EPIDEMIOLOGY OF INFECTION BY NONTUBERCULOUS MYCOBACTERIA .4. PREFERENTIAL AEROSOLIZATION OF MYCOBACTERIUM-INTRACELLULARE FROM NATURAL-WATERS

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Abstract
The 1st laboratory studies simulating the conditions for natural aerosolization of M. intracellulare and M. scrofulaceum are reported; the yields for this transfer pathway of pathogenic mycobacteria from water to air were estimated. M. intracellulare and M. scrofulaceum were both concentrated in droplets ejected from cell suspensions of densities comparable to those found in natural freshwaters (100-2000 colony-forming units/ml). The enrichment factor (defined as the concentration of cells/droplet vol divided by the concentration of cells in the bulk suspension/equivalent vol) for M. intracellulare isolates was 68-15,000, with an average of 2,922; for M. scrofulaceum it was 35-550, with an average of 177. One factor responsible for the greater aerosolization of M. intracellulare was their aggregation. After vortexing, M. intracellulare were still aerosolized more (enrichment factor, 325) than M. scrofulaceum. Increasing salt concentrations enriched the aerosolization of both species; the number of organisms transferred from water to air did not increase proportionately because the salt decreased the droplet vol. Other waterborne pathogens such as Legionella pneumophila were also enriched and transferred from water to air, indicating that this pathway for possible infection of humans may also be significant for other respiratory diseases.

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