Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water

Theodore K. Marras, Richard J. Wallace, Laura L. Koth, Michael S. Stulbarg, Clayton T. Cowl, Charles L. Daley

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Background: Hypersensitivity pneumonitis has been described with exposure to aerosolized Mycobacterium avium complex (MAC) in indoor hot tubs (hot tub lung). Objectives: To describe a case of MAC-associated hypersensitivity pneumonitis-like reaction possibly from showering and review previous hot tub lung reports. Methods: For the case report, we investigated a patient with histologically diagnosed hypersensitivity pneumonitis and MAC-positive sputum culture findings. Mycobacterial cultures were obtained from his home and workplace. Isolates were typed using pulsed-field gel electrophoresis. For the review, MEDLINE and EMBASE were searched for hot tub lung reports, which were reviewed and summarized. Results: A 50-year-old man had progressive dyspnea and episodic fever and myalgias. Pulmonary function testing results revealed obstruction and impaired diffusion; a chest CT scan found diffuse, centrilobular, ground-glass nodules, and air trapping, and a lymphocytic alveolitis with an elevated CD4/CD8 ratio. Transbronchial biopsy showed multiple well-formed nonnecrotizing granulomas. Multiple respiratory samples and shower and bathtub specimens grew MAC, with matching pulsed-field gel electrophoresis patterns. The patient changed from showering to tub bathing. Prednisone and antimycobacterial drugs were administered for approximately 1 year. His symptoms, pulmonary function abnormalities, and CT scan findings resolved. The literature review yielded 36 cases of hot tub lung. Clinical features included dyspnea (97%), cough (78%), and fever (58%). Pulmonary function testing showed obstruction (67%), restriction (55%), and impaired diffusion (75%). A chest CT scan showed ground-glass opacification (95%) and nodules (67%). Granulomas were well-formed in 95%. Treatments included discontinuation of hot tub use and prednisone, antimycobacterial drugs, or both. Outcomes were favorable. Conclusions: A hypersensitivity pneumonitis-like reaction to mycobacteria can occur from exposures other than hot tubs. There are key differences between classic hypersensitivity pneumonitis and MAC-associated hypersensitivity pneumonitis. Antimycobacterial therapy may be required. The possibility of MAC hypersensitivity pneumonitis from showering raises potential implications in the investigation of patients with hypersensitivity pneumonitis.

Original languageEnglish (US)
Pages (from-to)664-671
Number of pages8
JournalChest
Volume127
Issue number2
DOIs
StatePublished - Feb 2005

Fingerprint

Extrinsic Allergic Alveolitis
Mycobacterium avium
Mycobacterium avium Complex
Water
Lung
Pulsed Field Gel Electrophoresis
Prednisone
Granuloma
Dyspnea
Glass
Fever
Thorax
CD4-CD8 Ratio
Myalgia
Mycobacterium
Sputum
Cough
MEDLINE
Workplace
Pharmaceutical Preparations

Keywords

  • Alveolitis
  • Atypical
  • Extrinsic allergic
  • Mycobacterium avium-intracellulare infection
  • Mycobacterium infections
  • Water microbiology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Marras, T. K., Wallace, R. J., Koth, L. L., Stulbarg, M. S., Cowl, C. T., & Daley, C. L. (2005). Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water. Chest, 127(2), 664-671. https://doi.org/10.1378/chest.127.2.664

Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water. / Marras, Theodore K.; Wallace, Richard J.; Koth, Laura L.; Stulbarg, Michael S.; Cowl, Clayton T.; Daley, Charles L.

In: Chest, Vol. 127, No. 2, 02.2005, p. 664-671.

