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Hot tub lung: an occupational hazard

Harald Fjällbrant, Magnus Akerstrom, Erik Svensson, Eva Andersson
European Respiratory Review 2013 22: 88-90; DOI: 10.1183/09059180.00002312
Harald Fjällbrant
*Institute of Medicine, Dept of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, ¶Dept of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, +Institute of Biomedicine, Dept of Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and #AstraZeneca R&D, Mölndal, Sweden. §International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
*Institute of Medicine, Dept of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, ¶Dept of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, +Institute of Biomedicine, Dept of Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and #AstraZeneca R&D, Mölndal, Sweden. §International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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  • For correspondence: harald.fjallbrant@astrazeneca.com
Magnus Akerstrom
*Institute of Medicine, Dept of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, ¶Dept of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, +Institute of Biomedicine, Dept of Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and #AstraZeneca R&D, Mölndal, Sweden. §International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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Erik Svensson
*Institute of Medicine, Dept of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, ¶Dept of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, +Institute of Biomedicine, Dept of Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and #AstraZeneca R&D, Mölndal, Sweden. §International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
*Institute of Medicine, Dept of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, ¶Dept of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, +Institute of Biomedicine, Dept of Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and #AstraZeneca R&D, Mölndal, Sweden. §International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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Eva Andersson
*Institute of Medicine, Dept of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, ¶Dept of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, +Institute of Biomedicine, Dept of Bacteriology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and #AstraZeneca R&D, Mölndal, Sweden. §International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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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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Table 1. Characterisation of a cluster of confirmed, probable and possible cases of hot tub lung related to maintenance work on hot tubs

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 …

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Hot tub lung: an occupational hazard
Harald Fjällbrant, Magnus Akerstrom, Erik Svensson, Eva Andersson
European Respiratory Review Mar 2013, 22 (127) 88-90; DOI: 10.1183/09059180.00002312

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Hot tub lung: an occupational hazard
Harald Fjällbrant, Magnus Akerstrom, Erik Svensson, Eva Andersson
European Respiratory Review Mar 2013, 22 (127) 88-90; DOI: 10.1183/09059180.00002312
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