Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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Hot Tub Lung Due to Mycobacterium Avium Complex in a Public Bath

대중목욕탕 청소 근로자의 Mycobacterium Avium Complex에 의한 온수 욕조 폐

  • Kang, Chung-Won (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Chung, Yun-Kyung (Occupational Safety & Health Research Institute, KOSHA) ;
  • Lee, Hye-Eun (Occupational Safety & Health Research Institute, KOSHA) ;
  • Kim, Eun-A (Occupational Safety & Health Research Institute, KOSHA) ;
  • Hong, Yun-Chul (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Cho, Soo-Hun (Department of Preventive Medicine, Seoul National University College of Medicine)
  • 강충원 (서울대학교 의과대학 예방의학교실) ;
  • 정윤경 (한국산업안전보건연구원 직업병연구센터) ;
  • 이혜은 (한국산업안전보건연구원 직업병연구센터) ;
  • 김은아 (한국산업안전보건연구원 직업병연구센터) ;
  • 홍윤철 (서울대학교 의과대학 예방의학교실) ;
  • 조수헌 (서울대학교 의과대학 예방의학교실)
  • Received : 2010.02.16
  • Accepted : 2010.06.10
  • Published : 2010.06.30
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Abstract

Background: Hot tub lung is a hypersensitivity pneumonitis caused by nontuberculous mycobacteria (NTM); the primary causative agent is Mycobacterium avium complex (MAC) post contaminated water exposure. Recently, 2 cases of hot tub lung were found in public bath bodyscrubbers working in Korea. However, the disease causing NTM was not identified in these cases. Here, we reported one case, along with clinical diagnostic approach to occupational medicine throughout worksite investigation. Case: A 53 year-old woman working in the public bath for 13 months' duration developed shortness of breath. She had been cleaning the locker room, several pools and floors every day, and using scrubbers with detergent and warm water. After examination, the patient was diagnosed with hypersensitivity pneumonitis based on high resolution computerized tomography and lung biopsy. Because the Mycobacterium avium was identified in both the patient's sputum and the warm pool, she was diagnosed with hot tub lung due to MAC. Conclusion: Hot tub lung due to MAC was confirmed in public bath housekeeper. However, few cases have been reported, even though there are many cases. To prevent damages caused by hot tub lung, general environmental management such as ventilation and cleaning is important for bath operators. Likewise, awareness needs to be increased in workers with potential NTM environmental exposure and in clinicians through education about hot tub lung in order to reduce adverse harm from misdiagnosis and mistreatment of tuberculosis.

배경: 온수 욕조 폐(hot tub lung)는 비결핵성 항산균(nontuberculous mycobacteria, NTM) 중 주로 미코박테륨아비움복합체(Mycobacterium avium complex, MAC)에 오염된 온수에 노출되어 유발되어 발생하는 과민성 폐렴으로 알려져 있다. 최근 우리나라에서도 동일한 대중목욕탕에서 근무한 2명의 목욕관리사에서 발생한 온수 욕조 폐 2사례가 보고되었으나, 노출원 및 원인균은 확인하지 못하였다. 이에 임상적 진단과 더불어 작업환경에서 확인한 MAC에 의한 온수 욕조 폐 1예를 보고한다. 사례: 13개월 전부터 대중목욕탕에서 청소하던 53세 여자 환자가 20일 전부터 시작된 호흡곤란을 주소로 내원 하였다. 환자는 출근 후 매일 온수 욕조와 욕실 바닥을 청소하였다. 흉부 전산단층촬영과 폐조직 검사를 통해 과민성 폐렴으로 진단된 후, 객담과 온수 욕조에서 미코박테륨아비움(Mycobacterium avium)이 동정되어 온수 욕조 폐로 확진되었다. 결론: 대중목욕탕 근로자에서 MAC에 의한 온수 욕조 폐 사례가 확인되었으나 아직까지 알려지지 않은 많은 사례가 있을 수 있다. NTM이 잘 자라는 온수 욕조의 환경 관리가 매우 중요하며, 임상 의사들과 NTM에 오염된 온수에 노출되는 근로자들에게 온수 욕조 폐를 교육하고 홍보하여 결핵 등으로 오진하여 생길 수 있는 피해를 줄여나가야 한다.

Keywords

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