Surveillance of Extrapulmonary Nontuberculous Mycobacteria Infections

Oregon, USA, 2007-2012

Emily Henkle; Katrina Hedberg; Sean D. Schafer; Kevin L. Winthrop

Disclosures

Emerging Infectious Diseases. 2017;23(10):1627-1630. 

In This Article

Abstract and Introduction

Abstract

Limited data are available describing extrapulmonary nontuberculous mycobacteria (NTM) infections in the general population. We describe results from statewide population-based laboratory surveillance in Oregon, USA, during 2007–2012. We defined a case of extrapulmonary NTM infection as >1 isolate from skin/soft tissue, disseminated sites, lymph node, joint, or other sites. The annual incidence of extrapulmonary NTM infection (other than Mycobacterium gordonae) was stable, averaging 1.5 cases/100,000 population. Median age of the 334 patients was 51 years, and 53% of patients were female. Half of cases were caused by M. avium complex, but rapid-growing NTM species accounted for one third of cases. Most extrapulmonary NTM infections are skin/soft tissue. Compared with pulmonary NTM infection, more extrapulmonary infections are caused by rapid-growing NTM species. the designation of NTM as a reportable disease in Oregon in 2014 will result in better detection of changes in the incidence and patterns of disease in the future.

Introduction

Nontuberculous mycobacteria (NTM) are ubiquitous in water and soil and are a cause of opportunistic pulmonary and extrapulmonary infections. Extrapulmonary manifestations include disseminated, skin, joint, and lymph node infections. Extrapulmonary NTM infections are typically sporadic but may be associated with nosocomial outbreaks,[1] clinical procedures,[2] or nail salon pedicures.[3] Treatment is species dependent, typically consisting of 3–6 months of multidrug antimicrobial therapy.[4] Although numerous case series are found in the literature, few data exist to describe the population-based epidemiology of extrapulmonary NTM infections. Recent studies have shown an increase in the prevalence and incidence of pulmonary infections.[5,6] We describe the results of a statewide laboratory surveillance study in Oregon, USA, that identified all patients from whom NTM was isolated from extrapulmonary sites during 2007–2012. We report characteristics of patients with extrapulmonary NTM infection by species and site and calculate the annual incidence over the study period.

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