Hot Tub Lung Disease

Hot tub lung disease is a granulomatous lung disease thought to occur as a result of a hypersensitivity response to Non tuberculous mycobacteria.
Primarily seen as hypersensitivity pneumonitis after exposure to NTM from indoor hot tubs and spas, and occasionally contaminated showers, with aerosolization devices. The hot tubs are often poorly maintained and the water contain large numbers of NTM.
Typical radiographic findings are areas of ground glass attenuation, centrilobular pulmonary nodules and air trapping on expiratory images.
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.
Diagnostic criteria include the sub-acute onset of respiratory symptoms associated with hot tub exposure, positive mycobacterial cultures from respiratory and water samples, and characteristic radiographic findings.
Treatment predominately includes exposure avoidance with the use of prednisolone and/or antimicrobial agents.
Reference:
Rao R, Sheshadri S, Patil N, Rao K, Arivazhahan A. Lady Windermere Syndrome: A Very Rare Entity In Indian Medical Scenario. J Clin Diagn Res. 2016;10(1):OD01-OD2. doi:10.7860/JCDR/2016/17540.7024
Ryu YJ, Koh WJ, Daley CL. Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians' Perspectives. Tuberc Respir Dis (Seoul). 2016;79(2):74-84. doi:10.4046/trd.2016.79.2.74
Skolnik K, Kirkpatrick G, Quon BS. Nontuberculous Mycobacteria in Cystic Fibrosis. Curr Treat Options Infect Dis. 2016;8(4):259-274. doi:10.1007/s40506-016-0092-6
Ni Y, Ding L, Yu Y, Dai R, Chen H, Shi G. Oscillatory positive expiratory pressure treatment in lower respiratory tract infection. Exp Ther Med. 2018;16(4):3241-3248. doi:10.3892/etm.2018.6552
Image credit:
High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients; Polverosi R, Guarise A, Balestro E, Carloni A, Dalpiaz G and Feragalli B; Radiological Medicine; 2010; 115 (2); 191-204.
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