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.

Figure 1

rep-PCR fingerprint patterns of patient and household isolates, New York, New York, USA, 2001-2011. Lane 1, 100-bp ladder; lane 2, patient no. 5 Mycobacterium avium isolate AG-P-1; lane 3, patient no. 5 household filter M. avium isolate AG-F-2–0-2; lane 4, patient no. 5 household filter M. avium isolate AG-F-2-I-1; lane 5, patient no. 6 M. avium complex “X” cluster (MAC-X) isolate GG-P-1; lane 6, patient no. 6 household swab M. chimaera isolate GG-Sw-9–1; lane 7, patient no. 8 M. avium isolate GW-P-1; lane 8, patient no. 8 household water M. avium isolate GW-W-1–1; lane 9, patient no. 8 household swab M avium isolate GW-Sw-7–2; lane 10, patient no. 2 M. avium isolate BB-P-1; lane 11, patient no. 2 household water M. avium isolate BB-W-4–5; lane 12, 100-bp ladder.

Figure 2

Pulsed-field gel electrophoresis (PFGE) of AseI digest patterns of patient and household isolates, New York, New York, USA, 2001–2011. A) Patient and household isolates. Lane 1, λ ladder; lane 2, patient no. 5 Mycobacterium avium isolate AG-P-1; lane 3, patient no. 5 household filter M. avium isolate AG-F-2-0-2; lane 4, patient no. 5 household filter M. avium isolate AG-F-2-I-1 (environmental isolates in lanes 3 and 4 are indistinguishable; patient isolate in lane 2 considered clonal with 2 environmental isolates [6 bands difference]); with digestion with XbaI, the 3 were considered closely related.); lane 5, patient no. 6 M. avium complex “X” cluster (MAC-X) isolate GG-P-1; lane 6, patient no. 6 household swab M. chimaera isolate GG-Sw-9–1 (despite overall similarity, isolates in lanes 5 and 6 belong to different species and differ by 10 bands and are therefore unrelated). B) Additional patient and isolate from the person’s household. Lane 1, patient no. 2 M. avium isolate BB-P-1; lane 2, patient no. 2 household water M. avium isolate BB-W-4–5; lane 3, λ ladder.