Environmental Water Testing for the Presence of Nontuberculous Mycobacteria in Phoenix, Arizona's Municipal Water System
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Numerous species of nontuberculous mycobacteria (NTM) have been isolated from environmental sources such as water supplies, soil and sewage, among others. These acid-fast bacilli bacteria are opportunistic pathogens, usually manifesting as tuberculosis-like pulmonary disease in immunocompetent persons and as a disseminated disease in those that are immunocompromised. Besides this infection risk, some NTM species have been known to cause false-positive reactions to tuberculosis (TB) skin tests. When approximately twenty percent of the employees of the Phoenix (Arizona) Fire Department tested positive for TB in 1995, exposure to NTM-contaminated fire hydrant water was considered as a possible cause. Thus, we set out to test a number of fire hydrants from around Phoenix for the presence of NTM. In addition, we tested a number of sites in the city's general water system (which also supply the hydrants) and a few sites within the medical center itself, for a total of thirty-six sampled sources. Eleven of the eighteen water samples decontaminated with formalin did not become overgrown with contaminants. Six of those eleven samples were found to contain NTM. Of the thirty-six samples decontaminated with sodium hydroxide and oxalic acid, thirty-four were usable. Twenty of those samples were found to contain NTM. In all, thirteen different species were isolated, including a number commonly associated with causing false positive TB skin tests, lending a good deal of credibility to the theory that NTM contamination of the water supply may have caused the unusually high rate among the Fire Department employees.
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