Reducing Exposure to Nontuberculous Mycobacteria (NTM)

Posted by Armando @bolso1, Sep 16, 2021

Please see the attached document prepared by Dr. Joseph O. Falkinham, III, a world authority on the management of NTM dispersion.

Shared files

Reducing Exposure to Nontuberculous Mycobacteria (Reducing-Exposure-to-Nontuberculous-Mycobacteria.pdf)

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

@rits

I am confused with respect to why the source of the heat to boil the water matters. An electric kettle kills more pathogens than a kettle on a gas stove? Why? And what about an electric stove or a hot plate? I thought it was the boiling that killed the pathogens so why does it matter what type of heat brings it to a boil? Hopefully Dr Fallingham will answer this on the webinaire.

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@rits

In page 5 of the article Reducing Exposure to Nontuberculous Mycobacteria (NTM), Dr. Falkinham stated: First, if you are worried about swallowing NTM, boil water for 10 min. That will kill NTM. This list of recommendations has been updated May 3, 2021, because of a publication comparing the ability of killing fecal bacteria (Escherichia coli) by boiling water in a pan versus boiling water in an electric kettle. The electric kettle was far superior in its ability to kill the bacteria, so I recommend purchasing an electric kettle to boil water. They are available at the big box stores and online.

The publication that he refers to is attached. As you can see, it shows the results of a comprehensive evaluation of household water treatment in rural China, in which they measured many things, including the difference in efficacy in reducing thermotolerant coliforms between boiling water with electric kettles or pots. In page 3 of the document, I highlighted the procedure followed to measure the temperatures reached with both heating methods. In the highlighted text, you will find references to Figure S1 and Figure S2, which I am attaching as Slide 1 and Slide 2.
In Slide 1 you can see an example of the electric kettles and pots used, as well as the location of the sensors, and in Slide 2 you can see the variation in the temperature recorded each minute by the sensors during a period of 72 h. Each peak corresponds to a “boiling” event. Clearly, the temperatures reached with the kettle were more uniform and higher than with the pot, which can explain the higher efficacy of kettles in reducing coliforms. The higher uniformity and temperatures attained with the kettle are to be expected just because of the automatic way that they operate at. On the other hand, the pots were heated with firewood, so I can easily envision that people had to get firewood, feed the fire, put water in the pot, and wait for it to boil, all frequently resulting in “heating” more than “boiling”.

Now, I find it difficult to extrapolate from the conditions in rural China to the conditions of most of us. Maybe while camping one could use firewood to boil water in a pot, but otherwise I would guess that few of us would do it. Therefore, I doubt that under our normal conditions the electric kettle would be “far superior” than a pan to boil water.

But, how about the 10-min requirement? In my exchange with Dr. Falkinham, he clearly stated that reaching the rolling boiling stage suffices, which is when the electric kettles automatically shut off. So, I think that he assumes that the water in the kettle is exposed to temperatures around boiling for at least 10 min during the whole process. It is not clear to me, though, that such an assumption can be supported by the graphs in Slide 2. The temperature in the electric kettle reaches a very sharp peak and descends immediately. (By the way, the temperatures never reach 100C because the sensor was attached outside the kettle.)

Armando

Shared files

Boiling Water Electric Kettles EHP (Boiling-Water-Electric-Kettles-EHP.pdf)

REPLY
@bolso1

@rits

In page 5 of the article Reducing Exposure to Nontuberculous Mycobacteria (NTM), Dr. Falkinham stated: First, if you are worried about swallowing NTM, boil water for 10 min. That will kill NTM. This list of recommendations has been updated May 3, 2021, because of a publication comparing the ability of killing fecal bacteria (Escherichia coli) by boiling water in a pan versus boiling water in an electric kettle. The electric kettle was far superior in its ability to kill the bacteria, so I recommend purchasing an electric kettle to boil water. They are available at the big box stores and online.

The publication that he refers to is attached. As you can see, it shows the results of a comprehensive evaluation of household water treatment in rural China, in which they measured many things, including the difference in efficacy in reducing thermotolerant coliforms between boiling water with electric kettles or pots. In page 3 of the document, I highlighted the procedure followed to measure the temperatures reached with both heating methods. In the highlighted text, you will find references to Figure S1 and Figure S2, which I am attaching as Slide 1 and Slide 2.
In Slide 1 you can see an example of the electric kettles and pots used, as well as the location of the sensors, and in Slide 2 you can see the variation in the temperature recorded each minute by the sensors during a period of 72 h. Each peak corresponds to a “boiling” event. Clearly, the temperatures reached with the kettle were more uniform and higher than with the pot, which can explain the higher efficacy of kettles in reducing coliforms. The higher uniformity and temperatures attained with the kettle are to be expected just because of the automatic way that they operate at. On the other hand, the pots were heated with firewood, so I can easily envision that people had to get firewood, feed the fire, put water in the pot, and wait for it to boil, all frequently resulting in “heating” more than “boiling”.

