Chest
Volume 111, Issue 1, January 1997, Pages 242-245
Journal home page for Chest

Selected Reports
Mycobacterium avium Complex Infection in an Immunocompetent Young Adult Related to Hot Tub Exposure

https://doi.org/10.1378/chest.111.1.242Get rights and content

An unusual case of Mycobacterium avium complex infection occurred in a young adult with no preexisting disease and no evidence of immunodeficiency. There was diffuse interstitial involvement of the lungs which suggested an active alveolitis. Diagnosis required open-lung biopsy. Restriction fragment length polymorphism analysis and multilocus enzyme electrophoresis indicated that the source of the infection was a hot tub. The infection proved to be exceptionally responsive to treatment, and there was complete resolution with a four-drug regimen.

Section snippets

CASE REPORT

A 20-year-old female student was referred to the senior author on February 3, 1995, with a spasmodic cough and breathlessness on minor exertion that became progressively worse since early December 1994. There was no fever, but she had lost some weight. She had recently noted a skin rash. She was a nonsmoker. There was a history of asthma in infancy, but this had not recurred. There was a hot tub that she used frequently in her home. Examination revealed scaly erythematous skin lesions on the

DISCUSSION

The afebrile course in this case, with a clinical picture of nonproductive cough and progressive breathlessness, associated with a diffuse ground-glass radiographic pattern, suggested that we were dealing with an active alveolitis, possibly a hypersensitivity pneumonitis. Pullularia, for which there was a positive precipitin test, has been identified in allergic reactions to saunas.7 The open-lung biopsy, however, showed numerous noncaseating granulomas that were evidently due to a

REFERENCES (18)

  • RosenzweigD.Y.

    Pulmonary mycobacterial infections due to Mycobacterium intracellulare-avium complex: clinical features and course in 100 consecutive cases

    Chest

    (1979)
  • von ReynC.F. et al.

    Persistent colonisation of potable water as a source of Mycobacterium avium infection in AIDS

    Lancet

    (1994)
  • HorsburghC.R.

    Mycobacterium avium complex infection in the acquired immunodeficiency syndrome

    N Engl J Med

    (1991)
  • PrinceD.S. et al.

    Infection with Mycobacterium avium complex in patients without predisposing conditions

    N Engl J Med

    (1989)
  • HeifetsL.

    Qualitative and quantitative drug susceptibility tests in mycobacteriology

    Am Rev Respir Dis

    (1988)
  • YakrusM.A. et al.

    Characterization of isolates of Mycobacterium avium serotypes 4 and 8 from patients with AIDS by multilocus enzyme electrophoresis

    J Clin Microbiol

    (1992)
  • GuerreroC. et al.

    A novel insertion element from Mycobacterium avium, IS 1245, is a specific target for analysis of strain relatedness

    J Clin Microbiol

    (1995)
  • MetzgerW.J. et al.

    Sauna-takers disease: hypersensitivity pneumonitis due to contaminated water in a home sauna

    JAMA

    (1976)
  • HartmanT.E. et al.

    Mycobacterium avium-intracellulare complex: evaluation with CT

    Radiology

    (1993)
There are more references available in the full text version of this article.

Cited by (120)

  • Opportunistic premise plumbing pathogens (OPPPs) in the built-environment

    2021, Viruses, Bacteria and Fungi in the Built Environment: Designing Healthy Indoor Environments
  • Hot tub lung: A retrospective analysis of 14 cases

    2021, Revue des Maladies Respiratoires
  • Review: Environmental mycobacteria as a cause of human infection

    2015, International Journal of Mycobacteriology
    Citation Excerpt :

    Many common activities expose individuals to pathogenic NTM. The most studied are hot-tub use [30,37,6], showering [8,9,17], faucet use [39,53,54] and gardening [13]. These sources have been investigated by studies matching NTM strains between the patient and the environment.

View all citing articles on Scopus
View full text