Appl Environ Microbiol 65(6): 2492-2496

Occurrence of Nontuberculous Mycobacteria in Environmental Samples

National Exposure Research Laboratory, U.S. Environmental Protection Agency, Cincinnati, Ohio 45268

^{Corresponding author. Mailing address: U.S. Environmental Protection Agency, National Exposure Research Laboratory, 26 W. Martin Luther King Dr., Cincinnati, OH 45268. Phone: (513) 569-7318. Fax: (513) 569-7117. E-mail:}vog.ape.liamape@yrreT.trevoC.

Received 1998 Nov 2; Accepted 1999 Mar 16.

Abstract

Nontuberculous mycobacteria (NTM) are a major cause of opportunistic infection in immunocompromised hosts. Because there is no evidence of person-to-person transmission and NTM have been found in drinking water, the environment is considered a likely source of infection. In this study the widespread occurrence of NTM was examined in drinking water, bottled water, and ice samples. A total of 139 samples were examined for NTM by a membrane filtration culture technique followed by PCR amplification and 16S rRNA sequence determination to identify the isolates. NTM were not detected in bottled water or cisterns but were detected in 54% of the ice samples and 35% of the public drinking-water samples from 21 states. The most frequently occurring isolate was M. mucogenicum (formerly referred to as an M. chelonae-like organism).

Abstract

Attitudes toward the genus Mycobacterium have long been dominated by the belief that Mycobacterium tuberculosis was the only clinically significant species, beginning in 1882 when Koch first described the “tuberkelbazillus.” This organism was so important in public health that for the next 70 or 80 years other acid-fast bacilli found in humans, animals, or the environment were usually dismissed as saprophytes of little consequence (4, 26). Changes in attitudes toward species of mycobacteria other than M. tuberculosis were stimulated by numerous reports in the 1950s and 1960s that acid-fast bacilli had been cultured from pathological materials under circumstances that led some to believe that these organisms may be clinically significant. Searches for mycobacteria in the environment were renewed. Water did not at first assume much importance among the many sources of what became known as “atypical,” “anonymous,” “opportunist,” “tuberculoid,” or “nontuberculous” mycobacteria. Recently, however, there has been increasing evidence that water may be the vehicle by which these organisms infect or colonize the human body.

The nontuberculous mycobacteria (NTM) include those Mycobacterium species that are not members of the Mycobacterium tuberculosis complex. In recent years NTM have emerged as a major cause of opportunistic infections in those who have AIDS. NTM disease in AIDS is caused primarily by M. avium and is second only to AIDS wasting syndrome as the most common cause of death (11). There have been numerous reports showing that NTM can survive, persist, grow, and colonize in drinking water supply systems (6, 7, 23, 24). Without evidence of person-to-person transmission, it is proposed that humans are infected from environmental sources. There have been previous studies examining drinking water supplies in the United States for NTM. Generally, these studies have focused on the occurrence of MAC organisms (M. avium and M. intracellulare) only and examined samples from a limited geographical area, i.e., Boston (6), Los Angeles (9), and the northeastern United States (24). The present study examined samples from widely dispersed drinking water utilities and other environmental samples to determine not only the occurrence of MAC organisms but also of other NTM which may be clinically significant.

(This study was presented in part at the 97th General Meeting of the American Society for Microbiology, Miami, Fla., May 4 to 8, 1997 [4a].)

ACKNOWLEDGMENTS

We thank Suzanne Christ (USEPA) for her technical assistance with the fluorescence image analyzer and the state and USEPA microbiologists who assisted with sample collection.

ACKNOWLEDGMENTS

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