Journal Européen d’Hydrologie, tome 34, fasc. 1, 2003, p. 11 à 44 :
Y a-t-il des infections bactériennes opportunistes
transmises par les eaux d’alimentation ?

ARE THERE OPPORTUNISTIC BACTERIAL INFECTIONS
FROM DRINKING WATER ?

HENRI LECLERC
Faculté de Médecine de Lille et Institut Pasteur de Lille, France
Email : hleclerc@univ-lille2.fr

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Résumé La présence de certaines bactéries dites « pathogènes opportunistes » dans les eaux d’alimentation est sujet à débat. Il s’agit des Legionella, de P. aeruginosa, des Aeromonas et des bactéries du complexe M. avium. L’analyse des données montre que le risque de légionellose est présent et qu’il est plus élevé pour les populations sensibles, en particulier en milieu hospitalier. Les établissements de santé doivent définir des plans de sécurité sanitaire pour contrôler les risques inhérents à ces populations spécifiques. Il n’existe aucun lien significatif entre les bactéries HPC de l’eau d’alimentation et des infections entériques. Les eaux minérales naturelles ont un statut particulier parmi les eaux d’alimentation. Les populations bactériennes qui se développent naturellement dans ces eaux sont dénuées de pouvoir pathogène. Mots clés: évaluation des risques, bactéries opportunistes, HPC (Heterotrophic Plate Count), eau d’alimentation, eau minérale naturelle. Abstract This paper reviews the epidemiological evidence concerning whether HPC bacteria pose a risk to human health. We first consider epidemiological studies that have attempted to identify associations between gastro-intestinal illness in humans and some specific bacteria named «opportunistic pathogen bacteria » that can be considered as heterotrophic bacteria. There is no evidence of association of strains of P. aeruginosa, Aeromonas and M. avium complex with enteric infection through the water-borne route among the general population. However the public health significance of inhalation exposure to some Legionella has been demonstrated. Health care facilities including hospitals, health centres, dialysis centres and dental consulting room, representing a general area of concern for infection control because populations at increased risk, should have general water safety plans, being part of their infection control strategy. Such plans should be apply to control of external contamination by P. aeruginosa, and Legionella. We next consider those studies that have investiged the epidemiology of HPC bacteria. The strong evidence from these studies is that there is no such association. Natural mineral water is typical example of not vulnerable groundwater, i.e., not under the direct influence of surface water. Contrasting with treated drinking water, natural mineral waters cannot be subjected to any type of disinfection that modifies or eliminates their biological components, and they always contain heterotrophic bacteria (HPC) that are primarily a natural component of these waters. Overall experimental and epidemiologial data show that autochtonous bacteria of natural mineral waters have never brought about detectable pathological disorders in human or animals and, in vitro, are incapable of directly damaging human cells in tissue culture. Since the existence of european regulations dating from 1980 (EC, 1980), no outbreak or single case of disease due to the consumption of natural mineral water has been recorded in the literature, or by the health authorities of the countries within the European Community. Key-words: risk assessment, opportunistic bacteria, HPC (Heterotrophic Plate Count), drinking water, natural mineral water.

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