Case and Research Letters
Bilateral Mastitis as a Complication of Folliculitis Caused by Pseudomonas aeruginosa Following Hot-Tub Use
Mastitis bilateral como complicación de foliculitis por Pseudomonas aeruginosa, secundaria a uso de bañera de hidromasaje
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Hott, V. Catalán, O. Gómez, V. Águila" "autores" => array:4 [ 0 => array:4 [ "nombre" => "K." "apellidos" => "Hott" "email" => array:1 [ 0 => "dra.khott@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "V." "apellidos" => "Catalán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Águila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínico Universidad de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital de Carabineros, Santiago, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mastitis bilateral como complicación de foliculitis por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>, secundaria a uso de bañera de hidromasaje" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1000 "Ancho" => 750 "Tamanyo" => 114356 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Serpiginous erythematous macular lesion with poorly defined borders extending from the left periareolar region towards the left axilla, where a mobile and sensitive inflammatory lymph node of 1.5 cm was palpable.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> is a strictly aerobic, gram-negative, motile bacillus bacterium. It is widely distributed owing to its minimal nutritional requirements, tolerates a wide temperature range (4<span class="elsevierStyleHsp" style=""></span>°C–42<span class="elsevierStyleHsp" style=""></span>°C), and thrives in moist environments. These characteristics allow this bacterium to multiply in hot tubs with low chlorine concentrations, swimming pools, saunas, and hydrotherapy facilities.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P aeruginosa</span> can cause a very broad spectrum of infections, which largely depend on the immune status of the affected individual. The most commonly reported infections include otitis externa, paronychia, intertigo, folliculitis, cellulitis, and abscesses.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Upon skin contact with contaminated water <span class="elsevierStyleItalic">P aeruginosa</span> colonizes the skin and can enter the hair follicles or skin wounds, infecting the superficial portion of the pilosebaceous unit.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The most common presentation is folliculitis, characterized by the presence of follicular, macular, papular, vesicular, or pustular lesions on the axillae, sides of the thorax, abdomen, groin, perianal area, or any part of the body that has been submerged in contaminated water. <span class="elsevierStyleItalic">P aeruginosa</span> infection can also manifest as hot foot syndrome or hot hand-foot syndrome,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> characterized by the formation of nodules on the palms of the hands and the soles of the feet. In some cases, the release of exotoxins can cause systemic clinical signs including fever, gastrointestinal disorders, otalgia, and odynophagia.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The clinical presentation is evident within 6 to 48<span class="elsevierStyleHsp" style=""></span>hours after bathing and is usually self-limiting, resolving within 1 to 2 weeks.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the main differential diagnoses is folliculitis caused by <span class="elsevierStyleItalic">Staphylococcus aureus</span>, which is characterized by a circular pattern of laminar desquamation around the infected hair follicle. The differential diagnosis should also include scabies, arthropod bites, and other bacterial skin infections.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In most cases folliculitis caused by <span class="elsevierStyleItalic">P aeruginosa</span> is managed with topical treatment, although systemic treatment may be required in cases involving fever, constitutional symptoms, extracutaneous involvement, or immunocompromise.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Description</span><p id="par0035" class="elsevierStylePara elsevierViewall">A healthy, 35-year-old man was seen for follicular pustules and papules with an inflammatory erythematous halo. The lesions were neither painful nor pruritic and were located on the thorax, the side of the abdomen, the gluteus, and lower extremities (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). On each breast was an erythematous macular lesion with poorly-defined borders. From the lesion on the left breast a serpiginous, erythematous trail extended from the periareolar region to the left axilla (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), where a mobile and sensitive inflammatory lymph node of 1.5 cm in diameter was palpable. All lesions had appeared 48<span class="elsevierStyleHsp" style=""></span>hours after the patient bathed in a hot-water whirlpool bath in his home. The patient showed no signs of general compromise and fever was absent. Upon suspicion of folliculitis due to <span class="elsevierStyleItalic">P aeruginosa</span> complicated by mastitis, pustule samples were collected for culture and the patient began empirical treatment with ciprofloxacin (500 mg/12 h) for 7 days. The affected area was cleaned with antibacterial soap twice per<span class="elsevierStyleHsp" style=""></span> day during the treatment period. The patient progressed favorably, and the lesions resolved completely after 96<span class="elsevierStyleHsp" style=""></span>hours. Bacterial culture revealed the presence of multidrug-sensitive <span class="elsevierStyleItalic">P aeruginosa</span>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">There are several reports in the literature describing hot-tub-associated <span class="elsevierStyleItalic">P aeruginosa</span> infections, including otitis externa, balanitis, omphalitis, green-nail syndrome, and genitourinary tract infections (for which risk factors include sexual activity in whirlpool baths and exposure of the genitals to water jets).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Diseases that can occur concomitantly with <span class="elsevierStyleItalic">P aeruginosa</span> folliculitis include <span class="elsevierStyleItalic">P aeruginosa</span> pneumonia and hypersensitivity pneumonitis due to <span class="elsevierStyleItalic">Mycobacterium avium</span>.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The condition of our patient, a man with bilateral mastitis as a complication of <span class="elsevierStyleItalic">P aeruginosa</span> folliculitis associated with whirlpool-bath use, represents an unusual manifestation of this pathology, of which no cases are described in the literature.</p><p id="par0055" class="elsevierStylePara elsevierViewall">We believe it is important to report this case given the significant increase in diseases associated with the bathing in whirlpools, swimming pools, and spas.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Topical treatment options include polymyxin B, gentamicin, 2% acetic acid, and benzoyl peroxide (which helps avoid the development of resistance). Systemic treatment may be selected for patients who are immunocompromised or have fever, constitutional symptoms, or associated mastitis. Some cases in the literature describe treatment of affected patients with ciprofloxacin (0.5–1 g/d) while awaiting the results of antibiotic sensitivity tests.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Contamination of water with <span class="elsevierStyleItalic">P aeruginosa</span> can be prevented by changing the water daily, maintaining the pH between 7.2 and 7.8 and chlorine levels above 0.5 mg/L, and ensuring adequate drainage and drying of whirlpool baths after use.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Description" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hott K. Mastitis bilateral como complicación de foliculitis por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>, secundaria a uso de bañera de hidromasaje. Actas Dermosifiliogr. 2019;110:501–502.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 912 "Ancho" => 850 "Tamanyo" => 61741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Papules and pustules surrounded by an erythematous halo on the side of the thorax, abdomen, and buttocks.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1000 "Ancho" => 750 "Tamanyo" => 114356 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Serpiginous erythematous macular lesion with poorly defined borders extending from the left periareolar region towards the left axilla, where a mobile and sensitive inflammatory lymph node of 1.5 cm was palpable.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foliculitis por <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 30 | 19 | 49 |
| 2024 October | 167 | 88 | 255 |
| 2024 September | 158 | 45 | 203 |
| 2024 August | 250 | 86 | 336 |
| 2024 July | 292 | 61 | 353 |
| 2024 June | 183 | 54 | 237 |
| 2024 May | 167 | 64 | 231 |
| 2024 April | 167 | 41 | 208 |
| 2024 March | 227 | 39 | 266 |
| 2024 February | 288 | 56 | 344 |
| 2024 January | 245 | 40 | 285 |
| 2023 December | 335 | 30 | 365 |
| 2023 November | 436 | 39 | 475 |
| 2023 October | 480 | 44 | 524 |
| 2023 September | 407 | 38 | 445 |
| 2023 August | 353 | 31 | 384 |
| 2023 July | 336 | 42 | 378 |
| 2023 June | 218 | 29 | 247 |
| 2023 May | 290 | 36 | 326 |
| 2023 April | 297 | 27 | 324 |
| 2023 March | 298 | 31 | 329 |
| 2023 February | 301 | 40 | 341 |
| 2023 January | 377 | 42 | 419 |
| 2022 December | 278 | 36 | 314 |
| 2022 November | 221 | 45 | 266 |
| 2022 October | 196 | 37 | 233 |
| 2022 September | 214 | 50 | 264 |
| 2022 August | 225 | 37 | 262 |
| 2022 July | 145 | 55 | 200 |
| 2022 June | 107 | 43 | 150 |
| 2022 May | 234 | 46 | 280 |
| 2022 April | 314 | 41 | 355 |
| 2022 March | 479 | 65 | 544 |
| 2022 February | 423 | 43 | 466 |
| 2022 January | 557 | 44 | 601 |
| 2021 December | 433 | 45 | 478 |
| 2021 November | 338 | 42 | 380 |
| 2021 October | 305 | 58 | 363 |
| 2021 September | 229 | 43 | 272 |
| 2021 August | 320 | 36 | 356 |
| 2021 July | 323 | 19 | 342 |
| 2021 June | 445 | 41 | 486 |
| 2021 May | 381 | 45 | 426 |
| 2021 April | 933 | 91 | 1024 |
| 2021 March | 450 | 27 | 477 |
| 2021 February | 380 | 37 | 417 |
| 2021 January | 370 | 13 | 383 |
| 2020 December | 319 | 22 | 341 |
| 2020 November | 233 | 18 | 251 |
| 2020 October | 118 | 13 | 131 |
| 2020 September | 162 | 13 | 175 |
| 2020 August | 141 | 19 | 160 |
| 2020 July | 102 | 15 | 117 |
| 2020 June | 78 | 14 | 92 |
| 2020 May | 88 | 15 | 103 |
| 2020 April | 46 | 13 | 59 |
| 2020 March | 19 | 5 | 24 |
| 2020 February | 5 | 2 | 7 |
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