新研究著眼於綠膿桿菌水污染

腳熱病與新生兒腦膜炎

  八月二日的The New England Journal of Medicine期刊上,有兩份新研究報告著眼於來自水污染的綠膿桿菌。

New Studies Highlight Pseudomonas Water Contamination

'Hot Foot Syndrome' and Newborn Meningitis

By Aman Shah, MD
WebMD Medical News

Reviewed by Michael W. Smith, MD

Aug. 1, 2001 -- Two new reports in the Aug. 2 issue of The New England Journal of Medicine highlight the problem of Pseudomonas aeruginosa spreading from contaminated water.

"We describe an outbreak of a clinically distinct syndrome for which we propose the name 'Pseudomonas hot-foot syndrome,'" write the authors of one study, led by Loretta Fiorillo, MD, from the division of dermatology and cutaneous science at the University of Alberta in Edmonton. "It is characterized by the acute onset of exquisitely painful plantar nodules in children and a benign, self-limited course."

In the other report, German researchers describe a case of a woman in labor who took a warm tub bath prior to delivery, a common practice in many hospitals, which led to P. aeruginosa meningitis in her newborn. The researchers found that the plastic tubing used in the tub "is a perfect environment for the growth of P. aeruginosa in biofilms that increase the bacteria's resistance to disinfectants and promote its persistence."

The Canadian study reports on an outbreak of intense foot pain, followed by swelling, redness, heat, and weight-bearing difficulty among 40 children (ages 2-15 years) who had used a wading pool. Within 40 hours of exposure to the bacteria, the children developed painful erythematous plantar nodules that were red/purple, deep, and 1-2 cm in size. Some patients also developed a fever and palmar nodules.

All patients recovered within 14 days with symptomatic treatment or cephalexin.

"The major importance or significance of these findings relates to the ability of exposure to water -- even in apparent 'high hygiene' conditions -- to occasionally be the source of an infection," Gerald B. Pier, PhD, tells WebMD. "Certain groups of individuals, notably immunosuppressed children and children with cystic fibrosis, are highly susceptible to Pseudomonas infection. Also, the report on sepsis in a newborn re-emphasizes the vulnerable nature of neonates to infection if they are heavily exposed to a microbe during the birthing procedure." Pier is a microbiologist and a professor in the department of medicine at Brigham and Women's Hospital, Harvard Medical School in Boston.

"The hot-foot syndrome was self-limiting and mostly problematic in terms of pain and the compromise to normal activity. The authors of this report emphasize the unusual nature of the type of infection the children had. ... But if a child was immunosuppressed -- say, from cancer treatment -- or had CF, contaminated swimming pools or similar situations could present a greater danger to a more serious infection.

"For clinicians, these studies offer an awareness of the role of significant water exposure in development of both the hot-foot syndrome and other skin infections and the risk to newborns in pregnant women about to give birth," Pier says.

"Practically, the implications for providers of community bathing facilities, individuals with hot tubs, hospitals, or birthing services/midwives/etc. is that the ability of an organism like Pseudomonas to stick on pipes, tubes, etc. that are part of the water system must be vigorously checked and appropriate treatments of the pipes undertaken on a routine basis," says Pier. "It may not be enough to chlorinate a swimming or wading pool or just place fresh water into a tub bath. ... For physicians, it means checking into these exposures with the patient."

With reporting by Alison Palkhivala

 

© 2001 WebMD Corporation. All rights reserved.

 

    
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