Nontuberculous mycobacteria in the environment☆
Section snippets
What are environmental opportunistic mycobacteria?
Environmental opportunistic mycobacteria are those that are recovered from natural and human-influenced environments and can infect and cause disease in humans, animals, and birds. Other, less useful names for these mycobacteria are nontuberculous (however, they cause tuberculous lesions), atypical (to distinguish them from the typical Mycobacterium tuberculosis), and nontuberculous mycobacteria (NTM). Certain conditions (see Risk Factors, below) predispose to infection by the environmental
Why the emphasis on the environment?
Unlike infection by Mycobacterium tuberculosis, there is no evidence of person-to-person spread of the environmental opportunistic mycobacteria [4]. Recognition of that fact led to surveys to determine whether mycobacteria could be isolated from water and soil samples [26], [27]. Evidence for the presence of mycobacteria in the environment was also demonstrated by the fact that greater than 60% of single county residents of the southeastern coastal United States showed evidence of prior
Natural waters in lakes, ponds, rivers, and streams
A number of the environmental opportunistic mycobacteria have been isolated from natural waters [26], [30], [49], [77], [78], [79], [80], [81] (Table 5). Highest numbers were reported in the acid brown-water swamps of the southeastern coastal United States [78] and waters draining from boreal forest soils and peat lands in Finland [79], [82]. Consistent with the high numbers in waters from draining peat lands was earlier work showing high numbers of mycobacteria in Sphagnum vegetation [83] and
Structural characteristics
Environmental opportunistic mycobacteria are called acid-fast because they retain the dye fuchsin in phenolic solution after exposure to dilute solutions of mineral acids [173]. Dye retention is caused by the presence of long-chain lipids (mycolic acids) in the outer layers [174]. Members of the genus Mycobacterium have a thin peptidoglycan-based cell wall and both a cytoplasmic and outer membrane [174]. The fluidity of the outer membrane is determined by the structure of the mycolic acids [175]
Pathways of infection by environmental opportunistic mycobacteria
Infection by environmental opportunistic mycobacteria is a consequence of overlaps between human and mycobacterial environments. Drinking water has been shown to be at least one source of human and animal M avium infection. DNA fingerprints showed that water isolates of M avium were identical to those recovered from AIDS patients who either drank or were exposed to the waters [240]. Simian immunodeficiency virus-infected macaques were shown to be infected with M avium isolates whose
Summary
It is likely that the incidence of infection by environmental opportunistic mycobacteria will continue to rise. Part of the rise will be caused by the increased awareness of these microbes as human pathogens and improvements in methods of detection and culture. Clinicians and microbiologists will continue to be challenged by the introduction of new species to the already long list of mycobacterial opportunists (see Table 3). The incidence of infection will also rise because an increasing
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The work described was supported by grants from the National Institute of Allergy and Infectious Diseases and the American Water Works Association Research Foundation.