Chest
Selected ReportsPulmonary Illness Associated With Exposure to Mycobacterium-avium Complex in Hot Tub Water: Hypersensitivity Pneumonitis or Infection?
Section snippets
CASE 1
A 28-year-old healthy plumber used his indoor hot tub for 1 h daily. It was filled with well water in October and emptied in May without water changes. The temperature of the tub water was 37 to 39°C and the pH level was 7 to 8. In the second year of hot tub use, he developed episodes of a “flu-like” illness consisting of fever (38°C), chills, malaise, and headaches. He was empirically treated for bronchitis and chose to increase his hot tub use to alleviate symptoms. He became progressively
DISCUSSION
We believe that the temporal relationship between use of the hot tubs, the presence of the M avium complex in the water, and the isolation of M avium complex from the lung biopsy specimen and BAL specimen as well as from the sputum sample establish that this organism was responsible for the illnesses reported. Though the two isolates from the water did not match those from the patients, the hot tub water may have contained a mixed population of M avium complex, and the specific causal organism
ACKNOWLEDGMENT
We acknowledge the consultation from Dr. A. Pan on the first case, the radiologic assistance of Dr. B. Maycher for the CT scan, the work of Ms. J. Wolfe in the Mycobacterial Laboratory, Winnipeg, and the expertise of Charlotte Smith for serologic testing in the Centers for Disease Control and Prevention, Atlanta.
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