"Lifeguard lung": endemic granulomatous pneumonitis in an indoor swimming pool.

Abstract

The indoor pool where the lifeguards worked was located in a large municipal recreation center. The swimming area consisted of 3 separate pools joined by two 4-foot (120-cm) waterfalls. The pool area contained 3 wall spouts, 4 fan sprays, 4 bridge sprays, a large and a small water slide, a leviXjpi! tator pump, a "bubbler," and a "mushroom" fountain. Two hot tubs located in an alcove behind the lap pool were disinfected with hydrogen peroxide and a bromine solution. Pool water was disinfected with chlorine and recirculated through the water spray features.Discussion with aquatics supervisors revealed persistently increased combined chlorine levels and alkaline pool water, but review of logs showed that water chemistry parameters consistently met current standards. Water spray features ran continuously when the pool first opened in November 1986. Within several months, the guards complained of oppressive humidity when water spray features were in use, and an hourly rotation system was devised to keep some of the features on at all times and others on intermittently. Despite this system, the lifeguards frequently turned off the water spray features in an effort to improve air quality. Employee health records indicated that at least 10 lifeguards had experienced pool-related respiratory and systemic symptoms during the 3 years since the pool had opened. A number of lifeguards had quit as a result ofthese symptoms.Following extensive ventilation system and engineering improvements, the pool reopened in May 1990. Within 3 months, we recognized a second outbreak ofgranulomatous lung disease among both newly hired and

Molecular identification of potential pathogens in water and air of a hospital therapy pool

“…Elevated temperatures and the presence of detergents, commonly added to therapy pools and hot tubs, are expected to enhance the aerosol partitioning potential of microbes with hydrophobic cell walls, because even small temperature increases and low surfactant concentrations markedly decrease liquid-air interface surface tension (34). Whereas several studies have implicated hot tub use in hypersensitivity pneumonitis, granulomatous lung diseases, and non-tuberculosis pulmonary infections (2,4,35), these results present in situ evidence for aqueous͞biofilm enrichment, and the subsequent aerosol partitioning of potentially pathogenic agents.…”

“…Filters for nucleic acid extraction were stored at Ϫ80°C until used. Material on filters was eluted with 2 ml 100 mM KCl, 10 mM Tris⅐HCl (pH 7.4), 10 mM NH 4 Cl, and 1% CA-630 (Igepal) (Sigma), and DNA was extracted with a bead-beating protocol (18). SSU rRNA genes were amplified by PCR from the extracted DNA samples according to Frank et al (18).…”

“…16S rRNA genes ͉ bioaerosols ͉ hypersensitive pneumonitis ͉ molecular survey ͉ Mycobacterium P ublic warm-water therapy pools and hot tubs are implicated as environments with high exposure to common waterborne and airborne pathogens, such as Legionella and Mycobacterium spp. (1)(2)(3)(4)(5). Monitoring and regulation of the microbiology relevant to public health in warm-water recreational pools and other environments has relied primarily on culture-based analyses that specifically target classical indicator organisms.…”

Effects of Ceiling-Mounted HEPA-UV Air Filters on Airborne Bacteria Concentrations in an Indoor Therapy Pool Building

“…The levels reported here are also higher than endotoxin concentrations in the air of other indoor (cold water) swimming pools, houses, and offices, but significantly lower than those reported from surveys of other occupational and agricultural settings. Airborne endotoxin levels from a building housing an indoor swimming pool with outbreaks of granulomatous lung disease 12 . Because endotoxin recovery can be significantly influenced by collection and is sensitive to analytical methods (yet to be standardized), care should be exercised when comparing the absolute levels reported in the literature in the context of exposure.…”

“…8 More recently, buildings housing hospital therapy pools, "hot tubs," and other warm-water leisure and therapy pools have been implicated to support and aerosolize microorganisms that include opportunistic pathogens from the genera Legionella and Mycobacterium, 9 -11 causing diseases such as "lifeguard lung." 12 The possibility for disease transfer associated with infectious bioaerosols has prompted efforts to engineer economical systems to remove, disinfect, or otherwise inactivate bioaerosols in indoor environments. Ultraviolet (UV) radiation and high-efficiency particulate air (HEPA) filtration of indoor air have received heightened attention in recent years as effective and affordable engineering controls.…”