Identificación de Mycobacteria no pigmenteda de crecimiento rápido por el Método Molecular de Micobacterium de Genotipo CM / Identification of Fast-Growing Non-Pigmented Mycobacteria by the Genotype® Mycobacterium CM Molecular Method

Introducción: la micobacteria no terberculosa (NTM) forma un grupo heterogéneo de microorganismos que pueden causar infección en humanos. Las micobacterias no pigmentadas de rápido crecimiento (MNPCR) son de interés clínico debido al creciente número de pacientes infectados por ellos y a la dificultad del tratamiento. Dentro de este grupo, Mycobacterium fortuitum, Mycobacterium abscessus y Mycobacterium chelonae son reconocidos como patógenos potenciales; estas especies se han aislado de infecciones pulmonares y extrapulmonares. Objetivo: el objetivo de este trabajo es encontrar la frecuencia de aislamiento de especies micobacterianas de rápido crecimiento, específicamente el complejo Mycobacterium fortuitum, de muestras clínicas utilizando la técnica molecular de diagnóstico GenoType Mycobacterium CM. Material y Método: se analizaron 249 aislados de micobacterias no tuberculosas obtenidas de muestras pulmonares y extrapulmonares de pacientes sintomáticos en el período enero 2018-diciembre de 2022. La técnica molecular GenoType Mycobacterium CM se utilizó para identificar la especie. Resultados: Se obtuvieron 77 (3,9%) aislados de especies no pigmentadas de rápido crecimiento, estas se identificaron en orden decreciente: Mycobacterium fortuitum 65 (84,41%), Mycobacterium abcessus 9 (11,68%) y Mycobacterium chelonae 3 (4%). Conclusiones: los resultados reafirman que el complejo Mycobacterium fortuitum es responsable de la mayoría de las infecciones causadas por la micobacteria en rápido crecimiento en humanos. La técnica diagnóstica GenoType Mycobacterium CM es una herramienta útil para la rápida identificación de micobacterias; proporciona resultados precisos en menos tiempo, acortando significativamente el tiempo diagnóstico, permite la aplicación temprana de tratamiento específico, evitando así la propagación de la infección.

Introduction: non-tuberculous mycobacteria (NTM) form a heterogeneous group of mi-croorganisms that can cause infection in humans. Fast-growing non-pigmented my-cobacteria (MNPCR) are of clinical interest due to the increasing number of patients infected by them and the difficulty of treatment. Within this group, Mycobacterium fortuitum, Mycobacterium abscessus and Mycobacterium chelonae are recognized as potential pathogens; these species have been isolated from both pulmonary and ex-trapulmonary infections. Objective: the objective of this work is to find the frequency of isolation of fast-growing non-pigmented mycobacterial species, specifically the Myco-bacterium fortuitum complex, from clinical samples using the GenoType® Mycobacteri-um CM diagnostic molecular technique. Material and Method: 249 isolates of non-tu-berculous mycobacteria obtained from pulmonary and extrapulmonary samples from symptomatic patients in the period January 2018-December 2022 were analyzed. The G e n oTy p e® Mycobacterium CM molecular technique was used to identify the species. Results: 77 (30.9%) isolates of fast-growing non-pigmented species were obtained, these were identified in decreasing order: Mycobacterium fortuitum 65 (84.41%), Myco-bacterium abcessus 9 (11.68%) and Mycobacterium chelonae 3 (4%). Conclusions: the results reaffirm that the Mycobacterium fortuitum complex is responsible for most in-fections caused by fast-growing mycobacteria in humans. The GenoType® Mycobacte-riumCM diagnostic technique is a useful tool for the rapid identification of mycobacte-ria; it provides accurate results in less time, significantly shortening the diagnostic time, it allows the early application of specific treatment, thus avoiding the spread of infec-tion.

