Research Articles






Cimen Acikgul Funda, Ozer Burcin*, Savas Nazan

ABSTRACT:Objectives; It’s aimed to investigate the presence of Mycobacteria in the water pipes consumed in cafes and tea gardens in Hatay province. Methods; After determining the cafes and tea gardens which water pipes are consumed in, 250 samples were taken from water pipes. After samples were decontaminated and homogenised, they were stained with the method of Erlich Ziehl Neelsen (EZN) and were examined for acid-fast bacilli (ARB). For cultures of the samples, Lowenstein Jensen (L-J) media (BioMerieux, France) and BacT-ALERT MP (BioMerieux, France) were used. The nitrat reduction, niacin accumulation and catalase tests were made for identification of the strains isolated. Results; In our study, in 9 (3,6%) of 250 samples ARB were detected. Nontuberculous mycobacteria (NTM) were isolated from 27 (10,8%) samples by L-J media and from 75 (30%) samples by automated system. There was growth in both L-J as well as automated system in 24 (9,6%) samples. Thereby while isolating NTM in 78 (31,2%) of 250 samples, in none of them M. tuberculosis complex was isolated. Conclusions; It was thought that NTM strains might be in the tap water added into the water pipes or might be contaminated by infected users. Water pipe consumption found objectionable because of isolation of NTM in our study as NTM strains increasingly cause illness in recent years besides the many agents of infectious diseases especially M. tuberculosis.


Key words: Water pipe, Mycobacterium tuberculosis, nontuberculous mycobacteria


  1. Tiruviluamala P, Reichman LB. Tuberculosis. Annual Review of Public Health 2002; 23:403–26.

  2. Munckhof WJ, Konstantinos A, Wamsley M, Mortlock M, Gilpin C. A cluster of tuberculosis associated with use of a marijuana water pipe. Int J Tuberc Lung Dis. 2003; 7(9):860–5.

  3. Ward et al. Characteristics of US water pipe users: A preliminary report. Nicotine and Tobacco Research. December, 2007;9(12):1339-46.

  4. Barnett et al. Water pipe Tobacco Smoking Among Middle and High School Students. Am J Public Health, 2009.

  5. WHO Study Group on Tobacco Product Regulation (TobReg). Water pipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators. Advisory Note. 2005.

  6. Maziak W, Ward, KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a Water pipe: a re-emerging strain in a global epidemic. Tobacco Control. 2004; 13:327-33.

  7. Centers for Disease Control and Prevention. Estimates of Current Tobacco Use Among Youth. Information and Prevention Source. 2015.

  8. Pfyffer, G. E.  Mycobacterium: general characteristics, laboratory detection, and staining procedures. In P. R. Murray, E. J. Baron, J. H. Jorgensen, M. L. Landry, and M. A. Pfaller (ed.), Manual of clinical microbiology, 11th ed. ASM Press, Washington, DC, 2015; p. 536–569.

  9. Maziak W, Eissenberg T, Rastam S. et al. Beliefs and attitudes related to narghile (Water pipe) smoking among university students in Syria.. 2004;646-54.

  10. Amrock, SM, Gordon T, Zelikoff JT, Weitzman M. Hookah use among adolescents in the United States: Results of a national survey. Nicotine Tob. Res. 2014; 16:231–237.

  11. Salloum RG, Goma F, Chelwa G, Cheng, X, Zulu R. et al. Cigarette price and other factors associated with brand choice and brand loyalty in Zambia: Findings from the ITC Zambia Survey. Tob. Control. 2015;24:Suppl 3:iii33-iii40.

  12. Palamar JJ, Zhou S, Scott Sherman, and Weitzman M. Hookah use among U.S. high school seniors. Pediatrics.2014;134(2):227-34.

  13. Alvur MT, Çınar N, Akduran F, Dede C. Fallacies about water pipe use in Turkish university students-what might be the consequences? Asian Pac J Cancer Prev. 2014;15: 1977-80.

