Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections

The growing popularity of heated pools, especially whirlpools and hot tubs, has been accompanied by increasingly frequent outbreaks of an illness produced by Pseudomonas aeruginosa. The illness usually includes folliculitis, pruritic skin rash, and/or otitis externa and occasionally mastitis and systemic symptoms. Although usually self-limited, rare severe cases have been described. Motel and hotel whirlpools are most often implicated as the source of outbreaks. The relative importance of pool conditions and the bacteriology of P. aeruginosa in the pathogenesis of this illness remain to be elucidated. Implementing CDC Guidelines for public spas and hot tubs seem the most reasonable way of reducing the risk of large outbreaks. Prevention of cases arising from home hot tubs or whirlpools will be very difficult and may depend on extensive public education or the development of simple, inexpensive and effective disinfection systems.