Domestic reptiles as source of zoonotic bacteria: A mini review

Captive reptiles, always more often present in domestic environment as pets, may harbor and excrete a large variety of zoonotic pathogens. Among them, Salmonella is the most well-known agent, whereas there are very scant data about infections by mycobacteria, chlamydiae and leptospirae in cold-blooded animals. However, the investigations that found antibody reactions and/or the bacteria in samples collected from free-ranging and captive reptiles show that herpetofauna may be involved in the epidemiology of these infections. The present review reports the updated knowledge about salmonellosis, mycobacteriosis, chlamydiosis and leptospirosis in reptiles and underlines the risk of infection to which people, mainly children, are exposed.

Domestic reptiles as source of zoonotic bacteria: A mini review

Captive reptiles, always more often present in domestic environment as pets, may harbor and excrete a large variety of zoonotic pathogens. Among them, Salmonella is the most well-known agent, whereas there are very scant data about infections by mycobacteria, chlamydiae and leptospirae in cold-blooded animals. However, the investigations that found antibody reactions and/or the bacteria in samples collected from free-ranging and captive reptiles show that herpetofauna may be involved in the epidemiology of these infections. The present review reports the updated knowledge about salmonellosis, mycobacteriosis, chlamydiosis and leptospirosis in reptiles and underlines the risk of infection to which people, mainly children, are exposed.

Mycobacterium chelonae Skin Infection after Autologous Fat Transplantation / 대한피부과학회지

No abstract available.

Mecanismos de resistencia en micobacterias de crecimiento rápido / Resistance mechanisms of rapid growing mycobacteria

Las Micobacterias de crecimiento rápido (MCR) son patógenos oportunistas capaces de ocasionar infecciones en piel, pulmonares y diseminadas. En Venezuela existe un incremento de estas infecciones derivadas de procedimientos invasivos, entre ellas cirugías estéticas. El tratamiento de esas infecciones requiere la administración de al menos dos antibióticos por varios meses. En la presente revisión se describe los mecanismos de resistencia a los antibióticos que se han reportado en las MCR, principalmente las tres especies que frecuentemente se han asociado a infecciones en piel: M. abscessus, M. chelonae y M. fortuitum. Los factores más importantes relacionados a la resistencia en los esquemas de tratamiento son: cambios relacionados en la permeabilidad de la membrana al antibiótico, la inactivación enzimática y modificaciones del sitio blanco. En MCR se han evidenciado la presencia de betalactamasas con actividad penicilinasas y cefalosporinasas y de acetil-transferasas que pueden modificar los aminoglicósidos. Las modificaciones de las regiones ARNr 23S y ARNr 16S han permitido explicar, en parte, la resistencia a macrólidos y aminoglicósidos. La metilación de los sitios blanco de acción de los macrólidos es otro factor importante, sobre todo en especies como M. abscessus. Éste último mecanismo explica la falla terapéutica que se ha reportado en pacientes tanto en infecciones pulmonares como en infecciones en piel. Es necesario ampliar el estudio sobre los mecanismos de resistencia en estas especies, tomando en consideración las complicaciones que llevan estas infecciones y los tiempos prolongados de tratamientos pudiendo generar efectos secundarios en los pacientes y la frustración cuando ocurre la falla terapéutica.

The rapid growing mycobacteria (RGM) are opportunist pathogens able to cause skin, pulmonary and disseminated infections. In Venezuela there is an increase in the prevalence of these infections especially following esthetic surgery. The treatment of such infections is cumbersome requiring the administration of at least two antibiotics for several months. In the present review we describe the principal antibiotic resistance mechanisms reported for RGM, particular for the species most frequently associated with skin and soft tissue infection: M. abscessus, M. chelonae and M. fortuitum. The most important factors associated with resistance to antibiotics are impermeability of the cell membrane, enzymatic inactivation and changes in the target site. In RGM the presence of the beta-lactamases with penicillinases and cephalosporinase activity has been demonstrated and the presence of acetyl-transferases which can modify aminoglycosides. Changes in the 23S rRNA and 16S rRNA regions has allowed to explain, partly macrolide and aminoglycoside resistance. Mutation in the macrolide target site is another important resistance mechanism, particularly for the species group M. abscessus. This last mechanism can explain treatment failure reported in the patients with pulmonary or skin infection. We conclude that there is a need for more extensive studies about the mechanisms of antibiotic resistance of RGM; taking into account the complications of these infections, the prolonged treatment long time, producing secondary effects and the frustrations of patient and physician caused by therapeutic failures.

Mycobacteriosis pulmonar. Presentación de dos casos quirúrgicos / Lung mycobacteriosis. Presentation of two surgical cases

Introducción: la Mycobacteriosis es una enfermedad producida por Mycobacterias ambientales, su diagnóstico hasta hace pocos años era un hecho ocasional, actualmente ha pasado a ser una patología relativamente frecuente, sobre todo en los pacientes SIDA y asociada a enfermedades pulmonares crónicas. Requiere tratamientos agresivos y prolongados, así como la exéresis quirúrgica en casos de afección pulmonar localizada. Objetivo: determinar la importancia de la cirugía como tratamiento alternativo en caso de fracaso del tratamiento farmacológico. Presentación de los casos: se presentan dos casos con diagnóstico de Mycobacteriosis ambiental, por Mycobacterium Avium. Pacientes con síntomas respiratorios de larga fecha de evolución, principalmente tos y expectoración, asociado a fiebre. En el segundo caso se recoge el antecedente de neumonías frecuentes durante la infancia, con diagnóstico de Bronquiectasias. En ambos se les aisló en el cultivo del esputo un Mycobacterium Avium, la prueba de Mantoux resultó negativa (0 mm) y en los estudios imagenológicos se presentan las formas típicas de esta enfermedad, dadas por lesiones fibrocavitarias en los lóbulos superiores. Conclusiones: en los casos presentados, hubo fracaso en el tratamiento farmacológico recomendados en la actualidad, manteniendo cultivos de esputo positivos a Mycobacterium Avium. Se realizó tratamiento quirúrgico, obteniendo resultados positivos, con esputos negativos y mejoría del estado clínico.

Introduction. Mycobacteriosis is a disease caused by environmental mycobacteria, until a few years ago its diagnosis was an occasional event. Today it has become a relatively frequent pathology, mainly in patients with AIDS and associated to chronic lung diseases. It requires aggressive treatments as well as surgical exeresis in the event of localized lung affections. Objective. determine the importance of the surgery as an alternative treatment when the pharmacological treatment fails. Case Presentation. two cases were presented with a diagnosis of environmental mycobacteriosis, caused by Mycobacterium Avium. Patients had respiratory symptoms of long evolution, mainly cough, expectoration, and associated fever. In the second case there were records of frequent pneumonias during childhood with diagnosed bronchiecstasias. In both cases in the sputum culture the Mycobacterium Avium was isolated, the Mantoux test was negative (0 mm) and in the radiological studies there were shapes that are usually seen in this disease caused by fibrocavitary lesions in the upper lobes. Conclusions. in the cases that were presented the pharmacological treatment normally recommended at present times failed, and the sputum cultures positive to Mycobacterium Avium persisted. Surgical treatment was conducted with positive results, negative sputums and improvement in the clinical condition.

