Hot tub folliculitis or hot hand–foot syndrome caused by Pseudomonas aeruginosa

doi:10.1016/j.jaad.2007.04.004

Journal of the American Academy of Dermatology

Volume 57, Issue 4, October 2007, Pages 596-600

https://doi.org/10.1016/j.jaad.2007.04.004 Get rights and content

Pseudomonas aeruginosa is a ubiquitous gram-negative rod that can cause a well-recognized, acquired skin infection from bacterial colonization of contaminated water called “hot tub folliculitis.” We report an outbreak of pseudomonas skin infection associated with the use of a hot tub at a pool party in 33 children. In particular, 2 of the children were admitted to our hospital; both presented with high leukocyte counts, intermittent low grade fevers, and painful, erythematous nodules and papules on their palms and soles. One of the 2 children also presented with small erythematous pustular lesions on the face and trunk, which led to the diagnosis. Cultures from these pustules grew P aeruginosa. Thirty two other children at this pool/hot tub party developed similar lesions of varying severity 6 to 48 hours after the party. These findings were most consistent with the diagnosis of pseudomonas folliculitis/hot hand.

Section snippets

Case 1

A 9-year-old white girl presented to the emergency department in May with a one and a half day history of tenderness and erythema of her palms and a rash on her trunk and face. She had a low grade fever of 99°F, but otherwise she was healthy, with no other complaints. Two days earlier, she had been at a pool/hot tub party with approximately 30 other children. According to the patient, several other children who were at the same party developed similar symptoms, and one child had been admitted

Case 2

A healthy 4-year-old white boy also spent the day at the same swimming/hot tub party. At the party, the patient ran about with bare feet from the hot tub to the trampoline. That evening, he complained of his feet hurting, but his parents only saw wrinkling of the skin. He woke up at 3 am and again at 7 am with intense foot pain and a low grade fever. That morning, the patient was willing to walk only after much encouragement. He was admitted to Saint Louis Children's Hospital because of severe

Methods

Samples of water from the hot tub and pustular lesions from the patient (case 1) were cultured and grew P aeruginosa. They were subsequently subcultured onto blood agar plates and were incubated at 35°C. DNA was extracted from both cultures, after 1 to 3 days of incubation, with QIAamp DNA Mini kits (QIAGEN, Inc, Valencia, Calif) according to the manufacturer's instructions. For each extraction, several colonies were combined to provide the starting material. (Rep) PCR was performed as

Discussion

The ubiquitous bacterium P aeruginosa, found in soil and fresh water, is a known cause of community acquired skin infection. P aeruginosa colonizes the skin after exposure to contaminated water, and gains entry through hair follicles or via breaks in the skin. Two types of skin lesions, folliculitis and hot foot syndrome, have been previously described and have a benign, self-limited course.2, 3

We report an outbreak of hot tub folliculitis/hot hand–foot syndrome occurring in approximately 30

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Cited by (77)

