# Phylogeographic Analysis of Mycobacterium kansasii Isolates from Patients with M. kansasii Lung Disease in Industrialized City, Taiwan

## TL;DR

This study investigates how Mycobacterium kansasii spreads in a Taiwanese city, finding that water purification plants may be linked to lung disease caused by this bacterium.

## Contribution

The study identifies a novel association between specific water purification plants and the genetic relatedness of M. kansasii lung disease isolates.

## Key findings

- Patients from districts served by two water purification plants had higher odds of being infected with genetically related M. kansasii isolates.
- The adjusted odds ratios for the Weng Park and Fongshan plants were 1.81 and 1.39, respectively.
- The findings suggest a potential environmental transmission route for M. kansasii.

## Abstract

Little is known about environmental transmission of Mycobacterium kansasii. We retrospectively investigated potential environmental acquisition, primarily water sources, of M. kansasii among 216 patients with pulmonary disease from an industrial city in Taiwan during 2015–2017. We analyzed sputum mycobacterial cultures using whole-genome sequencing and used hierarchical Bayesian spatial network methods to evaluate risk factors for genetic relatedness of M. kansasii strains. The mean age of participants was 67 years; 24.1% had previously had tuberculosis. We found that persons from districts served by 2 water purification plants were at higher risk of being infected with genetically related M. kansasii isolates. The adjusted odds ratios were 1.81 (1.25–2.60) for the Weng Park plant and 1.39 (1.12–1.71) for the Fongshan plant. Those findings unveiled the association between water purification plants and M. kansasii pulmonary disease, highlighting the need for further environmental investigations to evaluate the risk for M. kansasii transmission.