Identificación de especies micobacterianas ambientales u oportunistas en pacientes sintomáticos y con VIH/sida / Identification of environmental or opportunistic mycobacterial species in symptomatic symptomatic and HIV/AIDS patients

El aumento de las infecciones por micobacterias ambientales u oportunistas (MAO) coincide mundialmente con el declive de la infección tuberculosa e incremento de la infección por el virus de inmunodeficiencia humana (VIH). El presente trabajo es un estudio retrospectivo realizado en el Laboratorio Nacional de Referencia-Investigaciones de Tuberculosis/Micobacterias/Lepra (LNRI-TB/Lepra/Micobacterias), del Instituto de Medicina Tropical Pedro Kourí (IPK), La Habana, Cuba, durante el período enero 2014-diciembre 2018. El objetivo de nuestro estudio fue conocer la variabilidad de especies aisladas para establecer un referente actualizado sobre las infecciones causadas por estas. En este trabajo se clasificaron-identificaron 413 cepas procedentes de pacientes sintomáticos; 162 (39.22%) eran aislamientos de pacientes con VIH/sida atendidos en nuestro Hospital Nacional de Referencia a Atención al paciente VIH/sida (IPK), y el resto (n = 251 [60.77%]), procedentes de pacientes inmunocompetentes, incluyendo aislamientos recibidos de los Centros Provinciales de Higiene, Epidemiología, y Microbiología (CPHEM). Las muestras fueron analizadas con las técnicas convencionales establecidas: las pulmonares fueron descontaminadas por el método de Petroff modificado; las extrapulmonares, por el método del ácido sulfúrico al 4%; el cultivo se realizó en medio de Löwenstein-Jensen modificado. Posteriormente se realizó la clasificación-identificación de especies según el esquema fenotípico-bioquímico establecido. Las especies con mayor porcentaje de aislamiento pertenecieron a los Grupos III y IV, complejo Mycobacterium avium-intracellulare (34.14%) y complejo M. fortuitum (20.82%), respectivamente. Estos resultados permitirán conocer la prevalencia de estas especies en nuestro país, reafirmando la importancia diagnóstica de estos microorganismos para aplicar tratamiento específico, sobre todo en pacientes con factores de riesgo, en quienes es más probable la diseminación de la infección.

The increase in infections by environmental or opportunistic mycobacteria (MAO) coincides worldwide with the decline in tuberculosis infection and an increase in infection by the human immunodeficiency virus (HIV). The present work is a retrospective study carried out at the National Reference Laboratory-Tuberculosis/Mycobacterial/Leprosy Research (LNRI-TB / Leprosy / Mycobacteria), of the Pedro Kourí Institute of Tropical Medicine (IPK), La Habana, Cuba, during the period January 2014-December 2018. The objective of our study was to know the variability of isolated species to establish an updated reference on the infections caused by MAO. In this study, 413 strains from symptomatic patients were classified and identified; 162 (39.22%) were isolates from patients with HIV/AIDS treated at our National Hospital of Reference for Attention to HIV/AIDS patients (IPK), and the remaining (n=251 [60.77%]), from immunocompetent patients, including isolates received from the Provincial Centers of Hygiene, Epidemiology, and Microbiology (CPHEM). The samples were analyzed with the established conventional techniques: the lung samples were decontaminated by the modified Petroff method; the extrapulmonary, by the 4% sulfuric acid method; the culture was carried out in modified Löwenstein-Jensen medium. Subsequently, the classification-identification of species was carried out according to the established phenotypic-biochemical scheme. The species with the highest percentage of isolation belonged to Groups III and IV, Mycobacterium avium-intracellulare complex (34.14%), and M. fortuitum complex (20.82%), respectively. These results will allow us to know the prevalence of these species in our country, emphasizing the diagnostic importance of these microorganisms and thus apply a specific treatment, especially in patients with risk factors, in whom the spread of the infection is more likely

Nontuberculous mycobacterial infection in a tertiary care center in Mexico, 2001-2017

ABSTRACT Introduction: Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. Methods: We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). Results: A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p = 0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p = 0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p = 0.27). Conclusions: Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.

