Whilst the potential impact on beach users from microorganisms in water has received considerable attention, there has been relatively little investigation into microbial contaminants in sand. 33 beaches across Portugal were analyzed during a five year period (2006)(2007)(2008)(2009)(2010) to determine the presence of yeasts, pathogenic fungi, dermatophytes, total coliforms, E. coli and intestinal enterococci in sand.Our results showed that 60.4% of the samples were positive for fungi and that 25.2% were positive for the bacterial parameters. The most frequent fungal species found were Candida sp.and Aspergillus sp., whereas intestinal enterococci were the most frequently isolated bacteria.Positive associations were detected among analyzed parameters and country-regions but none among those parameters and sampling period.Regarding threshold values, we propose 15 cfu/g for yeasts, 17 cfu/g for potential pathogenic fungi, 8 cfu/g for dermatophytes. 84 cfu/g for coliforms, 250 cfu/g for E. coli, and 100 cfu/g for intestinal enterococciHighlights:x 60.4% of the analyzed marine beach sand samples were positive for the studied fungi x Candida sp. and Aspergillus sp. were the most frequent fungal species found x 25.2% of the analyzed marine beach sand samples were positive to the studied bacteria

Beaches worldwide provide recreational opportunities to hundreds of millions of people and serve as important components of coastal economies. Beach water is often monitored for microbiological quality to detect the presence of indicators of human sewage contamination so as to prevent public health outbreaks associated with water contact. However, growing evidence suggests that beach sand can harbor microbes harmful to human health, often in concentrations greater than the beach water. Currently, there are no standards for monitoring, sampling, analyzing, or managing beach sand quality. In addition to indicator microbes, growing evidence has identified pathogenic bacteria, viruses, and fungi in a variety of beach sands worldwide. The public health threat associated with these populations through direct and indirect contact is unknown because so little research has been conducted relating to health outcomes associated with sand quality. In this manuscript, we present the consensus findings of a workshop of experts convened in Lisbon, Portugal to discuss the current state of knowledge on beach sand microbiological quality and to develop suggestions for standardizing the evaluation of sand at coastal beaches. The expert group at the "Microareias 2012" workshop recommends that 1) beach sand should be screened for a variety of pathogens harmful to human health, and sand monitoring should then be initiated alongside regular water monitoring; 2) sampling and analysis protocols should be standardized to allow proper comparisons among beach locations; and 3) further studies are needed to estimate human health risk with exposure to contaminated beach sand. Much of the manuscript is focused on research specific to Portugal, but similar results have been found elsewhere, and the findings have worldwide implications.

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• Beach sands represent reservoirs for a variety of bacterial, fungal, and protozoan pathogens. 1 • Epidemiological studies and monitoring efforts have only recently been explored to protect public health. 1 • Current monitoring efforts are based on culture-based enumeration of fecal indicator bacteria and selected fungal pathogens. 2 • Next-generation sequencing (NGS) methods are increasingly being used to more completely characterize microbial communities in sands. 3 • Taken together, NGS and conventional methods can be used in a tool-box approach to better assess health risks. 4 We hypothesized that NGS and culture-based methods would identify the same, predominant taxa in beach sands: Culture-based methods will show greater sensitivity to lowabundance potential pathogens  NGS will offer more extensive characterization of the community and identify novel targets for monitoring efforts

Homocystinuria due to cystathionine b-synthase deficiency or "classical homocystinuria" is a rare autosomal recessive condition resulting in altered sulfur metabolism with elevated methionine and homocysteine in plasma and homocystine in urine.