Research output: Contribution to journalArticle

Marras, TK, Wallace, RJ, Koth, LL, Stulbarg, MS, Cowl, CT & Daley, CL 2005, 'Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water', Chest, vol. 127, no. 2, pp. 664-671. https://doi.org/10.1378/chest.127.2.664
Marras TK, Wallace RJ, Koth LL, Stulbarg MS, Cowl CT, Daley CL. Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water. Chest. 2005 Feb;127(2):664-671. https://doi.org/10.1378/chest.127.2.664
Marras, Theodore K. ; Wallace, Richard J. ; Koth, Laura L. ; Stulbarg, Michael S. ; Cowl, Clayton T. ; Daley, Charles L. / Hypersensitivity pneumonitis reaction to Mycobacterium avium in household water. In: Chest. 2005 ; Vol. 127, No. 2. pp. 664-671.
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abstract = "Background: Hypersensitivity pneumonitis has been described with exposure to aerosolized Mycobacterium avium complex (MAC) in indoor hot tubs (hot tub lung). Objectives: To describe a case of MAC-associated hypersensitivity pneumonitis-like reaction possibly from showering and review previous hot tub lung reports. Methods: For the case report, we investigated a patient with histologically diagnosed hypersensitivity pneumonitis and MAC-positive sputum culture findings. Mycobacterial cultures were obtained from his home and workplace. Isolates were typed using pulsed-field gel electrophoresis. For the review, MEDLINE and EMBASE were searched for hot tub lung reports, which were reviewed and summarized. Results: A 50-year-old man had progressive dyspnea and episodic fever and myalgias. Pulmonary function testing results revealed obstruction and impaired diffusion; a chest CT scan found diffuse, centrilobular, ground-glass nodules, and air trapping, and a lymphocytic alveolitis with an elevated CD4/CD8 ratio. Transbronchial biopsy showed multiple well-formed nonnecrotizing granulomas. Multiple respiratory samples and shower and bathtub specimens grew MAC, with matching pulsed-field gel electrophoresis patterns. The patient changed from showering to tub bathing. Prednisone and antimycobacterial drugs were administered for approximately 1 year. His symptoms, pulmonary function abnormalities, and CT scan findings resolved. The literature review yielded 36 cases of hot tub lung. Clinical features included dyspnea (97{\%}), cough (78{\%}), and fever (58{\%}). Pulmonary function testing showed obstruction (67{\%}), restriction (55{\%}), and impaired diffusion (75{\%}). A chest CT scan showed ground-glass opacification (95{\%}) and nodules (67{\%}). Granulomas were well-formed in 95{\%}. Treatments included discontinuation of hot tub use and prednisone, antimycobacterial drugs, or both. Outcomes were favorable. Conclusions: A hypersensitivity pneumonitis-like reaction to mycobacteria can occur from exposures other than hot tubs. There are key differences between classic hypersensitivity pneumonitis and MAC-associated hypersensitivity pneumonitis. Antimycobacterial therapy may be required. The possibility of MAC hypersensitivity pneumonitis from showering raises potential implications in the investigation of patients with hypersensitivity pneumonitis.",
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AU - Cowl, Clayton T.

AU - Daley, Charles L.

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N2 - Background: Hypersensitivity pneumonitis has been described with exposure to aerosolized Mycobacterium avium complex (MAC) in indoor hot tubs (hot tub lung). Objectives: To describe a case of MAC-associated hypersensitivity pneumonitis-like reaction possibly from showering and review previous hot tub lung reports. Methods: For the case report, we investigated a patient with histologically diagnosed hypersensitivity pneumonitis and MAC-positive sputum culture findings. Mycobacterial cultures were obtained from his home and workplace. Isolates were typed using pulsed-field gel electrophoresis. For the review, MEDLINE and EMBASE were searched for hot tub lung reports, which were reviewed and summarized. Results: A 50-year-old man had progressive dyspnea and episodic fever and myalgias. Pulmonary function testing results revealed obstruction and impaired diffusion; a chest CT scan found diffuse, centrilobular, ground-glass nodules, and air trapping, and a lymphocytic alveolitis with an elevated CD4/CD8 ratio. Transbronchial biopsy showed multiple well-formed nonnecrotizing granulomas. Multiple respiratory samples and shower and bathtub specimens grew MAC, with matching pulsed-field gel electrophoresis patterns. The patient changed from showering to tub bathing. Prednisone and antimycobacterial drugs were administered for approximately 1 year. His symptoms, pulmonary function abnormalities, and CT scan findings resolved. The literature review yielded 36 cases of hot tub lung. Clinical features included dyspnea (97%), cough (78%), and fever (58%). Pulmonary function testing showed obstruction (67%), restriction (55%), and impaired diffusion (75%). A chest CT scan showed ground-glass opacification (95%) and nodules (67%). Granulomas were well-formed in 95%. Treatments included discontinuation of hot tub use and prednisone, antimycobacterial drugs, or both. Outcomes were favorable. Conclusions: A hypersensitivity pneumonitis-like reaction to mycobacteria can occur from exposures other than hot tubs. There are key differences between classic hypersensitivity pneumonitis and MAC-associated hypersensitivity pneumonitis. Antimycobacterial therapy may be required. The possibility of MAC hypersensitivity pneumonitis from showering raises potential implications in the investigation of patients with hypersensitivity pneumonitis.

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KW - Alveolitis

KW - Atypical

KW - Extrinsic allergic

KW - Mycobacterium avium-intracellulare infection

KW - Mycobacterium infections

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