M ycobacterium phocaicum and M ycobacterium avium‐intracellulare in a patient with hot tub lung

Abstract

A 77-year-old woman who used her spa pool at least twice a day to relieve pain from osteoarthritis, developed progressive breathlessness, impaired pulmonary function, and radiographic changes consistent with hypersensitivity pneumonitis-like lung disease. Mycobacterium avium-intracellulare complex (MAC) was cultured from bronchoalveolar lavage fluid. Transbronchial biopsies revealed non-necrotizing granulomatous inflammation. Sputum and spa pool water cultured Mycobacterium phocaicum but not MAC. She stopped using the spa pool and was treated with oral prednisone, which led to symptomatic, pulmonary function, and radiographic improvement. This is the first case of hypersensitivity pneumonitis-like granulomatous lung disease associated with exposure to M. phocaicum in spa pool water.

Antimicrobial Resistance in Rapidly Growing Nontuberculous Mycobacteria among Domestic and Wild Animals Emphasizing the Zoonotic Potential

“…Lung infections caused by M. peregrinum have also been described, but there is currently no established treatment for such infection [42]. Similarly, M. phocaicum was described as a cause of lung infection and was simultaneously isolated from the pool used by the patient [43]. Among our M. peregrinum and M. phocaicum isolates, we detected resistance to tobramycin, amoxicillin-clavulanate, cefriaxone and cefepime.…”

Identification of Nontuberculous Mycobacteria in Drinking Water in Cali, Colombia

“…In addition, drug-resistant isolates of M. mucogenicum have been reported from hospital surfaces [49]. M. phocaicum has been associated with lung disease acquired from hot tubs and pool water [50,51] and, at a lower rate, with bloodstream infection [52]. M. mageritense has been associated with pulmonary and skin infections.…”

Hot Tub Lung: A Diagnostic Challenge

“…HTL is a diffuse granulomatous lung disease that is associated with exposure to MAC and other NTMs that contaminate the hot tub water, swimming pools, and household showers [ 3 - 4 ]. Predisposing risk factors identified include poor compliance with hot tub maintenance, and inadequate ventilation and aerosolization.…”

“…Its pathogenesis continues to be a matter of debate as it exhibits both infectious and hypersensitivity-like features. However, the majority of the literature thus far supports the hypersensitivity hypothesis [ 1 , 3 , 5 ]. Clinically, it manifests as an acute flu-like illness with cough, fever, joint pain followed by protracted symptoms, such as dyspnea on exertion, fatigue, and weight loss [ 6 ].…”