Extrapulmonary Nontuberculous Mycobacteria Infections — Minnesota, 2013–2017

  • Healthcare related infections
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Background:
Approximately 80 species of nontuberculous mycobacteria (NTM) causing disease are found environmentally and in animal reservoirs. Typically, pulmonary NTM infections are sporadic; extrapulmonary infections are commonly outbreak-associated. Recent sources of extrapulmonary NTM (ENTM) outbreaks in Minnesota include contaminated heater-cooler units used during cardiac surgery and contaminated hormone injections. We examined patient demographics and characteristics of laboratory-confirmed ENTM isolates to assess potential value of systematic laboratory-based ENTM surveillance in Minnesota.

Methods:
The Minnesota Department of Health requested laboratory data from Mycobacterium testing during 2013–2017 from 4 Minnesota reference laboratories that characterize Mycobacterium isolates. Using the CSTE case definition, we excluded M. tuberculosis complex, M. bovisand M. leprae isolates, and isolates from feces, lung, bronchoalveolar lavage, tracheal secretion, and sputum.

Results:
Laboratories diagnosed 490 ENTM isolates, representing an estimated burden of 1.8 /100,000 people/year in Minnesota. Thirty-one species or complexes were identified; most common were M. avium complex (31.2%), M. chelonae (22.0%), M. fortuitum (10.6%), and M. abscessus (3.8%). Most common specimen collection sites included skin and soft tissue (38.4%), blood (15.3%), neck lymph node or tissue (11.8%), sinus (7.6%), joint or bone (5.1%), device or implant (3.7%) and eye (2.7%) infections. The patient’s median age was 55 years (range: 2–98 years); 18.4% were from patients aged <18 years, 19.5% aged 18–44 years, 28.2% aged 45–64 years and 33.9% aged >65 years. Sex was documented for 238 (48.6%) patients; 127 (53.4%) were males. County information was available for 313 isolates (63.9%); approximately half (48.8%) of patients resided in metropolitan Minneapolis-Saint Paul.

Conclusion:
Laboratory data can be used for ENTM surveillance in Minnesota. Implementing laboratory-based surveillance could detect ENTM cases, provide a mechanism for obtaining clinical and epidemiological information, and enable earlier identification of potential healthcare transmission or community clusters.

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