Systemic disseminated Mycobacterium fortuitum infection:one case report and literature review / 中国感染控制杂志

Objective To explore the clinical characteristics of systemic disseminated infection caused by Mycobacterium fortuitum (M.fortuitum), and improve the diagnostic rate and understanding of the disease.Methods One case of systemic disseminated M.fortuituminfection was reported, and analyzed in combination with relevant literatures.Results Patient was with multiple systemic involvement (including lung, lymph node, skin, joint), lymph node tissue culture was positive for M.fortuitum, patient was given clarithromycin+levofloxacin+linezolid for treatment, disease was remitted.Conclusion Systemic disseminated M.fortuituminfection is rare, and patient with GATA2 deletion and IFN-γautoantibody may be a potential mechanism, diagnosis is mainly based on pathological morphology and microbiological detection, but positive rate is low, diagnosis is difficult.

Úlcera crónica por Mycobacterium chelonae: informe de dos casos y claves para el diagnóstico de micobacteriosis cutáneas / Chronic ulcer by Mycobacterium chelonae: a report of two cases and keys for the diagnosis of cutaneous mycobacteriosis

Resumen Se comunican dos casos clínicos poco frecuentes de micobacteriosis cutáneas; uno adquirido en la comunidad y uno en medio hospitalario, ambos pacientes del género masculino, con dermatosis crónicas constituidas por úlceras, fístulas y placas de aspecto papilomatoso. El diagnóstico fue tardío y la evolución no fue satisfactoria, a pesar de prescribir tratamiento adecuado contra Mycobacterium chelonae. El propósito de este artículo es mostrar la manifestación clínica de las lesiones para sospecha diagnóstica temprana y oportuna de las diferentes disciplinas médicas que participan en la atención de los pacientes con estas infecciones.

Abstract This paper reports the two rare clinical cases of cutaneous mycobacterial infections. One of them acquired the infection within the community while the other was a nosocomial case, both cases were male with chronic ulcers, fistulae and papilloma-like lesions. In both cases diagnosis was late and evolution, despite correct Mycobacterium chelonae treatment, was unsatisfactory. The purpose of this paper is to show the clinical presentation and accurate suspicion of infection of the different medical areas involved in its management.

Coinfección por Mycobacterium fortuitum y Mycobacterium tuberculosis en abscesos esplénicos en un paciente con VIH / Co-infection by Mycobacterium fortuitum and Mycobacterium tuberculosis in splenic abscesses in a patient with HIV

RESUMEN Los pacientes con VIH son susceptibles a la infección por micobacterias. En el caso de las micobacterias de crecimiento rápido, grupo al que pertenece el Mycobacterium fortuitum (M. fortuitum), se han descrito infecciones en la piel, pulmones, ganglios linfáticos y enfermedad diseminada. Presentamos el caso de un paciente varón de 43 años, con diagnóstico previo de VIH en tratamiento antirretroviral, que acude por fiebre, astenia, pérdida de peso y diarrea crónica. Se realiza tomografía abdominal y se evidencia hepatoesplenomegalia con lesiones nodulares en el bazo. El cultivo esplénico, finalmente, fue positivo para M. fortuitum, con PCR positivo a Mycobacterium tuberculosis. Los protocolos actuales de tratamiento para este tipo de infecciones se basan en la susceptibilidad mostrada en los cultivos realizados. En lo que respecta a coinfecciones entre M. fortuitum y Mycobacterium tuberculosis, en pacientes VIH positivos, la información es aun menor.

ABSTRACT Patients with HIV are susceptible to mycobacterium infection. In the case of fast-growing mycobacteria, the group to which Mycobacterium fortuitum (M. fortuitum) belongs, infections have been described in the skin, lungs, lymph nodes and disseminated disease. We present the case of a 43-year-old male patient with pre-diagnosis of HIV in antiretroviral therapy, which comes as a fever, asthenia, weight loss and chronic diarrhea. Abdominal tomography is performed and hepatosplenomegaly is evidenced with nodular lesions in the spleen. The splenic culture was finally positive for M. Fortuitum, with positive PCR to Mycobacterium tuberculosis. The current treatment protocols for this type of infection are based on the susceptibility shown in the cultures performed. With regard to coinfections between M. Fortuitum and Mycobacterium tuberculosis, in HIV positive patients, there are even less information.

