Environmental risk of nontuberculous mycobacterial infection: Strategies for advancing methodology

Mercaldo, Rachel A.; Marshall, Julia E.; Cangelosi, Gerard A.; Donohue, Maura J.; Falkinham, Joseph O.; Fierer, Noah; French, Joshua P.; Gebert, Matthew J.; Honda, Jennifer R.; Lipner, Ettie M.; Marras, Theodore K.; Morimoto, Kozo; Stout, Janet E.; Thomson, Rachel; Prevots, D. Rebecca

doi:10.1016/j.tube.2023.102305

Cited by 11 publications

(3 citation statements)

References 48 publications

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“…At present, NTM is not a reportable disease in most states. Of the 14 states that report NTM in some form, 4 report only extrapulmonary, 2 report extrapulmonary and pulmonary NTM, and 8 report NTM but do not specify specimen type or NTM species [ 17 ]. Commercial laboratory networks, such as Labcorp, offer the possibility of analyzing NTM testing data in real-time.…”

Section: Discussionmentioning

confidence: 99%

“…Population-based data for pulmonary NTM infection and disease prevalence in the general population are limited because fewer than 20 states include NTM infection as a reportable condition [ 17 ]. Of the states that collect data on NTM, few differentiate between extrapulmonary and pulmonary NTM or collect species data [ 17 ]. NTM species identification is critical to informing clinical care because different species of NTM require different course of treatment [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Nontuberculous mycobacteria testing and culture positivity in the United States

Marshall,

Mercaldo,

Lipner

et al. 2024

BMC Infect Dis

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Background Nontuberculous mycobacteria (NTM) are environmental bacteria which may cause chronic lung disease. The prevalence of NTM pulmonary infection and disease has been increasing in the United States and globally. The predominant clinically relevant species of NTM in the United States are Mycobacterium avium complex (MAC) species and Mycobacterium abscessus. With the development of rapid species identification methods for NTM (e.g. PCR probes), more testing for NTM is being conducted through commercial labs, such as Laboratory Corporation of America (Labcorp), which provides deidentified real-time testing data to the Centers for Disease Control (CDC) pursuant to a data sharing agreement. Because NTM lung infections are not reportable in most states, other data sources are key to understanding NTM testing patterns, positivity rates, and species distributions to track infection trends and identify clinical care needs. Methods We obtained national Labcorp data for the period January 2019 through mid-April 2022. We subset the data to only respiratory samples sent for Acid Fast Bacilli (AFB) cultures. NTM positive results were defined as those which identified an NTM species and are not Mycobacterium tuberculosis, Mycobacterium bovis, or Mycobacterium gordonae. Results Overall, 112,528 respiratory samples were sent for AFB testing during the study period; 26.3% were from the Southeast U.S., identified as HSS Region IV in the Labcorp dataset, and 23.0% were from the Pacific and South Pacific region (Region IX). The culture positive prevalence ranged from 20.2% in the Southeast to 9.2% in the East North Central region (Region V). In the Southeast US, M. abscessus prevalence was 4.0%. For MAC, the highest prevalence was observed in the Mountain region (Region VII) (13.5%) and the lowest proportion was in the East South Central region (7.3%, Region III). Among positive tests, the proportion which was MAC varied from 61.8% to 88.9% and was highest in the Northeast U.S. The proportion of positive samples which were M. abscessus ranged from 3.8% to 19.7% and was highest in the Southeast. Conclusions The Southeastern region of the U.S. has the highest rate of culture positivity in Labcorp tests for total NTM and, of all positive tests, the highest proportion of M.abscessus. These estimates may underrepresent the true number of M.abscessus infections because M. absesscus-specific probes are not commercially available and not all NTM testing in the United States is done by Labcorp. Analysis of real-time testing data from commercial laboratories may provide insights into risk factors for NTM culture positivity in ‘hotspot’ areas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nontuberculous mycobacteria testing and culture positivity in the United States

Marshall,

Mercaldo,

Lipner

et al. 2024

BMC Infect Dis

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“…The Council of State and Territorial Epidemiologists has a standardized case definition for extrapulmonary NTM infections (opportunistic infections of wounds, soft tissue, or joints) to ensure consistency in reporting, and to identify outbreaks (26). NTM case reporting, and definitions vary across state and local public health departments, with certain departments reporting pulmonary and extrapulmonary, extrapulmonary only, or NTM site and species not specified (27)(28)(29). Health departments could consider making extrapulmonary NTM infections reportable within their jurisdictions (26).…”

Section: Future Directionsmentioning

confidence: 99%

Surveillance of Waterborne Disease Outbreaks Associated with Drinking Water — United States, 2015–2020

Kunz,

Lawinger,

Miko

et al. 2024

MMWR Surveill. Summ.

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Problem/Condition: Public health agencies in U.S. states, territories, and freely associated states investigate and voluntarily report waterborne disease outbreaks to CDC through the National Outbreak Reporting System (NORS). This report summarizes NORS drinking water outbreak epidemiologic, laboratory, and environmental data, including data for both public and private drinking water systems. The report presents outbreak-contributing factors (i.e., practices and factors that lead to outbreaks) and, for the first time, categorizes outbreaks as biofilm pathogen or enteric illness associated.

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