Lung Disease & Respiratory Health Center

Hot Tubs in the Hot Seat: Respiratory Illness, Infection Linked to Use

May 10, 2000 (Toronto) -- After a long day at work or a particularly vigorous workout, you plan a relaxing soak in the warm, bubbling comfort of a hot tub -- perhaps even with a glass of bubbly. But your seemingly harmless indulgence could give you more than much-needed downtime.

Genital herpes, Legionnaire's disease, and another respiratory illness have been linked to hot tub use. According to a study published in the Journal of the American Medical Association, herpes simplex virus, the organism that causes genital herpes, can be transmitted by using hot tubs because the virus can live up to four and a half hours on plastic-coated seats that don't come in contact with the hot tub's chlorinated water, which inactivates the virus.

The CDC has reported outbreaks of Legionnaire's disease associated with the use of hot tubs on a cruise ship and from being near an indoor retail whirlpool bath display at a large home-improvement store.

And Cecile S. Rose, MD, MPH, presented findings this week at the 96th annual meeting of the American Thoracic Society suggesting that nine people who developed symptoms of a respiratory illness inhaled bacteria while using hot tubs.

Over an 18 month period, she and colleagues treated nine people in the Denver area who developed flu-like fever and chills, shortness of breath, and a dry cough, as well as night sweats and weight loss. Four of the patients were hospitalized for three to five days. When cultures from the patients' lungs were collected, the same bacteria were found in the cultures and in the vapor from the hot tubs.

The culprit in this new case is mycobacteria, a type of bacteria that flourishes in warm water and is impervious to standard disinfectant treatments used in pools, such as chlorine and bromine, which are typically used in swimming pools and hot tubs, and are effective at killing most microorganisms.

Although mycobacteria are also found in ordinary tap water, the typical source of water for hot tubs, the health risk is associated with the bubbling process -- particularly if it's an indoor hot tub -- because the organisms are in the steam that is inhaled into the lower airways of the lungs.

Rose and her colleagues identified the illness as an immune system response rather than a true infection. It can't be spread from person to person; instead, exposure to the organism causes the immune system to respond in a way similar to an allergic reaction. On the other hand, it's not an allergy, either, says Rose, a pulmonologist at National Jewish Medical and Research Center in Denver, where she is an associate professor of medicine at the University of Colorado Health Sciences Center.

"It's not like seasonal allergies that cause runny noses. It's a respiratory illness [that affects the entire body], because the organism gets into the deep structures of the lung, where gas exchanges occur," Rose tells WebMD.