Padronização do teste imunoalérgico aplicado ao diagnóstico da tuberculose e micobacterioses em suínos (Sus scrofa) experimentalmente sensibilizados com suspensões oleosas de Mycobacterium bovis ou M. avium inativados / Standardization of the immunoallergic skin test applied for the diagnosis of tuberculosis and mycobacterioses in swine (Sus scrofa) experimentally sensitized with oil suspensions of inactivated Mycobacterium bovis or M. avium

Foi investigado o valor diagnóstico da resposta alérgica cutânea em leitões experimentalmente sensibilizados, pela via intramuscular, com suspensões oleosas de Mycobacterium bovis ou M. avium inativados pelo calor.Foram utilizados 91 animais, divididos em quatro grupos: grupos A e B, cada um com 25 indivíduos, grupos C e D com 21 e 20 indivíduos respectivamente, balanceando-se as características de raça, linhagem, faixa etária e sexo. Aos 30 dias de idade, todos os animais foram submetidos a uma triagem com a aplicação de tuberculina PPD bovina, pela via intradérmica na base da orelha e não houve qualquer tipo de reação. Decorridos 60 dias do teste tuberculínico de triagem, o grupo A recebeu injeção intramuscular de 0,5 mL de uma suspensão oleosa de M. avium estirpe D4; o grupo B recebeu 0,5 mL de uma suspensão oleosa de M. bovis estirpe AN5; o grupo C (controle I), recebeu 0,5 mL do adjuvante oleoso; e o grupo D (controle II), recebeu 0,5 mL de solução fisiológica. Após 30 dias da sensibilização foi realizada a prova de tuberculinização comparativa com reação medida pela variação da espessura da pele com cutímetro de mola às 0h, 24h, 48h e 72h, após a aplicação das tuberculinas. No teste comparativo, lido às 48 ou 72 horas, a reação foi considerada negativa quando a diferença das reações entre o PPD bovino e o PPD aviário foi menor que 6,7 mm; suspeito ou inconclusivo quando a diferença se situou na faixa de 6,7 a 7,5 mm; e positiva de acordo com o tipo de PPD, considerando-se tuberculose para PPD M. bovis e micobacteriose para PPD M. avium, quando a diferença da reação foi superior a 7,5 mm.

The diagnostic value of the cutaneous allergic response to tuberculin in piglets experimentally sensitized intramuscularly with the oily suspensions of heat inactivated M. bovis or M. avium was investigated. Ninety-one animals were used and divided into four groups: groups A and B were formed each with 25 individuals, and groups C and D, with 21 and 20 individuals, respectively, balancing the characteristics of race, ancestry, age and sex. At the age of 30 days, all the animals were submitted to the screening test with the use of M. bovis PPD, by the intradermal route at the base of the ear and no reaction was detected. Sixty days after the screening tuberculin test, animals of the group A were injected intramuscularly with 0.5 mL of oily suspension of M. avium D4 strain; animals of the group B received 0.5 mL of an oily suspension of M. bovis, AN5 strain; group C (control I) received 0.5 mL of an oily adjuvant; and the individuals of the group D (control II) received 0.5 mL of saline solution. Following 30 days of sensitization, comparative skin reactions were measured by the variation in skin thickness with a caliper at 0h, 24h, 48h an 72h after applications of tuberculins. In the comparative test measured at 48 or 72h, the reaction was considered negative when the difference of the reactions between bovine PPD and avian PPD was less than 6.7 mm; suspected or inconclusive, when the difference stood in the range of 6.7 to 7.5 mm; and positive according to the type of PPD, considering tuberculosis the M. bovis PPD and mycobacteriosis the M. avium PPD, when the difference of the reaction was greater than 7.5 mm.

Fatores e espécies de micobactérias não tuberculosas associadas aos casos de micobacterioses pulmonar e extrapulmonar no estado de Pernambuco / Factors and species of nontuberculous mycobacteria associated with cases of pulmonary and extrapulmonary mycobacteriosis in the state of Pernambuco

