However, in individuals without obvious pre-existing risk factors, it is likely that multiple risk factors – some genetic or other acquired factors – may collude to increase their vulnerability. While most casual NTM exposures do not results in disease, those with anatomic lung abnormalities of bronchiectasis and emphysema are particularly predisposed to develop NTM lung disease (NTM-LD). NTM share these environments with humans and domesticated animals and repeated exposure is a well-accepted mode of acquiring these infections. Nontuberculous mycobacteria (NTM) and their environments are intricately bound. Because of its geographic isolation and unique ecosystem, the Hawaiian environment is being probed for correlative factors that may promote environmental NTM colonization. state with the highest number of NTM lung disease cases. Specifically, the Hawaiian Island environment is currently being studied as a model to identify other point sources of exposure as it is the U.S. New studies on the horizon aim to significantly expand the current knowledge of environmental NTM niches in order to improve our current understanding of the specific ecological factors driving the emergence of NTM lung disease. However, NTM have also been recovered in biofilms from ice machines, heated nebulizers, and heater-cooler units, as well as seat dust from theaters, vacuum cleaners, and cobwebs. Well documented sources of NTM include peat-rich soils, natural waters, drinking water, hot water heaters, refrigerator taps, catheters, and environmental amoeba. Support comes from reports demonstrating NTM isolated from the lungs of patients are genetically identical to NTM found in their environment. It is likely that patients acquire their infections from repeated exposures to their environments, based on the well-accepted paradigm that water and soil bioaerosols – enriched for NTM – can be inhaled into the lungs. Seminal microbiological work of environmental nontuberculous mycobacteria (NTM) includes the discovery that NTM inhabit water distribution systems and soil, and that the species of NTM found are geographically diverse.
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