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Dear expert team,
our son wants absolutely an aquarium, which I do refuse vehemently because of the risk of germs. As he sticks to his guns and my wife starts to fall into despair, I would like to ask you for help. How do you judge the risk for a CF patient?
Many thanks
Dear questioner,
reliable data hardly exist on the contamination of home aquariums with P. aeruginosa or other CF-germs resp. on the resulting risk of infection for CF patients, therefore a really satisfying answer is not possible.

The risk of getting infected with P.aeruginosa via an aquarium is potentially very small in case of a short contact resp. in case of adherence to certain precautional measures (see below), however cannot be excluded similar to the case of room-fontains, hydrocultures etc.
The recommendation for CF patients is in general to avoid the contact to aquariums as a water reservoir and therefore as a potential source of infection (1). In the following still some remarks on this.
- A high microbiological water quality can not be achieved in aquariums. A contamination of aquariums (via water, waterplants, etc.) with several (humid-)germs but also with mould fungi has been described. Also CF-relevant germs can occur here.
-Especially in case of high temperatures (warm water aquariums) there is furthermore a multiplication of the germs and the increasment of the risk of transmission possible.
- In spite of the fact that CF-germs do not belong to the primary spectrum of germs in aquariums and these do only bubble gently, the formation of respective contaminated aerosols can not be excluded. In closed, narrow rooms the risk of transmission is in general higher than outdoors, where aerosols do spread quickly (coverages which are tight for aerosoles should be available, about their efficiency however I could not say anything). Aquariums should therefore not be installed in the rooms resp. bedrooms of CF patients.
- CF patients should in any case strictly abandonne the cleaning resp. changing of water (especially aerosol forming).
- Infections of CF patients e.g. with P.aeruginosa/B. cepacia in connection with an aquarium are until now not described. In the environment many different humid areas exist, which come into account as a source of infection. In CF patients only very seldom the source of a humid germ which could be detected in the airways can be clarified (2). Therefore no certain reservoir has until now been identified as especially relevant for infection.
-Typical infections for persons dealing with aquariums are skin infections on the hands resp. forearms with Mycobactrium marinum, therefore gloves are recommended in case of cleaning the aquarium. There is until now one case report of an infection of a CF patient with Aeromonas hydrophila (humid germ, but no typical CF-germ) in connection with aquariums, which do at least prove the potential risk of an aquarium as a source of transmission (3).
- Very important in the estimation of the risk is also the clinical situation of the patient (lung function, ABPA, colonization with germs?), probably discuss the question also with the physician in charge.
Yours sincerely,
M. Hogart

(2) P. Schelstraete, S. Van daele, K. De Boeck, M. Proesmans, P. Lebecque, J. Leclercq-Foucart, A. Malfroot, M. Vaneechouttee and F. De Baets. Pseudomonas aeruginosa in the home environment of newly infected cystic fibrosis patients. Eur Respir J 2008; 31: 822–829.

(3) Cremonesini D und Thomson A. Lung colonization with Aeromonas hydrophila in cystic fibrosis believed to have come from a tropical fish tank. J R Soc Med. 2008 Jul 101 Suppl. 1: S44-5.