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
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.Recovery of NTM from the sinus cavity has been documented in 19 patients, including those with cystic fibrosis (3), HIV infection (4–10), and diabetes (11). NTM isolation from the sinus cavity has been rarely reported in immunocompetent, nondiabetic patients who do not have cystic fibrosis (12–15). 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 (18–20). 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. avium7>
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