To the Editor:
Hot tub baths have become increasingly common in residences as well as hotels and spa facilities. Recently, such baths have been associated with an emerging disorder known as hot tub lung (HTL). HTL is a diffuse granulomatous lung disease caused by inhalation of water aerosol containing non-tuberculous mycobacteria (NTM), in most cases belonging to the Mycobacterium avium complex [1]. Here, we report a cluster of confirmed, probable and possible HTL with occupational associations. To our knowledge, case 1 is the first confirmed case of occupational HTL in the literature.
A 30-yr-old hotel technician (case 1, table 1) developed episodes of cough, dyspnoea, fever and joint pain. His condition progressed with fatigue, weight loss and increasing dyspnoea. He was hospitalised at his third emergency visit. His oxygen tension was moderately reduced (8.9 kPa). His C-reactive protein level was 16 mg·L−1. A chest radiograph was normal but computed tomography showed ground-glass opacities without signs of embolism. He was dismissed after spontaneous remission 3 days later. He continued having some fatigue and dyspnoea on exertion. Fever, accentuated dyspnoea and cough relapsed twice after returning to work. Chest radiography showed diffuse interstitial infiltration and his diffusion capacity was reduced. Lymphocytosis was found in his bronchoalveolar lavage (BAL) fluid, and transbronchial biopsies showed interstitial inflammation and granuloma. HTL was diagnosed when growth of M. avium was found in BAL fluid and it became clear that he had cleaned the hotel’s hot tub facility (facility 1) and its nylon filters with a pressure washer twice weekly.
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Two colleagues who had substituted for the first hotel technician at servicing the bath facility during his sick leave also fell ill with similar symptoms (cases 2 and 3, table 1). They were eventually diagnosed with probable HTL but the work-up was insufficient …
