Pseudomonas aeruginosa dose response and bathing water infection.
Pseudomonas aeruginosa is the opportunistic pathogen mostly implicated in folliculitis and acute otitis externa in pools and hot tubs. Nevertheless, infection risks remain poorly quantified. This paper reviews disease aetiologies and bacterial skin colonization science to advance dose-response theory development. Three model forms are identified for predicting disease likelihood from pathogen density. Two are based on Furumoto & Mickey's exponential 'single-hit' model and predict infection likelihood and severity (lesions/m2), respectively. 'Third-generation', mechanistic, dose-response algorithm development is additionally scoped. The proposed formulation integrates dispersion, epidermal interaction, and follicle invasion. The review also details uncertainties needing consideration which pertain to water quality, outbreaks, exposure time, infection sites, biofilms, cerumen, environmental factors (e.g. skin saturation, hydrodynamics), and whether P. aeruginosa is endogenous or exogenous. The review's findings are used to propose a conceptual infection model and identify research priorities including pool dose-response modelling, epidermis ecology and infection likelihood-based hygiene management.
UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia.
D J
DJ
Roser
UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia.
B
B
van den Akker
Department of Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, Woodville, SA, Australia.
S
S
Boase
Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, USA.
C N
CN
Haas
UNSW Water Research Centre, School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia.
N J
NJ
Ashbolt
The School of Biotechnology and Biomolecular Sciences and the Centre for Marine Bio-Innovation, University of New South Wales, Sydney, NSW, Australia.
S A
SA
Rice
D004196:Disease Outbreaks; D006358:Hot Temperature; D006801:Humans; D006920:Hygiene; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000472:pathogenicity*; D017192:Skin Diseases, Bacterial / Q000382:microbiology*; D013551:Swimming Pools; D014871:Water Microbiology