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Unexplained acute fever after a hot bath.

An outbreak of repeated chills, fever, respiratory-tract symptoms, and muscle pain, starting 4 h after a hot bath, involved 56 persons, nearly all of whom lived in an area supplied with water from the same source. The symptoms lasted for 6--15 h. A polymorphonuclear leucocytosis was a feature of the illness. The causal agent, which has not yet been identified, was found to enter the body by inhalation. Bacteriological and chemical studies and investigation of the water for endotoxins and algae revealed nothing unusual.

Acute Disease↗

Legionnaires' disease in a transplant unit: isolation of the causative agent from shower baths.

Legionnaires' disease was diagnosed in two patients in a transplant unit, both patients having occupied the same postoperative cubicle shortly before onset of their illnesses. Legionella pneumophila was found in water taken from the cubicle shower bath and from other showers in the unit. To eradicate the legionellae, the water supply was treated with chlorine, but this had only a temporary effect.

Adult↗

[Thermophilic bacteria resistant to antibiotics in traditional public baths].

Three thermophilic bacteria strains, designated strain BS1, BS2 and BS3, resistant to beta-lactam antibiotics, and leaving at an optimal temperature for growth of about 50 degrees C, were isolated from traditional baths in Meknes-city in Morocco. Physiological and biochemical studies showed that these organisms belong to Gram positive Bacilli. They could not be identified with the Bergey's Manuel of Systematic Bacteriology (1986). The dosage of beta-lactamase during the exponential growth phase has revealed that the strain BS3 produces a maximal amount of this enzyme. Studies aimed at determining the optimal conditions for incubation and growth have been performed in order to optimize the excretion of beta-lactamase by BS3 cells and thus facilitate the purification and and characterization of this enzyme.

Ampicillin↗

Aquadynia: noradrenergic pain induced by bathing and responsive to clonidine.

We describe two women in whom bathing was regularly followed by intense, widespread burning pain that lasted 15 to 45 minutes, which we term aquadynia. This water-induced pain was not caused by any skin or systemic diseases. We view it as a type of noradrenergic pain induced by contact with water, because it can be blocked with clonidine or propranolol. It appears to be an extension of the phenomenon of aquagenic pruritus, which we have also found to respond to clonidine or propranolol.

Adrenergic alpha-Agonists↗

Severe anaphylaxis after a chlorhexidine bath.

Anaphylaxis to chlorhexidine is rare. We report a patient who experienced anaphylaxis during a whole body bath with chlorhexidine. Early signs of a type I allergy may have been masked because of previous concomitant treatment with corticosteroids and PUVA.

Administration, Cutaneous↗

Delayed death after uncomplicated hot tub bathing in dogs and monkeys.

Prolonged heat exposure as in hot tub bathing, although frequently practiced, has occasionally resulted in fatalities that have been explained by an underlying disease. We explored the tolerance of hot water immersion of 60 min in five previously healthy animals (three dogs and two monkeys). With invasive monitoring, experimental body immersion in water at 40-45 degrees C, with core temperature kept at 40-42 degrees C for 60 min, caused no significant cardiovascular, pulmonary or metabolic changes during hyperthermia or for 2 h after return to normothermia. Then secondary deterioration occurred with progressive hypotension, petechial hemorrhages throughout the viscera, gross gastrointestinal hemorrhages and irreversible (hypovolemic) shock. These effects occurred earlier in the monkeys than in the dogs. This shock state did not respond to standard resuscitation attempts. One dog survived the secondary shock state. We conclude that during and after hot tub immersion, good initial tolerance to heat exposure can, several hours after return of normothermia, result in delayed secondary deterioration and death. We recommend that the mechanism of this delayed shock state with apparent capillary leakage be clarified.

Animals↗

Burns sustained by hot bath and shower water.

An 8-year retrospective review of patients admitted to Stoke Mandeville Hospital (Aylesbury, UK) because of burns sustained by hot bath and shower water was undertaken. Fifty-seven patients of all ages were identified and stratified into paediatric (< 16 years) and adult groups. Nine patients died. The main characteristics of the burns, causes and outcomes of treatment were analysed for each group. Children were predominantly under three years of age (83%), sustaining most frequently only superficial burns (41%) with areas of less than 10% total body surface area (72%). Parents' supervision was inadequate in 85% of cases. Eighty-three percent of the adults were over the age of 60. Two thirds had some form of psycho-motor disorder that predisposed to an accident which should have been anticipated. In comparison to children, adults suffered more extensive and deeper burns that resulted in a mortality of 44% (8/18). In both groups, the lower parts of the body were most frequently involved. The observed decline in the number of admissions for the period of investigation is encouraging. It supports an ultimate need for further development and actual implementation of preventative measures for hot water burns in the homes of people who are at greatest risk.

Accidents, Home↗

Qualitative and quantitative molecular detection of enteroviruses in water from bathing areas and from a sewage treatment plant.

