Nontuberculous mycobacteria from drinking water: beyond the lung disease epidemic.

Raquel Duarte

Principal Investigator

Integrated Member (PhD)



Participating institutions:

Instituição proponente: Centro de Neurociências e Biologia Celular (CNBC/UC); Instituições participantes: Administração Regional de Saúde do Centro (ARSC); Universidade de Coimbra (UC); Instituto de Saúde Pública da Universidade do Porto (ISPUP/UP).

Sources of financing:

FCT - Fundação para a Ciência e Tecnologia

Start date:


(Predicted) End date:


Research line:

L2 - Syndemics, health inequalities and vulnerable populations

Research lab:

Epidemiology of Mycobacteria Infection, HIV and other Sexually Transmitted Infections


Water sanitation is among the greatest public health achievements of civilization in promoting a drastic reduction in the incidence of waterborne epidemics such as cholera or typhoid. However, beginning the 3rd decade of the 21st century, municipal water distribution systems still disseminate environmental nontuberculous mycobacteria (NTM), some of which serious opportunistic pathogens. NTM disease is not communicable and inadequate diagnostic procedures prevent an estimate of its real prevalence and epidemiological control. Their natural resistance to antibiotics combined with the lack of investment in their renewal seriously compromises our ability to fight these infections. NTM most often infect the lungs of people with weakened immune systems or chronic diseases such as cystic fibrosis, COPD and the elderly. Although not described to date, NTM disease cases are anticipated to increase in some COVID-19 survivors, which may be at much higher risk due to reported sequelae (Long Covid). On the other hand, the chronically ill also frequently carry intestinal disorders. Adding these susceptibility factors to the lack of NTM surveillance of drinking waters and to their ability to multiplicate in plumbing systems, conditions are created to aggravate a public health threat still with diffuse contours.

NTM are regularly part of our diet in drinking water but their interaction with the intestinal ecosystem is unknown, although the link between NTM and gut disease is not new (M. avium paratuberculosis-Johne’s/Chron’s Disease). This unexplored “drinking water NTM-gut” paradigm is the main argument of the project and, to better understand the threat, NTM prevalence and microbiome profiles of domestic waters of infected patients’ homes will be assessed, as will the impact of chronic ingestion of NTM by animal models. This project aims to help fill the gaps in the knowledge of NTM diversity and impact of their chronic intake by unveiling epidemiological links between water NTM and population demographics, ultimately to advise public health decision makers to start monitoring and control these opportunistic microbes in municipal drinking water towards a healthier living and wellbeing.

Research Team