The Several Agues of Charybdis
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One day in 1948, the inventor Candido Jacuzzi appropriated one of the hydraulic pumps manufactured by the family firm at their factory in Chino, California. Candido took the pump home and fitted it to the family bathtub, hoping to replicate at home the hydrotherapy treatment, which his son Kenny had been receiving in hospital for his chronic rheumatoid arthritis. In 1955, Jacuzzi Brothers began to market the pump – by now known as the J300 – to the bathroom supply industry. In 1968, the first fully integrated whirlpool baths went on sale, followed in the early 1970’s by larger units with integrated heating and filtration systems, much akin to the whirlpools and hot tubs of the modern age. — Chino, California, Hydraulic pump, Candido Jacuzzi
The first reports of infection associated with the use of hot tubs date from this period. These early reports for the most part implicate Pseudomonas aeruginosa as the infecting agent, with Pseudomonas dermatitis or folliculitis as the most common diagnosis. — Pseudomonas aeruginosa
During this so-to-speak cretaceous era in the history of hot tub pathology, hot tub folliculitis came to be associated mainly if not exclusively with P.aeruginosa, so much so that the terms ‘Pseudomonas folliculitis’ and ‘hot tub folliculitis’ became and to some extent remain interchangeable. See e.g. Zacherle & Silver [1982]. A number of different P.aeruginosa serotypes have been associated with folliculitis outbreaks, with serotype 0.11 identified by Ratnam et al [ibid.] as the — Pseudomonas folliculitis
In 2008, there was the first report of a more severe hot tub folliculitis case, in relation to which Aeromonas hydrophila rather than P.aeruginosa is thought to have been the etiological agent [sc. Mulholland & Yong-Gee 2008; as discussed below]. A.hydrophila is described as a gram-negative, rod-shaped bacterium, which is motile by means of a polar flagellum and is known to be common in both brackish and standing water and in soil. Historically speaking, the taxonomy of the Aeromonas genus to which A.hydrophila belongs has been the source of a certain amount of controversy. See in particular Joseph & Carnahan [2000], also both papers by Janda & Abbott [see below]. — Aeromonas hydrophila
- Severe cases:- subcutaneous infections spreading along fascial planes, i.e. necrotizing fasciitis, potentially involving severe damage to muscle tissue, i.e. myonecrosis. — Necrotizing fasciitis
More than two thirds of Aeromonas ssti’s arise either from “traumatic occupational injuries” [p53] or from exposures via sporting or recreational injuries. The leading authority on the subject of Aeromonas infections acquired by this route is probably Amy Horneman (formerly Martin-Carnahan). In particular, her co-authored Joseph & Carnahan [2000] is recognized as a seminal publication in the field. To quote the L.A Times [q.v. previous f.n.], — Amy Horneman
A propos of present proceedings, the first report implicating a hot tub as the source of an Aeromonas infection [Mulholland & Yong-Gee 2008] describes the oedema and pubic folliculitis suffered by a thirty-something couple from Brisbane; and features some particularly unsparing colour photographs of the male patient’s genitals, although judging by appearance and description this qualifies as an intermediate case. However, the Mulholland & Yong-Gee report requires a caveat, as the title of their paper suggests (“A possible case of …” [my itals.]), insofar as the involvement of the hot tub as the source of the infection is not proven. A.hydrophila can certainly be accepted as the etiological agent, since a bacterial culture of the male patient’s follicular pus grew a colony thereof; whereupon ciprofloxacin was prescribed in accordance with usual practice – see earlier fn. However, a culture of the water from the hot tub only — Brisbane