Now, I find it difficult to extrapolate from the conditions in rural China to the conditions of most of us. Maybe while camping one could use firewood to boil water in a pot, but otherwise I would guess that few of us would do it. Therefore, I doubt that under our normal conditions the electric kettle would be “far superior” than a pan to boil water.

But, how about the 10-min requirement? In my exchange with Dr. Falkinham, he clearly stated that reaching the rolling boiling stage suffices, which is when the electric kettles automatically shut off. So, I think that he assumes that the water in the kettle is exposed to temperatures around boiling for at least 10 min during the whole process. It is not clear to me, though, that such an assumption can be supported by the graphs in Slide 2. The temperature in the electric kettle reaches a very sharp peak and descends immediately. (By the way, the temperatures never reach 100C because the sensor was attached outside the kettle.)

Armando

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Okay, Armando, you found the study regarding electric kettles, but it still doesn't answer the question about NTM.
They are measuring TTC's (thermotolerant choliforms) which are not the same as NTM (non-tubercular mycobacteria) because of the issue of spores and whether NTM are more heat-resistant.

Personally, I think the "boil 10 minutes" recommendation vs "bring to a rolling boil" was not necessarily based on a specific test on various strains of NTM. As campers, we also used to be told to "boil 10 minutes" before using stream or lake water, that has been changed to 1 minute.

So it looks like we still need clarification on the issue. For myself, I will continue to use spring water to drink, filtered tap water to cook with and boiled a minute water for cleaning my equipment. So far it has worked for over 3 years.
Sue

REPLY
@sueinmn

Okay, Armando, you found the study regarding electric kettles, but it still doesn't answer the question about NTM.
They are measuring TTC's (thermotolerant choliforms) which are not the same as NTM (non-tubercular mycobacteria) because of the issue of spores and whether NTM are more heat-resistant.

Personally, I think the "boil 10 minutes" recommendation vs "bring to a rolling boil" was not necessarily based on a specific test on various strains of NTM. As campers, we also used to be told to "boil 10 minutes" before using stream or lake water, that has been changed to 1 minute.

So it looks like we still need clarification on the issue. For myself, I will continue to use spring water to drink, filtered tap water to cook with and boiled a minute water for cleaning my equipment. So far it has worked for over 3 years.
Sue

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I agree Sue, we need clarifications.
Physicians often use some terms very loosely, and it is important to clarify if by "10 min" they mean actual 10 min by a stopwatch or rather "some time". As an example, and in a different note, we recently found out that the concept of "a day" as the time during which you can take medicines, can vary considerably among physicians: in agreement with her pulmonologist, my wife was spreading her antibiotics over a 24-h day – to minimize adverse effects – but at National Jewish she found out that she should distribute the pill intake over a 12-h day, instead!
Armando

REPLY
@bolso1

@rits

In page 5 of the article Reducing Exposure to Nontuberculous Mycobacteria (NTM), Dr. Falkinham stated: First, if you are worried about swallowing NTM, boil water for 10 min. That will kill NTM. This list of recommendations has been updated May 3, 2021, because of a publication comparing the ability of killing fecal bacteria (Escherichia coli) by boiling water in a pan versus boiling water in an electric kettle. The electric kettle was far superior in its ability to kill the bacteria, so I recommend purchasing an electric kettle to boil water. They are available at the big box stores and online.

The publication that he refers to is attached. As you can see, it shows the results of a comprehensive evaluation of household water treatment in rural China, in which they measured many things, including the difference in efficacy in reducing thermotolerant coliforms between boiling water with electric kettles or pots. In page 3 of the document, I highlighted the procedure followed to measure the temperatures reached with both heating methods. In the highlighted text, you will find references to Figure S1 and Figure S2, which I am attaching as Slide 1 and Slide 2.
In Slide 1 you can see an example of the electric kettles and pots used, as well as the location of the sensors, and in Slide 2 you can see the variation in the temperature recorded each minute by the sensors during a period of 72 h. Each peak corresponds to a “boiling” event. Clearly, the temperatures reached with the kettle were more uniform and higher than with the pot, which can explain the higher efficacy of kettles in reducing coliforms. The higher uniformity and temperatures attained with the kettle are to be expected just because of the automatic way that they operate at. On the other hand, the pots were heated with firewood, so I can easily envision that people had to get firewood, feed the fire, put water in the pot, and wait for it to boil, all frequently resulting in “heating” more than “boiling”.

Now, I find it difficult to extrapolate from the conditions in rural China to the conditions of most of us. Maybe while camping one could use firewood to boil water in a pot, but otherwise I would guess that few of us would do it. Therefore, I doubt that under our normal conditions the electric kettle would be “far superior” than a pan to boil water.