  14. Özcebe H, Guciz B, İnal E, Haznedaroğlu D, Bertan M. Smoking water pipe habits of university students and related sociodemographic characteristics. TAF Prev Med Bull. 2014;13:19-28.

  15. Şahin S. ve Çınar N. Perceptions of Turkish University Students about the Effects of Water Pipe Smoking on Health. Asian Pac J Cancer Prev. 2015;6 (1): 4615-21.

  16. Singh AK, Maurya AK, Umrao J. et al. Role of genotype mycobacterium common mycobacteria/additional species assay for rapid differentiation between complex and different species of non-tuberculous mycobacteria. . 2013;83–9.

  17. Hasegawa N, Miura T, Ishii K. et al. New simple and rapid test for culture confirmation of Mycobacterium tuberculosis complex: a multicenter study. Journal of Clinical Microbiology. 2002; 908–12.

  18. Maurya AK, Nag VL, Kushwaha RAS, Kumar M, Singh AK. et al. Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary CareCenters in Northern India .BioMed Research International. 2015;1-5.

  19. Ingen Van J, Boeree M. J, Dekhuijzen P. N. R, and Van Soolingen D. Environmental sources of rapid growing nontuberculous mycobacteria causing disease in humans. Clinical Microbiology and Infection. 2009;888–93.

  20. Chien JY, Lai CC, Sheng WH, Yu CJ, Hsueh PR. Pulmonary Infection and Colonization with Nontuberculous Mycobacteria, Taiwan, 2000–2012. Emerging Infectious Diseases. 2014;1382-5.

  21. Simons S, Ingen van J, Hsueh PR, Van Hung N, Dekhuijzen RPN. et al. Nontuberculous Mycobacteriain Respiratory Tract Infections, Eastern Asia. Emerg Infect Dis. 2011;343-932.

  22. Gopinath K, Singh S. Non-tuberculous mycobacteria in TB-endemic countries: are we neglecting the danger? PLoS Negl Trop Dis. 2010;1-4.

  23. Shao Y, Chen C, Song H, Li G, Liu Q et al. The Epidemiology and Geographic Distribution of Nontuberculous Mycobacteria Clinical Isolates from Sputum Samples in the Eastern Region of China. PLOS Negl Trop Dis. 2015; e0003623.

  24. Ito Y, Hirai T, Maekawa K, Fujita K, Imai S. et al. Predictors of 5-year mortality in pulmonary Mycobacterium avium-intracellulare complex disease. Int J Tuberc Lung Dis.2012;16: 408–14.

  25. Wu J, Zhang Y, Li J, Lin S, Wang L. et al. Increase in Nontuberculous Mycobacteria Isolated in Shanghai, China: Results from a Population-Based Study. PLOSONE 2014; 9(10): e109736.

  26. Shen G, Xue Z, Shen X, Sun B, Gui X, et al. The study recurrent tuberculosis and exogenous reinfection, Shanghai, China.Emerg Infect Dis. 2006;12:1776–8.

  27. Jing H, Wang H, Wang Y, Deng Y, Li X, et al. Prevalence of nontuberculous mycobacteria infection, China, 2004–2009. Emerg Infect Dis. 2012;18: 527–8.

  28. Whiley H, Keegan A, Fallowfield H, and Bentham R. Detection of , and Mycobacterium Avium Complex (MAC) along Potable Water Distribution Pipelines. Int. J. Environ. Res. Public Health 2014;11(7): 7393-405.

  29. Wang H, Edwards MA, Falkinham JO. Pruden A. Molecular survey of occurrence of spp., spp., and amoeba hosts in two chloraminated drinking water distribution systems. ; :6285–94.

  30. Albayrak N, Şimşek H, Sezen F, Arslantürk A, Tarhan G et al. Evaluation of the distribution of non-tuberculous mycobacteria strains isolated in National Tuberculosis Reference Laboratory in 2009-2010, Turkey. Mikrobiyol Bul.2012;46(4):560-7.