Pseudomonas aeruginosa urosepsis from use of a hot-water spa
2003; Elsevier BV; Volume: 115; Issue: 7 Linguagem: Inglês
10.1016/s0002-9343(03)00444-3
ISSN1555-7162
Autores Tópico(s)Palliative Care and End-of-Life Issues
ResumoA 42-year-old white man, who had been seropositive with human immunodeficiency virus type 1 (HIV-1) since 1986, presented with sudden onset of high fever, myalgia, and fatigue that began 2 days before. The patient noted an increase in urinary frequency without dysuria or penile discharge. Physical examination showed prostate tenderness and an oral temperature of 103.5°F. A urine dipstick suggested infection, and urine and blood cultures were obtained. The patient appeared well and, because of an allergy to fluoroquinolones, was discharged with oral sulfamethoxazole/trimethoprim for presumed urinary tract infection with prostatitis.Two years before presentation, the patient had an absolute CD4+ T-cell count nadir of 224/μL and was placed on 4-drug antiretroviral therapy. HIV-1 plasma viremia rapidly became less than the limit of detection (branched deoxyribonucleic acid, 600/μL. Similar values had been maintained since that time.Gram-negative rods were reported growing from both blood and urine culture within 18 hours and were identified as Pseudomonas aeruginosa, which was susceptible to antipseudomonal penicillins and cephalosporins, fluoroquinolones, and aminoglycosides. Treatment was initiated with ceftazidime and once-daily gentamicin, resulting in immediate clearing of blood and urine, defervescence, and overall clinical improvement. Review of risk factors for pseudomonas infection revealed a recent exposure in a nonpublic hot-water spa, in which the patient allowed a water jet to come in direct contact with his urethra. Confirmatory cultures of the spa water were not taken.Infectious complications with pseudomonas species from artificial water environments such as spas, whirlpools, and swimming pools are well described and include dermatitis and folliculitis (1Gregory D.W. Schaffner W. Pseudomonas infections associated with hot tubs and other environments.Infect Dis Clin North Am. 1987; 1: 635-648PubMed Google Scholar), otitis externa (1Gregory D.W. Schaffner W. Pseudomonas infections associated with hot tubs and other environments.Infect Dis Clin North Am. 1987; 1: 635-648PubMed Google Scholar), and sepsis (2Wareham D.W. Sepsis in a newborn due to Pseudomonas aeruginosa from a contaminated tub bath.N Engl J Med. 2001; 345: 1644-1645PubMed Google Scholar), but urologic infection rarely (3Salmen P. Dwyer D.M. Corse H. Kruse W. Whirlpool-associated Pseudomonas aeruginosa urinary tract infections.JAMA. 1983; 250: 2025-2026Crossref PubMed Scopus (30) Google Scholar). There are few studies regarding urinary tract infection in HIV-infected men (4De Pinho A.M. Lopes G.S. Ramos-Filho C.F. et al.Urinary tract infection in men with AIDS.Genitourin Med. 1994; 70: 30-34PubMed Google Scholar). A recent prospective analysis of P. aeruginosa bacteremia in HIV-1 infected patients showed independent risk factors to be nosocomial origin, neutropenia, and an absolute CD4+ T-cell count of <50 cells/μL, with HIV-infected patients at greater risk of pseudomonas bacteremia than an unselected hospitalized population (5Vidal F. Mensa J. Martinez J.A. et al.Pseudomonas aeruginosa bacteremia in patients infected with human immunodeficiency virus type 1.Eur J Clin Microbiol Infect Dis. 1999; 18: 473-477Crossref PubMed Scopus (46) Google Scholar). The patient had well-controlled HIV infection and was without these risk factors, yet manifested invasive disease, presumably from a single mucosal exposure to P. aeruginosa. This suggests that despite antiretroviral-induced immune reconstitution, HIV-infected patients remain at increased risk of serious infectious complications because of residual immune dysfunction and should avoid excessive exposure to potentially contaminated water environments. A 42-year-old white man, who had been seropositive with human immunodeficiency virus type 1 (HIV-1) since 1986, presented with sudden onset of high fever, myalgia, and fatigue that began 2 days before. The patient noted an increase in urinary frequency without dysuria or penile discharge. Physical examination showed prostate tenderness and an oral temperature of 103.5°F. A urine dipstick suggested infection, and urine and blood cultures were obtained. The patient appeared well and, because of an allergy to fluoroquinolones, was discharged with oral sulfamethoxazole/trimethoprim for presumed urinary tract infection with prostatitis. Two years before presentation, the patient had an absolute CD4+ T-cell count nadir of 224/μL and was placed on 4-drug antiretroviral therapy. HIV-1 plasma viremia rapidly became less than the limit of detection (branched deoxyribonucleic acid, 600/μL. Similar values had been maintained since that time. Gram-negative rods were reported growing from both blood and urine culture within 18 hours and were identified as Pseudomonas aeruginosa, which was susceptible to antipseudomonal penicillins and cephalosporins, fluoroquinolones, and aminoglycosides. Treatment was initiated with ceftazidime and once-daily gentamicin, resulting in immediate clearing of blood and urine, defervescence, and overall clinical improvement. Review of risk factors for pseudomonas infection revealed a recent exposure in a nonpublic hot-water spa, in which the patient allowed a water jet to come in direct contact with his urethra. Confirmatory cultures of the spa water were not taken. Infectious complications with pseudomonas species from artificial water environments such as spas, whirlpools, and swimming pools are well described and include dermatitis and folliculitis (1Gregory D.W. Schaffner W. Pseudomonas infections associated with hot tubs and other environments.Infect Dis Clin North Am. 1987; 1: 635-648PubMed Google Scholar), otitis externa (1Gregory D.W. Schaffner W. Pseudomonas infections associated with hot tubs and other environments.Infect Dis Clin North Am. 1987; 1: 635-648PubMed Google Scholar), and sepsis (2Wareham D.W. Sepsis in a newborn due to Pseudomonas aeruginosa from a contaminated tub bath.N Engl J Med. 2001; 345: 1644-1645PubMed Google Scholar), but urologic infection rarely (3Salmen P. Dwyer D.M. Corse H. Kruse W. Whirlpool-associated Pseudomonas aeruginosa urinary tract infections.JAMA. 1983; 250: 2025-2026Crossref PubMed Scopus (30) Google Scholar). There are few studies regarding urinary tract infection in HIV-infected men (4De Pinho A.M. Lopes G.S. Ramos-Filho C.F. et al.Urinary tract infection in men with AIDS.Genitourin Med. 1994; 70: 30-34PubMed Google Scholar). A recent prospective analysis of P. aeruginosa bacteremia in HIV-1 infected patients showed independent risk factors to be nosocomial origin, neutropenia, and an absolute CD4+ T-cell count of <50 cells/μL, with HIV-infected patients at greater risk of pseudomonas bacteremia than an unselected hospitalized population (5Vidal F. Mensa J. Martinez J.A. et al.Pseudomonas aeruginosa bacteremia in patients infected with human immunodeficiency virus type 1.Eur J Clin Microbiol Infect Dis. 1999; 18: 473-477Crossref PubMed Scopus (46) Google Scholar). The patient had well-controlled HIV infection and was without these risk factors, yet manifested invasive disease, presumably from a single mucosal exposure to P. aeruginosa. This suggests that despite antiretroviral-induced immune reconstitution, HIV-infected patients remain at increased risk of serious infectious complications because of residual immune dysfunction and should avoid excessive exposure to potentially contaminated water environments.
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