Food- and water-borne infections (FWI) remain a major cause of morbidity and mortality worldwide. In addition to established pathogens, new microorganisms, e.g. Cyclospora cayetanensis have emerged in recent years as causes of FWI and there are an ever-increasing number of candidate organisms such as enterotoxigenic Bacteroides fragilis. The laboratory diagnosis of FWI, especially in the traveller returning from areas where these infections are more prevalent, is thus becoming more difficult and there is a need for new diagnostic techniques.
Management of FWI is becoming ever more problematic because many pathogens manifest resistance to multiple antimicrobial agents – resistance which may have emerged in response to the use of antimicrobials in agriculture.
With some agents of FWI such as Cryptosporidium hominis, the range of therapeutic agents has always been very narrow and given the potential for life-threatening infection in some vulnerable groups of patients, there is a pressing need for new drugs.
Attention is being paid to alternatives to conventional antimicrobial agents for the prevention and treatment of FWI, such as probiotics and prebiotics. The evidence base to underpin the use of these is narrow and further studies are needed.
The elucidation of the epidemiology of FWI is becoming increasingly complex due to international food distribution and retailing. International networks which use discriminative, reproducible and standardised methods for strain typing of FWI-associated pathogens are of key importance.
Over recent decades there have been substantial changes in the way that food is purchased, stored and prepared by consumers and access to information on safe storage and preparation of food products is needed, thus encouraging consumers to assume their own responsibilities in eating safely.
The consumption of bottled water has increased almost exponentially over recent years, but the significance of environmental bacteria found in some products for immunocompromised individuals has yet to be established and these individuals and their caregivers await guidance on the microbiological safety of these products.