But, how about the 10-min requirement? In my exchange with Dr. Falkinham, he clearly stated that reaching the rolling boiling stage suffices, which is when the electric kettles automatically shut off. So, I think that he assumes that the water in the kettle is exposed to temperatures around boiling for at least 10 min during the whole process. It is not clear to me, though, that such an assumption can be supported by the graphs in Slide 2. The temperature in the electric kettle reaches a very sharp peak and descends immediately. (By the way, the temperatures never reach 100C because the sensor was attached outside the kettle.)

Armando

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I can only say, "wow!" As you point out the pot was heated with a wood fire and the kettle with electricity. I was thinking of comparing an electric plug- in kettle v a gas stove.

In an case … Dr Falkinham answered questions about water in a recent post to the ntmir support group. He does say boil for 10 minutes. They are setting up a webinair where he will answer questions and are talking about the logistics of the q and a.

REPLY
@rits

I can only say, "wow!" As you point out the pot was heated with a wood fire and the kettle with electricity. I was thinking of comparing an electric plug- in kettle v a gas stove.

In an case … Dr Falkinham answered questions about water in a recent post to the ntmir support group. He does say boil for 10 minutes. They are setting up a webinair where he will answer questions and are talking about the logistics of the q and a.

Jump to this post

@rits
I would like to mention that I received that paper from Dr. Falkinham in response to my queries about all of these issues.
Armando

REPLY

Adding to the confusion, the Arikayce folks tell us to boil the nebulizer parts for 5 minutes.

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@pamelasc1

Hello everyone – I have been absent from our group for some time now, but now I am suddenly overwhelmed with an issue that I am hoping others have some experience with. From 2015 to 2017 I was on the Big 3 for MAC – it was cleared up but since then I have had various bouts of different types of bacteria in my lungs. The main drug used for treatment was the quinolone antibiotic, Levofloaxin. It worked like a charm. But just this winter I began to have neuropathy in my feet and toes, one of the long term side affects of Levo that can happen many months to years after taking it. Last week, my sputum sample came back with pseudemonas ( I have had it 3 times already, and always used the Levo for 10 days to clear it up). Now I am afraid to use the Levo for fear of my neurapathy getting worse. My doctor says there are no other antibiotics, other than Cipro or Levo ( both quinolones) to treat it. I do feel he is right on this, unless someone out there has been treated with something other for pseudemonas and it cleared up. ?? I think the pseudemonas is getting a bit worse and I feel totally overwhelmed with the choices I have: do I go back on the Levo, have it clear the bacteria, but risk more severe neuropathy? Do I just wait it out, and hope the psedemonas clears up on its own? Or has anyone taken something else for this particular bacteria that worked and did not carry the risks of this drug? I believe it has been banned in Germany – it really does its work, but for someone my age ( now 72) it can be very dangerous. Does anyone have any thoughts on my dilemma?

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I had the same side effects with Cipro and Levo. Fortunately I have not had an infection that requires another antiobotic other than the ones I am on for NTM

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@dulwich

Adding to the confusion, the Arikayce folks tell us to boil the nebulizer parts for 5 minutes.

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In distilled water. I'm no longer on it but I follow the Arikayce procedures for cleaning and disinfecting for my aerobika and neb cup every evening.

REPLY
@sueinmn

Okay, Armando, you found the study regarding electric kettles, but it still doesn't answer the question about NTM.
They are measuring TTC's (thermotolerant choliforms) which are not the same as NTM (non-tubercular mycobacteria) because of the issue of spores and whether NTM are more heat-resistant.

Personally, I think the "boil 10 minutes" recommendation vs "bring to a rolling boil" was not necessarily based on a specific test on various strains of NTM. As campers, we also used to be told to "boil 10 minutes" before using stream or lake water, that has been changed to 1 minute.

So it looks like we still need clarification on the issue. For myself, I will continue to use spring water to drink, filtered tap water to cook with and boiled a minute water for cleaning my equipment. So far it has worked for over 3 years.
Sue

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Everyone,
Dr. Falkinham replied to my email to him that he is setting the webinar for Nov 29. He will be sending out an announcement soon. He also welcomes questions in advance. I am willing to compile everyone's questions to send to him. I just joined the NTM Info and Research support group and they are asking the same questions we are. They have a list of questions which I will send to you all to start the process of compiling our list of questions.
Lora Jo

REPLY

Thank you for posting Dr. Falkinham's article. It condensed all of of our past revelations about MAC. The discussion at the end of the article about the 'Pink Slime' not co-existing with mac made me wonder; could we nebulize that to kill the mac?? I say that tongue in cheek of course. LOL.

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