Epidemiology of Mycobacterial Infections

National Institute Of Allergy And Infectious Diseases

Investigators

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Abstract

This past fiscal year we had two major accomplishment related to the above goals: Project: Increasing trends of NTM in the United States among persons with Cystic Fibrosis We used the Cystic Fibrosis Foundation Patient Registry (CFFPR) data for the period 2010 through 2019. Our study population comprised persons with CF 12 years of age who had been tested for NTM PI. We included only registry participants with NTM culture results. We defined incident cases as persons with one positive mycobacterial culture preceded by two negative mycobacterial cultures. We defined non-cases as persons with 1) two negative mycobacterial cultures. We estimated average annual NTM PI incidence by region. Using quasi-Poisson models, we calculated annual percent change in incidence by region. We identified 3,771 incident NTM infections. Of these cases, 1,816 (48.2%) were Mycobacterium avium complex (MAC) infections and 960 (25.5%) were Mycobacterium abscessus infections. The average annual incidence of NTM PI among pwCF in the U.S. was 58.0 cases per 1,000 persons. The Northeast had the highest incidence of MAC (33.5/1,000 persons tested) and the South had the highest incidence of M. abscessus (20.3/1,000 persons tested). From 2010 to 2019, the annual incidence of total NTM PI increased significantly by 3.5% per year in the U.S.. NTM PI incidence is increasing among pwCF. Identifying high risk areas and increasing trends is important for allocating public health and clinical resources as well as evaluating interventions. Project: Drinking water quality and increased lung infections in people with cystic fibrosis High levels of some minerals and metals in environmental water supplies may increase the risk of nontuberculous mycobacteria (NTM) pulmonary infections in people with cystic fibrosis We found the presence of the metals molybdenum and vanadium along with sulfatea collection of mineral saltsin the U.S. municipal water system was associated with an increased incidence of NTM pulmonary infections, the leading cause of drinking-water associated illnesses. Prior studies have shown that certain environmental conditions, including the presence of trace metals, likely contribute to a higher abundance of NTM in the water. Two of the most common forms of NTM bacteria in the U.S. are Mycobacterium avium complex (MAC) and M. abscessus. Both are linked to chronic lung infections in people with cystic fibrosis and other lung diseases. More than 35,000 people in the U.S. have cystic fibrosis, which causes the body to produce thick mucus, causing lung damage and trapping bacteria, increasing the likelihood of lung infection. This study measured whether the concentration of metals and minerals in the water had any influence on the probability of MAC and M. abscessus infection in people with cystic fibrosis. The case-control, population-based study included Cystic Fibrosis Foundation Patient Registry data from 3,897 people with cystic fibrosis living in states that had trace metal water data available in at least 50% of counties: Arizona, California, Colorado, Connecticut, Maine, Massachusetts, Nevada, New Mexico, Rhode Island, Utah and Wyoming. The study revealed 484 people had MAC while 222 had M. abscessus. The presence of sulfate and vanadium were positively associated with MAC, and the presence of molybdenum was positively associated with M. abscessus.