eaten uncooked. While commercially available filters, iodine tablets and chlorine may get rid of some pathogens, others are hearty enough to survive all but boiling temperatures.
• If you depend on a private well for your water, be sure to have the water checked annually for contamination.
• Don't swim when you have diarrhea. You can spread germs in the water and sicken others.
• Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers. Germs on your body end up in the water.
• Take your kids on bathroom breaks or check diapers often. Waiting to hear "I have to go" may mean that it's too late.

For additional safety: If you live near water and have a septic system, have the system checked periodically to make sure it is functioning properly and not leaking waste into the water.