Environmental surveillance of Pseudomonas aeruginosa in recreational waters in tourist facilities of the Balearic Islands, Spain (2016–2019)
2023, Travel Medicine and Infectious Disease
Pseudomonas aeruginosa is a major opportunistic human pathogen commonly connected with recreational water activities. Spain is a tourist destination where most of the establishments have swimming pool. Nevertheless, the prevalence of P. aeruginosa in public swimming pools in our country is unknown. This works aimed to survey the P. aeruginosa presence in tourist Spanish recreational waters.
Tourist recreational water in hotels in the Balearic Islands were visited for four years (2016–2019). The levels of selected parameters were determined, and their correlation with P. aeruginosa contamination investigated.
We evaluated 11,014 samples from 254 facilities. Unacceptable levels of at least one legislated parameter were detected in 30.7% of cases, implicating closure in 15.9%, being P. aeruginosa the leading cause of closure. The prevalence of the pathogen was 14.2%, with lower presence in outer swimming pools. Disinfectant levels influence P. aeruginosa contamination, and bromine-maintained pools were more often contaminated than those treated with chlorine. Prevalence remained constant over the years, although it increased in 2019.
P. aeruginosa prevalence in our recreational waters is similar to other countries, and the contamination rates depend on the installations and type and disinfectant levels. Corrective measures are still needed to improve pathogen control.
A citywide, clonal outbreak of Pseudomonas aeruginosa
2022, International Journal of Infectious Diseases
Citation Excerpt :
Mortality (ranging between 18% to 61%) and morbidity attributable to P. aeruginosa remain considerable among bloodstream infection and VAP cases treated with incorrect empirical antibiotic therapy (Kang et al. 2003; Ramírez-Estrada et al. 2016). Folliculitis and hot-foot syndrome following recreational water exposure (swimming pools, jacuzzies, hot tubs) are infections usually encountered from the community setting in healthy individuals (Yu et al. 2007). The wide spectrum of infections associated with P. aeruginosa is partially explained by the bacterium's battery of virulence factors.
Outbreaks of community-acquired Pseudomonas aeruginosa are typically small and localized. We investigated an increase in community-acquired infections with P. aeruginosa in Cape Town, South Africa.
Cases were defined as P. aeruginosa isolated from any clinical sample, and “wild-type” as those susceptible to all antibiotics tested. The residential addresses of community-acquired wild-type cases were mapped. Whole-genome sequencing and multilocus sequence typing were used to determine clonality and identify virulence genes. A clinical study in a subset of patients with bloodstream infection compared demographic and clinical characteristics between sequence types (STs).
The outbreak lasted 10 months from December 2016 to September 2017 with 3,321 documented cases. At the peak, cases reached 2.3-fold baseline rates. Cases were distributed widely across the city. Multilocus ST 303 was predominant during the outbreak. A total of 51 virulence genes were differentially present in ST303 compared with other STs, including genes involved in biofilm formation, iron uptake, and gut penetration.
The investigation confirmed a citywide outbreak of P. aeruginosa. We identified a predominant outbreak-associated clone, ST303, which harbored genes that could contribute to virulence and survival in adverse environmental conditions such as those associated with drought.
Enhancement of photodynamic bactericidal activity of curcumin against Pseudomonas Aeruginosa using polymyxin B
2022, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
P. aeruginosa infections is associated with high mortality (up to 50%) in patients hospitalized with cancer, cystic fibrosis and burns [3]. Particularly, P. aeruginosa skin infection has been identified as the cause of green nail syndrome, interdigital infections and folliculitis [4–6]. Moreover, due to its low outer membrane permeability and active efflux pumps, P. aeruginosa displays resistance to a variety of antibiotics (eg. ceftazidime, ciprofloxacin, levofloxacin, amikacin, and piperacillin/tazobactam) [7, 8].
Pseudomonas aeruginosa (P. aeruginosa) is an emerging opportunistic pathogen, which can cause bacterial skin diseases such as green nail syndrome, interdigital infections and folliculitis. Curcumin-mediated antimicrobial photodynamic therapy (aPDT) has been demonstrated as a promising therapeutic option for the treatment of skin infection though its inactivation of gram-negative bacteria such as P. aeruginosa.
In the present study, we examined the adjuvant effect of polymyxin B on the antibacterial activity of curcumin-mediated aPDT against P. aeruginosa. P. aeruginosa was treated with curcumin in the presence of 0.1–0.5 mg/L polymyxin B and irradiated by blue LED light (10 J/cm²). Bacterial cultures treated with curcumin alone served as controls. Colony forming units (CFU) were counted and the viability of P. aeruginosa was calculated after aPDT treatment. The possible underlying mechanisms for the enhanced killing effects were also explored.
The killing effects of curcumin-mediated aPDT against P. aeruginosa was significantly enhanced by polymyxin B (over 2-log reductions). Moreover, it was also observed that addition of polymyxin B in the curcumin-mediated aPDT led to the apparent bacterial membrane damage with increased leakage of cytoplasmic contents and extensive DNA and protein degradation.
The photodynamic action of curcumin against P. aeruginosa could be significantly enhanced by the FDA-approved drug polymyxin B. Our results highlight the potential of introducing polymyxin B to enhance the effects of aPDT treatment against gram-negative skin infections, in particular, P. aeruginosa.
