Pseudomonas aeruginosa skin infections in persons using a whirlpool in Vermont

Abstract

Four guests at a ski resort in Vermont reported contracting a characteristic papular, pustular, or vesicular rash after using the resort's whirlpool. Pseudomonas aeruginosa serotype 1, bacteriophage type 86, was isolated from a pustule on one patient, water within the whirlpool, and the whirlpool diatomaceous earth filter. This appears to be the first outbreak of dermatitis associated with P. aeruginosa serotype 1. Previous reports of whirlpool-associated dermatitis outbreaks have identified serotype 9 and 11 isolates of P aeruginosa as the causative agents.

Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review

“…This is one of an increasing number of outbreaks of Pseludoinonis folliculitis associated with the use of whirlpools. Factors contributing to the occurrence of this syndrome include the high temperature of the water, water turbulence and aeration, heavy bather load per volume of water, the ubiquitous distribution of P. aeruiginosa, and the ability of this organism to withstand chlorine and to multiply rapidly in water at elevated temperatures (16,27,35,43,44). In the outbreak reported here the whirlpool had an automatic disinfectant dispenser.…”

“…Crowding is a significant risk factor (22,44); however, outbreaks are not always associated with high bather load (43). Attack rates have varied from 7 to 100% (Table 1), and it is not known why there is such a wide range.…”

“…The rash is most severe in areas occluded by a snug bathing suit (4,12,13,30,43,44), and women wearing one-piece bathing suits are at increased risk (20a), and swimsuits worn for several hours after exposure may facilitate infection (14), but interestingly, this syndrome has also been reported in persons who did not have any clothes on while in the whirlpool (8, 43). Topical occlusive lotions, oils, or creams are not considered to be risk factors (43). Showering after the use of a contaminated pool may not be protective (13,22,29,35,42,43).…”

“…Topical occlusive lotions, oils, or creams are not considered to be risk factors (43). Showering after the use of a contaminated pool may not be protective (13,22,29,35,42,43).…”

Revised pyocin typing method for Pseudomonas aeruginosa

“…At particular risk are patients who have suffered major trauma or burns and are exposed to intensive care units (16). Also at risk are normal individuals exposed to a compromising occupational or recreational environment, e.g., a deep-sea diving bell, in which outbreaks of acute and painful otitis externa due to P. aeruginosa have been reported (1), or the jacuzzi, in which P. aeruginosa has been implicated in the irritating skin rash known as "hot tub" or jacuzzi syndrome (17).…”