European Society of Mycobacteriology - Instituto Nacional de Saúde ...

PP-54
Mycobacterium avium alveolitis after cleansing hotel spa whirlpools
Svensson; Erik 1; Ridell; Malin 1; Åkerström; Magnus 2; Andersson; Eva 2
1 - Institute for Biomedicine, University of Gothenburg
2 - Department of Occupational and Environmental Medicine, University of Gothenburg
Hotel staff cleaning spa whirlpools and filters became ill in a disease suspected to be the so-called hot tub lung, which is an
allergic alveolitis-like granulomatous lung disease. In total seven employees at three hotels were involved. Mycobacterium
sp. was suspected to be the cause. Cultures from patients and from water and outlet filters were done. A quantitative
culture method was developed and water from different parts of the equipment was analysed.
One patient had definite allergic alveolitis and M. avium was isolated. Two other employees from the same hotel had
suspected alveolitis, but no cultivation for mycobacteria was done. In this hotel the cleansing of the spa filters was done
with high-pressure washers.
Two employees at another hotel had fever, chills and dyspnea related to cleansing the equipment. Their disease was not
regarded as allergic alveolitis, but both of them were colonized with M. avium
In the third hotel, two employees were colonized with M. avium, but no one hade symptoms related to work. One patient,
though, had flu like symptoms shortly after bathing in the pool.
In respiratory samples from five of the seven patients M. avium was isolated. The pool water and the surface films of the
water filters contained M. avium, often mixed with other, rapidly growing mycobacteria, however a pure culture was never
obtained. In the quantitative water culture 0 - 16000 CFU/mL of M. avium was isolated.
These are the first reported cases of hot tub lung alveolitis (hypersensitivity pneumonitis) in Sweden. Cultures from
patients, filters and water have contained M. avium. The symptoms of the patients have presently ceased. The cleaning
practices have been changed and the pool filter equipment has been rebuilt.
126 ESM 2009