Abstract
Seminal microbiological work of environmental nontuberculous mycobacteria (NTM) includes the discovery that NTM inhabit water distribution systems and soil, and that the species of NTM found are geographically diverse. It is likely that patients acquire their infections from repeated exposures to their environments, based on the well-accepted paradigm that water and soil bioaerosols – enriched for NTM – can be inhaled into the lungs. Support comes from reports demonstrating NTM isolated from the lungs of patients are genetically identical to NTM found in their environment. Well documented sources of NTM include peat-rich soils, natural waters, drinking water, hot water heaters, refrigerator taps, catheters, and environmental amoeba. However, NTM have also been recovered in biofilms from ice machines, heated nebulizers, and heater-cooler units, as well as seat dust from theaters, vacuum cleaners, and cobwebs. New studies on the horizon aim to significantly expand the current knowledge of environmental NTM niches in order to improve our current understanding of the specific ecological factors driving the emergence of NTM lung disease. Specifically, the Hawaiian Island environment is currently being studied as a model to identify other point sources of exposure as it is the U.S. state with the highest number of NTM lung disease cases. Because of its geographic isolation and unique ecosystem, the Hawaiian environment is being probed for correlative factors that may promote environmental NTM colonization.
Highlights
Nontuberculous mycobacteria (NTM) and their environments are intricately bound
The interaction of humans with their natural and built environments along with changes humans make to their environment, and differences in the robustness of human health may impact the emergence of infectious diseases
Because NTM are found in the environment, it is plausible that these bacteria were historically aerosolized from soil with increased fire-making, infecting human lungs already impacted by long-term exposure to campfire smoke
Summary
Nontuberculous mycobacteria (NTM) and their environments are intricately bound. NTM share these environments with humans and domesticated animals and repeated exposure is a wellaccepted mode of acquiring these infections. Nontuberculous Mycobacteria, Environment specific factors facilitating their acquisition remains poorly characterized. These factors encompass (i) varied sources of infection, (ii) modes of aquisition, and (iii) other physical aspects of the environment such as temperature, humidity, air exchange, surface types, and turbulence created by wind and natural disasters, and (iv) human behaviors, the combination of which are likely to be relatively unique among affected individuals (Honda et al, 2015; Nishiuchi et al, 2017). We summarize previous studies that link ecological factors with risk for infection and epidemiological information. We introduce new, ongoing work to study the particular environmental drivers of NTM emergence in Hawai’i, a geographic location deemed a major hot spot for NTM-LD
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