Hypersensitivity pneumonitis-like granulomatous lung disease with nontuberculous mycobacteria from exposure to hot water aerosols

Environ Health Perspect. 2007 Feb;115(2):262-6. doi: 10.1289/ehp.9542. Epub 2006 Nov 6.


Objective: Human activities associated with aerosol-generating hot water sources are increasingly popular. Recently, a hypersensitivity pneumonitis (HP)-like granulomatous lung disease, with non-tuberculous mycobacteria from exposure to hot water aerosols from hot tubs/spas, showers, and indoor swimming pools, has been described in immunocompetent individuals (also called "hot tub lung"). Our objective in this study was to examine four additional cases of hot tub lung and compare these cases with others reported in the English print literature on this disease.

Data sources and extraction: We retrospectively reviewed all cases (n = 4) of presumptively diagnosed hot tub lung in immunocompetent individuals at the various physician practices in Springfield, Illinois, during 2001-2005. In addition, we searched MEDLINE for cases of hot tub lung described in the literature.

Data synthesis: We summarized the clinical presentation and investigations of four presumptive cases and reviewed previously reported cases of hot tub lung.

Conclusions: There is a debate in the literature whether hot tub lung is an HP or a direct infection of the lung by nontuberculous mycobacteria. Primary prevention of this disease relies on ventilation and good use practices. Secondary prevention of this disease requires education of both the general public and clinicians to allow for the early diagnosis of this disease.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Aerosols
  • Alveolitis, Extrinsic Allergic / diagnosis*
  • Alveolitis, Extrinsic Allergic / microbiology*
  • Female
  • Granuloma / diagnosis*
  • Granuloma / microbiology*
  • Hot Temperature*
  • Humans
  • Inhalation Exposure
  • Middle Aged
  • Mycobacterium avium Complex / isolation & purification*
  • Water Microbiology*


  • Aerosols