title: Pulmonary Mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in England, Wales and Northern Ireland, 2007-2012.
abstract: BACKGROUND
  The incidence of non-tuberculous mycobacteria (NTM) isolation from humans is increasing worldwide. In England, Wales and Northern Ireland (EW&NI) the reported rate of NTM more than doubled between 1996 and 2006. Although NTM infection has traditionally been associated with immunosuppressed individuals or those with severe underlying lung damage, pulmonary NTM infection and disease may occur in people with no overt immune deficiency. Here we report the incidence of NTM isolation in EW&NI between 2007 and 2012 from both pulmonary and extra-pulmonary samples obtained at a population level.
  
  
  METHODS
  All individuals with culture positive NTM isolates between 2007 and 2012 reported to Public Health England by the five mycobacterial reference laboratories serving EW&NI were included.
  
  
  RESULTS
  Between 2007 and 2012, 21,118 individuals had NTM culture positive isolates. Over the study period the incidence rose from 5.6/100,000 in 2007 to 7.6/100,000 in 2012 (p < 0.001). Of those with a known specimen type, 90 % were pulmonary, in whom incidence increased from 4.0/100,000 to 6.1/100,000 (p < 0.001). In extra-pulmonary specimens this fell from 0.6/100,000 to 0.4/100,000 (p < 0.001). The most frequently cultured organisms from individuals with pulmonary isolates were within the M. avium-intracellulare complex family (MAC). The incidence of pulmonary MAC increased from 1.3/100,000 to 2.2/100,000 (p < 0.001). The majority of these individuals were over 60 years old.
  
  
  CONCLUSIONS
  Using a population-based approach, we find that the incidence of NTM has continued to rise since the last national analysis. Overall, this represents an almost ten-fold increase since 1995. Pulmonary MAC in older individuals is responsible for the majority of this change. We are limited to reporting NTM isolates and not clinical disease caused by these organisms. To determine whether the burden of NTM disease is genuinely increasing, a standardised approach to the collection of linked national microbiological and clinical data is required.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.|TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.|, 49 Bodley Road, New Malden, Surrey, KT3 5QD, UK.
authors.forename: Neeraj M
authors.initials: NM
authors.lastname: Shah
authors.affiliation: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Davidson
authors.affiliation: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Anderson
authors.affiliation: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Maeve K
authors.initials: MK
authors.lastname: Lalor
authors.affiliation: MRC Clinical Trials Unit and Centre for Infectious Disease Epidemiology, University College London, London, UK.
authors.forename: Jusang
authors.initials: J
authors.lastname: Kim
authors.affiliation: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: H Lucy
authors.initials: HL
authors.lastname: Thomas
authors.affiliation: UCL Respiratory, Division of Medicine, University College London, London, UK. marclipman@nhs.net.
authors.forename: Marc
authors.initials: M
authors.lastname: Lipman
authors.affiliation: TB Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.|MRC Clinical Trials Unit and Centre for Infectious Disease Epidemiology, University College London, London, UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
mesh_terms: D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D006801:Humans; D007153:Immunologic Deficiency Syndromes; D007166:Immunosuppressive Agents; D008171:Lung Diseases / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000453:epidemiology / Q000382:microbiology; D015269:Mycobacterium avium Complex / Q000472:pathogenicity*; D015270:Mycobacterium avium-intracellulare Infection / Q000453:epidemiology* / Q000382:microbiology; D009660:Northern Ireland / Q000453:epidemiology; D014852:Wales / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents
keywords: Environmental mycobacterium; Incidence; Mycobacterium avium-intracellulare complex; Nontuberculous mycobacteria