Nontuberculous mycobacteria in tap water.
Article Type: Letter to the editor
Subject: Drinking water (Health aspects)
Mycobacteria (Health aspects)
Mycobacteria (Research)
Mycobacterium (Health aspects)
Mycobacterium (Research)
Lung diseases (Causes of)
Lung diseases (Diagnosis)
Lung diseases (Research)
Authors: Hernandez-Garduho, Eduardo
Elwood, Kevin
Pub Date: 02/01/2012
Publication: Name: Emerging Infectious Diseases Publisher: U.S. National Center for Infectious Diseases Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 U.S. National Center for Infectious Diseases ISSN: 1080-6040
Issue: Date: Feb, 2012 Source Volume: 18 Source Issue: 2
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 281175430
Full Text: To the Editor: A recently published study by Falkinham (1) showed that 17 (46%) of 37 households were contaminated with nontuberculous mycobacteria (NTM) of the same species as those found in patients with lung disease and that 7 (41%) of 17 had the same DNA fingerprint as the patient. One patient's isolate from sputum matched the isolate found in the shower water. Therefore, the patient's lung disease was likely acquired by inhalation of aerosols while showering. An isolate from another patient matched the isolate found in tap water. If the patient drank the contaminated water, Mycobacteria avium may have reached the lungs by aspiration because 26% of patients with NTM lung disease have been found to experience gastroesophageal reflux disease (GERD) (2). Even if none of these scenarios was present, however, NTM patient contamination of samples is still likely. Six of the 7 matching households had water heater temperatures [less than or equal to] 125[degrees]C, indicating a negative correlation between NTM growth and temperature. Most M. avium and M. intracellulare are killed in <5 seconds (3) when exposed to 70oC; thus, all NTM species would likely be killed a few seconds after water reached the boiling point.

In a recent study, we have shown that Canadian-born persons from ethnic groups from eastern and Southeast Asia were less likely to be colonized with M. avium complex than were other ethnic groups (4). We hypothesized that boiling water before consumption, a common practice in persons from Asia, may have partially protected them against pulmonary colonization. Another protective factor is the low prevalence of GERD in persons from Asia (<7%) (5), compared with 19.8% in white persons from Olmstead County, Minnesota, USA. Future studies like that of Falkinham are needed to determine routes of transmission. Factors to investigate in such studies include the ethnicity of participants and associated predisposing disorders, particularly GERD; culturing of gastric washings; handwashing frequency; and water consumption habits (whether drinking from the bottle, from the tap, or after boiling).

Eduardo Hernandez-Garduho and Kevin Elwood

Author affiliations: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada



Address for correspondence: Eduardo Hernandez-Garduno, British Columbia Centre for Disease Control, TB Control, 1063-655 W 12th Ave, Vancouver, British Columbia V5Z 4R4, Canada; email: investigador.tuberculosis@

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(2.) Koh WJ, Lee JH, Kwon YS. Prevalence of gastroesophageal reflux disease in patients with nontuberculous mycobacterial disease. Chest. 2007;131:1825-30. http://

(3.) Schulze-Robbecke R, Buchholtz K. Heat susceptibility of aquatic mycobacteria. Appl Environ Microbiol. 1992;58:1869 73.

(4.) Hernandez-Garduno E, Elwood RK. Demographic risk factors of pulmonary colonization by non-tuberculous mycobacteria. Int J Tuberc Lung Dis. 2010;14:106-12.

(5.) Wong BC, Kinoshita Y. Systematic review on epidemiology of gastroesophageal reflux disease in Asia. Clin Gastroenterol Hepatol. 2006;4:398-407. http://dx.doi. org/10.1016/j.cgh.2005.10.011
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