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Nontuberculous mycobacteria isolations from residents of three counties in North Carolina, 2006 – 2010
Citation:
Hilborn, E, G. Smith, J. Stout, K. Messier, M. Murphy, S. Pfaller, E. Hudgens, J. Maillard, AND Andy Ghio. Nontuberculous mycobacteria isolations from residents of three counties in North Carolina, 2006 – 2010. International Conference on Emerging Infectious Disease, Atlanta, GA, March 08 - 11, 2015.
Impact/Purpose:
Mycobacterium avium represents nontuberculous mycobacteria (NTM) as a group on the Contaminant Candidate List of emerging drinking water contaminants. Neither M. avium nor NTM is a reportable disease in the US and little is known of the public health burden. This work represents the first population-based surveillance of NTM isolations in the southeastern United States, a region believed to be at higher risk for the occurrence of NTM. We find that M. avium is the most common species isolated from clinical specimens and that older persons of white race have higher prevalence of isolation than other races or ages.
Description:
Background: Nontuberculous mycobacteria (NTM) are emerging infections among the elderly and immunocompromised but the epidemiology is poorly characterized. Reports of NTM isolation from clinical specimens is a readily available, if imperfect surrogate for disease prevalence. Methods: We collected reports from clinical laboratories of initial NTM isolation among residents of 3 counties with isolation dates during 2006 – 2010. Demographic data included age, gender, and race. Isolates were characterized by date of isolation, species or complex and site of sample collection. We calculated prevalence per 100,000 persons with 2010 US Census base population data.Results: We identified 1033 unique individuals with NTM isolation during 2006 – 2010. Of these, 51% were male, 46% were ≥60 years of age. Of the 800 with reported race, 66% were white, 23% black and 10% ‘other’. Overall isolation prevalence per 100,000 was 15.9. Prevalence was highest (54.8) in those ≥60 years, and lowest (3.3) among those <20 years. Prevalence among those ≥60 years was highest among whites, 49.3 and ‘other’ race, 45.8. Of 945 isolates of known anatomic origin, 750 (79%) were isolated from respiratory specimens (prevalence 11.5), 5.6% were from sterile sites (0.81), 1.6% from dermal specimens (0.23), and 0.7% from catheters (0.11). Prevalence of sterile site isolation was highest among those 20 – 39 (0.31) and 40 – 59 years (0.35), among those of black race (0.40, vs. 0.28 for whites and 0.06 for ‘other’ race). M. avium complex was most frequently identified among 456/944 (48.3%) of isolates with species identification, comprising 51% of pulmonary and 73% of sterile site isolates. Other species predominated at: dermal sites where M. abscessus comprised 47% of isolates, and catheter sites where M. immunogenum comprised 57% of isolates.Conclusions: This is the first population-based surveillance of NTM isolate reports in the southeastern United States. NTM isolation was highly prevalent from respiratory sites, particularly in older whites, reflecting prior understanding of the epidemiology of NTM pulmonary disease. Sterile site isolation was not rare and likely reflects a combination of disseminated M. avium complex in persons with advanced HIV and a mixture of disseminated NTM infections among persons with other forms of immune compromise. This abstract is of a proposed presentation and does not necessarily reflect EPA policy.