fish bowl

Question

Does a fish bowl contain stagnant water? Or can there be other dangerous bacteria for a child with Cf? Can the child help changing the fishbowl water?

Answer

Chronic pulmonary infection by specific bacteria such as Pseudomonas aeruginosa is the biggest problem for patients with cystic fibrosis. The Pseudomonas bacterium is present in the entire environment but is mainly found in stagnant water. There is a hype around this topic among patients and among some caretakers. A lot of rules have been imposed on children and parents in order to avoid potential contamination sources. The question is whether these changes do or do not have a significant effect on contracting infection with Pseudomonas aeruginosa. New data on this important topic allow us to take a clear position.

The EPIC study evaluated the best treatment for initial Pseudomonas infection. A part of this study, it was also examined which factors determine the age at first Pseudomonas infection. This large study of almost 1000 patients shows that mainly the patient’s genotype ( read: his specific CF mutation) determines whether an infection with Pseudomonas will occur at an early age or later. There is no influence of pool and jacuzzi use, nursery attendance or other environmental factors and habits. So there is really no reason to impose major restrictions on many activities that are pleasant for the patient and his family. The use of pools (and maybe even jaccuzi) can not be discouraged. In practice, this means that you should not be afraid when your child helps you with changing the water of the fishbowl.
Prof. Kris de Boeck

11.12.2012

11.12.12
Even if the underlying genetics is unquestionably the most important factor determining the risk of early Pseudomonas acquisition, recommendations of experts concerning the avoidance of environmental risk factors differ substantially. Here are some points, trying to explain this situation:
1. There is no unequivocal evidence to support the idea of general restrictions concerning all kinds of "Water sports and fun".
2. There is no unequivocal evidence against such risks related to all kinds of "Water sports and fun".
3. There is the need to weigh the Pros and Cons according to individual factors like genetically determined susceptibility, quality of water (likelyhood of PA), type of sport or fun activity (inhalation probability is different in swimming, sailing, and fishing).
So our written recommendation as well as any kind of personal advice in the doctor's office is always a compromise, hopefully the best possible compromise taking into account fears and wishes of the patient and parents and doctors. One statement cannot be the right one for all patients, but there is a spectrum of possible interpretations which should be taken as the basis for shared decision making by empowered patients.
TOF Wagner