f Recent studies have shown that respiratory isolates from pulmonary disease patients and household water/biofilm isolates of Mycobacterium avium could be matched by DNA fingerprinting. To determine if this is true for Mycobacterium intracellulare, household water sources for 36 patients with Mycobacterium avium complex (MAC) lung disease were evaluated. MAC household water isolates from three published studies that included 37 additional MAC respiratory disease patients were also evaluated. Species identification was done initially using nonsequencing methods with confirmation by internal transcribed spacer (ITS) and/or partial 16S rRNA gene sequencing. M. intracellulare was identified by nonsequencing methods in 54 respiratory cultures and 41 household water/biofilm samples. By ITS sequencing, 49 (90.7%) respiratory isolates were M. intracellulare and 4 (7.4%) were Mycobacterium chimaera. In contrast, 30 (73%) household water samples were M. chimaera, 8 (20%) were other MAC X species (i.e., isolates positive with a MAC probe but negative with species-specific M. avium and M. intracellulare probes), and 3 (7%) were M. avium; none were M. intracellulare. In comparison, M. avium was recovered from 141 water/biofilm samples. These results indicate that M. intracellulare lung disease in the United States is acquired from environmental sources other than household water. Nonsequencing methods for identification of nontuberculous mycobacteria (including those of the MAC) might fail to distinguish closely related species (such as M. intracellulare and M. chimaera). This is the first report of M. chimaera recovery from household water. The study underscores the importance of taxonomy and distinguishing the many species and subspecies of the MAC. P revious studies have suggested household water (especially from bathroom showers) as a source of the Mycobacterium avium complex (MAC), which causes chronic lung disease (1, 2, 3, 4, 5). Both M. avium and M. intracellulare have been recovered from sputum, sinus, and household or potable water samples in multiple countries, including the United States and Japan (1, 4-8). In the majority of these studies, either hybridization probe methods (AccuProbe; Hologic Gen-Probe, Inc., San Diego, CA) or a multiplex 16S rRNA gene PCR was used for identification (1, 5, 9, 10). Isolates positive with the MAC probe but negative with the species-specific M. avium and M. intracellulare probes are collectively referred to as MAC X species.Currently We recently completed a study of variable-number tandemrepeat (VNTR) typing of clinical isolates of M. intracellulare using ITS sequencing to confirm the species designation (7). We then began household water biofilm studies for some of our patients and performed species identification and VNTR genotyping for MAC isolates as needed.Preliminary studies suggested that respiratory isolates of M. intracellulare indeed belonged to that species based on ITS sequencing (7) but that biofilm isolates thought to be M. intracellulare were actually M. chimaera ...

Millions of Americans live with chronic sinus infection. Most infections are caused by either bacteria or fungi. Some of these infections can be hard to treat, eluding medical and surgical treatment and persisting for months or even years. A recent study in New York found that some patients with a chronic sinus infection had tuberculosis-like organisms (mycobacteria) in their sinuses and that the same organisms were also in the tap water at their homes. These mycobacteria can be resistant to commonly used antimicrobial drugs. Doctors should check for mycobacteria in patients with treatment-resistant sinus infection. Patients who flush their sinuses at home should use sterile saline, not tap water.

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Home i.v. antibiotics provide an excellent alternative to surgery for patients who have either had unsuccessful surgery or who have refused surgery.