Managing adult skin infections
2021, Revista Medica Clinica Las Condes
En la actualidad, las infecciones de piel y partes blandas forman parte de un alto porcentaje de las consultas en salud. Estas van desde infecciones leves, donde el manejo se realiza con tratamiento tópico, hasta aquellas con severo compromiso sistémico, requiriendo terapia antibiótica sistémica e incluso el desbridaje quirúrgico. En general, son producto de un desbalance entre los mecanismos de defensa de la barrera cutánea y los factores de virulencia y patogenicidad de los microorganismos que la afectan. Se pueden clasificar según distintos criterios, como por ejemplo, profundidad, gravedad, microorganismos involucrados y si estas son purulentas o no. El reconocer estas entidades clínicas es de suma importancia para llevar a cabo un adecuado tratamiento en los pacientes que presentan estas afecciones, ya que los diagnósticos erróneos llevan a las múltiples consultas con el consiguiente aumento de costos asociados en atención en salud.
Currently, skin and soft tissue infections are part of a high percentage of health consultations. These range from mild infections, where management is performed with topical treatment, to those with severe systemic compromise requiring systemic antibiotic therapy and even surgical debridement. In general, they are the product of an imbalance between the defense mechanisms of the skin barrier and the virulence and pathogenicity factors of the microorganisms that affect it, which can vary from bacterial, viral, fungal and parasites agents. Skin and soft tissue infections can be classified according to different criteria, such as depth, severity, microorganisms involved and whether they are purulent or not. Recognizing these clinical entities is of utmost importance to carry out adequate treatment in patients with these conditions, since erroneous diagnoses lead to multiple consultations with the consequent increase in costs associated with health care.
Musa acuminata and its bioactive metabolite 5-Hydroxymethylfurfural mitigates quorum sensing (las and rhl) mediated biofilm and virulence production of nosocomial pathogen Pseudomonas aeruginosa in vitro
2020, Journal of Ethnopharmacology
Citation Excerpt :
Hence, the controlling of the bacterial growth and their virulence traits is a possible way to prevent the bacterial infections in burn wounds site. Pseudomonas aeruginosa is one of the clinically vital pathogens that causes numerous infections including skin/wound infections such as burn wound sepsis, hot-foot syndrome, necrotizing fasciitis, subcutaneous nodules, ecthyma gangrenosum, gangrenous cellulitis and surgical site infections (Wu et al., 2011; Yu et al., 2007). P. aeruginosa able to syntheses numerous virulence factors such as protease, elastase and pyocyanin.
Musa acuminata, a tropical plant belongs to the family Musaceae. The fruit peels of this plant have been well documented for their therapeutic value in Asia and Africa. It has also been previously reported for numerous biological applications such as antimicrobial, antioxidant, itching, psoriasis and anti-diarrheal activities. Moreover, M. acuminata peels have been well known for its anti-healing and antiseptic properties and most commonly used for healing wounds and heat burns in South Asian and African traditional medicines.
Aim of the study: To evaluate the QS-mediated antibiofilm and antivirulence potential of M. acuminata, and its bioactive metabolites 5-Hydroxymethylfurfural (5HMF) against Pseudomonas aeruginosa.
The M. acuminata peel methanol extract (MAM) was evaluated for its antibiofilm potential against P. aeruginosa with increasing concentration. Besides, biofilm related phenomenon's such as total biofilm proteins, microcolony formation exopolysaccharides (EPS) and cell surface hydrophobicity (CSH) productions were also examined to support the antibiofilm potential of MAM. Further, MAM was evaluated for its antivirulence efficacy against P. aeruginosa by assessing the protease, LasA protease, LasB elastase, pyocyanin, alginate and rhamnolipid productions at 400 μg ml⁻¹ concentration. Transcriptional analysis of QS regulated virulence genes expression level was also done by real-time PCR analysis. Then, the MAM was subjected to column chromatography for further fractions and the bioactive compounds present in MAM were identified by gas chromatograph-mass spectrometry analysis. Further, the major compounds such as 5-hydroxymethylfurfural, vaccenic acid and pentanoic acid identified from active fraction of MAM were evaluated for their antibiofilm and antivirulence potential against P. aeruginosa.
MAM significantly inhibited the biofilm formation in P. aeruginosa at 400 μg ml⁻¹ concentration which also inhibited the production of biofilm proteins, biofilm adherence, EPS and CSH productions to the level of 79%, 82% and 77% respectively. Further, the antivirulence potential was confirmed through numerous virulence inhibition assays. The MAM at 400 μg ml⁻¹ concentration inhibited the QS-mediated virulence production such as protease, LasA protease, LasB elastase, pyocyanin, alginate and rhamnolipid productions to the level of 77%, 75%, 68%, 80%, 78% and 69% respectively. Moreover, the results of qPCR analysis confirmed the downregulation of QS regulated virulence genes expression upon treatment with MAM. The chromatographic analysis revealed the presence of 5-Hydroxymethylfurfural (5HMF), vaccenic acid and pentanoic acid in MAM and the potential bioactive compounds with antibiofilm and antivirulence was identified as 5-hydroxymethylfurfural, without exerting any growth inhibition in P. aeruginosa.
This study investigated the ideal antibiofilm and antivirulence potential of MAM and its bioactive compound 5HMF, and confirms the ethnopharmacological value of these peels against P. aeruginosa infections.
Superficial Bacterial Skin Infections and Cellulitis
2018, Principles and Practice of Pediatric Infectious Diseases