Rapid identification for Mycobacterium fortuitum with RNA isothermal transcription-mediated amplification and real-time detection assay / 中国人兽共患病学报

The aim of the study is to establish and evaluate a RNA isothermal transcription-mediated amplification and realtime detection assay (RIARD-MF) for the identification of Mycobacterium fortuitum in clinical isolates.RNA probes and specific primers of reverse transcription and amplification for T7 promoter were designed based on the sequence of M.fortuitum 16S rRNA.The isothermal successive cycles of amplification were performed for real-time detection by using T7 RNA polymerase at 42 ℃.Five non-mycobacterium strains,20 Mycobacterium strains and 259 clinical strains were detected by the established assay to evaluate the specificity and sensitivity,and the results were compared with those of PCR sequencing.In the test of 5 non-mycobacterium strains and 20 Mycobacterium strains,only M.fortuitum was positive,and the remaining 24 strains of bacteria were negative,which was consistent with PCR gene sequencing.The sensitivity and specificity of RIARD-MF reached 60 CFU/mL and 100％.In the test of 259 strains of clinical isolates,5 strains were identified to be M.fortuitum,the remaining 254 strains were not identified to be M.Fortuitum,which was also consistent with PCR gene sequencing.Both the specificity and sensitivity reached up to 100％ in the detection of clinical isolates.It suggested that the RIAR-DMF established in this study is a specific,sensitive,accurate and rapid method for the identification of M.Fortuitum and it may be hopeful for rapid identification of M.fortuitum in clinical isolates.

Rapid identification for Mycobacterium fortuitum with RNA isothermal transcription-mediated amplification and real-time detection assay / 中国人兽共患病学报

The aim of the study is to establish and evaluate a RNA isothermal transcription-mediated amplification and realtime detection assay (RIARD-MF) for the identification of Mycobacterium fortuitum in clinical isolates.RNA probes and specific primers of reverse transcription and amplification for T7 promoter were designed based on the sequence of M.fortuitum 16S rRNA.The isothermal successive cycles of amplification were performed for real-time detection by using T7 RNA polymerase at 42 ℃.Five non-mycobacterium strains,20 Mycobacterium strains and 259 clinical strains were detected by the established assay to evaluate the specificity and sensitivity,and the results were compared with those of PCR sequencing.In the test of 5 non-mycobacterium strains and 20 Mycobacterium strains,only M.fortuitum was positive,and the remaining 24 strains of bacteria were negative,which was consistent with PCR gene sequencing.The sensitivity and specificity of RIARD-MF reached 60 CFU/mL and 100％.In the test of 259 strains of clinical isolates,5 strains were identified to be M.fortuitum,the remaining 254 strains were not identified to be M.Fortuitum,which was also consistent with PCR gene sequencing.Both the specificity and sensitivity reached up to 100％ in the detection of clinical isolates.It suggested that the RIAR-DMF established in this study is a specific,sensitive,accurate and rapid method for the identification of M.Fortuitum and it may be hopeful for rapid identification of M.fortuitum in clinical isolates.

Cutaneous Mixed Infection of Mycobacterium fortuitum and Mycobacterium intracellulare after a Fat Graft / 대한피부과학회지

Atypical mycobacteria, widely distributed in nature, are opportunistic infection strain, rare pathogen in immunocompetent patients. Recently, the increase of invasive cosmetic treatment and surgery has increased the infection of atypical mycobacteria. We report a case of cutaneous infection by Mycobacterium fortuitum and Mycobacterium intracellulare that occurred after a fat graft. A 62-year-old female patient presented painful, erythematous nodules and purulent discharge on her face after a fat graft. A skin biopsy and culture were performed. Polymerase chain reaction-hybridization to identify mycobacterium other than tuberculosis revealed M. fortuitum and M. intracellulare. The patient was treated with clarithromycin, rifampicin, and ethambutol for 1 month after excision and drainage of pus, after which the skin lesions improved. In cases of refractory cutaneous infection after an invasive cosmetic procedure, atypical mycobacterial infection should be suspected.

Disseminated Mycobacterium fortuitum Infection Associated with Venous Access Device.

Mycobacterium fortuitum is an important opportunistic pathogen among the rapidly growing Mycobacteria. Disseminated disease occurs as a consequence of bacteremia linked to vascular catheters, which carry high morbidity and mortality when they occur in immuno-compromised patients. Conventional culture methods often miss these organisms since they may grow more slowly (after 48 h) and are dismissed as skin contaminants because of their morphological resemblance to diphtheroids on grams staining. We report a case of 10 months old child with primitive neuroectodermal tumor who developed disseminated disease with M. fortuitum that was related to an indwelling intravascular device. The isolates were confirmed as M. fortuitum by polymerase chain reaction based DNA sequencing targeting heat shock protein 65 gene. The child was treated with, rifampicin, ethambutol and azithromycin. The patient improved remarkably and became afebrile 2 days after institution of therapy and removal of the catheter. The treatment was given for 3 months.

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.

Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease

Around 50 mycobacteria species cause human disease. Immunosuppressive states predispose to non-tuberculous mycobaterium infection, such as Mycobacterium chelonae: AFB, non-tuberculous, fast growth of low virulence and uncommon as a human pathogen. It may compromise the skin and soft tissues, lungs, lymph nodes and there is also a disseminated presentation. The diagnosis involves AFB identification and culture on Agar and Lowenstein-Jensen medium base. A 41-year-old female with MCTD (LES predominance) is reported, presenting painless nodules in the right forearm. She denied local trauma. Immunosuppressed with prednisone and cyclophosphamide for 24 months. Lesion biopsy has demonstrated positive bacilloscopy (Ziehl-Neelsen stain) and M.chelonae in culture (Lowenstein-Jensen medium base), therefore clarithromycin treatment has been started (best therapy choice in the literature).

Spondylitis with an Epidural Abscess due to Mycobacterium fortuitum: A Case Report / 대한내과학회지

Mycobacterium fortuitum is a rapidly growing mycobacteria that causes skin and soft tissue infection, pulmonary infection, and occasionally disseminated disease in severely immunocompromised patients. While three cases of spondylitis caused by M. fortuitum have been reported, no case has been reported in Korea. We describe the first reported case of M. fortuitum spondylitis and an epidural abscess after lumbar acupuncture, and a surgical procedure to treat spinal stenosis.

Subdural empyma due to Mycobacterium fortuitum in a non-HIV patient.

A 14‑year‑old male child presented with high grade intermittent fever with altered sensorium since 5‑6 days and generalised seizures. On examination neck stiffness noticed with normal haemogram and chest X‑ray. CSF microscopy was normal and no growth seen in aerobic culture. CT scan showed loculated lesion. Drained pus showed acid fast organism and culture on Lowestein Jensen medium showed pale‑coloured growth on 3rd day. Organism identified as Mycobacterium fortuitum by biochemical test. Interesting aspect of this case was there is no history of trauma or injection and patient was negative for HIV antibody.

Mycobacterium fortuitum-related lymphadenitis associated with the varicella-zoster virus

Lymphadenitis caused by non-tuberculous mycobacteria is an uncommon manifestation in immunocompetent individuals. Here, we report a case of Mycobacterium fortuitum infection in a previously healthy 9-year-old patient who developed cervical lymphadenitis evolving to a suppurative ulcer associated with a varicella-zoster virus infection. We discuss the relationship between the varicella-zoster virus and the immune response of the host as an explanation for the unusual progression of the case.

Isolation of Mycobacterium fortuitum in sputum specimens of a patient with chronic cough: Is it clinically significant?

Managing chronic cough is diagnostically challenging especially in primary care. This case report highlights the difficulties experienced in approaching a case of chronic cough from a primary care perspective. The discussion also involves the clinical significance and treatment dilemma of M. fortuitum chelonae complex that was isolated from the sputum cultures of an elderly woman who presented with chronic cough for more than a year.

