This is the first report on fecal pollution using molecular markers in Southeast Asia where serious sewage pollution has occurred. A simple and sensitive analytical method using gas chromatography-mass spectrometry for 10 sterols in various environmental samples was developed to monitor extensive areas of tropical Asia. First, the method was applied to wastewater to confirm that >95% of sterols existed in the particulate phase. Then the approach was applied to a tropical Asian region, Malaysia and Vietnam, with a selection of 59 sampling stations in total. River water and sediment samples were collected and analyzed for chemical markers (coprostanol and other sterols) and microbiological markers (fecal coliforms and fecal streptococci). Particulate coprostanol concentrations ranged from <0.0001 to 13.47 microg/L in tropical river and estuarine waters, indicating severe fecal pollution in populous areas. Coprostanol concentrations in the sediments ranged from 0.005 to 15.5 microg/g-dry. The sedimentary coprostanol concentrations were lower than those reported in some urban areas of industrialized countries. This is probably because frequent heavy rain induces intensive input of eroded soil, which dilutes fecal material in river sediments. The relationship between the concentrations of fecal sterols and bacterial indicators was examined in an attempt to develop public health criteria for coprostanol levels applicable to the tropical region. Coprostanol concentrations of 30-100 ng/L or percent coprostanol levels of 2% corresponded to approximately 1000 fecal coliforms per 100 mL, which is set for secondary contact limit in many countries. These coprostanol concentrations were lower than those proposed as criteria in temperate countries, probably owing to greater survival of bacteria in warmer tropical waters. On the basis of these criteria, extensive monitoring of sediments suggests that poor sanitary conditions exist in most of the urbanized area of Malaysia and in several urban and rural sites in Vietnam.
This paper reports the result of sewage pollution monitoring conducted in South and Southeast Asia during 1998-2003 using linear alkylbenzenes (LABs) as molecular tracers of sewage contamination. Eighty-nine water samples collected from Malaysia, Vietnam, and Japan (Tokyo), and 161 surface sediment samples collected from Tokyo, Thailand, Malaysia, Philippines, Vietnam, Cambodia, Indonesia, and India were analyzed for alkylbenzenes. The concentration range of SigmaLABs in river water particles in Southeast Asia (<0.005-0.913 microg/L) was comparable to or higher than those found in Tokyo (<0.005-0.638 microg/L). I/E ratios (a ratio of internal to external isomers of LABs) in tropical Asian waters were close to the value of LABs in raw sewage ( approximately 1) and much lower than those in secondary effluents (3-5). This suggests that untreated or inadequately treated sewage is discharged into the water. SigmaLABs concentrations in sediments from South and Southeast Asia ranged from <0.002-42.6 microg/g-dry with the highest concentration occurring at several populous cities. Low I/E ratios of the sediments with high SigmaLABs concentrations suggest a heavy load of untreated sewage. Clearly in view of the current data and evidence of the implications of sewage pollution, this paper highlights the necessity of the continuation of water treatment system improvement in tropical Asia.
Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies.