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Nontuberculous mycobacteria (NTM) are environmental organisms that can cause opportunistic pulmonary disease with species diversity showing significant regional variation. In the United States, Hawai’i shows the highest rate of NTM pulmonary disease. The need for improved understanding of NTM reservoirs led us to identify NTM from patient respiratory specimens and compare NTM diversity between outdoor and indoor locations in Hawai’i. A total of 545 water biofilm samples were collected from 357 unique locations across Kaua’i ( n  = 51), O’ahu ( n  = 202), Maui ( n  = 159), and Hawai’i Island ( n  = 133) and divided into outdoor ( n  = 179) or indoor ( n  = 366) categories.  rpoB  sequence analysis was used to determine NTM species and predictive modeling applied to develop NTM risk maps based on geographic characteristics between environments.  M. chimaera  was frequently identified from respiratory and environmental samples followed by  M. chelonae  and  M. abscessus;  yet significantly less NTM were consistently recovered from outdoor compared to indoor biofilms, as exemplified by showerhead biofilm samples. While the frequency of  M. chimaera  recovery was comparable between outdoor and indoor showerhead biofilms, phylogenetic analyses demonstrate similar  rpoB  gene sequences between all showerhead and respiratory  M. chimaera  isolates, supporting outdoor and indoor environments as possible sources for pulmonary  M. chimaera  infections.

Lower Recovery of Nontuberculous Mycobacteria from Outdoor Hawai’i Environmental Water Biofilms Compared to Indoor Samples