Fresh water exposure: skin and soft tissue infections

Pseudomonas aeruginosa likes wet environments, and its associations with swimmer’s ear and wound infections are well recognised, although isolation from a wound swab often reflects colonisation only.

A less well-recognised entity is pseudomonas folliculitis, with clusters of cases being linked to whirlpools, spas, water slides, bath sponges and swimming pools. Spas are most commonly implicated because of elevated water temperature, less effective chlorination and because some Pseudomonas strains are heat-tolerant.