|
|
Letter
Hot-Tub–Associated Mycobacterial
Infections in Immunosuppressed Persons
Read original article,
http://www.cdc.gov/ncidod/eid/vol7no6/mangione.htm
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 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 pool (3).
Very recently, an outbreak of 110 cases of furunculosis was attributed
to M. fortuitum contamination of a footbath at a nail salon (4).
These experiences indicate the absolute need for careful cleaning of
hot tubs. Not only are immunosuppressed patients at risk for atypical
mycobacterial infections but even otherwise healthy persons may be susceptible.
Donald R. Graham
Springfield Clinic, Springfield, Illinois, USA
References
- Mangione EJ, Huitt G, Lenaway D, Beebe J, Bailey A,
Figoski M, et al. Nontuberculous
mycobacterial disease following hot tub exposure. Emerg Infect Dis
2001;7:1039–42.
- Aubuchon C, Hill JJ Jr, Graham DR. Atypical
mycobacterial infection in soft tissue associated with the use of a
hot tub. J Bone Joint Surg 1986;68‑A:766–8.
- Communicable Disease Surveillance Centre. Mycobacterium chelonei
associated with a hydrotherapy pool. Commun Dis Rep 1985, October 11:3–4.
- 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.
|
