Pseudomonas Folliculitis Acquired From a Health Spa Whirlpool

Abstract

\s=b\Three cases of an unusual Pseudomonas skin infection acquired from a health spa whirlpool were reported, and an epidemiologic survey showed 17 additional cases. This dermatosis is characterized by the abrupt onset of urticarial papules and superficial and deep papulopustules that spare only the head and neck and occur eight to 48 hours after using the whirlpool. Cultures from one patient's pustules and from the spa whirlpool environment were positive for P aeruginosa, serotype 0-11. The condition cleared in all but one patient, without treatment, within seven to ten days. This patient continues to have recurrent follicular pustules three months after exposure.Samples from whirlpools at six other selected establishments were also positive for P aeruginosa.

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

“…This is also supported by an earlier observation that superhydration of the stratum corneum favors colonization of skin with P. aeruiginlos(l (19). Occlusion promotes Pseiu-do0msonls infection (35). 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).…”

“…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.…”

“…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).…”

“…Associated symptoms include earache, sore throat, sore eyes, conjunctivitis, lymphadenopathy, rhinitis, swollen and painful breasts, nausea, vomiting, abdominal cramps, malaise, fatigue, headache, myalgias, chills, painful axillary nodules, and low-grade fever (12,14,16,22,24,27,29), but these symptoms do not imply systemic spread of infection. Although generally considered to be self-limiting, the symptoms may last for several weeks, and the initial infection could result in recurrent folliculitis and chronic abscess (12,13,16,20,35,42). However, no specific therapy is generally required for Pseludoinonias folliculitis (15,22,30,46).…”

Hospital hydrotherapy pools treated with ultra violet light: bad bacteriological quality and presence of thermophilicNaegleria

“…P. aerugino8a has been isolated more frequently in hospital swimming pools than in other pools (Schindler, 1978). Outbreaks of infections due to P. aeruginiosa in swimming pools (Reid & Porter, 1981) and health spa whirlpools (Sansker et al 1978) are still being reported. When P. aeruginosa was isolated during this study, large numbers were found in the filter.…”