Hot-tub-associated mycobacterial infections in immunosuppressed persons. (Letters).To the Editor: I read with interest the report by Mangione et al. regarding Mycobacterium avium infection in a Colorado family who used an inadequately sanitized hot tub (1). The authors noted that the source of the M. avium complex was not clear, although the reservoir did appear to have been the hot tub. Twenty years ago, I helped treat a patient with a local infection caused by M. fortuitum in his amputation amputation (ăm'pyətā`shən), removal of all or part of a limb or other body part. Although amputation has been practiced for centuries, the development of sophisticated techniques for treatment and prevention of infection has greatly stump (2). The patient had sat in his tub postoperatively three to four times per week. Although he had added disinfectants as recommended by the manufacturer, he had not cleaned the tub mechanically at any time during the incubation period of his infection. We recovered what appeared to be the same strain of M. fortuitum from the abscess on his amputation stump and specimens from the hot tub water and filter. However, we could not recover any mycobacteria from his or his neighbor's tap water. Three years after our experience with this patient, M. chelonei was found to cause colonization of sputum of patients with cystic fibrosis after they had been treated in a hydrotherapy hydrotherapy, use of water in the treatment of illness or injury. Although the medicinal and hygienic value of water was recognized by the early Greeks, hydrotherapy attained its widest use in the 18th and 19th cent. pool (3). Very recently, an outbreak of 110 cases of furunculosis furunculosis /fu·run·cu·lo·sis/ (fu-rung?ku-lo´sis) 1. the persistent sequential occurrence of furuncles over a period of weeks or months. 2. the simultaneous occurrence of a number of furuncles. was attributed to M. fortuitum contamination of a footbath foot·bath n. A small bath, such as a basin or shallow pool, for washing or disinfecting the feet. Noun 1. footbath - a small bathtub for warming or washing or disinfecting the feet at a nail salon (4). These experiences indicate the absolute need for careful cleaning of hot tubs. Not only are immunosuppressed Immunosuppressed A state in which the immune system is suppressed by medications during the treatment of other disorders, like cancer, or following an organ transplantation. Mentioned in: Fifth Disease patients at risk for atypical mycobacterial infections Mycobacterial Infections, Atypical Definition Atypical mycobacterial infections are infections caused by several types of mycobacteria similar to the germ that causes tuberculosis. but even otherwise healthy persons may be susceptible. Donald R. Graham Springfield Clinic, Springfield, Illinois, USA References (1.) Mangione EJ, Huitt G, Lenaway D, Beebe J, Bailey A, Figoski M, et al. Nontubercuious mycobacterial disease following hot tub exposure. Emerg Infect Dis 2001;7:1039-42. (2.) Aubuchon C, Hill JJ Jr, Graham DR. Atypical mycobacterial infection atypical mycobacterial infection Infectious disease Clinical infection with mycobacteria other than those causing TB or lepra Risk factors Immune compromise, AIDS Clinical Abscesses, septic arthritis, osteomyelitis; AMIs include those with M avium in soft tissue associated with the use of a hot tub. J Bone Joint Surg 1986;68-A:766-8. (3.) Communicable Disease Surveillance Centre. Mycobacterium chelonei associated with a hydrotherapy pool. Commun Dis Rep 1985, October 11:3-4. (4.) Winthrop KL, Abrams M, Yakrus M, Schwartz I, Ely J, Gillies D, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med 2002;346:1366-71. |
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