title: Bilateral mastoiditis from red tide exposure.
abstract: BACKGROUND
  Bilateral mastoiditis in adults has previously been reported only in association with diabetes mellitus or immunocompromised patients.
  
  
  OBJECTIVE
  To describe a case of bilateral mastoiditis in a healthy adult and to investigate the etiology.
  
  
  METHODS
  A 53-year-old woman presented to the Emergency Department with bilateral otitis externa and mastoiditis after scuba diving during a harmful algal bloom, commonly known as a "red tide." The levels of coliform bacteria recorded at the time and location of her dive exceeded health regulatory limits and correlate with her atypical culture results.
  
  
  CONCLUSIONS
  Elevated bacterial counts that result from harmful algal blooms may account for this rare infection.
authors.affiliation: Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Honner
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Kudela
authors.forename: Ethan
authors.initials: E
authors.lastname: Handler
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004242:Diving / Q000009:adverse effects*; D004433:Earache / Q000188:drug therapy / Q000382:microbiology; D016983:Enterococcus; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000188:drug therapy; D057097:Harmful Algal Bloom; D006801:Humans; D008417:Mastoiditis / Q000209:etiology / Q000382:microbiology*; D008875:Middle Aged; D010032:Otitis Externa / Q000209:etiology / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000150:complications* / Q000188:drug therapy; D011550:Pseudomonas aeruginosa
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents