Micobacteriosis atípica post mesoterapia / Atypical mycobacteriosis post mesotherapy

Resumen La utilización de procedimientos estéticos que mejoren la imagen corporal está en constante crecimiento, y también las infecciones asociadas a ellos, como las micobacteriosis atípicas. La meso terapia es un procedimiento mínimamente invasivo que consiste en la aplicación de sustancias que buscan estimular la dermis y el tejido celular subcutáneo, para el tratamiento de la celulitis y el rejuvenecimiento de la piel. Reportamos un caso de infección micobacteriana posterior a una mesoterapia en glúteos y muslos que se presentó como abscesos subcutáneos, que respondieron satisfactoriamente al tratamiento antibiótico prolonga do con claritromicina y trimetoprima-sulfametoxazol. Se han informado infecciones asociadas a mesoterapia en España, América Latina y el Caribe, que tendrían posiblemente un origen común: la falta de controles sanitarios. Destacamos la importancia de estar alertados sobre estas complicaciones infecciosas y la necesidad de reforzar las medidas de seguridad necesarias para evitarlas.

Abstract The use of aesthetic procedures that improve body image is constantly growing, as well as infections associated with them, such as atypical mycobacteriosis. Mesotherapy is a minimally invasive aesthetic procedure that consists of the application of substances that seek to stimulate the dermis and subcutaneous cellular tissue, for the treatment of cellulite and skin rejuvenation. We report a case of mycobacterial infection after mesotherapy in the buttocks and thighs that appeared as subcutaneous abscesses, they responded satisfactorily to prolonged antibiotic treatment with clarithromycin and trimethoprim-sulfamethoxazole. Infections associated with mesotherapy have been reported in Spain, Latin America and the Caribbean, all possibly related to lack of health controls. We emphasize the importance of being aware of these infectious complications and the need to reinforce the necessary security measures to avoid them.

Management of infections with Mycobacterium other than tuberculosis as a complication of surgical procedures

Background: Atypical Mycobacterium other than tuberculosis (MOTT) have emerged as significant human pathogens, causing post-surgical wound infections. The aim of this study is to assess the causative organisms of such infection and their treatment response.Methods: After matching the criteria, 28 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture.Results: Among 28 patients, 16 were females (median age of 45.5 year). Patients had undergone laparoscopic cholecystectomy (n=13), laparoscopic appendicectomy (n=3), laparoscopic hernioplasty (n=2), open appendicectomy (n=2), open mesh hernioplasty (n=7), exploratory laparotomy (n=1). No major comorbidities or immunosuppression was identified. All patients were initially treated with repeated incision and drainage and started conventional antibiotics until culture and sensitivity report was available. All except one patient had culture confirmed MOTT infection. Combination antibiotics (clarithromycin, linezolid and ofloxacin) given for initial 3 months. 12 well responded within 3 months. 9 required additional few months to get complete cure. 4 patients cured after 6 months of treatment and 3 patients did not come for follow up.Conclusions: Delayed onset chronic wound infection by atypical mycobacteria is preventable. These organisms are not responsive to conventional antitubercular drugs but to specific drug regimens.

Aislamiento y caracterización molecular de micobacterias no tuberculosas en el sistema de distribución de agua en un hospital de lima (perú) / Isolation and molecular characterization of nontuberculous mycobacteria in the water distribution system in a hospital of lima (perú)

RESUMEN Introducción: Las infecciones por micobacterias pueden causar lesiones cutáneas y pulmonares; las micobacterias pueden hallarse en fuentes de agua intrahospitalarias, pudiendo llegar a los pacientes inmunosuprimidos y provocar enfermedades severas. Objetivo: Aislar y caracterizar micobacterias no tuberculosas en el sistema de distribución de agua en un hospital de Lima. Materiales y métodos: Se aislaron las micobacterias en medios convencionales a base de huevo; y se emplearon pruebas bioquímicas y herramientas moleculares como la reacción en cadena de la polimerasa ―PCR― y secuenciación para su identificación. Para el análisis de secuenciación se empleó el GenBank y para el árbol filogenético se utilizó MEGA 6. Resultados: Fue posible el aislamiento de bacilos ácido alcohol resistentes en muestras de agua potable fría, aunque no en agua caliente del hospital. Se aislaron e identificaron varias especies de micobacterias no tuberculosas en las muestras de agua, siendo el 100 % de crecimiento rápido, estas fueron: Mycobacterium canariasense; M. frederiksbergense; M. mucogenicum; Mycobacterium fortuitum y Mycobacterium chelonae. Conclusiones: Esta es la primera vez que se aíslan micobacterias en agua potable de un hospital en Perú. Se concluye que la existencia de micobacterias en el agua del hospital podría ser fuente potencial de brotes nosocomiales, por lo que debería tenerse en cuenta su estudio periódicamente.

ABSTRACT Introduction: Mycobacterial infections can cause skin and lung lesions. Mycobacteria can be found in intra-hospital water sources which can reach immuno-suppressed patients and cause severe disease. Objective: To isolate and characterize non-tuberculous mycobacteria in the water distribution system in a hospital in Lima. Materials and Methods: Mycobacteria were isolated in conventional culture egg-based media and biochemical tests and molecular tools such as polymerase chain reaction (PCR) and sequencing were used for their identification. The GenBank was used for sequencing analysis and MEGA 6 was used for the phylogenetic tree. Results: Isolation of acid-fast bacilli was possible in samples of cold drinking water, although not in the hospital hot water. Several species of non-tuberculous mycobacteria were isolated and identified in the water samples being a 100% of rapid growth such as Mycobacterium canariasense, M. frederiksbergense, Mycobacterium fortuitum, Mycobacterium chelonae, and M. mucogenicum. Conclusions: This is the first time that mycobacteria are isolated in drinking water at a hospital in Perú. It is concluded that the existence of mycobacteria in hospital water could be a potential source of nosocomial outbreaks and should be analyzed periodically.

Mycobacterium marinum: reporte de un caso / Mycobacterium marinum: a case report

El Mycobacterium marinum es un tipo de micobacteria no tuberculosa (NTM). La infección por esta bacteria es frecuente en peces de agua dulce o salada y muy raramente, suele causar infecciones en la población humana. Presentamos el caso de un paciente varón de 60 años, que consulta por placa ulcerosa en dorso de mano izquierda. El estudio histopatológico de biopsia informa: hiperplasia epitelial con un denso infiltrado en dermis y escasos granulomas con células gigantes. Se solicitan distintas pruebas, siendo únicamente positiva el PCR para Mycobacterium marinum, por lo que se procede a instaurar regimen antimicrobiano con evolución favorable. El contagio por esta bacteria, se produce por inoculación directa del microorganismo, a través de heridas o erosiones cutáneas o por mordeduras de peces contaminados. Las formas de presentación clínica varían, siendo la más común la presencia de pápulas o nódulos solitarios en dedos o manos. También se puede manifestar en forma de linfangitis proximal o esporotricoide, extensión a órganos profundos y patrón esporotricoide facial. El diagnóstico requiere un alto índice de sospecha, debido a que la frecuencia de esta afección es muy baja, siendo de 0.04 a 0.27 por cada 100.000 habitantes. La biopsia de tejido proporciona el diagnóstico en solo la mitad de los casos. El cultivo confirma el diagnóstico, pero se reportan como positivos en 70 a 80% de los casos. Técnicas de amplificación de ácidos nucleicos, como la reacción en cadena polimerasa (PCR) son otros métodos para el diagnóstico, su mayor ventaja es la rapidez de sus resultados en comparación con el cultivo. Existen muchas modalidades terapéuticas: el tratamiento tópico, la administración sistémica de antimicrobianos, la cirugía, la termoterapia local y la terapia combinada. Sin embargo, los pacientes infectados con M. marinum por lo común, son tratados con antimicrobianos en monoterapia o combinados.

Introduction: Mycobacterium marinum is a type of non-tuberculous mycobacterium (NTM). Infection by this bacterium is frequent in freshwater or saltwater fish and very rarely causes infection in human population. Case report: we present the case of a 60-year-old male patient, who consulted for an ulcerative plaque on the back of his left hand. The histopathological study of biopsy reports: epithelial hyperplasia with a dense infiltrate in dermis and few granulomas with giant cells. Different tests were requested, PCR the only one positive for Mycobacterium marinum, which is why we proceeded to establish an antimicrobial regimen with favorable evolution. Discussion: infection by this bacterium is produced by direct inoculation of the microorganism through wounds or skin erosions or by contaminated fish bites. The forms of clinical presentation vary, being the most common the presence of solitary papules or nodules on fingers or hands. It can also manifest in the form of proximal or sporotrichoid lymphangitis, extension to deep organs, and facial sporotrichoid pattern. Diagnosis requires high index of suspicion, since the frequency of this condition is very low, from 0.04 to 0.27 per 100.000 habitants. Tissue biopsy provides the diagnosis in only half of the cases. Culture confirms the diagnosis, but they are reported as positive in 70 to 80% of cases. Nucleic acid amplification techniques, such as polymerase chain reaction (PCR) are other methods for diagnosis; its greatest advantage is the speed of its results compared to culture. There are many therapeutic modalities: topical treatment, systemic administration of antimicrobials, surgery, local thermotherapy and combination therapy. However, patients infected with M. marinum are usually treated with antimicrobials alone or in combination.

Mycobacterium chelonae infection complicating traumatic and surgical wounds: A case series

Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacterium. The skin and soft tissue infections due to this organism are steadily on the rise and need to be delineated specifically as most of these are not responsive to routine antituberculosis treatment. Here, we report 3 different presentations caused by Mycobacterium chelonae in traumatic and surgical wounds. Mycobacterium chelonae can complicate surgical or traumatic wounds.This infection may also present as injection site abscesses. Diabetics on insulin injections are especially at risk. A high index of suspicion is necessary in long standing culture negative lesions for clinching the diagnosis. PCR can be helpful in confirming the diagnosis.

Port Site Chronic Sinuses – A Wisdom of 5 Years and 50 Cases.

Background: Laparoscopic surgery has now become an accepted method of minimal invasion of human anatomy but the dreaded problem of port site complications especially the chronic sinuses has rejuvenated the proponents of open techniques. The scope of laparoscopy widened from diagnostic purposes to resecting large tumors in almost all the systems of the body. As the time progressed, the problems associated with use of long instruments and dexterity of movements started creeping in. The vision, which was analogue, to start with, became 3D digital and with the introduction of robotic arm, the problem of dexterity was addressed to some extent. One thing that persisted right through so much of technical development was the problem of infection and sinuses and the enormity of this issue can be gauged by its evergrowing number. Methods: Although minimal invasive surgery is here to stay for all intent and purposes, we have decided to study 50 cases of chronic port site sinuses treated and followed up for 5 years in various wards of department of surgery in Guru Nanak Dev Hospital, Amritsar. In this study the authors present their experience and rationale regarding various factors like age and sex distribution, site of infection, results of microscopy and culture/sensitivity, treatment given (both surgical and non surgical), response time and prognosis. Results: In the cases where there was discharge culture of the pus yielded skin and soft tissue infections like staphylococcus, streptococcus, pseudomonas, E. coli and klebsiella. Out of 50, 20 cases were treated by appropriate antibiotics after culture sensitivity and quinolones.Conclusion: From the above discussion and flow chart, it can be safely concluded that atypical mycobacteria and some of the anaerobes remain the main offending agents.

Micobacterias atípicas en cinco pacientes adultos sin evidencias de inmunosupresión: Construyendo una experiencia / Atypical mycobacterial infections in five adult patients without evidence of immunosuppression: Making an experience

We aim to communicate the experience gathered during the management of infections by atypical mycobacteria in immunocompetent patients in a general practice. Between 2008 and 2013, 5 patients with non-tuberculous mycobacterial infections were identified: 2 with cutaneous involvement and 3 with lung infection. None of them had evidence of immunosuppression. A patient with elbow bursitis by M. chelonae presented with a high mononuclear count in fluid analysis with mycobacterial growth at the fifth day of culture. He evolved satisfactorily with clarithromycin. A case with M. fortuitum skin infection had a delayed initial diagnosis with progression to local draining lymph nodes; the culture when requested was positive after 13 days of incubation. Patients with pulmonary infection presented with prolonged cough and sputum and had in common to be postmenopausal women displaying small nodules and bronchiectases at lung images, a classical pattern. Time elapsed between respiratory sampling and a definitive inform ranged from 40 to 89 days. Non-tuberculous mycobacterial infections in non-immunosuppresed patients can generate diagnostic and therapeutic challenges. Delay in identification contributes to this problem.

El objetivo de este trabajo es reportar la experiencia acumulada sobre infecciones por micobacterias atípicas en pacientes sin inmunosupresión. Entre el año 2008 y 2013 se observaron cinco pacientes con infección por micobacterias atípicas: dos con infección cutánea y tres con infección pulmonar. Ninguno de estos pacientes tenía evidencias de inmunosupresión. Un paciente con bursitis de codo por M. chelonae tuvo un estudio citoquímico con aumento de celularidad de predominio mononuclear y desarrollo de bacterias al quinto día; respondió favorablemente a claritromicina. Un caso con infección cutánea por M. fortuitum evolucionó en forma prolongada con supuración ganglionar antes del diagnóstico y el cultivo solicitado a los 13 días fue positivo. Los tres pacientes con aislados pulmonares presentaron tos y expectoración y tenían en común ser mujeres en edad post-menopáusica y presentar pequeños infiltrados nodulares asociados a bronquiectasias en el estudio de imágenes pulmonares, un patrón descrito en la literatura científica. En estos tres casos, la latencia entre la toma de muestra y el informe definitivo tuvo un rango de 40 a 89 días. El aislamiento de micobacterias atípicas en muestras de expectoración en pacientes sin inmunosupresión se da en un contexto típico pero plantea dificultades diagnósticas y terapéuticas. El lento crecimiento de estos microorganismos en el laboratorio contribuye a este problema.

Mycobacterial co-infection in retroviral disease.

Atypical mycobacteria are increasingly afflicting pulmonary and extra pulmonary systems. Disease caused by these organisms are less common compared with tuberculosis caused by human strain of mycobacteria, but there has been a significant increase in pulmonary and extra pulmonary infections due to atypical mycobacteria especially in retroviral disease in the last two decades. 75 HIV positive patients who had pulmonary and/or extrapulmonary manifestations suggestive of Tuberculosis were included in our study. Of these,48 (64%) were males and 27(36%)were females. Majority of these patients were in economically productive and sexually active age group of 31-50 years. Of the 75 samples, 25 were culture positive for Acid Fast Bacilli whereas 50 samples showed no growth on culture at end of 8 weeks. Of the 25 who had positive cultures, 15 showed growth for Mycobacterium TB and 10 showed growth for Atypical mycobacteria. Of the 25 patients who were Culture positive, 16 i.e 64% had Sputum smears by Z-N stain positive for AFB, which was statistically significant. It was observed that Atypical mycobacterial infection was more common in CD4 count < 100 cells/cu mm. Infection with Mycobacterium TB was more common in CD4 count between 101-200 cells/cu mm.

Pulmonary Infection by Rapidly Growing Mycobacterium in an Immunocompetent Child.

Background: Pulmonary infections by rapidly growing mycobacteria are rare in immunocompetent children. Case characteristics: A 2-year-old boy with persistent right upper lobe pneumonia. Observation: Bronchoalveolar lavage culture demonstrated growth of Mycobacterium atocessus. Outcome: Complete resolution of disease with multidrug chemotherapy with imipenam, clarithromycin and amikacin. Message: Persistent upper lobe cavitory lesions can rarely be caused by rapidly growing mycobacteria.

A Rare Case of Mycobaterium Avium Complex (MAC) Infection in an Immunocompetent Person.

It is well known that Mycobaterium avium complex (MAC) infection occurs commonly in immunecompromised patients. We are reporting a case of MAC infection in a person in whom no evidence of immune-compromisation has been found despite thorough examination.

Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease / 대한내과학회지

The incidence of chronic pulmonary disease caused by nontuberculus mycobacteria (NTM) in human immunodeficiency virus (HIV)-negative patients has been increasing worldwide. In Korea, the common etiologic pathogens for this disease are Mycobacterium avium complex and Mycobacterium abscessus. Most NTM pulmonary diseases present one of two forms such as fibrocavitary or nodular bronchiectatic disease according to their radiographic features. However they also present hypersensitivity like diseases and solitary pulmonary nodules. NTM pulmonary disease has specific diagnostic criteria including repeated isolations of organisms because they are ubiquitous environmental organisms and NTM isolation can be a result of specimen contamination. However diagnosing NTM pulmonary disease does not mean the need for immediate treatment. Also since it needs multiple antibiotics for a long time, treatment is expensive and has significant side effects. Therefore treating NTM lung diseases can be extremely difficult and factors such as patient's age, comorbid conditions, and progression rates of symptoms and disease should be considered in the decision of treatment.

Coexistent Kaposi's sarcoma and atypical mycobacterial infection involving lymph node: A case report and review of literature.

Patients infected with human immunodeficiency virus frequently manifest with rare infections as well as neoplasms. We report an unusual and interesting case of an intranodal Kaposi's sarcoma (KS) with coexistent/concurrent granulomatous lymphadenitis secondary to atypical mycobacteria in a groin lymph node. "Mycobacterium pseudotumor" is a nonneoplastic condition and should be distinguished from true KS as these 2 entities differ in their prognosis and treatment. In this article, we discuss the diagnosis and differential diagnosis of this exceptional clinical and pathologic manifestation.

Mycobacterium chelonae and Mycobacterium fortuitum infection following open fracture: A case report and review of the literature.

We report a case of dual nontuberculous mycobacterial infections complicating an open distal radius and ulna fracture after polytrauma in a 35-year-old man. There was persistent wound discharge after definitive fixation of this fracture, but microbiological cultures did not yield any organism. The patient underwent multiple debridement, and subsequent tissue grew Mycobacterium chelonae and Mycobacterium fortuitum. Despite appropriate chemotherapy and surgical debridement the infection persisted until radical bone excision and tissue debridement were done. This case indicates that nontuberculous mycobacterial infections should be considered when conventional microbiological assays fail to identify the infecting agent in suspected osteomyelitis following open fracture. A combination of radical debridement, including removal of infected bone, and prolonged antimicrobial therapy are required to eradicate the infection completely.

Standardized Combination Antibiotic Treatment of Mycobacterium avium Complex Lung Disease

PURPOSE: The optimal treatment regimen for Mycobacterium avium complex (MAC) lung disease has not yet been fully established. We evaluated the efficacy of standardized combination antibiotic therapy and the factors that might affect unfavorable microbiologic responses in patients with MAC pulmonary disease. MATERIALS AND METHODS: This retrospective study reviewed data from 96 patients (56 females; median age 59 years) treated with newly diagnosed MAC lung disease between January 2003 and December 2006. RESULTS: All patients received standardized combination antibiotic therapy, consisting of clarithromycin, rifampicin, and ethambutol. Streptomycin was additionally given in 72 patients (75%) for a median duration of 4.5 months. The overall favorable microbiologic response rate was 79% (76/96); 20 patients (21%) had unfavorable microbiologic responses, including failure to sputum conversion (n = 13), relapse (n = 3), and MAC-related death (n = 4). A positive sputum acid-fast bacillus smear at the start of treatment was an independent predictor of an unfavorable microbiologic response. CONCLUSION: Standardized combination antibiotic therapy consisting of clarithromycin, rifampicin, and ethambutol with or without initial use of streptomycin is effective in treating patients with newly diagnosed MAC lung disease.

Sequential Bilateral Lung Resection in a Patient with Mycobacterium Abscessus Lung Disease Refractory to Medical Treatment

Mycobacterium abscessus (M. abscessus) is the second most common nontuberculous mycobacteria (NTM) in South Korea. Nevertheless, the diagnosis and treatment of M. abscessus lung disease can be problematic. Surgical resection has been tried for patients with localized M. abscessus lung disease refractory to medical treatment. Here, we report on a 25-year-old woman with M. abscessus lung disease who had been diagnosed and treated three times for pulmonary tuberculosis. She was initially diagnosed as having M. intracellulare lung disease; however, M. abscessus was isolated after several months of medication. She had multiple bronchiectatic and cavitary lesions bilaterally, and M. abscessus was repeatedly isolated from her sputa despite prolonged treatment with clarithromycin, ethambutol, moxifloxacin, and amikacin. She improved only after sequential bilateral lung resection. Based on the experience with this patient, we suggest that, if medical treatment fails, surgical resection of a diseased lung should be considered even in patients with bilateral lesions.

Identificação laboratorial de micobactérias em amostras respiratórias de pacientes HIV-positivos com suspeita de tuberculose / Laboratory identification of mycobacteria in respiratory samples from HIV-positive patients suspected of tuberculosis

Foram analisados retrospectivamente os registros (2000 a 2004) do Laboratório de Microbiologia do Instituto Adolfo Lutz de Santos, SP referentes a pacientes infectados pelo virus da imunodeficiência humana com suspeita de tuberculose pulmonar. Foram encaminhadas 1.321 amostras com finalidade de diagnóstico, correspondendo a 880 casos suspeitos de tuberculose em 693 pacientes. Cento e trinta e quatro baciloscopias foram positivas e em 188 culturas houve crescimento de micobactérias, correspondendo a 161 casos confirmados. Houve identificação de Mycobacterium tuberculosis em 126 (78,3 por cento) e micobactérias não tuberculosas em 39 (24,2 por cento). Em quatro casos, houve concomitância de Mycobacterium tuberculosis e micobactérias não tuberculosas (porém em amostras distintas). O perfil de sensibilidade às drogas antituberculose revelou 18 (14,3 por cento) casos de resistência a pelo menos um medicamento. Estes resultados reforçam a necessidade de submeter à rotina laboratorial completa - baciloscopia, cultura com identificação e testes de sensibilidade às drogas - as amostras respiratórias de pacientes soropositivos para o vírus da imunodeficiência humana com suspeita de tuberculose para direcionamento terapêutico adequado.

The records (2000 to 2004) of the Microbiology Laboratory of the Adolfo Lutz Institute in Santos, Brazil, were retrospectively analyzed regarding patients infected with the human immunodeficiency virus (HIV) and suspected of pulmonary tuberculosis. 1,321 samples for diagnosis purposes were selected, corresponding to 880 suspected tuberculosis cases in 693 patients. There were 134 smear-positive samples and mycobacteria growth occurred in 188 cultures, corresponding to 161 confirmed cases. Mycobacterium tuberculosis was identified in 126 (78.3 percent) and non-tuberculous mycobacteria in 39 (24.2 percent). In four cases, both Mycobacterium tuberculosis and non-tuberculous mycobacteria were simultaneously recovered from different samples. The profile of sensitivity to anti-tuberculosis drugs revealed 18 (14.3 percent) cases of resistance to at least one drug. These results reinforce the need to carrying out the complete laboratorial routine (sputum smear microscopy, culture and susceptibility to antituberculous drugs) for respiratory samples from human immunodeficiency virus-positive patients with suspected tuberculosis in order to direct appropriate therapy.

Recovery Rate of Nontuberculous Mycobacteria and the Clinical Course of Nontuberculous Mycobacterial Pulmonary Disease at a Secondary Hospital / 결핵및호흡기질환

BACKGROUND: To examine the recovery rate of nontuberculous mycobacteria (NTM) from respiratory specimens and the clinical course of NTM pulmonary disease at a 700-bed secondary hospital. METHODS: This study analyzed the results of 843 acid-fast bacilli (AFB) culture-positive respiratory specimens from 650 subjects collected between May 2003 and April 2008. In addition, the clinical course of NTM pulmonary disease, diagnosed using criteria established by the American Thoracic Society, was examined. RESULTS: There were 67 (7.9%) NTM isolates recovered from 52 (8.0%) subjects. Among the 535 AFB smear-positive specimens, 34 (6.3%) NTM isolates were recovered. There were 33 (10.7%) NTM isolates were recovered from 308 AFB smear-negative specimens. Of 52 subjects with isolated NTM, M. intracellulare was the most common species at 73.1% (n=33), followed by M. kansassi (n=7), M. abscessus (n=2), M. fortuitum (n=2), and M. avium (n=1). Sixteen (30.8%) patients had NTM pulmonary disease and the most common causative organism was M. intracellulare (n=14, 87.5%). Of these, 6 cases attained negative conversion in culture, 4 cases failed to attain negative conversion because of poor cooperation or expiration from complicated underlying lung disease, and 5 cases were transferred to a higher-grade hospital. CONCLUSION: The recovery rate of NTM from respiratory specimens was relatively low and the most common species was M. intracellulare. Patients with NTM pulmonary disease showed variable clinical outcomes.

Successful Treatment of Mycobacterium fortuitum Lung Disease with Oral Antibiotic Therapy: a Case Report / 결핵및호흡기질환

Mycobacterium fortuitum usually causes colonization or transient infection in patients with underlying lung disease, such as prior tuberculosis or bronchiectasis. The majority of these patients may not need to receive antibiotic therapy for M. fortuitum isolates. We report here on a patient with M. fortuitum lung disease and who was successfully treated with combination oral antibiotic therapy. A 53-year-old woman was referred to our institution because of purulent sputum and dyspnea. A chest radiograph and computed tomography scan revealed cavitary consolidation in the left upper lobe and multiple small cavities in the left lower lobe. Numerous acid-fast bacilli (AFB) were seen in multiple sputum specimens and M. fortuitum was identified by culture from the sputum specimens. The patient received antibiotic treatment including clarithromycin, ciprofloxacin and sulfamethoxazole, because her symptoms were worsening despite conservative treatment. Sputum conversion was achieved after one month of antibiotic therapy. Both the patient's symptoms and radiographic findings improved after 10 months of antibiotic therapy.

Diagnosis and treatment of nontuberculous mycobacterial lung disease / 대한내과학회지

As the prevalence of tuberculosis declines, the proportion of mycobacterial lung disease due to nontuberculous mycobacteria (NTM) is increasing worldwide. In Korea, Mycobacterium avium-intracellulare complex and Mycobacterium abscessus account for most of the pathogens encountered, whilst Mycobacterium kansasii is a relatively uncommon cause of NTM lung diseases. When NTM lung disease occurs, it is likely to present in one of two forms: apical fibrocavitary disease often affecting older male smokers with previous tuberculosis or chronic obstructive pulmonary disease; nodular bronchiectasis classically occurring in middle-aged or older woman who never smoked and present with cough. Because its clinical features are frequently indistinguishable from those of pulmonary tuberculosis and NTMs are ubiquitous in the environment, the isolation and identification of causative organisms are mandatory for diagnosis, and some specific diagnostic criteria have been proposed. Treatment of disease depends on the infecting species, extent and form of disease, and overall condition of the patient, but decisions concerning the institution of treatment are never easy. Treatment requires the use of multiple drugs for 18 to 24 months. Thus, treatment is expensive, often has significant side effects, and is frequently not curative. Surgery for localized disease may be useful for those species expected to be refractory to medical therapy. Observation without treatment may be appropriate for some patients with slowly progressive disease that is expected to be particularly difficult to treat.

Pulmonary Disease Caused by Mycobacterium xenopi: The First Case in Korea

Mycobacterium xenopi is a nontuberculous mycobacterium (NTM) that rarely causes pulmonary disease in Asia. Here we describe the first case of M. xenopi pulmonary disease in Korea. A 66-year-old man was admitted to our hospital with a 2-month history of productive cough and hemoptysis. His past medical history included pulmonary tuberculosis 44 years earlier, leading to a right upper lobectomy. Chest X-ray upon admission revealed cavitary consolidation involving the entire right lung. Numerous acid-fast bacilli were seen in his initial sputum, and M. xenopi was subsequently identified in more than five sputum cultures, using molecular methods. Despite treatment with clarithromycin, rifampicin, ethambutol, and streptomycin, the infiltrative shadow revealed on chest X-ray increased in size. The patient's condition worsened, and a right completion pneumonectomy was performed. The patient consequently died of respiratory failure on postoperative day 47, secondary to the development of a late bronchopleural fistula. This case serves as a reminder to clinicians that the incidence of NTM infection is increasing in Korea and that unusual NTM are capable of causing disease in non-immunocompromised patients.