Shower Secrets

October 25, 2006 Non-tuberculosis Mycobacterium Infection A non-tuberculosis mycobacterium (NTM) infection is a disease caused by a bacterium in the same family as that which causes tuberculosis (TB) and leprosy. Like TB, the infection tends to mainly affect the lungs. Patients may experience chronic cough, fever, weight loss, night sweats, fatigue, loss of appetite and blood-tinged phlegm. According to the National Jewish Medical and Research Center, each year, about two in every 10,000 Americans develop an NTM infection. A common cause is a bacterium called Mycobacterium avium, leading to Mycobacterium avium complex, or MAC. It can be difficult for doctors to diagnose NTM. The infection is somewhat rare and patients may be initially misdiagnosed. Some only have an annoying cough that never seems to go away. Others may develop signs of pneumonia and will be treated for that condition. When symptoms continue to persist, doctors may order an X-ray. If the X-ray is suspicious, a CT chest scan may be ordered. NTM has very characteristic patterns on the chest CT scan. A culture of the sputum can confirm the presence of the NTM bacteria. Once the diagnosis is made, treatments can be started. John Hansen-Flaschen, M.D., a Pulmonary and Critical Care Medicine Specialist at the University of Pennsylvania Hospital, says the bacteria are often resistant to at least one antibiotic. So patients are usually placed on multiple antibiotics. Even with treatment, the bacteria are very difficult to eliminate. So patients may be on antibiotics for as long as a year or two. In some patients, if the infection is confined to a small area of the lung, surgeons may remove that portion of the lung. Women, Showers and NTM Doctors are seeing an increase in the number of cases of NTM infection, especially in older women (typically over 50). The bacteria are commonly found in water and soil. Some investigators have been able to find the bacteria in showerheads and on the walls of shower stalls. Michael Iseman, M.D., a Pulmonologist with National Jewish Medical and Research Center, says researchers theorize women acquire the bacteria by inhaling contaminated droplets in the mist of shower water. Not everyone gets the infection. So doctors arent sure why older women appear to be more at risk for the disease. NTM is not contagious from person to person. But it can be very difficult to eradicate. The bacteria can live for a long time on surfaces and in the water and soil. It is resistant to common germicides and is tolerant to heat. Hansen-Flaschen says heating the water for two to three minutes at more than 170 degrees will kill the bacteria. But water at that temperature would cause serious burns. Switching to baths (instead of showers) may reduce the risk of infection. For those who prefer showers, an alternative may be a low impact showerhead that doesnt produce a fine mist or spray. AUDIENCE INQUIRY For information about non-tuberculosis mycobacterium (NTM) and Mycobacterium avium complex: Centers for Disease Control and Prevention, http://www.cdc.gov National Jewish Medical and Research Center, http://www.njc.org Stop NYM Now, http://www.stopntmnow.com/index.php BIBLIOGRAPHY "About Nontuberculous Mycobacteria (NTM)," Denver: National Jewish Medical and Research Center, downloaded from website (http://www.njc.org), July 24, 2006. Agrawal, Anjali, and Anurag Agrawal, "Lung, Nontuberculous Mycobacterial Infections," eMedicine, updated September 9, 2005, downloaded from website (http://www.emedicine.com), July 24, 2006. Falkinham, Joseph, III, "Mycobacterial Aerosols and Respiratory Disease," Emerging Infectious Diseases, July 2003, Vol. 9, No. 7, pp. 763-767. Field, Stephen, et al., "Mycobacterium avium Complex Pulmonary Disease in Patients Without HIV Infection," Chest, August 2004, Vol. 126, No. 2, pp. 566-581. Han, Xiang, et al., "Clinical Significance and Epidemiologic Analyses of Mycobacterium avium and Mycobacterium intracellulare Among Patients Without AIDS," Journal of Clinical Microbiology, September 2005, Vol. 43, No. 9, pp. 4407-4412. Hanak, V., et al., "Hot Tub Lung," Respiratory Medicine, April 2006, Vol. 100, No. 4, pp. 610-615. Kupeli, E, et al., "Clues for the Differential Diagnosis of Hypersensitivity Pneumonitis as an Expectant Variant of Diffuse Parenchymal Lung Disease," Postgraduate Medical Journal, June 2004, Vol. 80, No. 944, pp. 339-345. Lacasse, Yves, et al., "Clinical Diagnosis of Hypersensitivity Pneumonitis," American Journal of Respiratory and Critical Care Medicine, October 15, 2003, Vol. 168, No. 8, pp. 952-958. Maekura, Ryoji, et al., "Clinical and Prognostic Importance of Serotyping Mycobacterium avium-Mycobacterium intracellulare Complex Isolates in Human Immunodeficiency Virus-Negative Patients," Journal of Clinical Microbiology, July 2005, Vol. 43, No. 7, pp. 3150-3158. Mangione, Ellen, et al., "Nontuberculosis Mycobacterial Disease Following Hot Tub Exposure," Emerging Infectious Diseases, December 2001, Vol. 7, No. 6, pp. 1039-1042. Marras, Theodore, et al., "Hypersensitivity Pneumonitis Reaction to Mycobacterium avium in Household Water," Chest, February 2005, Vol. 127, No. 2, pp. 664-671. Merrill, William, "Hypersensitivity Pneumonitis," Chest, October 2001, Vol. 120, No. 4, pp. 1055-1057. "Mycobacterium avium Complex," Atlanta: Centers for Disease Control and Prevention, downloaded from website (http://www.cdc.gov), July 24, 2006. Reed, C., et al., et al., "Environmental Risk Factors for Infection with Mycobacterium avium Complex," American Journal of Epidemiology, July 1, 2006, Vol. 164, No. 1, pp. 32-40. Rickman, Otis, D.O., et al., "Hypersensitivity Pneumonitis Associated with Mycobacterium avium Complex and Hot Tub Use," Mayo Clinic Proceedings, November 2002, Vol. 77, No. 11, pp. 1233-1237. Selman, Moises, M.D., "Hypersensitivity Pneumonitis," Clinics in Chest Medicine, September 2005, Vol. 25, No. 3, pp. 531-547. Research compiled and edited by Barbara J. Fister