Water Bugs in Mist Tents

L. J. Janchar of Marion, Ohio, wrote: "In PEDIATRICS IN REVIEW, July 1980 (p 29), in regard to the article `Mist Tent for Cystic Fibrosis' you state that " mist therapy increases the risk of `water-bug' infection (Pseudomonas, Serratia, etc)..."I have often heard this comment but I have seen no literature in regard to evidence supporting this statement. Could you please furnish me with references in regard to the risk of infection secondary to mist therapy?" Dr Rapkin (author of the abstract) replied: "In July 1967, Dr Hugh Moffet and colleagues in a series of three articles described the association of infection and inhalation therapy. The titles of the articles are revealing: "Bacteria recovered from distilled water and inhalation therapy equipment"; `Survival and dissemination of bacteria in nebulizers and incubators'; `Colonization of infants exposed to bacterially contaminated mists' (Am J Dis Child 114:7, 13, 21, 1967). Previously Hoffman and Finberg (J Pediatr 46:626, 1955) had made the association between water and infection. Much subsequent data have been accumulated and the bibliography is long and detailed. The conclusions have been the same as Moffet's: mist therapy and use of inhalationtherapy apparatus poses an additional risk which must be carefully weighed against the benefit of the therapy to the patient.