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PubMed2005

Clinical, microbiological, and epidemiological findings of an outbreak of Mycobacterium abscessus hand-and-foot disease.

In 2003, we identified an outbreak of clinically distinct lesions involving the hands and feet associated with a public wading pool in Edmonton, Alberta, Canada. A total of 85 cases were identified. The management and follow-up of 41 children and 1 adult patients is presented. Skin lesions occurred within a median incubation period of 29 days and approximately 88 days for the adult patient. Lesions resolved within a median of 58 days and approximately 150 days for the adult patient. Patients were treated with clarithromycin, topical antibiotic dressings, and/or incision and drainage of pustules or followed without treatment. All resolved without complication. The pool was closed and cleaned. The M. abscessus hand-and-foot disease is characterized by the onset, mainly in children, of tender, erythematous papules, pustules, and abscesses with a self-limited course. This is the first documented M. abscessus outbreak associated with wading pool exposure.

Adolescent↗

PubMed2000

Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study.

OBJECTIVE: To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome (FM). METHODS: The study population comprised 58 patients, randomized to a treatment or a control group. Patients were instructed to match the pool exercises to their threshold of pain and fatigue. The education focused on strategies for coping with symptoms and encouragement of physical activity. The primary outcome measurements were the total score of the Fibromyalgia Impact Questionnaire (FIQ) and the 6 min walk test, recorded at study start and after 6 mo. Several other tests and instruments assessing functional limitations, severity of symptoms, disabilities, and quality of life were also applied. RESULTS: Significant differences between the treatment group and the control group were found for the FIQ total score (p = 0.017) and the 6 min walk test (p < 0.0001). Significant differences were also found for physical function, grip strength, pain severity, social functioning, psychological distress, and quality of life. CONCLUSION: The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM.

Adult↗

PubMed1994

An outbreak of Escherichia coli O157 associated with a children's paddling pool.

In May 1992, a small, circumscribed community outbreak of infection due to verotoxin-producing Escherichia coli O157 phage type 49 occurred in a semi-rural area of south-east Scotland. On the basis of stool cultures, six cases were identified, one of whom was asymptomatic. One child developed the haemolytic uraemic syndrome. Although the source of infection of the index case was not established nor could the extent of person-to-person spread be fully determined, the clinical, microbiological and epidemiological evidence available indicated that a children's paddling pool served as the focal point in the transmission of infection causing the outbreak.

Child, Preschool↗

PubMed1990

Childhood drowning and near-drowning in the United States.

More than 2000 children drown each year; in some states drowning is considered the leading cause of death for children under the age of 5 years. Many survivors of near-drowning have permanent neurologic disability. There are two distinct high risk groups: children under 5 years of age and boys aged 15 to 19 years. Most drownings in the former group occur in residential pools. Among survivors, the clinical course is bimodal; intact survival and survival with severe permanent disability are the most likely outcomes. The outcome of an immersion event is determined within a few minutes of the onset of immersion, mandating an emphasis on primary prevention. A requirement for pool fencing is the most promising such strategy and could be implemented soon. Training in cardiopulmonary resuscitation and (for older children) alcohol abuse prevention programs may be valuable adjuncts.

Accident Prevention↗

PubMed1976

Pseudomonas aeruginosa serogroup 11 and pool-associated skin rash.

The isolation of Pseudomonas aeruginosa, serogroup 11, from the skin lesions of bathers and from public whirlpools during outbreaks of pool-associated rash illness raises the question of whether the association is an etiologic one and if so what accounts for it. We suggest that a particular environmental adaptation of some strains of Pseudomonas and certain virulence factors they possess may enhance their pathogenic potential.

Disease Outbreaks↗

PubMed1998

Chlorine inhalation: the big picture.

BACKGROUND: Causes of acute chlorine exposures from community pool accidents have many reported etiologies. This case series involves 13 children exposed to high levels of chlorine at two community pools after an unusual mishap in the chlorination maintenance procedure. CASE REPORT: During maintenance, the water feeding lines to pools are normally turned off, the chemicals replaced, the water turned back on, and the chemicals then reinjected into the line. In two separate disasters in the summer of 1996, the feeding lines were not reprimed with water before the reactants, sodium hypochlorite and muriatic acid, were injected. This caused an unusually high volume of concentrated chlorinated water to be released when refed to the pool. RESULTS: All patients were treated with beta agonists and humidified oxygen, and five were admitted. None received bicarbonate inhalation. An extensive literature review of chlorine inhalation injuries indicates considerable variance in opinions of the pathophysiology, clinical presentation and treatment modalities, especially steroids and bicarbonate inhalation. CONCLUSION: In community pools, failure to reprime feeding lines with water after replacing and injecting chlorinating reactants may result in severe and large-scale chlorine exposures. Beta agonist administration and humidified oxygen remains the mainstay of treatment; steroid therapy and bicarbonate inhalation are still inadequately supported.

