Health Departments


Delays in recognizing outbreaks of extrapulmonary NTM can occur because of:

  • the long period of time between exposure and symptom onset
  • the nonspecific symptomatology
  • the act that patients often present to different healthcare facilities

This can results in delays in public health actions and further infections. Health departments should therefore consider adding extrapulmonary NTM infections to the list of reportable conditions in their jurisdiction.

Reporting of extrapulmonary NTM infections can lead to timely outbreak detection and implementation of public health interventions to decrease the risk of new infections. Jurisdictions that have added extrapulmonary NTM infections to the list of conditions which are required to be reported to the health department have been able to analyze surveillance data to identify and promptly respond to NTM outbreaks.

Outbreaks of extrapulmonary NTM infections have occurred in a number of settings, and are usually due to a water source.

Settings with increased risk of NTM infections include:

  • Tattoo parlors
  • Nail salons
  • Hot tubs or spas
  • Healthcare settings

NTM outbreaks have been reported in healthcare settings due to the ability of NTM to form biofilms in hospital plumbing and on medical devices. Healthcare-associated outbreaks often result from breaches in infection control practices that allow patients to be exposed to contaminated water during invasive procedures such as injections, infusions, or surgeries. Healthcare-associated NTM outbreaks can also result from contaminated medical equipment, such as bronchoscopes or heater-cooler devices used in cardiac surgery. NTM outbreaks can occur in many different clinical settings and result from a wide range of medical procedures and practices including:

  • Surgery
    • Breast surgery
    • Heart surgery, including infections related to heater-cooler devices
    • Eye surgery with exposure to consumer-grade humidifiers
  • Dental procedures
  • Medical tourism
  • Cosmetic surgery
  • Medicine compounding and mixing
  • Medication preparation
  • Injection preparation and administration
  • Central line placement and maintenance
  • Manufacturing of medical products

Public health case definition for extrapulmonary NTM

In June of 2017 the Council of State and Territorial Epidemiologist approved a standardized case definition for extrapulmonary NTM infections [PDF – 13 pages]. The purpose of the definition is to assist state health departments in making extrapulmonary NTM infections reportable, ensure consistency across jurisdictions, and facilitate detection and reporting of extrapulmonary NTM outbreaks. The case definition focuses on extrapulmonary NTM infections as these infections are more likely to be associated with outbreaks compared to pulmonary NTM infections. The case definition is intended to be utilized for public health surveillance and not clinical diagnosis.

Health Departments Should:

Examples of select healthcare-associated NTM outbreaks