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Journal of the American Academy of Dermatology

Section snippets

Case 1

Case 2

Methods

Discussion

References (16)

Idiopathic plantar hidradenitis

J Eur Acad Dermatol Venereol

Recreationally associated Pseudomonas aeruginosa folliculitis. Report of an epidemic

Arch Dermatol

Pseudomonas folliculitis: an outbreak and review

Rev Infect Dis

The pseudomonas hot-foot syndrome

N Engl J Med

Stability of repetitive-sequence PCR patterns with respect to culture age and subculture frequency

J Clin Microbiol

Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerase chain reaction

Clin Infect Dis

Recurrent palmoplantar hidradenitis in children

Arch Dermatol

Is recurrent plantar hidradenitis in children induced by exposure to a wet and cold milieu?

Br J Dermatol

Cited by (77)

Environmental surveillance of Pseudomonas aeruginosa in recreational waters in tourist facilities of the Balearic Islands, Spain (2016–2019)

A citywide, clonal outbreak of Pseudomonas aeruginosa

Enhancement of photodynamic bactericidal activity of curcumin against Pseudomonas Aeruginosa using polymyxin B

Managing adult skin infections

Musa acuminata and its bioactive metabolite 5-Hydroxymethylfurfural mitigates quorum sensing (las and rhl) mediated biofilm and virulence production of nosocomial pathogen Pseudomonas aeruginosa in vitro

Superficial Bacterial Skin Infections and Cellulitis

ReportHot tub folliculitis or hot hand–foot syndrome caused by Pseudomonas aeruginosa

Section snippets

Case 1

Case 2

Methods

Discussion

J Eur Acad Dermatol Venereol

Recreationally associated Pseudomonas aeruginosa folliculitis. Report of an epidemic

Arch Dermatol

Pseudomonas folliculitis: an outbreak and review

Rev Infect Dis

The pseudomonas hot-foot syndrome

N Engl J Med

Stability of repetitive-sequence PCR patterns with respect to culture age and subculture frequency

J Clin Microbiol

Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: use of repetitive-element-sequence polymerase chain reaction

Clin Infect Dis

Recurrent palmoplantar hidradenitis in children

Arch Dermatol

Is recurrent plantar hidradenitis in children induced by exposure to a wet and cold milieu?

Br J Dermatol

Report
Hot tub folliculitis or hot hand–foot syndrome caused by Pseudomonas aeruginosa