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The Unfunny Hot Foot

Swimmers' outbreak leads to novel name for uncommon foot infection

WEDNESDAY, Aug. 1, 2001 (HealthDayNews) -- When the patsy gets a hot foot in a slapstick gag, it's funny. But when the source of that heat is an infection, no one smiles.

Canadian researchers have described an unusual waterborne germ outbreak that leads to excruciatingly painful foot sores so red and burning they've dubbed it "hot-foot syndrome." The cause of the inflammation: Pseudomonas aeruginosa, a bug sometimes found in hot tubs, swimming pools and other public baths.

Although "hot-foot syndrome" is painful, it's not particularly serious, and the condition clears up without antibiotics in a matter of days or weeks. Still, the scientists say, it could pose an important, if uncommon, public health threat.

The finding, by researchers in Alberta, appears in the Aug. 2 issue of The New England Journal of Medicine.

The problem surfaced between March and May of 1998. Forty Alberta children, ages 2 to 15, developed "exquisitely painful" and tender nodules on the soles of their feet within two days of using one community wading pool The sores were red and hot and made walking difficult. Some of the children developed fever, nausea and a general ill feeling.

Tests of the water in the pool, which had an abrasive gritty substance on the bottom that could scrape feet, and a test of an affected child's foot revealed Pseudomonas aeruginosa. All the children recovered within two weeks of the infection, and only three received antibiotics, which didn't seem to hasten their improvement. Three children were re-infected after revisiting the pool.

The researchers say the Alberta illnesses were "clinically distinct" from other pseudomonas outbreaks, even those related to water contact with the microbe. "This syndrome is a potentially important public health hazard that can be prevented by superchlorination of pool water; reduction of the abrasiveness of pool floors; and scrubbing of the floors, water pipes" and other equipment with certain chemicals to stop the growth of the organisms, they add.

Dr. William Foshee, a pediatrician at the Medical College of Georgia in Augusta, says pseudomonas infections are a well-known hazard of hot tubs, because they cause pustules to form around hair follicles. They can also occur as "swimmer's ear" and after puncture wounds in people, particularly children, who wear sneakers, because the organism thrives in one of the inner layers of the shoes.

But Foshee adds that hot-foot syndrome is a new one. "I'll be interested to read more about it," he says.

What To Do

For more on pseudomonas, check out the University of Wisconsin.

For more on other waterborne infections, try the World Health Organization or the Centers for Disease Control and Prevention.

SOURCES: Interview with William S. Foshee, M.D., associate professor of pediatrics, Medical College of Georgia, Augusta; Aug. 2, 2001, New England Journal of Medicine
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