Embil J, Warren P, Yakrus M, Stark R, Corne S, Forrest D, Hershfield E
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Chest. 1997 Mar;111(3):813-6. doi: 10.1378/chest.111.3.813.
Mycobacterium avium complex is common in water. When aerosolized, it is frequently inhaled but rarely causes illness in healthy people. Hypersensitivity pneumonitis to inhaled aerosols has been described; these aerosols are from several sources of water. The pneumonitis forms are collectively known as humidifier lung; the responsible agent in the water remains uncertain.
To report five cases of respiratory illness in healthy subjects using hot tubs contaminated with M avium complex.
Descriptive case reports.
Consultations in two teaching hospitals.
Five healthy people developed respiratory illnesses characterized by bronchitis, fever, and "flu-like" symptoms after using a hot tub. Acute exacerbations of their illness developed within hours of heavy use of the hot tubs.
A chest radiograph and sputum culture in all, BAL in one, CT scan and lung biopsy in another were performed. Culture of the water of the two hot tubs also was done.
Chest radiographs showed interstitial infiltrates or a miliary nodular pattern. Cultures of all sputum samples, the lung biopsy specimens, lung lavage and water samples were positive for M avium complex. The lung biopsy specimen revealed noncaseating granulomas. All patients recovered with no treatment for M avium complex.
We conclude that the M avium complex in the water was responsible for the pulmonary illnesses. The symptoms and the results of investigations are more suggestive of a hypersensitivity pneumonitis than of an infection, but no serologic proof of an immunologic reaction to the M avium complex or water was obtained.
鸟分枝杆菌复合体在水中很常见。雾化后，它经常被吸入，但在健康人中很少致病。吸入气溶胶引起的过敏性肺炎已有报道；这些气溶胶来自多种水源。这种肺炎形式统称为加湿器肺；水中的致病因子仍不确定。
报告5例使用被鸟分枝杆菌复合体污染的热水浴缸的健康受试者发生呼吸道疾病的病例。
描述性病例报告。
两家教学医院的会诊。
5名健康人在使用热水浴缸后出现以支气管炎、发热和“流感样”症状为特征的呼吸道疾病。在大量使用热水浴缸数小时内，病情急性加重。
对所有患者进行了胸部X线检查和痰培养，1例进行了支气管肺泡灌洗，另1例进行了CT扫描和肺活检。还对两个热水浴缸的水进行了培养。
胸部X线检查显示间质浸润或粟粒状结节影。所有痰标本、肺活检标本、肺灌洗和水样培养均为鸟分枝杆菌复合体阳性。肺活检标本显示非干酪样肉芽肿。所有患者未经针对鸟分枝杆菌复合体的治疗均康复。
我们得出结论，水中的鸟分枝杆菌复合体是肺部疾病的病因。症状和检查结果更提示为过敏性肺炎而非感染，但未获得对鸟分枝杆菌复合体或水的免疫反应的血清学证据。
