Infections range from mild external ones (affecting the ear or hair follicles) to serious internal infections (affecting the lungs, bloodstream, or heart valves).
Symptoms vary depending on which area of the body is infected.
Identifying the bacteria in a sample taken from infected tissue confirms the diagnosis.
Antibiotics are applied externally for external infections or given intravenously for more serious, internal infections.
(See also Overview of Bacteria Overview of Bacteria Bacteria are microscopic, single-celled organisms. They are among the earliest known life forms on earth. There are thousands of different kinds of bacteria, and they live in every conceivable... read more .)
Pseudomonas bacteria, including Pseudomonas aeruginosa, are present throughout the world in soil and water. These bacteria favor moist areas, such as sinks, toilets, inadequately chlorinated swimming pools and hot tubs, and outdated or inactivated antiseptic solutions. Occasionally, these bacteria are present in the armpits and genital area of healthy people.
Pseudomonas aeruginosa infections range from minor external infections to serious, life-threatening disorders. Infections occur more often and tend to be more severe in people who
Are weakened (debilitated) by certain severe disorders
Have diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Urination and thirst are... read more or cystic fibrosis Cystic Fibrosis (CF) Cystic fibrosis is a hereditary disease that causes certain glands to produce abnormally thick secretions, resulting in tissue and organ damage, especially in the lungs and the digestive tract... read more
Have a disorder that weakens the immune system, such as human immunodeficiency virus (HIV) infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS). HIV is transmitted... read more
Take drugs that suppress the immune system, such as those used to treat cancer or to prevent rejection of transplanted organs
These bacteria can infect the blood, skin, bones, ears, eyes, urinary tract, heart valves, and lungs, as well as wounds (such as burns, injuries, or wounds made during surgery). Use of medical devices, such as catheters inserted into the bladder or a vein, breathing tubes, and mechanical ventilators, increase the risk of Pseudomonas aeruginosa infections. These infections are commonly acquired in hospitals. In hospitals, the bacteria are often present in sinks, antiseptic solutions, and containers used to collect urine from a bladder catheter.
Symptoms of Pseudomonas Infections
Pseudomonas aeruginosa causes many different infections.
Swimmer’s ear (external otitis Ear Canal Infection (Swimmer's Ear) Bacteria and sometimes fungi can cause acute infection of the skin of the ear canal. Ear canal infection is caused by bacteria or, less commonly, fungi. Typical symptoms are pain and discharge... read more ) is a mild external infection that can occur in otherwise healthy people. Water containing the bacteria can enter the ear during swimming. Swimmer’s ear causes itching, pain, and sometimes a discharge from the ear.
Malignant external otitis Malignant External Otitis Malignant external otitis is infection of the external ear that has spread to the skull bone (temporal bone) containing the ear canal, the middle ear, and the inner ear. Malignant external otitis... read more is a more severe external ear infection. It is most common among people with diabetes. Tissues become swollen and inflamed, partly or completely closing the ear canal. Symptoms may include fever, loss of hearing, inflammation of tissues around the infected ear, severe ear pain, a foul-smelling discharge from the ear, and nerve damage.
Hot-tub folliculitis Folliculitis Folliculitis and skin abscesses are pus-filled pockets in the skin resulting from bacterial infection. They may be superficial or deep, affecting just hair follicles or deeper structures within... read more is another mild external infection. Hair roots (follicles) become infected in people who use hot tubs or whirlpools, particularly if the hot tubs and whirlpools are inadequately chlorinated. Spending a lot of time in the water softens the follicles, making them easier for bacteria to invade. An itchy rash consisting of tiny pimples develops. Pimples may have a drop of pus in their center.
Ecthyma gangrenosum is a skin sore that occurs in people who have too few white blood cells (neutropenia Neutropenia Neutropenia is an abnormally low number of neutrophils (a type of white blood cell) in the blood. Neutropenia, if severe, significantly increases the risk of life-threatening infection. Neutropenia... read more ). The sore has a purple-black center and is surrounded by a band of red. These sores usually occur in moist areas, such as the armpit or genital areas.
Eye infections due to these bacteria may damage the cornea, often permanently. Enzymes produced by the bacteria can rapidly destroy the eye. Infections usually result from injuries but may result from contamination of contact lenses or contact lens solution.
