Questions 21 25 refer to the following clinical case. In February 1999, the Colo
ID: 254926 • Letter: Q
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Questions 21 25 refer to the following clinical case. In February 1999, the Colorado Department of Public Health and Environment was notified of approximately 15 people who had developed an infectious skin rash after they used a hotel pool and hot tub. The cases occurred among children and adults attending two birthday parties at the hotel and among community residents who entered the pool on a pay-to-swim basis. Twenty-five community residents who used the pool and/or hot tub between February 5 and 7 were identified through discussions with area physicians, hotel management, and other swimmers. These community residents were interviewed by the Colorado Department of Public Health and Environment by using a telephone questionnaire. Case patients were defined as people who developed an infectious skin rash, with or without other symptoms, within 3 days of using either the pool or the hot tub at the hotel. Questionnaires were completed for 22 (88%) of the 25 cases. Of the 20 people who had used the hot tub, 19 developed a rash and met the case definition. Analysis of the rash indicated the infection was primarily within hair follicles or in the dermis. Fourteen (74%) of the 19 case patients had more severe illnesses (a rash of more than 2 weeks duration or rash and one other symptom), some lasting more than 6 weeks. Specimens collected from the hot tub filter and the base of the handrail were cultured. The pathogenic bacterium was Gram-negative, motile using 0 polar flagella, and oxidase positive. The cultures were green in color and had a fruity odor.Explanation / Answer
21. b. The patients were infected with Pseudomonas aeruginosa.
22. c. These are among the most antibiotic resistant of all clinically relevant bacteria
23. a. Proper sanitation
24.b. A combination of antibiotics
25. d. Exotoxin A
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