Esta Tese aborda as infecções pulmonares e extrapulmonares, os fatores associados para o adoecimento por micobactérias não tuberculosas (MNT), a diversidade e a frequência das espécies de MNT, além do diagnóstico das micobacterioses no estado de Pernambuco, região nordeste brasileira. Os resultados são apresentados em três artigos científicos que respondem a seus objetivos. O primeiro artigo destaca as lacunas no diagnóstico convencional das micobacterioses e avalia uma PCR Multiplex na diferenciação de espécies de MNT como método auxiliar no diagnóstico diferencial entre as micobacterioses e a tuberculose. O segundo trás o primeiro relato no Brasil de infecção extrapulmonar por Mycobacterium wolinskyi diagnosticada após procedimento cirúrgico invasivo em serviço privado do estado. O terceiro artigo descreve o perfil clínico, epidemiológico, laboratorial e fatores associados aos casos de micobacterioses pulmonar por MNT, como também a frequência, diversidade e perfil de resistência aos antimicrobianos das espécies de MNT no estado de Pernambuco que é sabidamente uma região endêmica para tuberculose. Conclui-se que as técnicas de biologia molecular (PCR multiplex, PRA-hsp65 e sequenciamento de genes específicos) podem ser ferramentas valiosas para identificação das espécies de micobactérias reduzindo o tempo necessário para diagnóstico correto e início do tratamento adequado...

This work addressespulmonary and extrapulmonary infections, associated factors to thedisease caused by nontuberculous mycobacteria(NTM), the diversity and frequency of NTMspecies, as well as the diagnosis of mycobacteriosis in the state of Pernambuco Brazilian northeast...

Surgical resection of a cutaneous nodule in the left foot caused by mycobacteria / Exérese cirúrgica de nódulo cutâneo no pé esquerdo causado por uma micobactéria

Nontuberculous mycobacteria are etiologic agents of opportunistic human infections. Although they usually affect superficial tissues, infections in bones and joints have been described. The contamination is associated with increased environmental exposure. With appropriate therapy, the cases usually progress to complete recovery of the patient. This study reports the case of a patient who developed a cutaneous nodule in her left foot acquired when her skin was punctured by a fish. The anatomopathological examination revealed chronic central suppurative granulomatous dermo-hypodermal inflammation. Furthermore, the screening for resistant acid-fast bacilli was positive.

Micobactérias não tuberculosas são agentes causadores de infecções oportunistas no homem. Embora, geralmente, afetem tecidos superficiais, infecções em ossos e articulações têm sido descritas. O contágio está associado ao aumento da exposição do homem ao meio ambiente. Diante da terapêutica adequada, os casos normalmente evoluem com recuperação total do indivíduo. Este estudo descreve o caso clínico de um paciente que apresentou nódulo cutâneo no pé esquerdo após traumatismo com um peixe. O exame anatomopatológico revelou inflamação crônica granulomatosa centralmente supurativa dermo-hipodérmica e a pesquisa de bacilos álcool-ácido resistentes (BAAR) foi positiva.

Estudio de la susceptibilidad a los antibióticos de aislados clínicos de Mycobacterium abscessus: Reporte preliminar / Study of antibiotic susceptibility of Mycobacterium abscessus clinical isolates: Preliminary report

Mycobacterium abscessus posee una elevada resistencia a los antibióticos, lo cual limita las opciones terapéuticas para tratar las infecciones causadas por este microorganismo. En este estudio se determinó la susceptibilidad antimicrobiana de 26 cepas de M. abscessus de origen clínico frente a 14 antibióticos, mediante el método de microdilución en caldo (MDC) de acuerdo al procedimiento descrito por el CLSI (2011). Todas las cepas fueron sensibles a la amikacina, seguidas de claritromicina (62%) e imipenem (46%), mientras que el porcentaje de sensibilidad a ciprofloxacina, ampicilina/sulbactam, meropenem, ceftriaxona, amoxacilina y doxiciclina osciló entre 0 y 8%. Nueve diferentes patrones de resistencia fueron observados, representados por la asociación de 4 a 12 antibióticos. La combinación de 8 y 10 marcadores de resistencia constituyeron los patrones más frecuentes (28% cada uno). La amikacina fue el antibiótico con mayor actividad inhibitoria frente a las cepas estudiadas (0,5 - 16 µg/mL). Los patrones de resistencia observados sugieren la necesidad de utilizar las pruebas de susceptibilidad como herramientas que permitan orientar y optimizar las conductas terapéuticas en infecciones producidas por M. abscessus.

