Don't swim in the pool!

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Don't swim in the pool!

  1. 1. Don't Swim in the Pool! A case study by Robert and Lauren
  2. 2. Background <ul><li>Skin rash infection </li></ul><ul><li>Hotel A in Bangor Maine </li></ul><ul><ul><li>February 18-27 2000 </li></ul></ul><ul><li>Nine people affected </li></ul><ul><li>Stayed in either the hot tub or pool </li></ul><ul><ul><li>Seven stayed in both </li></ul></ul>
  3. 3. Patient Symptoms <ul><li>Folliculitis </li></ul><ul><li>Rash lasted 7 days or less </li></ul><ul><li>Some had an infection of the outer ear </li></ul>
  4. 4. About the Facilities <ul><li>Hot tub & pool within 5 feet of each other </li></ul><ul><ul><li>Separate filtration systems </li></ul></ul><ul><li>Pool had automated chlorination system </li></ul><ul><li>Hot tub levels were maintained manually </li></ul><ul><li>During outbreak, chlorine levels were low </li></ul><ul><ul><li><1.0mg/L </li></ul></ul><ul><ul><li>State requirement: 1 to 3 mg/L </li></ul></ul><ul><li>Facilities were thoroughly cleaned </li></ul><ul><ul><li>Samples from the top of the pool filter and draining of an ear were cultured </li></ul></ul>
  5. 5. More About Folliculitus <ul><li>Inflamed hair follicles </li></ul><ul><li>Can occur anywhere on the skin </li></ul><ul><li>Can be bacterial, fungal, viral, or non-infectious </li></ul><ul><li>Symptoms: rash, pimples/ustules, itching skin, spreading through improper treatment </li></ul>
  6. 6. Gram Staining <ul><li>Cells are added to a slide </li></ul><ul><li>Stained with Crystal Violet, rinsed with water </li></ul><ul><li>Covered with Grams iodine, rinsed with acetone-alcohol </li></ul><ul><li>Safranin is added </li></ul><ul><li>Gram (+) is purple; (-) is pink </li></ul><ul><li>Patient sample is gram (-) </li></ul>
  7. 8. Selective Differential Media <ul><li>Chose MacConkey Agar </li></ul><ul><ul><li>Only allows gram negative to grow </li></ul></ul><ul><ul><ul><li>Contains lactose </li></ul></ul></ul><ul><li>Spread cells and allowed to grow </li></ul><ul><li>Results </li></ul><ul><ul><li>E. coli (control) was gram (-) and had lactose digestion </li></ul></ul><ul><ul><li>Patient sample couldn't digest lactose, but showed growth </li></ul></ul>
  8. 9. Antimicrobial Susceptibility <ul><li>Plate was completely covered with patient sample bacteria </li></ul><ul><li>Added the antibiotics: Streptomycin, Penicillin, Chloramphenicol, Tetracycline, Gentamicin, Vancomycin </li></ul><ul><li>Patient sample was resistant to everything, except intermediate to Streptomycin and sensitive to Gentamicin </li></ul>
  9. 10. Pseudomonas aeruginosa Overview <ul><li>Can cause disease in animals </li></ul><ul><li>Can be found in soil, WATER , skin flora, most man-made environments </li></ul><ul><li>Symptoms usually include inflammation </li></ul>
  10. 11. Pseudomonas aeruginosa Cell <ul><li>Bacterium </li></ul><ul><li>Aerobic </li></ul><ul><li>Rod—shaped </li></ul><ul><li>Single-polar flagellum </li></ul><ul><li>Gram negative </li></ul><ul><ul><li>Cell wall has thin layer of peptidoglycan and thick layer of lipopolysaccharide </li></ul></ul>
  11. 12. Pseudomonas aeruginosa <ul><li>Metabolism requires little nutrients </li></ul><ul><ul><li>Acetate as a source for Carbon </li></ul></ul><ul><ul><li>Ammonium sulfate for Nitrogen </li></ul></ul><ul><li>Infecting cells </li></ul><ul><ul><li>Can infect respiratory and urinary systems, too </li></ul></ul><ul><ul><li>Uses virulence factor extoxin A to inhibit protein synthesis in eukaryotic cells </li></ul></ul>

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