Fatal Pseudomonas aeruginosa pneumonia in a previously healthy woman was most likely associated with a contaminated hot tub

Abstract

Community-acquired pneumonia due to Pseudomonas aeruginosa in previously healthy individuals is a rare disease that is associated with high fatality. On 14 February 2010 a previously healthy 49-year-old woman presented to an emergency room with signs and symptoms of pneumonia, 2 days after returning from a spa holiday in a wellness hotel. Blood cultures and respiratory specimens grew P. aeruginosa. Despite adequate antimicrobial therapy, the patient died of septic multiorgan failure on day nine of hospitalization. On February 26, nine water samples were taken from the hotel facilities used by the patient: In the hot tub sample 37,000 colony-forming units of P. aeruginosa/100 ml were detected. Two of five individual colonies from the primary plate used for this hot tub water sample were found to be genetically closely related to the patients’ isolates. Results from PFGE, AFLP and MLST analysis allowed the two lung isolates gained at autopsy and the whirlpool bathtub isolates to be allocated into one cluster. The patient most likely acquired P. aeruginosa from the contaminated water in the hotel’s hot tub. The detection of P. aeruginosa in high numbers in a hot tub indicates massive biofilm formation in the bath circulation and severe deficiencies in hygienic maintenance. The increasing popularity of hot tubs in hotels and private homes demands increased awareness about potential health risks associated with deficient hygienic maintenance.

Successful Treatment of Fulminant Community-Acquired <i>Pseudomonas aeruginosa</i> Necrotizing Pneumonia in a Previously Healthy Young Man

“…On the other hand, P. aeruginosa has been reported to be the cause of severe CAP (CAP necessitating admission to the ICU or causing shock) in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100% (16)(17)(18)(19). Although the classic features of pneumonia due to P. aeruginosa are its occurrence in compromised hosts and in lung-disease patients with hemorrhagic and necrotizing lung pathology, there have been case reports of previously healthy individuals with CAP caused by P. aeruginosa (3)(4)(5)(6). Such cases are often rapidly progressive and fatal, with morbidity rates exceeding 30% (3).…”

“…Such cases are often rapidly progressive and fatal, with morbidity rates exceeding 30% (3). Some cases were attributable to an identifiable source, such as a home humidifier or a home whirlpool spa (5,6). Occupational exposure also may be a risk factor for P. aeruginosa pneumonia.…”

“…The typical patient presenting with nosocomial P. aeruginosa infection is mechanically ventilated, has slowly progressive lung infiltrates, and has been colonized with P. aeruginosa for days (2). Although rare, there have been some reports of community-acquired P. aeruginosa pneumonia in previously healthy individuals (3)(4)(5)(6), for example, among individuals who have inhaled contaminated hot tub steam (5,6), and P. aeruginosa community-acquired pneumonia (CAP) presents as a rapidly progressive, sometimes fatal disease (3)(4)(5)(6).…”

Molecular typing of bacteria for epidemiological surveillance and outbreak investigation / Molekulare Typisierung von Bakterien für die epidemiologische Überwachung und Ausbruchsabklärung

“…To compare data obtained from different runs or-even worse-from different laboratories, strict protocols must be applied (Swaminathan et al, 2001). Owing to its high discriminatory power, PFGE is the method of choice in outbreak investigation, although faster and simpler methods are highly appreciated (Ruppitsch et al, 2007a(Ruppitsch et al, , 2007cFretz et al, 2010aFretz et al, , 2010bHuhulescu et al, 2011;Chung et al, 2012). In our laboratory, PFGE analysis was applied for epidemiological investigation and elucidation of a multinational listeriosis outbreak in Austria, Germany, and the Czech Republic in the years 2009-2010 (Fretz et al, 2010a(Fretz et al, , 2010b and an ongoing outbreak in Germany (Ruppitsch et al, 2015b).…”

<i>Pseudomonas aeruginosa</i> Bacteremia among Immunocompetent and Immunocompromised Patients: Relation to Initial Antibiotic Therapy and Survival

“…aeruginosa has long been recognized as an opportunistic pathogen that usually causes infection in immunocompromised patients (3,5). However, there are several reports of severe P. aeruginosa infection in patients without apparent immunodeficiency (6)(7)(8)(9). Some cases of P. aeruginosa community-acquired pneumonia described in these reports were caused by inhalation of contaminated water aerosols.…”