title: Prolonged respiratory illness after single overnight continuous positive airway pressure humidification: endotoxin as the suspect.
abstract: A patient developed a prolonged respiratory illness after a single overnight use of tap water to humidify air supplied by a constant positive airway pressure (CPAP) device, which she had previously used for six years without difficulty. During those years, she used only distilled water for this purpose, as instructed by her sleep specialist. Analysis of the well water supplying her home showed no microorganisms, metals or other analytes likely to have caused her illness, but endotoxin was found at concentrations well above that recommended by the U.S. Pharmacopeia, as a maximum in water which may be inhaled as an aerosol.
authors.affiliation: Carolinas Health Care System, Charlotte, NC 28232, USA. Larry.Raymond@carolinashealthcare.org
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Raymond
authors.forename: John E
authors.initials: JE
authors.lastname: Barkley
authors.forename: Ricky
authors.initials: R
authors.lastname: Langley
authors.forename: Robert
authors.initials: R
authors.lastname: Sautter
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects* / Q000295:instrumentation; D003371:Cough / Q000382:microbiology*; D004417:Dyspnea / Q000382:microbiology; D004731:Endotoxins / Q000009:adverse effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006095:Gram-Positive Cocci / Q000302:isolation & purification*; D006801:Humans; D006813:Humidity; D008875:Middle Aged; D012129:Respiratory Function Tests; D014881:Water Supply / Q000592:standards*
chemical_list: D004731:Endotoxins