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Applied and Environmental Microbiology, August 2004, p. 4906-4910, Vol. 70, No. 8
0099-2240/04/$08.00+0     DOI: 10.1128/AEM.70.8.4906-4910.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Investigation of Spa Pools Associated with Lung Disorders Caused by Mycobacterium avium Complex in Immunocompetent Adults

Richard Lumb,1 Richard Stapledon,2 Andrew Scroop,3 Peter Bond,4 David Cunliffe,4 Allan Goodwin,1 Robyn Doyle,1 and Ivan Bastian1*

Infectious Diseases Laboratories, Institute of Medical and Veterinary Science,1 South Australian Tuberculosis Services, Royal Adelaide Hospital,2 Adelaide Respiratory Specialists,3 Environmental Health Branch, Department of Human Services, Adelaide, South Australia, Australia4

Received 17 December 2003/ Accepted 5 May 2004

Three cases of Mycobacterium avium complex-related lung disorders were associated with two poorly maintained spa pools by genotypic investigations. Inadequate disinfection of the two spas had reduced the load of environmental bacteria to less than 1 CFU/ml but allowed levels of M. avium complex of 4.3 x 104 and 4.5 x 103 CFU/ml. Persistence of the disease-associated genotype was demonstrated in one spa pool for over 5 months until repeated treatments with greater than 10 mg of chlorine per liter for 1-h intervals eliminated M. avium complex from the spa pool. A fourth case of Mycobacterium avium complex-related lung disease was associated epidemiologically but not genotypically with another spa pool that had had no maintenance undertaken. This spa pool contained low numbers of mycobacteria by smear and was culture positive for M. avium complex, and the nonmycobacterial organism count was 5.2 x 106 CFU/ml. Public awareness about the proper maintenance of private (residential) spa pools must be promoted by health departments in partnership with spa pool retailers.

* Corresponding author. Mailing address: Mycobacterium Reference Laboratory, Infectious Diseases Laboratories, Institute of Medical and Veterinary Science, Box 14, Rundle Mall, Adelaide 5000, South Australia, Australia. Phone: 61 8 8222 3579. Fax: 61 8 8222 3543. E-mail: ivan.bastian{at}imvs.sa.gov.au.

Applied and Environmental Microbiology, August 2004, p. 4906-4910, Vol. 70, No. 8
0099-2240/04/$08.00+0     DOI: 10.1128/AEM.70.8.4906-4910.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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