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American Journal of Epidemiology Advance Access published online on May 4, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj159
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received April 14, 2005
Accepted January 19, 2006

ORIGINAL CONTRIBUTIONS

Environmental Risk Factors for Infection with Mycobacterium avium Complex

Carrie Reed 1 *, C. Fordham von Reyn 2, Sandra Chamblee 3, Tedd V. Ellerbrock 4, Johnny W. Johnson 3, Bryan J. Marsh 2, Linda S. Johnson 4, Robert J. Trenschel 5, and C. Robert Horsburgh Jr. 1

1 Department of Epidemiology, Boston University School of Public Health, Boston, MA
2 Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
3 Glades Health Initiative, Inc., Belle Glade, FL
4 Division of HIV/AIDS Prevention, Surveillance, and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA
5 Palm Beach County Health Department, Belle Glade, FL

* To whom correspondence should be addressed.
Carrie Reed, E-mail: reedc{at}bu.edu


  Abstract

Infection with Mycobacterium avium complex is acquired from the environment, but risk factors for M. avium complex infection and disease are poorly understood. To identify risk factors for infection, the authors performed a 1998-2000 cross-sectional study in western Palm Beach County, Florida, using a population-based random household survey. M. avium complex infection was identified by use of the M. avium sensitin skin test. Of 447 participants, 147 (32.9%) had a positive test reaction, 186 (41.6%) had a negative test reaction, and, for 114 (25.5%), test results were indeterminate. Among the 333 participants with positive or negative M. avium sensitin skin tests, age-adjusted independent predictors of M. avium complex infection in a multivariate model included Black race (odds ratio = 3.8, 95% confidence interval: 2.2, 6.6), birth outside the United States (odds ratio = 2.1, 95% confidence interval: 1.1, 3.9), and more than 6 years' cumulative occupational exposure to soil (odds ratio = 2.7, 95% confidence interval: 1.3, 6.0). Exposure to water, food, or pets was not associated with infection. Results indicate that soil is a reservoir for M. avium complex associated with human infection and that persons whose occupations involve prolonged soil exposure are at increased risk of M. avium complex infection.

Keywords: HIV; Mycobacterium avium complex; opportunistic infections; risk factors.
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