Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 2010-2012.

Leah Lande,Donald D Peterson,Richard J Wallace,Elena Iakhiaeva,Rebecca Kwait,David C Alexander,Ravikiran Vasireddy,Joseph O Falkinham,Stephen Olshefsky,Ronit Devon,Myra Williams,Andrew D.S Cameron

doi:10.3201/eid2503.180336

Abstract

Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We investigated MAC colonization of household plumbing in suburban Philadelphia, Pennsylvania, USA. We used variable-number tandem-repeat genotyping and whole-genome sequencing with core genome single-nucleotide variant analysis to compare M. avium from household plumbing biofilms with M. avium isolates from patient respiratory specimens. M. avium was recovered from 30 (81.1%) of 37 households, including 19 (90.5%) of 21 M. avium patient households. For 11 (52.4%) of 21 patients with M. avium disease, isolates recovered from their respiratory and household samples were of the same genotype. Within the same community, 18 (85.7%) of 21 M. avium respiratory isolates genotypically matched household plumbing isolates. Six predominant genotypes were recovered across multiple households and respiratory specimens. M. avium colonizing municipal water and household plumbing may be a substantial source of MAC pulmonary infection.

Highlights

Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control
We used variable-number tandem-repeat (VNTR) and whole-genome sequencing (WGS) to test the hypothesis that household plumbing is a reservoir for Nontuberculous mycobacteria (NTM) and is responsible for some cases of pulmonary MAC infection
Patient Characteristics All 26 patients were female, had nodular bronchiectasis confirmed by computed tomography, and had MAC lung disease as defined by the ATS/IDSA criteria [2]

Summary

Introduction

Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We used variable-number tandemrepeat genotyping and whole-genome sequencing with core genome single-nucleotide variant analysis to compare M. avium from household plumbing biofilms with M. avium isolates from patient respiratory specimens. For 11 (52.4%) of 21 patients with M. avium disease, isolates recovered from their respiratory and household samples were of the same genotype. M. avium colonizing municipal water and household plumbing may be a substantial source of MAC pulmonary infection. Several species of NTM, including members of the Mycobacterium avium complex (MAC), can cause potentially life-threatening pulmonary infections that are difficult to treat [1,2]. We used VNTR and WGS to test the hypothesis that household plumbing is a reservoir for NTM and is responsible for some cases of pulmonary MAC infection

Methods

Results

Conclusion