Administration, Inhalation↗

PubMed1976

Mycobacterium marinum skin infections mimicking cutaneous leishmaniasis.

Ten cases of skin infection due to Mycobacterium marinum are reported from Israel. Most of the infections were contracted in natural bathing pools at Ein Feshka on the shores of the Dead Sea, south of Jericho. The lesions closely resembled those of cutaneous leishmaniasis prevalent in this region. The condition does not seem to have been detected previously in the Middle East.

Adult↗

PubMed1985

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.

Dermatitis↗

PubMed2005

Non-invasive biomarkers of pulmonary damage and inflammation: Application to children exposed to ozone and trichloramine.

To date, airways injury or inflammation caused by air pollutants has been evaluated mainly by analysis of bronchoalveolar lavage, an invasive technique totally unsuitable to children. The assessment of respiratory risks in this particularly vulnerable population has thus for a long time relied on spirometric tests and self-reported symptoms which are relatively late and inaccurate indicators of lung damage. Research in the field of biomarkers is now opening new perspectives with the development of non-invasive tests allowing to monitor inflammation and damage in the deep lung. Blood tests measuring lung-specific proteins (pneumoproteins) such as Clara cell protein (CC16) and surfactant-associated proteins (A, B or D) are now available to evaluate the permeability and/or the cellular integrity of the pulmonary epithelium. The application of these tests to children has recently led to the discovery of a lung epithelium hyperpermeability caused by trichloramine (nitrogen trichloride), an irritant gas contaminating the air of indoor-chlorinated pools. Serum CC16 can also serve to detect increases of airway permeability during short-term exposures to ambient ozone. Indicators measurable in exhaled air such as nitric oxide (NO) appear more useful to detect airway inflammation. By applying the exhaled NO test to children attending summer camps, we recently found that ambient ozone produces an acute inflammatory response in children from levels slightly lower than current air quality guidelines. In a study exploring the links between atopy, asthma, and exposure to chlorination products in indoor pools, we also found that the exhaled NO test can serve to detect the chronic airway inflammation associated with excessive exposure to trichloramine. Lung-specific proteins measurable in serum and markers in exhaled air represent sensitive tools that can be used to assess non-invasively the effects of air pollutants on the respiratory tract of children.

Biomarkers↗

PubMed2002

Risk of giardiasis in Aucklanders: a case-control study.

BACKGROUND: Giardia is one of the leading protozoal causes of human gastrointestinal illnesses. It is prevalent in both developed and developing countries. Currently, giardiasis is the most commonly notified waterborne disease in New Zealand. The aim of the study was to identify potentially modifiable risk factors for Giardia infection in the adult population in Auckland. METHODS: This case-control study involved 183 Giardia-positive cases and 336 randomly selected controls, aged between 15 and 64 years. Exposure information was collected retrospectively over the telephone for the 21 days preceding the date of onset of symptoms. Both univariate and multiple logistic regression analyses were carried out. RESULTS: The majority of cases were in the 25-44-year age group and in the New Zealand European ethnic group. Housewives and nursing mothers were at significant risk of the disease (odds ratio (OR)=2.06; 95% CI=1.4-3.74), as were the occupational groups exposed to human wastes (OR=4.04, 95% CI=1.85-8.85). Consumption of drinking water from New Zealand supplies other than metropolitan mains supplies (OR=2.11, 95% CI=1.36-3.27) or from sources outside New Zealand (OR=7.97, 95% CI=4.20-15.12) represented a significantly higher risk, as did traveling (OR=7.57, 95% CI=4.03-14.23) and swimming in pools or fresh water at least once a week (OR=2.04, 95% CI= 1.33-3.12). CONCLUSIONS: The study identified potentially modifiable risk factors for Giardia infection. These findings should be investigated further in different groups and settings to ensure better protection of the public health.

Adolescent↗

PubMed2005

Pediatric drowning: a 20-year review of autopsied cases: I. Demographic features.

