Hot Tub Lung

 

Conditions causing respiratory disease associated with hot tub use:

(1) hypersensitivity pneumonitis due to micro-organisms

(2) hypersensitivity pneumonitis due to chemical irritants

(3) pneumonia

 

Factors associated with the development of respiratory complaints:

(1) use of tub indoors vs outdoors

(2) types of bacteria in local water supply

(3) immunocompetence of the person

(4) hot tub maintenance (changing filters, changing water, etc.)

 

Factors favoring proliferation of micro-organisms and respiratory complications:

(1) high humidity

(2) decreased effectiveness of halides due to high temperature or due to failure to maintain adequate levels

(3) turbulence from water jets, favoring droplet formation

(4) resistant environmental organisms

 

Hypersensitivity pneumonitis may be associated with:

(1) Mycobacterium avium complex, M. fortuitum, M. kansasii, M. abscessus, M. xenopi

(2) Aspergillus

(3) Cladosporium

(4) other molds

 

Features of hypersensitivity pneunomitis:

(1) chills and low grade fever

(2) cough

(3) some sputum production

(4) dyspnea

(5) myalgias

(6) lassitude and fatigue

(7) headache

 

Chemical irritants – associated with the chemicals used to inhibit bacteria:

(1) bromine

(2) chlorine

 

Features of chemical irritants:

(1) symptoms of reactive airways dysfunction syndrome (RADS)

(2) irritation of skin, eyes and mucous membranes

(3) chemical discoloration of items in the environment

 

Pneumonia may be a greater risk to those who are immunodeficient:

(1) Mycobacterium avium complex

(2) Aspergillus

(3) Legionella

(4) Pseudomonas species

 

Features of pneumonia:

(1) high fever with prostration

(2) cough

(3) dyspnea

 

The diagnosis depends on what investigation is conducted:

(1) isolation of organisms from the hot tub water

(2) isolation of organisms from the environment around the hot tub

(3) isolation of organism from the sputum or lung of patients

(4) evidence of chemical misuse

(5) location of the hot tub (indoors vs outdoors)

(6) maintenance records for the tub (water changes, filter changes, etc.)