Although uncommon, nontuberculous mycobacterial (NTM) pulmonary infection in the Hawaiian Islands has a relatively high incidence and mortality compared to the mainland U.S. As a result, this study examines the possible geological and hydrological pathways by which NTM patients may become infected, including the environmental conditions that may favor growth and transport. Previously suggested infection routes include the inhalation of NTM attached to micro‐droplets from infected home plumbing systems and aerosolized dust from garden soil. In this study, we evaluate the possible routes NTM may take from riparian environments, into groundwater, into public water supplies and then into homes. Because NTM are notoriously hydrophobic and prone to attach to surfaces, mineralogy, and surface chemistry of suspended sediment in streams, soils, and rock scrapings suggest that NTM may especially attach to Fe‐oxides/hydroxides, and be transported as particles from losing streams to the aquifer on time‐scales of minutes to days. Within the aquifer, flow models indicate that water may be drawn into production wells on time scales (months) that permit NTM to survive and enter domestic water supplies. These processes depend on the presence of interconnected fracture networks with sufficient aperture to preclude complete autofiltration. The common occurrence of NTM in and around streams, in addition to wells, implies that the natural and built environments are capable of introducing a source of NTM into domestic water supplies via groundwater withdrawals. This may produce a persistent source of NTM infection to individuals through the presence of NTM‐laden biofilms in home plumbing.

中文翻译：

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非结核分枝杆菌通过土壤、溪流和地下水的暴露途径，美国夏威夷


虽然非结核分枝杆菌 (NTM) 肺部感染并不常见，但与美国大陆相比，夏威夷群岛的发病率和死亡率相对较高。因此，本研究探讨了 NTM 患者可能感染的地质和水文途径，包括环境因素可能有利于增长和运输的条件。之前提出的感染途径包括吸入附着在受感染家庭管道系统微滴上的 NTM 和花园土壤中的雾化灰尘。在这项研究中，我们评估了 NTM 从河岸环境进入地下水、进入公共供水系统，然后进入家庭的可能路线。由于 NTM 具有众所周知的疏水性，并且易于附着在表面，溪流、土壤和岩石碎屑中悬浮沉积物的矿物学和表面化学表明，NTM 特别可能附着在铁氧化物/氢氧化物上，并作为颗粒从流失的溪流输送到含水层的时间尺度为分钟到天。在含水层内，水流模型表明，水可能会在一定时间尺度（数月）内被抽入生产井，从而使 NT​​M 能够生存并进入生活供水系统。这些过程取决于具有足够孔径以阻止完全自滤的互连裂缝网络的存在。除井外，NTM 在溪流及其周围也很常见，这意味着自然环境和建筑环境能够通过抽取地下水将 NTM 源引入生活供水中。由于家庭管道中存在含有 NTM 的生物膜，这可能会给个人带来持久的 NTM 感染源。