The burden of non-tuberculosis mycobacterium (NTM) infections on the US healthcare systems is estimated to cost $815 million annually.  NTM causes chronic lung infections most commonly in older, immunocompromised, and cystic fibrosis patients.  NTM can by-pass drinking water treatment and has been shown to proliferate in household plumbing biofilms after chlorine-sensitive competitors have been inactivated.  Data is generally lacking on the prevalence of opportunistic pathogen NTM in NJ waters and the goal of this research was to fill this gap in knowledge.

The aim of this work was to screen both the Raritan and treated water in the homes of consumers drinking treated water from the Raritan to determine the prevalence of NTM in both the source water and premise plumbing biofilm of NTM patients and the general public.  To complete this work, a doctor from the Public Health Research Institute (Christopher Vinnard, MD) helped identify NTM patients from his clinic and RWJ to participate in a study conducted by our environmental engineering team.

Towards screening the Raritan, we have prepared methods for sampling for NTM, which requires concentrating ~10L of water for our biomolecular techniques.  Delays in the production of new membranes for our tangential flow filtration system resulted in our fieldwork being delayed until spring (membranes arrived in January 2020).  For sampling home water systems, we recruited five NTM patients and 19 members of the general public (disease status unknown) with either private well water (supported by a seed grant from NJ DOH) or public water supplies.  Preliminary data are available for two marker genes of Mycobacteria:  atpE was observed in 55% of the samples analyzed and 80% of the homes sampled, the Myco marker of the 16S rRNA gene was observed in 66% of samples and 90% of homes.  Recruiting of participants will continue through Fall 2020 and biofilm, water quality and source, and survey data will be compiled to understand factors associated with the biomolecular results.

During the project period, the team published a review article on NTM (Parikh et. al., 2019) and MS student working on the project, Sophia Blanc (Figure 1), was awarded (pending congressional budget approval) funding to perform further analysis of the biofilm microbiomes.  Our results will provide insight into the prevalence of waterborne pathogen NTM in NJ and serve as preliminary data for a larger multi-pronged epidemiological study of NTM in NJ.

The study team included Nicole Fahrenfeld, PhD, Associate Professor, Civil & Environmental Engineering, student Sophia Blanc, and Christopher Vinnard, MD, Assistant Professor, Public Health Research Institute.

For further information, contact Dr. Fahrenfeld at nfahrenf@rutgers.edu.  This project received funding through a 2019 Rutgers Raritan River Consortium Mini-Grant.

Reference

Parikh, A., C. Vinnard, N. Fahrenfeld, R. Panettieri, A. Gow, A. Lardizabal, A. Patrawalla, A. Davidow and M. Gennaro, Revisiting John Snow to meet the challenge of Nontuberculous mycobacterial disease International Journal of Environmental Research & Public Health, 2019, 16 4250.  https://doi.org/10.3390/ijerph16214250