Hot Tub–Associated Necrotizing Pneumonia due to Pseudomonas aeruginosa

Department of Medicine and Section of Infectious Diseases, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 03/2003; 36(3):e55-7. DOI: 10.1086/345851
Source: PubMed


We describe a case of severe necrotizing pneumonia due to community-acquired Pseudomonas aeruginosa. Cultures of fluid obtained from the filter of the patient's hot tub grew the same P. aeruginosa strain as that grown from culture of the patient's sputum. Centers for Disease Control and Prevention guidelines should be strictly followed for hot tub maintenance to prevent P. aeruginosa overgrowth: the range of free chlorine levels in the water should be kept at 1-3 mg/L, and the pH should be kept at 7.2-7.8.

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    • "The disease was associated with exposure to contaminated water aerosols in at least two of the 11 cases published: Alan et al. [13] reported on a case of community-acquired P. aeruginosa pneumonia associated with the use of a home humidifier, and Rose et al. [10] reported on P. aeruginosa pneumonia occurring following a single extended (90 min) exposure to contaminated water aerosols in a private home whirlpool. In 2003, Crnich et al. [2] reported on another case of community-acquired hot tub-associated necrotizing pneumonia in a previously healthy 40-year-old with a smoking history. "
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    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 patient's 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.
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