Nontuberculous mycobacteria in aerosol droplets and bulk water samples from therapy pools and hot tubs

Craig S. Glazer, John W. Martyny, Ben Lee, Tracy L. Sanchez, Tricia M. Sells, Lee S. Newman, James Murphy, Leonid Heifets, Cecile S. Rose

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Hot tub exposure has been causally associated with a steroid-responsive, granulomatous lung disease featuring nontuberculous mycobacterial (NTM) growth in both clinical and environmental samples. Little is known regarding prevalence of and risk factors for NTM-contamination and associated illness in these settings. In this study, the frequency of NTM growth and aerosolization in 18 public hot tubs and warm water therapy pools and the factors associated with mycobacterial growth were analyzed. Each site was characterized by water chemistry analysis; a questionnaire on maintenance, disinfection, and water quality; and air and water sampling for quantitative NTM culture. NTM were detected in air or water from 13/18 (72%) sites; a strong correlation was found between the maximum air and water NTM concentrations (rho 0.49, p = 0.04). Use of halogen (chlorine or bromine) disinfection was associated with significantly lower air and water concentrations of NTM compared with disinfection using ultraviolet light and hydrogen peroxide (p = 0.01-0.04). Higher water turnover rates were also associated with lower air and water NTM concentrations (p = 0.02-0.03). These findings suggest that NTM are frequently detectable in the air and water of spas and therapy pools and that particular maintenance and disinfection approaches affect NTM bioaerosol concentrations in these settings.

Original languageEnglish (US)
Pages (from-to)831-840
Number of pages10
JournalJournal of Occupational and Environmental Hygiene
Issue number11
StatePublished - Nov 2007


  • Bioaerosols
  • Granulomas
  • Hot tubs
  • Hypersensitivity pneumonitis
  • Nontuberculous mycobacteria

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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