You are here:
*Environmental mycobacteriosis and drinking water: an emerging problem for developed countries
Citation:
HILBORN, E. D. AND A. J. GHIO. *Environmental mycobacteriosis and drinking water: an emerging problem for developed countries. Presented at International Society for Environmental Epidemiology, Dublin, Northern Ireland, IRELAND, August 25 - 29, 2009.
Impact/Purpose:
research results
Description:
Background and Objective: Rates ofpulmonary environmental mycobacteriosis (EM) appear to be increasing among developed countries during the past 20 years. EM is caused by multiple species of pathogenic mycobacteria that have been recovered from soil, water, water aerosols, biofilms and drinking water. Humans acquire infection primarily from environmental sources. Drinking water is one documented source of exposure implicated in human EM colonization and infection, but overall, the epidemiology ofEM is poorly characterized. Our goal is to summarize and describe the evidence to date ofthe risk ofpulmonary EM from exposure to drinking water sources. Methods: We performed a systematic review ofthe peer-reviewed literature. We included only those reports describing an epidemiologic and/or molecular association between human pulmonary EM and drinking water. Results: We identified 43 reports ofpulmonary EM with documented drinking water sources ofexposure. Seventeen (40%) ofthese were associated with nosocomial exposures; 10 isolates from drinking water, 7 isolates from processed or modified drinking water. Fifteen (35%) reports described hot tub exposures. Nine (21%) reports described isolation from home drinking water. Multiple species ofmycobacteria were isolated. Conclusion: Drinking water is a well-established source ofEM. However, this review identified that many reports describe potentialcontamination events associated with modified drinking water quality after the original point ofuse; these include water processing, ice making machines, or drinking water further used for recreation or bathing. The extent ofdetection and reporting bias associated with these published reports is unknown. Population-based studies ofindividuals are needed to further characterize the risk ofEM colonization and infection associated with drinking water exposures. This is an abstract ofa proposed presentation and does not necessarily reflect EPA policy.