BACKGROUND: Nontuberculous mycobacteria (NTM), ubiquitous in soil and water, comprise >100 species. Multiple species can infect the lungs, skin, bone, joints, and lymphatic system. Trauma, surgeries, and tattooing can inoculate NTM into soft tissue, potentially resulting in substantial morbidity and death. Eight states, including Oregon, require NTM reporting. We sought to characterize extrapulmonary NTM infection burden and assesses usefulness of Oregon’s NTM surveillance system in detecting outbreaks.
METHODS: Confirmed cases are culture-confirmed extrapulmonary NTM infections involving a wound or abscess, lymph node, or normally sterile site (e.g., blood or spinal fluid). Using surveillance data collected through laboratory reporting, patient interview, and chart review, we assessed demographic, risk, and clinical characteristics of Oregon extrapulmonary NTM cases and reviewed investigation of data-identified clusters.
RESULTS: Of 117 confirmed extrapulmonary NTM cases (0.98 cases/100,000 persons annually), 53% were female; median age was 49 years. Commonly identified species included Mycobacterium avium complex (46%), Mycobacterium fortuitum (15%), and Mycobacterium chelonae (8%). Reported exposures included potting soil (30%), surgery (24%), trauma (19%), and infusions (19%). Wounds or abscesses were reported in 68% of patients; 31% were hospitalized; 14% were septic; and 1 died. Three clusters by time, place, and mycobacterial species were identified; subsequent investigation identified common exposures leading to public health action, including 4 cases associated with artificial joints from a common supplier, 2 with use of unsterile tattoo diluent at a single venue, and 2 with abdominoplasty at a single venue.
CONCLUSIONS: Extrapulmonary NTM infections cause substantial morbidity in Oregon. NTM surveillance proved useful in detecting NTM outbreaks amenable to public health action. States should investigate the utility of NTM surveillance for outbreak detection. Nontuberculous mycobacteria (NTM), ubiquitous in soil and water, comprise >100 species. Multiple species can infect the lungs, skin, bone, joints, and lymphatic system. Trauma, surgeries, and tattooing can inoculate NTM into soft tissue, potentially resulting in substantial morbidity and death. Eight states, including Oregon, require NTM reporting. We sought to characterize extrapulmonary NTM infection burden and assesses usefulness of Oregon’s NTM surveillance system in detecting outbreaks.