April 06, 2008

Hot tubbin'

Sundays are my work-out study days. I usually cruise down to a swanky condominium near Ala Moana Beach in the afternoon to study with a few of my classmates, J and G. We go over our cases (summarizing them and then writing up a quick review with key points) or pathology question books ("slapping in" when we've got the right answer after someone reads it aloud to make it more like a game show.)

Then we work out in the gym and have what G affectionately calls "pool time" :) The gym/pool is a big motivator for me to meet every weekend with them; the weather usually behaves and we catch the last few rays of sunshine before the golden-red glow of the sun signals that it's about time to leave the jacuzzi and get some food.

G told me about one time she broke out with a strange rash a few days after enjoying her pool time. It was like having bumpy acne from her chest down...
"G!!!! You had hot tub folliculitis!" I exclaimed, in the excited tone I adopt whenever I stumble across a surprisingly cool diagnosis.
"Whhaaaa... what's that?!?!" She said in shock.
Hot tub folliculitis is caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the water's acid and chlorine levels are strictly controlled.

Hot tub folliculitis can be seen within several hours to 2 days of exposure. It first appears as itchy bumps, some of which may be filled with pus. It may then develop into dark red tender nodules. The rash may be thicker under swimsuit areas, where the material has held the contaminated water in contact with the skin for a longer period of time. via Medline
"Ewww!!!! Gross!"
"Yeah, I guess it cleared ok for you," I said, performing a cursory examination of her skin"
"You perv," she said, laughing, splashing some water at me.

There's another condition that's linked with hot tubs and microorganisms.
It's called Hot Tub Lung!
This 49 year old patient was admitted with several weeks of worsening dyspnoea and dry cough. He had no history of previous respiratory illness. Further history revealed that several months prior he and his wife installed a hot tub in their bathroom. His HRCT chest showed widespread areas of ground glass opacity. via Radiology Picture of the Day
Diagnosis? Mycobacterium. Not the type that gives you TB though... Mycobacterium avium intracellulare, apparently. It gets aerosolized from all the bubbles and then you get an allergic reaction from its presence in your lungs.

Don't worry, most people handle MAI just fine. It's ubiquitous... found in dirt and water everywhere. Just an activated macrophage here or there and CHOMP! The infection is handled without the breathing problems.

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