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Correspondence |

A Patient-Based Analysis of the Geographic Distribution of Mycobacterium avium complex, Mycobacterium abscessus, and Mycobacterium kansasii Infections in the United States FREE TO VIEW

Mehdi Mirsaeidi, MD, MPH; Ann Vu, MD; Philip Leitman, MBA; Arash Sharifi, PhD; Susan Wisliceny; Amy Leitman, JD; Andreas Schmid, MD; Michael Campos, MD; Joe Falkinham, PhD; Matthias Salathe, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami, Miami, FL

bNTM Info & Research, Virginia Tech, Coral Gables, FL

cDepartment of Biological Sciences, Virginia Tech, Blacksburg, VA

CORRESPONDENCE TO: Mehdi Mirsaeidi, MD, MPH, Division of Pulmonary and Critical Care, Miller School of Medicine, University of Miami, 1600 NW 10th Ave, #7060A, Miami, FL 33136


Copyright 2017, . All Rights Reserved.


Chest. 2017;151(4):947-950. doi:10.1016/j.chest.2017.02.013
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Nontuberculous mycobacteria (NTM) are ubiquitous and prevalent in the environment. The prevalence of NTM among the elderly is 47 patients per 100,000 people.,

There is a lack of information on NTM species distribution on a state-by-state level in the United States. Here, we present data on the geographic distribution of pulmonary Mycobacterium avium complex (MAC), Mycobacterium abscessus, and Mycobacterium kansasii infections in the United States.

We conducted a patient-centered, cross-sectional study via online survey that was distributed to patients who had received a diagnosis of pulmonary NTM. All data were collected between January and March 2016, using the NTM Info & Research, Inc. website (NTMinfo.org). Heat map figures were generated to provide data on the density of distribution for the most commonly reported NTM isolates across the various states. The data grid was based on the geographic coordinates of each subject’s city of residence and was generated by the Kriging method and available US mainland data.

Five hundred and thirty-seven subjects from 46 US states responded to the survey. The mean age was 66.9 years (range, 13 to 91 years), and 95% of the study participants were female. Previous treatment for NTM was reported in 259 (48%), active anti-NTM therapy in 139 (26%), and no treatment in 139 (26%). Five states had the highest number of respondents (n = 268, or 50%), including the following: Florida, 85 (15.8%); California, 61 (11.3%); New York, 52 (9.7%); Texas, 36 (6.7%); and Pennsylvania, 34 (6.3%).

All respondents reported their isolated Mycobacterium species. Seven hundred and twenty-eight isolates were reported as some subjects reported being infected with more than one species. Table 1 shows the data of NTM-infected subjects and their mycobacterial species by state. Figures 1 and 2 show the distribution of MAC- and M abscessus-infected subjects at the state level.

Table Graphic Jump Location
Table 1 Number and Percentage of Subjects With Positive Results for MAC, M abscessus, and M kansasii Infection Relative to the Total Number of Subjects With Nontuberculous Mycobacterial Infection by State

M = Mycobacterium; MAC = Mycobacterium avium complex.

Figure Jump LinkFigure 1 Heat map depicting the percentage of subjects with Mycobacterium avium complex (MAC) infection across the United States, reported as the percentage of subjects with positive results for MAC relative to the total number of nontuberculous mycobacteria-infected subjects at the state level.Grahic Jump Location

Figure Jump LinkFigure 2 Heat map depicting the percentage of Mycobacterium abscessus-infected subjects across the United States, reported as the percentage of subjects with positive results for M abscessus infection relative to the total number of nontuberculous mycobacteria-infected subjects at the state level.Grahic Jump Location

Limited studies previously described the distribution of MAC, M abscessus, and M kansasii infection in individual states in the United States. We present new data mapping self-reported NTM infections confirming the coastal predominance of NTM. The higher frequency of NTM infection in these areas supports observations that very high numbers of NTM are present in coastal swamps and estuaries. This observed difference may be due to environmental factors such as water characteristics and geochemical differences in soil composition.

These data will help to improve the detection of NTM disease in the United States and enhance our knowledge of disease patterns. Detecting the geographic cluster of pathogenic NTM strains in the United States will help us to improve our preventive measures for those with underlying pulmonary disorders such as bronchiectasis.

Falkinham J.O. III. Environmental sources of nontuberculous mycobacteria. Clin Chest Med. 2015;36:35-41 [PubMed]journal. [CrossRef] [PubMed]
 
Adjemian J. .Olivier K.N. .Seitz A.E. .Holland S.M. .Prevots D.R. . Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med. 2012;185:881-886 [PubMed]journal. [CrossRef] [PubMed]
 
Adjemian J. .Olivier K.N. .Seitz A.E. .Falkinham J.O. III.Holland S.M. .Prevots D.R. . Spatial clusters of nontuberculous mycobacterial lung disease in the United States. Am J Respir Crit Care Med. 2012;186:553-558 [PubMed]journal. [CrossRef] [PubMed]
 
Kirschner R.A. Jr..Parker B.C. .Falkinham J.O. III. Epidemiology of infection by nontuberculous mycobacteria: Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium scrofulaceum in acid, brown-water swamps of the southeastern United States and their association with environmental variables. Am Rev Respir Dis. 1992;145:271-275 [PubMed]journal. [CrossRef] [PubMed]
 
Falkinham J.O. III.Parker B.C. .Gruft H. . Epidemiology of infection by nontuberculous mycobacteria. I. Geographic distribution in the eastern United States. Am Rev Respir Dis. 1980;121:931-937 [PubMed]journal. [PubMed]
 

Figures

Figure Jump LinkFigure 1 Heat map depicting the percentage of subjects with Mycobacterium avium complex (MAC) infection across the United States, reported as the percentage of subjects with positive results for MAC relative to the total number of nontuberculous mycobacteria-infected subjects at the state level.Grahic Jump Location
Figure Jump LinkFigure 2 Heat map depicting the percentage of Mycobacterium abscessus-infected subjects across the United States, reported as the percentage of subjects with positive results for M abscessus infection relative to the total number of nontuberculous mycobacteria-infected subjects at the state level.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 Number and Percentage of Subjects With Positive Results for MAC, M abscessus, and M kansasii Infection Relative to the Total Number of Subjects With Nontuberculous Mycobacterial Infection by State

M = Mycobacterium; MAC = Mycobacterium avium complex.

References

Falkinham J.O. III. Environmental sources of nontuberculous mycobacteria. Clin Chest Med. 2015;36:35-41 [PubMed]journal. [CrossRef] [PubMed]
 
Adjemian J. .Olivier K.N. .Seitz A.E. .Holland S.M. .Prevots D.R. . Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med. 2012;185:881-886 [PubMed]journal. [CrossRef] [PubMed]
 
Adjemian J. .Olivier K.N. .Seitz A.E. .Falkinham J.O. III.Holland S.M. .Prevots D.R. . Spatial clusters of nontuberculous mycobacterial lung disease in the United States. Am J Respir Crit Care Med. 2012;186:553-558 [PubMed]journal. [CrossRef] [PubMed]
 
Kirschner R.A. Jr..Parker B.C. .Falkinham J.O. III. Epidemiology of infection by nontuberculous mycobacteria: Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium scrofulaceum in acid, brown-water swamps of the southeastern United States and their association with environmental variables. Am Rev Respir Dis. 1992;145:271-275 [PubMed]journal. [CrossRef] [PubMed]
 
Falkinham J.O. III.Parker B.C. .Gruft H. . Epidemiology of infection by nontuberculous mycobacteria. I. Geographic distribution in the eastern United States. Am Rev Respir Dis. 1980;121:931-937 [PubMed]journal. [PubMed]
 
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