Mycobacterium fortuitum Infection Associated with Facial Fat Grafting: Simultaneous Infection of Liposuction and Liposculpture Site

We report a case of Mycobacterium fortuitum infection of the face and abdomen in a 25 years old man following cosmetic autologous fat injection. The goal of this manuscript is to increase awareness and suspicion of such as atypical mycobacterial infections complicating liposuction and fat injection. The clinical presentation, laboratory studies utilizing acid-fast stains and cultures, prevention and treatment including surgical debridement, and pharmacologic regimens in the ultimate diagnosis for Mycobacterium fortuitum infections are discussed.

Breast Abscess due to Mycobacterium Fortuitum: A Case Report / 대한내과학회지

The rapidly growing nontuberculous mycobacterium, Mycobacterium fortuitum, is of increasing clinical importance. The ubiquitous M. fortuitum has been isolated from water, soil, and dust. M. fortuitum usually causes skin or soft-tissue infection following trauma or surgery, but may also infect a wide variety of tissues, including the lungs, lymph nodes, bones, joints, and meninges. We believe this is the first report of a breast abscess due to M. fortuitum, which presented in an immunocompetent woman in Korea after nipple piercing. A 26-year-old non-pregnant female presented with a 5-month history of a tender right breast lump that gradually increased in size. Pus from the right breast supported the growth of M. fortuitum. Mycobacterial infection should be considered in cases of recurrent breast abscess with sterile bacterial cultures, particularly when there is a history of nipple piercing procedures.

Mycobacterium fortuitum Infection after Footbath / 대한피부과학회지

Mycobacterium fortuitum is one of the rapidly-growing atypical mycobacteria, belonging to Runyon group IV. M. fortuitum infection is usually related to trauma, injections and surgical procedures, and is resistant to treatment with anti-tuberculous agents. Herein, we report on a case of M. fortuitum infection after footbath. A 51-year-old male presented with painful, erythematous nodules and plaques with crust and purulent discharge on the lower legs for 3 months. The skin lesion occurred after two herb and aroma footbaths and leg massage. He went to the massage shop again, and received the footbath one more time. The skin lesion aggravated and he visited a hospital, then the skin biopsy was performed but the result was unremarkable. He was treated with antihistamine and antibiotics but there was no improvement. So he visited our hospital, and culture demonstrated atypical mycobacterium, which was identified as M. fortuitum by polymerase chain reaction. He was treated with oral clarythromycin for 5 months, and the skin lesions have improved.

Laboratory aspects of clinically significant rapidly growing mycobacteria.

The pathogenic potential of the rapidly growing mycobacteria (RGM) has started being recognized. This is due to more sensitive and specific techniques in the laboratory. The RGM are generally defined as nontuberculous species of mycobacteria that show visible growth on agar media within 7 days. RGM are widely distributed in nature and have been isolated from natural water, tap water, and soil. Several biochemical tests, high performance liquid chromatography, and molecular techniques have been developed for rapid identification of these species. The American Thoracic Society and the Infectious Disease Society of America recommend that RGM should be identified to the species level using a recognized acceptable methodology such as polymerase chain reaction restriction enzyme analysis or biochemical testing and routine susceptibility testing of RGM should include amikacin, imipenem, doxycycline, the fluorinated quinolones, a sulphonamide or trimethoprim-sulphamethoxazole, cefoxitin, clarithromycin, linezolid, and tobramycin. The diseases caused by these organisms have varied manifestations. They have been responsible for a number of healthcare-associated outbreaks and pseudo-outbreaks. For recognition of outbreaks, it is important to be familiar with the causative organisms like RGM which are most frequently involved in healthcare-associated outbreaks and pseudo outbreaks. It is essential to intervene as soon as possible to interrupt this transmission. Large gaps still exist in our knowledge of RGM. Unquestionably more studies are required. Through this review, we wish to emphasize that reporting of RGM from clinical settings along with their sensitivity patterns is an absolute need of the hour.