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Pseudomonas aeruginosa Dose-Response and Bathing Water Infection
Roser, D., B. van den Akker, S. Boase, C. Haas, N. Ashbolt, AND S. Rice. Pseudomonas aeruginosa Dose-Response and Bathing Water Infection. EPIDEMIOLOGY AND INFECTION. Cambridge University Press, New York, NY, 142(3):449-462, (2014).
To review the literature so as to develop approaches to undertake dose-response modelling of the water-based pathogen Pseudomonas aeruginosa
Pseudomonas aeruginosa is the most commonly identified opportunistic pathogen associated with pool acquired bather disease. To better understand why this microorganism poses this protracted problem we recently appraised P. aeruginosa pool risk management. Much is known about the wider ecology of P. aeruginosa. However, in contrast to ingested and inhaled pathogens, neither the preceding exposure conditions, the dermal route of infection, nor infectious doses, appeared well-defined. The goal of this follow-up review is to explore these knowledge gaps through a survey of data and theory on: i) dose-response, i.e. bodily responses arising from different microbial doses  ; ii) Folliculitis and Acute Otitis Externa (AOE) aetiology; and iii) ecological processes preceding infection. The review commences with an introduction to P. aeruginosa pool disease attributes, research drivers and knowledge gaps, and microbial dose-response theory. Next Folliculitis and AOE aetiology relating to pools and experimental disease induction are reviewed, including uncertainties, notably whether P. aeruginosa might be autochthonous and whether Folliculitis should be viewed as multiple localised infections rather than a systemic infection. Biophysical steps whereby P. aeruginosa migrates from the pool void to the epidermis are reviewed in the third section. How to progress dose-response theory bearing in mind aetiology and ecology is then analysed. Finally, using all information we discuss management implications, propose a conceptual framework and identify priority research.
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Record Details:Record Type: DOCUMENT (JOURNAL/PEER REVIEWED JOURNAL)
Organization:U.S. ENVIRONMENTAL PROTECTION AGENCY
OFFICE OF RESEARCH AND DEVELOPMENT
NATIONAL EXPOSURE RESEARCH LABORATORY
MICROBIOLOGICAL AND CHEMICAL EXPOSURE ASSESSMENT DIVISION