Surveillance of Extrapulmonary Nontuberculous Mycobacteria Infections

Oregon, USA, 2007-2012

Emily Henkle; Katrina Hedberg; Sean D. Schafer; Kevin L. Winthrop

Emerging Infectious Diseases. 2017;23(10):1627-1630.

Statistical Analysis

We described patients by age, sex, and species isolated overall and by source of specimen. We considered extrapulmonary cases to be incident at the time of isolation, given that treatment for extrapulmonary infections is typically in the range of weeks to several months and the cure rate is high.^[4] We calculated the annual incidence as the number of new cases in a given year divided by the midyear population using population data from the Portland State University Population Research Center^[7] and report the average annual incidence and standard 95% CIs for 2007–2012. We used Poisson models using a log link to estimate the overall incidence rate trend over the study period. We imported all data into SAS version 9.3 (SAS Institute Inc., Cary, NC) for analysis. The study was considered to be public health practice (nonresearch) by the Oregon Health Authority and was conducted under Oregon Administrative Rule 333–019–0005 (Conduct of Special Studies).

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Table. Characteristics of 334 nontuberculous mycobacterium infections, Oregon, USA, 2007–2012*
Category	Infection site†					Total, N = 334
Category	Skin/soft tissue, n = 197	Disseminated, n = 57	Lymph node, n = 28	Joint, n = 14	Other, n = 38	Total, N = 334
Annual incidence/100,000 population	0.9	0.2	0.1	0.1	0.2	1.5
Patient demographics
Sex
F	115 (58)	19 (33)	15 (54)	7 (50)	20 (52)	176 (53)
M	82 (42)	38 (67)	13 (46)	7 (50)	18 (48)	158 (47)
Median age, y (range)	51 (0.8–92)	41 (1–82)	44 (0.8–76)	70 (39–88)	61 (21–88)	51 (0.8–92)
HIV positive	8 (4)	34 (60)	5 (18)	0 (0)	3 (8)	50 (15)
Mycobacterium species
Rapid-growing species	85 (43.1)	5 (8.8)	2 (7.1)	3 (21.4)	13 (34.2)	108 (32.3)
M. chelonae/abscessus complex	40 (20.3)	2 (3.5)	1 (3.6)	1 (7.1)	8 (21.1)	52 (15.6)
M. fortuitum complex	28 (14.2)	1 (1.8)	1 (3.6)	1 (7.1)	1 (2.6)	32 (9.6)
M. chelonae	17 (8.6)	2 (3.5)	0 (0)	1 (7.1)	4 (10.5)	24 (7.2)
Slow-growing species
M. avium/intracellulare complex	70 (35.5)	45 (78.9)	23 (82.1)	9 (64.3)	20 (52.6)	167 (50)
M. marinum	20 (10.2)	0 (0)	0 (0)	0 (0)	1 (2.6)	21 (6.3)
M. goodii	5 (2.5)	0 (0)	1 (3.6)	0 (0)	0 (0)	6 (1.8)
M. aubagnense	1 (0.5)	1 (1.8)	0 (0)	0 (0)	1 (2.6)	3 (0.9)
M. xenopi	1 (0.5)	0 (0)	1 (3.6)	0 (0)	1 (2.6)	3 (0.9)
M. alvei	2 (1)	0 (0)	0 (0)	0 (0)	0 (0)	2 (0.6)
M. neoaurum	0 (0)	2 (3.5)	0 (0)	0 (0)	0 (0)	2 (0.6)
Other species‡	13 (6.6)	4 (7)	1 (3.6)	2 (14.3)	2 (5.3)	22 (6.6)

*Values are no. (%) patients except as indicated. Total excludes 13 M. gordonae isolates: 6 skin/soft tissue, 1 disseminated, 1 lymph node, 5 other.†Skin/soft tissue: wound, abscess, tissue, or exit catheter; disseminated: blood, bone marrow, cerebrospinal fluid, pericardial fluid, or peritoneal fluid; lymph node: lymph node or neck abscess; joint: synovial or joint fluid; other: urine, eye, sinus, or nasopharyngeal.‡Other species were 8 unspeciated and 1 each of M. asiaticum, M. branderi, M. brisbanense, M. heckeshornense, M. immunogenum, M. interjectum, M. kansasii, M. lentiflavum, M. llaterense, M. mucogenicum/phocaicum, M. obuense, M. simiae, M. thermoresistible, and M. vaccae.