Drowning is a significant cause of childhood mortality in the developed world. Males and preschool-aged children are overrepresented in most series of pediatric drowning. To obtain a better understanding of age- and gender-related factors, a retrospective review of autopsy records over a 20-year period (1984-2003) for cases of drowning (exclusive of bathtub drownings) was performed. Sixty-three consecutive cases of drowning were identified in 45 males and 18 females (ratio 2.5; P = 0.0007). The ages ranged from 9 months to 17 years, and most cases occurred in the 0- to 4-year age group (57%). Boys tended to be older than girls (5 years 9 months versus 4 years 4 months; P = 0.2133). Sites of drowning were open water (48%) and pools (44%), with children drowning in open water being significantly older than those drowning in pools (6 years 6 months versus 4 years 6 months; P = 0.0462). Most boys drowned in open water (53%), whereas most girls drowned in pools (50%). Resuscitation was attempted after the drowning episode in 84% of cases, with children aged 4 years or less having significantly higher rates than older children (P = 0.0346). The present study highlights differences in the pattern of drowning according to age and sex and may aid in developing targeted educational and preventative campaigns.

Adolescent↗

PubMed2005

Effects of ceiling-mounted HEPA-UV air filters on airborne bacteria concentrations in an indoor therapy pool building.

The purpose of this study was to assess the effectiveness of a new generation of high-volume, ceiling-mounted high-efficiency particulate air (HEPA)-ultraviolet (UV) air filters (HUVAFs) for their ability to remove or inactivate bacterial aerosol. In an environmentally controlled full-scale laboratory chamber (87 m3), and an indoor therapy pool building, the mitigation ability of air filters was assessed by comparing concentrations of total bacteria, culturable bacteria, and airborne endotoxin with and without the air filters operating under otherwise similar conditions. Controlled chamber tests with pure cultures of aerosolized Mycobacterium parafortuitum cells showed that the HUVAF unit tested provided an equivalent air-exchange rate of 11 hr(-1). Using this equivalent air-exchange rate as a design basis, three HUVAFs were installed in an indoor therapy pool building for bioaerosol mitigation, and their effectiveness was studied over a 2-year period. The HUVAFs reduced concentrations of culturable bacteria by 69 and 80% during monitoring periods executed in respective years. The HUVAFs reduced concentrations of total bacteria by 12 and 76% during the same monitoring period, respectively. Airborne endotoxin concentrations were not affected by the HUVAF operation.

Aerosols↗

PubMed2000

Prolonged swimming exercise training induce hypophosphatemic osteopenia in stroke-prone spontaneously hypertensive rats (SHRSP).

Stroke-prone spontaneously hypertensive rats (SHRSP) induce spontaneous osteoporosis. To elucidate the specific characteristics of bone metabolism, the SHRSP was compared with age matched Wistar-Kyoto (WKY) rats. We investigated the effects of prolonged swimming exercise training on bone mineral density (BMD) and metabolism in the SHRSP. Seven-week-old male SHRSP and WKY were divided into three groups; the sedentary control WKY group (n = 6, WKY), the sedentary control SHRSP group (n = 6, SP) and the swimming exercise training SHRSP group (n = 6, SWIM) (in pool with 60 min./day, 5 days/week for 12 weeks). The femoral BMD, bone mineral content (BMC), strength, Ca and P contents (%) of SHRSP were approximately 17, 27, 25, 20 and 9%, respectively, lower than that of WKY (p < 0.001). Serum alkaline phosphatase (AlP) had not changed between both of SP and WKY, but tartrate-resistant acid phosphatase (TrAcP) of SP approximately 3-fold higher than that of WKY (p < 0.05). Both serum calcium (Ca) and intact parathyroid hormone (i-PTH) were similar between SP and WKY. However, serum phosphate (P) of SP was approximately 18% lower than that of WKY (N.S.). These results suggested that SHRSP induces osteopenia by the bone turnover of the promoted osteoclast activity with disturbed phosphate homeostasis. On the other hand, the femoral BMD and strength were approximately 7% and 20%, respectively, decreased in the SWIM (p < 0.001), and femoral bone Ca and P contents (%) were also approximately 11% and 14%, respectively, lower than that of SP (p < 0.001). There were no significant difference between SWIM and SP on serum Ca, but serum P of SWIM was significantly lower than that of SP (p < 0.05). These results suggested that the prolonged swimming exercise training in the SHRSP induces more cruelly hypophosphatemia, and leading to osteopenia eventually. We conclude that SHRSP induces osteopenia with disturbance of phosphate homeostasis, and the prolonged swimming exercise in the SHRSP might deteriorate hypophosphatemia and osteopenia.

Animals↗

PubMed2001

[Control of low Legionella concentrations in pool water].

