Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1995 Nov 25;311(7017):1407–1410. doi: 10.1136/bmj.311.7017.1407

Risk of otitis externa after swimming in recreational fresh water lakes containing Pseudomonas aeruginosa.

I A van Asperen 1, C M de Rover 1, J F Schijven 1, S B Oetomo 1, J F Schellekens 1, N J van Leeuwen 1, C Collé 1, A H Havelaar 1, D Kromhout 1, M W Sprenger 1
PMCID: PMC2544405  PMID: 8520277

Abstract

OBJECTIVE--To determine whether an outbreak of otitis externa was due to bathing in recreational fresh water lakes and to establish whether the outbreak was caused by Pseudomonas aeruginosa in the water. DESIGN--Matched case-control study. SETTING--The Achterhoek area, the Netherlands. SUBJECTS--98 cases with otitis externa and 149 controls matched for age, sex, and place of residence. MAIN OUTCOME MEASURES--Odds ratios for type of swimming water and frequency of swimming; presence of P aeruginosa in ear swabs and fresh water lakes. RESULTS--Otitis externa was strongly associated with swimming in recreational fresh water lakes in the previous two weeks (odds ratio 15.5 (95% confidence interval) 4.9 to 49.2) compared with non-swimming). The risk increased with the number of days of swimming, and subjects with recurrent ear disease had a greatly increased risk. The lakes met the Dutch bathing water standards and those set by the European Commission for faecal pollution in the summer of 1994, but P aeruginosa was isolated from all of them, as well as from the ear swabs of 78 (83%) of the cases and 3 (4%) of the controls. CONCLUSIONS--Even when current bathing water standards are met, swimming can be associated with a substantial risk of otitis externa because of exposure to P aeruginosa. People with recurrent ear disease should take special care when swimming in waters containing P aeruginosa.

Full text

PDF
1407

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balarajan R., Soni Raleigh V., Yuen P., Wheeler D., Machin D., Cartwright R. Health risks associated with bathing in sea water. BMJ. 1991 Dec 7;303(6815):1444–1445. doi: 10.1136/bmj.303.6815.1444. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cabelli V. J., Dufour A. P., McCabe L. J., Levin M. A. Swimming-associated gastroenteritis and water quality. Am J Epidemiol. 1982 Apr;115(4):606–616. doi: 10.1093/oxfordjournals.aje.a113342. [DOI] [PubMed] [Google Scholar]
  3. Cheung W. H., Chang K. C., Hung R. P., Kleevens J. W. Health effects of beach water pollution in Hong Kong. Epidemiol Infect. 1990 Aug;105(1):139–162. doi: 10.1017/s0950268800047737. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Corbett S. J., Rubin G. L., Curry G. K., Kleinbaum D. G. The health effects of swimming at Sydney beaches. The Sydney Beach Users Study Advisory Group. Am J Public Health. 1993 Dec;83(12):1701–1706. doi: 10.2105/ajph.83.12.1701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Havelaar A. H., During M., Delfgou-Van Asch E. H. Comparative study of membrane filtration and enrichment media for the isolation and enumeration of Pseudomonas aeruginosa from sewage, surface water, and swimming pools. Can J Microbiol. 1985 Aug;31(8):686–692. doi: 10.1139/m85-130. [DOI] [PubMed] [Google Scholar]
  6. Kay D., Fleisher J. M., Salmon R. L., Jones F., Wyer M. D., Godfree A. F., Zelenauch-Jacquotte Z., Shore R. Predicting likelihood of gastroenteritis from sea bathing: results from randomised exposure. Lancet. 1994 Oct 1;344(8927):905–909. doi: 10.1016/s0140-6736(94)92267-5. [DOI] [PubMed] [Google Scholar]
  7. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976 Feb;103(2):226–235. doi: 10.1093/oxfordjournals.aje.a112220. [DOI] [PubMed] [Google Scholar]
  8. SINGER D. E., FREEMAN E., HOFFERT W. R., KEYS R. J., MITCHELL R. B., HARDY A. V. Otitis externa; bacteriological and mycological studies. Ann Otol Rhinol Laryngol. 1952 Jun;61(2):317–330. doi: 10.1177/000348945206100201. [DOI] [PubMed] [Google Scholar]
  9. STEVENSON A. H. Studies of bathing water quality and health. Am J Public Health Nations Health. 1953 May;43(5 Pt 1):529–538. doi: 10.2105/ajph.43.5_pt_1.529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Seyfried P. L., Cook R. J. Otitis externa infections related to Pseudomonas aeruginosa levels in five Ontario lakes. Can J Public Health. 1984 Jan-Feb;75(1):83–91. [PubMed] [Google Scholar]
  11. Seyfried P. L., Tobin R. S., Brown N. E., Ness P. F. A prospective study of swimming-related illness. I. Swimming-associated health risk. Am J Public Health. 1985 Sep;75(9):1068–1070. doi: 10.2105/ajph.75.9.1068. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Seyfried P. L., Tobin R. S., Brown N. E., Ness P. F. A prospective study of swimming-related illness. II. Morbidity and the microbiological quality of water. Am J Public Health. 1985 Sep;75(9):1071–1075. doi: 10.2105/ajph.75.9.1071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Springer G. L., Shapiro E. D. Fresh water swimming as a risk factor for otitis externa: a case-control study. Arch Environ Health. 1985 Jul-Aug;40(4):202–206. doi: 10.1080/00039896.1985.10545918. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES