Nontuberculous Mycobacterial Disease Following Hot Tub Exposure

Mangione, Ellen J.; Huitt, Gwen A.; Lenaway, Dennis; Beebe, James L.; Bailey, Ann; Figoski, Mary; Rau, Michael P.; Albrecht, Kurt D.; Yakrus, Mitchell A.

doi:10.3201/eid0706.010623

Cited by 108 publications

(85 citation statements)

References 26 publications

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“…A number of case reports attribute pulmonary disease to hot-tub use, when organisms may be readily aerosolized. 3 Historically, NTM have been a cause of serious disease in immunocompromised hosts. In contrast, healthy pediatric hosts have mild infection, such as superficial adenopathy or cutaneous lesions.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic Disease From Nontuberculous Mycobacteria in Children: Two Cases and a Review of the Literature

2003

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Section: Discussionmentioning

confidence: 99%

Intrathoracic Disease From Nontuberculous Mycobacteria in Children: Two Cases and a Review of the Literature

2003

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“…NTM are ubiquitous in the environment, frequently detected in soil and water samples as well as in biofilms that form in municipal water sources (1). Exposure is typically believed to originate from exposure to environmental sources (2). Although severe infection can affect the lymph nodes, skin, soft tissues, bones, and joints, the vast majority of disease is pulmonary (3).…”

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confidence: 99%

Prevalence of Nontuberculous Mycobacterial Lung Disease in U.S. Medicare Beneficiaries

Adjemian

Olivier

Seitz

et al. 2012

Am J Respir Crit Care Med

594

466

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Rationale: Pulmonary nontuberculous mycobacteria (PNTM) are an important cause of morbidity among older adults in the United States, but national prevalence estimates are lacking. Objectives: To describe the prevalence and trends of PNTM disease among adults aged 65 years or older throughout the United States. Methods: A nationally representative 5% sample of Medicare Part B beneficiaries was analyzed from 1997 to 2007. Demographic and medical claims data were compiled and prevalence estimates for PNTM and selected comorbidities were calculated and trends over time evaluated. Logistic regression was used to identify demographic and geographic factors associated with PNTM. Measurements and Main Results: From 1997 to 2007, the annual prevalence significantly increased from 20 to 47 cases/100,000 persons, or 8.2% per year. The period prevalence was 112 cases/100,000 persons, although prevalence was twofold higher among Asians/Pacific Islanders than among whites (228 vs. 116 cases/100,000 persons). Western states had the highest period prevalence at 149 cases/ 100,000 persons, with Hawaii having the highest prevalence at 396 cases/100,000 persons, followed by southeastern states, which had a period prevalence of 131 cases/100,000 persons. PNTM cases had more comorbid conditions than noncases and were 40% more likely to die than noncases. Women were 1.4 times more likely to be a PNTM case than men. Relative to whites, Asians/Pacific Islanders were twice as likely to be a case, whereas blacks were half as likely. Conclusions: The prevalence of PNTM is increasing across all regions of the United States and among both men and women. Significant racial/ethnic and geographic differences suggest important geneenvironment interactions.Keywords: nontuberculous mycobacteria; pulmonary; epidemiology; prevalence; United States Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of morbidity in the United States. NTM are ubiquitous in the environment, frequently detected in soil and water samples as well as in biofilms that form in municipal water sources (1). Exposure is typically believed to originate from exposure to environmental sources (2). Although severe infection can affect the lymph nodes, skin, soft tissues, bones, and joints, the vast majority of disease is pulmonary (3). More than 140 NTM species have been identified, although approximately 80% of pulmonary NTM (PNTM) infections in the United States are associated with Mycobacterium avium complex, and prevalence varies by geographic region (4).Recent studies suggest that the prevalence of PNTM disease is increasing throughout the United States (4, 5), especially among older adults (4, 5). Women appear to bear a disproportionate burden of PNTM disease (4, 6), with several studies identifying physical correlates of risk for PNTM (7). Although the increased risk of PNTM among older adults is well established, disease prevalence estimates vary widely by geographic region. Characterizing PNTM disease distribution by region, sex, age,...

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“…Infection with NTM is typically thought to result from environmental exposures, including soil and water sources (2). Although individual host susceptibility is important to disease risk (1,3,4), geographic variation in prevalence is largely a function of environmental and climatic factors (1,5).…”

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confidence: 99%

Nontuberculous Mycobacteria among Patients with Cystic Fibrosis in the United States. Screening Practices and Environmental Risk

Adjemian

Olivier

Prevots

2014

Am J Respir Crit Care Med

127

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Rationale: Persons with cystic fibrosis (CF) are at greater risk of nontuberculous mycobacterial (NTM) infections than the general population. However, among patients with CF, geographic variation in prevalence is poorly understood.Objectives: To describe the prevalence and screening practices of NTM among U.S. patients with CF.Methods: CF Patient Registry data from 2010-2011 were obtained to estimate the prevalence of NTM among patients with CF 12 years of age or older by state. Climatic data were also obtained and predictors of NTM infection analyzed using regression analysis. Geographic clustering and mycobacterial culture rates by state were also assessed.Measurements and Main Results: Among patients with CF 12 years of age or older, 58% had mycobacterial cultures; 14% were positive for NTM. Most states (n = 31) had a prevalence of 10-20%; seven states predominantly in the West and Southeast had a prevalence of 20% or greater, including Alaska, which cultured patients more frequently than any other state. Nearly 60% of positive cultures were for Mycobacterium avium complex, although this ranged by state, from 29% in Louisiana to 100% for Nebraska/Delaware. Significant (P , 0.002) spatial clustering of NTM was detected, centering in Wisconsin, Arizona, Florida, and Maryland. Higher saturated vapor pressure increased risk for NTM (odds ratio = 1.06; 95% confidence interval = 1.02-1.10). The proportion of patients cultured for mycobacteria varied greatly by state of residence (median = 46%; range = 9-73%).Conclusions: NTM prevalence varies significantly among patients with CF by geographic area, and is largely influenced by environmental factors. However, NTM culture practices vary greatly, with some high-prevalence states screening less than 25% annually. Routine screening for all patients with CF is needed for timely detection.Keywords: nontuberculous mycobacteria; pulmonary; epidemiology; cystic fibrosis; spatial At a Glance CommentaryScientific Knowledge on the Subject: Individuals with cystic fibrosis (CF) are at significantly greater risk of acquiring nontuberculous mycobacterial (NTM) infections than the general population. However, among patients with CF, geographic variation in prevalence across the United States is poorly understood.What This Study Adds to the Field: NTM prevalence varies significantly among patients with CF by geographic area, and appears to be largely influenced by environmental factors. However, NTM screening practices also vary greatly by state, with some high-prevalence states only routinely culturing less than one-quarter of their patients with CF for mycobacteria. Correspondence and requests for reprints should be addressed to Jennifer Adjemian, Ph.D., Quarters 15 B-1,

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Nontuberculous Mycobacterial Disease Following Hot Tub Exposure

Cited by 108 publications

References 26 publications

Intrathoracic Disease From Nontuberculous Mycobacteria in Children: Two Cases and a Review of the Literature

Intrathoracic Disease From Nontuberculous Mycobacteria in Children: Two Cases and a Review of the Literature

Prevalence of Nontuberculous Mycobacterial Lung Disease in U.S. Medicare Beneficiaries

Nontuberculous Mycobacteria among Patients with Cystic Fibrosis in the United States. Screening Practices and Environmental Risk

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