Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 2010-2012

Abstract

Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We investigated MAC colonization of household plumbing in suburban Philadelphia, Pennsylvania, USA. We used variable-number tandem-repeat genotyping and whole-genome sequencing with core genome single-nucleotide variant analysis to compare M. avium from household plumbing biofilms with M. avium isolates from patient respiratory specimens. M. avium was recovered from 30 (81.1%) of 37 households, including 19 (90.5%) of 21 M. avium patient households. For 11 (52.4%) of 21 patients with M. avium disease, isolates recovered from their respiratory and household samples were of the same genotype. Within the same community, 18 (85.7%) of 21 M. avium respiratory isolates genotypically matched household plumbing isolates. Six predominant genotypes were recovered across multiple households and respiratory specimens. M. avium colonizing municipal water and household plumbing may be a substantial source of MAC pulmonary infection.

Keywords: Mycobacterium avium; Mycobacterium avium water; Nontuberculous mycobacteria; Pennsylvania; Philadelphia; United States; VNTR; bacteria; genome sequencing; household biofilms; tuberculosis and other mycobacteria.

Figure

Area of study of Mycobacterium avium in community and household water, Philadelphia, Pennsylvania, USA, 2010–2012. The 26 patients (black tags) and 11 controls (gray tags) lived in suburban Philadelphia (Montgomery and Delaware Counties). White dot symbol in upper left indicates 3 patients who lived in the same apartment building. Star indicates patient and control households in very close proximity. All households were supplied by water that came from the Schuylkill River and was processed by the same water treatment plant.