Pathogenic enteric viruses can be introduced into the environment as a result of human activities. Enteroviruses are regularly detected in environmental waters or shellfish and can provoke potentially serious diseases. Some authors believe that enteroviruses could represent an interesting indicator of viral contamination in the environment. Since molecular approaches seem to be promising for the detection of these viruses, we developed a simple qualitative RT-PCR procedure for enteroviruses, together with a quantitative RT-PCR assay using RNA internal standard. After one-tube-RT-PCR, this standard and wild enterovirus RNA were detected by differential hybridization with specific probes and a fluorimetric reaction. The quantification of enteroviruses, conducted in a sewage treatment plant, showed a decreasing number of genomic copies from the entrance to the exit (from 3.8 x 10(5) to 5.4 x 10(4) RNA copies/mL) but indicated the presence of enterovirus RNA in the neighboring river (2.2 x 10(3) RNA copies/mL). In bathing areas, enterovirus RNA was detected in 16 out of 226 samples, with copies numbers ranging from 3.7 x 10(2) RNA copies/mL to 7 x 10(4) RNA copies/mL.

Bathing Beaches↗

Presence of Campylobacter and Salmonella in sand from bathing beaches.

The purpose of this study was to determine the presence of thermophilic Campylobacter spp. and Salmonella spp. in sand from non-EEC standard and EEC standard designated beaches in different locations in the UK and to assess if potentially pathogenic strains were present. Campylobacter spp. were detected in 82/182 (45%) of sand samples and Salmonella spp. in 10/182 (6%). Campylobacter spp. were isolated from 46/92 (50%) of samples from non-EEC standard beaches and 36/90 (40%) from EEC standard beaches. The prevalence of Campylobacter spp. was greater in wet sand from both types of beaches but, surprisingly, more than 30% of samples from dry sand also contained these organisms. The major pathogenic species C. jejuni and C. coli were more prevalent in sand from non-EEC standard beaches. In contrast, C. lari and urease positive thermophilic campylobacters, which are associated with seagulls and other migratory birds, were more prevalent in sand from EEC standard beaches. Campylobacter isolates were further characterized by biotyping and serotyping, which confirmed that strains known to be of types associated with human infections were frequently found in sand on bathing beaches.

Bathing Beaches↗

Childhood vitiligo successfully treated with bath PUVA.

A significant proportion of vitiligo patients are children. Systemic PUVA therapy, the most consistently effective and practical therapy for this disease, has not been recommended in pediatric patients because of concerns regarding potential long-term side effects. We report a 9-year-old Caucasian girl with progressive vitiligo who was successfully treated with bath PUVA. This form of PUVA therapy may provide a wider margin of safety, in that less exposure to ultraviolet A (UVA) radiation is required and systemic absorption of psoralen is minimal.

Baths↗

A comparison of the effects of bath additives on the barrier function of skin in normal volunteer subjects.

BACKGROUND: Emollients form an occlusive layer on the skin surface, reducing transepidermal water loss (TEWL), thus providing a temporary restoration of barrier function in compromised skin. This study evaluated the ability of three bath additives to reduce TEWL from compromised skin. METHODS: The stratum corneum on areas of forearm skin was removed by the repeated application of D-Squame discs. After 1 hour, baseline measurements (t = 0) of TEWL were recorded before each arm was immersed for 10 min in a warm waterbath containing one of four treatments. The arms were air-dried for 20 min and the TEWL measurements repeated. Three further TEWL measurements were made at 30-min intervals. Measurements were made using a Tewameter in a controlled atmosphere. RESULTS: There was little difference between the products in terms of changes in mean TEWL values. However, when expressed relative to t = 0 values, some differences became apparent. The mean values for sites treated with Balmandol were lower than the other sites at 60, 90 and 120 min. When analysed by using the summary statistic AUC (area under the curve), the difference between Balmandol and water and also Balmandol and Eucerin was statistically significant (p < 0.05). CONCLUSION: These results would suggest that Balmandol has a greater effect on barrier function (as assessed by measurement of a reduction in TEWL values) than Eucerin.

Adult↗

Bacteriological and virological quality of seawater bathing areas along the Tyrrhenian coast.

Monitoring was carried out during summer 1997 along a selected area of the Tyrrhenian coast near the Tiber river mouth. Fifty-eight seawater samples, collected from 19 stations, were examined for coliforms, streptococci, Enteroviruses, Salmonellae, coliphages, Bacteroides fragilis phages, Pseudomonas, alophilic Vibrios, Aeromonas and yeasts. Salmonellae and coliphages were isolated in 3 and 12 out of 58 samples, respectively. Enteroviruses and Bacteroides fragilis phages were not isolated. Reoviruses were isolated only from 2 out of 58 samples. A limited number of samples of the northern stations located near the Tiber and other river mouths exceeded the guide values for bathing water by the EU Directive. All the southern stations, located near canals, were of very good microbiological quality. Pseudomonas, Vibrio, Aeromonas and yeasts were isolated from all stations and their values in 100 ml of seawater were 10-10(6), 10-10(6), 0-10(6) and 1-10(3), respectively. An extensive disinfection practice carried out on domestic wastes, which are discharged in rivers and canals, probably brought pollution levels of most stations to values within the bacterial standards. The spread of Pseudomonas, Aeromonas, etc. showed that all the coastal area studied was characterized by the presence of organic matter coming from land that can support the presence of opportunistic pathogens and other microbial flora.

