jueves, 27 de septiembre de 2012

Nontuberculous Mycobacteria in Household Plumbing as Possible Cause of Chronic Rhinosinusitis - - Emerging Infectious Disease journal - CDC

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Nontuberculous Mycobacteria in Household Plumbing as Possible Cause of Chronic Rhinosinusitis - - Emerging Infectious Disease journal - CDC


Research

Nontuberculous Mycobacteria in Household Plumbing as Possible Cause of Chronic Rhinosinusitis

Wellington S. Tichenor1Comments to Author , Jennifer Thurlow1, Steven McNulty, Barbara A. Brown-Elliott, Richard J. Wallace, and Joseph O. Falkinham
Author affiliations: The Center for Allergy, Asthma and Sinusitis, New York, New York, USA (W.S. Tichenor, J. Thurlow); New York Medical College, Valhalla, New York (W.S. Tichenor); University of Texas Health Science Center, Tyler, Texas, USA (S. NcNulty, B.A. Brown-Elliott, R.J. Wallace, Jr.); Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA (J.O. Falkinham III)

Abstract

Symptoms of chronic rhinosinusitis (CRS) often persist despite treatment. Because nontuberculous mycobacteria (NTM) are resistant to commonly used antimicrobial drugs and are found in drinking water that patients may use for sinus irrigation, we investigated whether some CRS patients were infected with NTM in New York, New York, USA, during 2001–2011. Two approaches were chosen: 1) records of NTM-infected CRS patients were reviewed to identify common features of infection and Mycobacterium species; 2) samples from plumbing in households of 8 NTM-infected patients were cultured for NTM presence. In 3 households sampled, M. avium sharing rep-PCR and pulsed field gel electrophoresis fingerprints identified M. avium isolates clonally related to the patients’ isolates. We conclude that patients with treatment-resistant CRS may be infected with NTM and should have cultures performed for NTM so appropriate therapy can be instituted. In addition, the results suggest that CRS patients can be infected by NTM in their household plumbing.
A subset of patients with chronic rhinosinusitis (CRS) often experience persistent symptoms, despite undergoing many medical and surgical modes of treatment. Current theories regarding the cause of CRS include immunologic reactions to microorganisms (1,2). Even though they receive various treatments, including antimicrobial drugs and sinus irrigation, many patients continue to be symptomatic (2). One possible reason for the persistence of symptoms is the presence of microorganisms that are resistant to typically prescribed antimicrobial drugs, for example, nontuberculous mycobacteria (NTM).
Recovery of NTM from the sinus cavity has been documented in 19 patients, including those with cystic fibrosis (3), HIV infection (410), and diabetes (11). NTM isolation from the sinus cavity has been rarely reported in immunocompetent, nondiabetic patients who do not have cystic fibrosis (1215). One case of infection with NTM is documented in a study by Spring and Miller (14). The patient had a 21-year history of rhinosinusitis and exhibited left maxillary facial pain, nasal discharge, and congestion. Mycobacterium chelonae, Staphylococcus aureus, and Pseudomonas aeruginosa were recovered from sinus cultures. Successful treatment ultimately required a 3-year course of multiple intravenous antimicrobial drug combinations and subsequent sinus operations (14). Recently, a new member of the M. abscessus-chelonae complex, M. franklinii, was isolated from patients in the northeastern United States who have chronic sinusitis (16).
NTM are environmental opportunistic pathogens found in natural and human-engineered waters, including drinking water distribution systems (17) and household plumbing (1820). NTM species can be classified into 2 groups on the basis of growth rates; rapidly growing mycobacteria (e.g., M. chelonae and M. abscessus) form colonies in <7 37="37" and="and" at="at" days="days" e.g.="e.g." growing="growing" mycobacteria="mycobacteria" slowly="slowly">M. avium
and M. intracellulare) take >7 days at 37°C to form colonies. Because NTM are resistant to commonly used antimicrobial drugs (21) and are found in drinking water, they might be responsible for antimicrobial drug–resistant, chronic rhinosinusitis. We report the isolation, identification, and fingerprinting of NTM isolates from patients with CRS and from their household plumbing.

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