The Legionella proof is necessary in pool water according to DIN 19 643 in case of possible aerosol formation. In lab tests it was proven that the direct spatulation of 1 ml water offers high-grade proof with high correlation of the determined concentration to the actual germ content. With very small germ concentrations, however, preceding filtration of larger sample volumes is necessary. During the investigation of routine samples a Legionella proof was possible thereby in individual cases, whereas direct spatulation remained negative.

Bacteriological Techniques↗

PubMed2006

The recovery of locomotory activity following exhaustive exercise in juvenile rainbow trout (Oncorhynchus mykiss).

This study investigated the recovery of locomotory activity in exhausted juvenile rainbow trout (Oncorhynchus mykiss, approximately 6-10-cm fork length) in response to two conditions: (1) direct transfer to a range of velocities (0-15 cm s(-1)) in a swim flume (forced swimming) and (2) direct transfer to a pool downstream of a swim channel where a choice of velocities was presented: 2-3 cm s(-1) in the lower half of the pool, a range of velocities from 7 to 40 cm s(-1) in the upper half the pool near the channel entrance, and a velocity of 57 cm s(-1) in a swim channel emptying into the pool (volitional swimming). Exhausted trout showed a pronounced delay in the recovery of normal locomotory activity. With forced swimming, the time required to resume swimming was inversely proportional to water velocity. At 15 cm s(-1), almost all exhausted fish recovered immediately, whereas it took about 1 h for recovery at a current of 5 cm s(-1). In contrast, nonexhausted fish responded to imposed velocity with immediate rheotactic responses (orientation and station holding) at all test velocities. In voluntary swim trials, exhausted trout showed a marked preference for holding station in current in the downstream pool (approximately 11 cm s(-1)) but took, on average, 2 h longer than nonexhausted fish to make transits in the swim channel. Moreover, their ground speed in the swim channel was significantly slower. We conclude that swimming performance is impaired for at least 6 h by exhaustive exercise. Maladaptive behaviors during this time include a preference for current near the surface over cover and a reduced capacity for burst activity, both of which would translate into greater predation risk and reduced ability to forage.

Animals↗

PubMed1991

Child drownings: a changing pattern.

Paediatric drownings in New South Wales during the years 1987-1990 are reviewed to document the current pattern. Over these three years we have registered 250 paediatric deaths by physical injury. Sixty-one (24%) of these deaths were by drowning. Twenty-nine of the 61 drownings (47%) occurred in domestic pools; 25 of these were in unfenced or inadequately fenced pools. Of the remaining four cases, one was associated with a chair being used to gain access and the other three remain unexplained. Thirty-three of the 61 drownings occurred in country areas; of these 10 were in pools, eight in rivers or creeks, six in boating accidents, four in the surf and three in dams. A changing trend identified by this study is the increasing percentage of drownings (44%) occurring in nominally "fenced" pools in which the fencing was not functioning because the gate was open or the fencing was in disrepair. Legislation must be supported by public education and council inspection if the full benefit of isolation fencing is to be realised. With respect to all drownings there is a continuing need for education about the dangers that bodies of water, even in the bath or a bucket, pose to young children, and the need for parents to strive for optimal supervision.

Adolescent↗

PubMed1981

[Microbiological studies of small hot-bath-pools and hot-whirl-pools (author's transl)].

Hot small bathing pools and hot whirl-pools have the following characteristics: small watervolume, thick squeeze of swimmers, high water temperature (37-40 degrees C) and small dimension of filters. By this, the quality of bathing-water is influenced detrimentally. To elaborate the hygienic problems, bathing-water samples were taken before, during and after the visiting-hours and were tested for facultative-pathogenic microorganisms. During this investigation E. coli was isolated in 25 degrees, Coliforms and Proteus species in 37.3%, P. aeruginosa in 36%, S. aureus in 26.3%, Enterococci in 42.3 %, Candida albicans in 3.6% and yeast totally in 8.3%.

Bacteria↗

PubMed2003

Aquatic fitness training for children with juvenile idiopathic arthritis.

OBJECTIVE: To evaluate the effects of an aquatic training programme for JIA patients. METHODS: Fifty-four patients with JIA (age range 5 to 13 yr) participated in this study and were randomized into an experimental (n = 27) and a control (n = 27) group. The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions. Effects were analysed on the following domains: functional ability, health-related quality of life, joint status and physical fitness. RESULTS: Although all measures improved more in the experimental group than the control group, none of the differences was statistically significant. CONCLUSIONS: The current research found no significant effect of an aquatic fitness training programme in children with JIA. Since there were no signs of worsening in health status, one can conclude that this was a safe exercise programme.

Arthritis, Juvenile↗