Bathing Beaches↗

Fatal hyperthermia in hot baths in individuals with multiple sclerosis.

The authors report the case of a 47-year-old black man with a history of multiple sclerosis who was found dead in a bathtub, head above water, with a body temperature of 105.7 F. Results of a complete autopsy and toxicologic screen were negative. Individuals with multiple sclerosis, if immersed in hot water, develop motor weakness, which may be so severe as to prevent them from getting out of the water, whether they be in a bathtub or whirlpool bath. In this case, the individual was trapped in a bathtub in which there was a continuous flow of hot water. This overwhelmed an already impaired thermoregulatory mechanism, causing hyperthermia and death.

Baths↗

Reflections on the interactive newborn bath demonstration.

This article describes how a staff nurse changed the routine nature of her work on a mother/baby unit. Using patient education techniques and a newly acquired knowledge about newborn behavior enhanced how she completed the newborn bath demonstration for new parents. She applied her understanding of newborn reflexes, newborn states and state management, and consoling interventions to alter her practice and help parents explore the newborn together. This nurse's goal was to educate and simultaneously empower the parents to better read their baby's cues and respond to their baby. She recounts how this new interactive approach has benefitted the newborns and parents, and has enhanced her satisfaction with her everyday work.

Adult↗

Trioxsalen bath plus UVA effective and safe in the treatment of psoriasis.

Seventy-four patients with psoriasis were treated using a trioxsalen bath (50 mg/150 l of water) and long wave ultraviolet light (UVA) given in an ordinary PUVA-cabin. Good or excellent results were observed in 92% of the patients in the initial phase and in 63% during the maintenance treatment. Because of local side-effects the therapy was discontinued in two patients. One of them developed contact hypersensitivity to trioxsalen and the other developed blisters with such low doses of UVA that it was difficult to maintain the proper dose. The therapy was started with 0.28 J/cm2 of UVA and after an average of 18 treatments, when the average dose was 1.70 J/cm2, the patients were moved to maintenance treatment which took place at 1--4 week intervals. The therapy was well tolerated and cosmetically very acceptable. The final tan was even on all but the face, which remained untanned.

Adolescent↗

Bath-water delivery of 8-methoxypsoralen therapy for psoriasis.

Twenty-one patients with chronic plaque psoriasis were treated with bath 8-methoxypsoralen (8-MOP) and ultraviolet A (UVA). Clearing was achieved in sixty per cent of patients which was less than would be expected with oral 8-MOP. The treatment was well tolerated and was preferred by those who had previously been treated with oral psoralen. The cumulative dose of UVA was only one-fifth that expected with oral 8-MOP.

Adult↗

Microbial characteristics of marine sediments in bathing area along Pesaro-Gabicce coast (Italy): a preliminary study.

AIMS: This paper evaluates the presence of human pathogen micro-organisms in marine sediments in a coastal area suitable for bathing. In addition, the grain size analysis was performed in order to correlate the characteristics of the sediments and the microbial content. METHODS AND RESULTS: The samples were collected in two small bays along the central Adriatic coast, where breakwaters had been built for the purpose of halting marine erosion. Faecal contamination indicators, Salmonella and Vibrio species, enteric viruses were investigated using standard techniques for isolation and identification. The grain size was determined using calibrated sieves and 'Sedigraph' device. In some samples, the faecal contamination indices overstepped legislative limits. Salmonella was never found. Vibrio and enteric viruses were isolated: the micro-organisms were preferentially abundant in fine sediments. CONCLUSIONS: Marine sediments can represent an important reservoir of allochthonous and marine micro-organisms and the microbial charge correlates with the characteristics of the sediments. SIGNIFICANCE AND IMPACT OF THE STUDY: This study indicates that it is important to analyse marine sediments before defining the quality of coastal areas.

Bathing Beaches↗

'Hair wash' or 'head bath' triggering migraine - observations in 94 Indian patients.

Identification of trigger factors is helpful in the diagnosis and management of migraine. Common triggers of migraine are well established but 'hair wash or head bath' as a trigger for migraine has so far not been reported. This prospective study analysed this unusual trigger link in 94 out of 1500 Indian patients who fulfilled the International Headache Society criteria for migraine. In 11 patients, hair wash was the only trigger; in 45 patients hair wash was one of the triggers and in 38 patients hair wash was a trigger concurrently and in combination with another common trigger. The effect of episodic and long-term prophylaxis in preventing this trigger-like headache has been analysed. The underlying pathophysiological basis is not established but it is important for this unusual regional trigger to be identified and incorporated in the management strategy.

Adult↗