Waterborne Mycobacterium avium Infection-Reply

In Reply. —  Drs Yagupsky and Menegus agree with us that M avium is frequently isolated from respiratory specimens of immunocompromised patients.Other airborne or aerosol-borne potential pathogens, notably Cryptococcus neoformans and Neisseria meningitidis, originate in the respiratory tract before they may invade the bloodstream without being "seen in lung tissue sections." The traditional concept that all species of aerosol-borne mycobacteria supposedly cause pulmonary tuberculosis before dissemination may have to be reexamined in the context of the immunoincompetent host. It certainly does not apply to M avium disease in chickens, in which the liver and spleen are involved.¹Granted, gastrointestinal mycobacterial disease in AIDS patients may be the result of ingesting large amounts of M avium in the drinking water rather than inhaling aerosols. But why does the mode of transmission of M avium have to be further elucidated, and why is it premature now to discourage massive exposure