Soft-tissue infections include those in muscle, tendons, ligaments, fat, and skin. These infections can occur in deep puncture wounds (for example, stepping on a nail). Pseudomonas bacteria can also infect pressure sores, burns, and wounds due to injuries or surgery. When these bacteria grow in soiled dressings, the dressings turn green and smell like newly mowed grass. Fluids draining from these wounds often have a sweet, fruity smell.
Severe pneumonia Hospital-Acquired Pneumonia Hospital-acquired pneumonia is lung infection that develops in people who have been hospitalized, typically after about 2 days or more of hospitalization. Many bacteria, viruses, and even fungi... read more can develop in hospitalized people, especially those who need to use a breathing tube and a mechanical ventilator. In people with HIV infection, Pseudomonas bacteria commonly cause pneumonia or sinus infections.
Urinary tract infections Overview of Urinary Tract Infections (UTIs) In healthy people, urine in the bladder is sterile—no bacteria or other infectious organisms are present. The tube that carries urine from the bladder out of the body (urethra) contains no bacteria... read more usually develop in the following circumstances:
After a procedure involving the urinary tract is done
When the urinary tract is blocked
When a catheter must remain in the bladder a long time
Bloodstream infections (bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections ... read more ) often result when the following occur:
Bacteria enter the bloodstream from an infected organ (such as the urinary tract).
A contaminated illegal drug is injected into a vein.
A contaminated needle or syringe is used to inject illegal drugs.
A catheter in a blood vessel (called an intravascular catheter) is left in place.
Sometimes the source of the bacteria is unknown, as may occur in people who have too few white blood cells after cancer chemotherapy. Purple-black spots surrounded by a red rim on the skin (ecthyma gangrenosum) often develop in the armpits and groin. Without treatment, a bloodstream infection can lead to shock and death.
Bone and joint infections usually occur in the spine, pubic bone, and/or the joint between the collarbone and breastbone. The bacteria usually spread to bones and joints from the bloodstream, particularly in people who use illegal intravenous drugs. Less often, the bacteria spread from nearby soft tissues that have been infected after an injury or surgery.
Heart valve infections are rare. They usually occur in people who inject intravenous drugs and in people with artificial heart valves. The bacteria usually spread to heart valves from the bloodstream.
Diagnosis of Pseudomonas Infections
Culture of a sample of blood or other body fluids
Doctors diagnose Pseudomonas aeruginosa infections by taking a sample of blood or other body fluids and sending it to a laboratory to grow (culture) and identify the bacteria.
Tests to determine which antibiotics are likely to be effective (susceptibility tests Testing of a Microorganism's Susceptibility and Sensitivity to Antimicrobial Drugs Infectious diseases are caused by microorganisms, such as bacteria, viruses, fungi, and parasites. Doctors suspect an infection based on the person's symptoms, physical examination results,... read more ) are also done.
Treatment of Pseudomonas Infections
Usually antibiotics applied topically, taken by mouth, or given intravenously, depending on where the infection is
Swimmer’s ear can be effectively treated, as well as prevented, by irrigating the ears with an acetic acid (vinegar) solution before and after swimming. Or the infection can be treated with a topical antibiotic such as polymyxin applied to the ear.
Hot-tub folliculitis usually resolves without treatment.
Eye infections are treated with highly concentrated antibiotic drops, applied frequently at first. Sometimes antibiotics must be injected directly into the eye.
Urinary tract infections that cause symptoms can often be treated with levofloxacin or ciprofloxacin, taken by mouth. If these infections do not cause symptoms, they are usually not treated.
Serious infections due to Pseudomonas aeruginosa are difficult to treat. Malignant external otitis, internal infections (such as pneumonia or heart valve infection), and blood infections require weeks of antibiotics given intravenously. Usually, one antibiotic, such as ceftazidime or ciprofloxacin, is effective. But sometimes a combination of antibiotics is required because many strains, particularly those acquired in health care facilities, are resistant to many antibiotics. Doctors initially choose an antibiotic that is usually effective in their geographic area. They may change the antibiotics after test results indicate which antibiotics are likely to be effective.
For heart valve infections, open-heart surgery to replace the valve plus antibiotic therapy is usually needed (see Replacing a Heart Valve Replacing a Heart Valve Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more ).