Mycobacterium abscessus has a high antibiotic resistance, which limits therapeutic options for treating infections produced by this microorganism. In this study we determined the antimicrobial susceptibility of 26 M. abscessus strain of clinical origin towards 14 antibiotics through the broth microdilution method (BMD) according to the procedure described by the CLSI (2011). All the strains were sensitive to amikacine, followed by clarithromycin (62%), and imipenem (46%), while the percentage sensitivity to ciprofloxacin, ampicillin/sulbactam, meropenem, ceftriaxone, amoxicycillin, and doxicycline varied between 0 and 8%. Nine different resistant patterns were observed, represented by the association of 4 to 12 antibiotics. The combination of 8 and 10 resistance markers constituted the most frequent patterns (28% each). Amikacin was the antibiotic with the highest inhibitory activity towards all the strains studied (0.5 - 16 µg/mL). The resistance patterns observed indicate the need of using susceptibility tests as tools that allow to guide and optimize the therapeutic approach to M. abscessus produced infections.

Enfermedad pulmonar por especies del complejo Mycobacterium avium intracellulare y correspondencia terapéutica / Mycobacterium avium intracellulare complex pulmonary disease species and therapeutic match

Introducción: la preocupación mundial ante las enfermedades causadas por micobacterias ambientales es creciente, debido a las dificultades diagnósticas y de tratamiento. Objetivos: determinar el comportamiento de la enfermedad pulmonar por especies del complejo Mycobacterium avium intracellulare y la correspondencia con la terapéutica recibida en el Hospital Neumológico Benéfico Jurídico de La Habana, durante el período 2000-2010. Métodos: se realizó un estudio descriptivo retrospectivo, que abarcó 55 pacientes con el diagnóstico de la enfermedad, los cuales cumplieron con los criterios de inclusión-exclusión predefinidos; la tendencia en el registro de diagnósticos se basó en el coeficiente de correlación lineal; en las variables cualitativas y cuantitativas discretas se usaron distribuciones de frecuencia con el cálculo del porcentaje y su respectivo intervalo de confianza de 95 porciento. Resultados: se obtuvo una tendencia decreciente en el diagnóstico de enfermedad pulmonar por especies del complejo Mycobacterium avium intracellulare, el 47,3 porciento de los pacientes estudiados se encontraba entre los 50 y 69 años de edad. La mayor parte del grupo no tenía ocupación de riesgo epidemiológico y la comorbilidad pulmonar se detectó en 97,9 porciento, sobresaliendo la tuberculosis pulmonar. Se comprobó la no correspondencia entre la terapéutica recibida y el régimen recomendado por la American Thoracic Society, en 100 porciento de los pacientes. Conclusión: la instauración de un programa ajustado a las normativas de tratamiento internacionalmente aceptadas, constituye en el Hospital Benéfico Jurídico, una necesidad para la atención a este grupo de enfermos

Introduction: the global concern about diseases caused by environmental mycobacteria is growing since their diagnosis and treatment are difficult. Objectives: to determine the behavior of Mycobacterium avium intracellulare complex pulmonary disease, and the therapeutic match with the treatment given at Benéfico Jurídico Pneumological Hospital, during the 2000-2010 period. Methods: a retrospective descriptive study of 55 patients diagnosed with the disease, who met the previously defined inclusion/exclusion criteria. The diagnostic registration trend was based on the linear correlation coefficient; the qualitative quantitative discrete variables used frequency distributions with percentage calculations and their respective 95 percent confidence intervals (CI). Results: a decreasing trend in the diagnosis of pulmonary disease from Mycobacterium avium-intracellular complex species; 47.3 percent of the studied patients aged 50 to 69 years. Most of the group had no occupation with epidemiological risk, and the pulmonary comorbidity was detected in 97.9 percent of patients, mainly pulmonary tuberculosis. A mismatch between the received therapy and the recommended treatment by the American Thoracic Society (ATS) was proved in 100 percent of patients. Conclusion: the introduction of a therapeutic program adapted to the internationally accepted standards of treatment is a must for the care of this group of patients in Benefico Juridico Hospital

<b>A case of Refractory Bloody Sputum due to Pulmonary Atypical Mycobacteriosis Successfully Treated by Shakanzoto and Yokuinin </b> / 日本東洋医学雑誌

Pulmonary atypical mycobacteriosis is a refractory pulmonary disease that has become resistant to the commonly used medicines. Here we report a case in which shakanzoto with yokuinin was useful in the treatment of bloody sputum caused by pulmonary atypical mycobacteriosis through Mycobacterium avium complex infection. An 86-year-old woman was diagnosed with pulmonary atypical mycobacteriosis four years before hospital admission because of repeated incidents of bloody sputum that had been unsuccessfully treated with stypsis. We administered shakanzoto with yokuinin, after which the bloody sputum disappeared rapidly. Although shakanzoto is usually prescribed for arrhythmia and cardioneurosis, our results suggest that shakanzoto is also useful for pulmonary diseases in which the pulse rate is irregular.

Tuberculosis in goats and sheep slaughtered in the semiarid of the Paraíba state, Northeast region of Brazil / Tuberculose em caprinos e ovinos abatidos no semiárido da Paraíba, Brasil

The aim of this work was to isolate and characterize microorganisms in hypertrophied lymph nodes or gross lesions suggestive of tuberculosis collected from 12 goats and 28 sheep slaughtered at the public slaughterhouse of Patos municipality, Paraíba State, in the Northeast region of Brazil. The identification of mycobacteria was performed by the PRA method (PCR-Restriction Enzyme Analysis). Histopathological examination of lesions was also performed. Organs affected were liver, lung, mammary gland, bladder and mediastinal, mesenteric, submandibular, parotid, popliteal, precrural, prescapular and superficial inguinal lymph nodes. Histopathological examination showed the presence of granulomas in 8 (20.00%) animals. Of the 12 goats, 1 (8.33%) was positive in the culture of mycobacteria, and by PRA method the isolate was classified as belonging to the M. tuberculosis complex. Two (7.14%) sheep were positive for the presence of environmental mycobacteria. There was isolation of Corynebacterium pseudotuberculosis in 8 (66.66%) goats and 17 (60.71%) sheep, and simultaneous isolation of mycobacteria and C. pseudotuberculosis in 1 (8.33%) goat and 1 (3.57%) sheep. The isolation of mycobacteria of the M. tuberculosis complex in goats in this study raises concerns of public health, as professionals involved in handling these animals and the meat and milk consumers are exposed to the risk [...]

O objetivo do presente trabalho foi isolar e tipificar micro-organismos presentes em linfonodos hipertrofiados ou lesões macroscópicas sugestivas de tuberculose colhidos de 12 caprinos e 28 ovinos abatidos no matadouro público do município de Patos, Paraíba. A identificação de micobactérias foi feita com o método PRA (PCR-Restriction Enzyme Analysis). Também foi realizado o exame histopatológico das lesões. Os órgãos afetados foram fígado, pulmão, glândula mamária, bexiga e linfonodos mediastínicos, mesentéricos, submandibulares, parotídeos, poplíteos, pré-crural, pré-escapular e inguinal superficial. O exame histopatológico apontou a presença de granulomas em 8 (20,00%) animais. Dos 12 caprinos, 1 (8,33%) foi positivo no cultivo de micobactérias, e pelo método PRA o isolado foi classificado como pertencente ao complexo M. tuberculosis. Dois (7,14%) ovinos foram positivos para a presença de micobactérias ambientais. Houve isolamento de Corynebacterium pseudotuberculosis em 8 (66,66%) caprinos e em 17 (60,71%) ovinos, e isolamento simultâneo de micobactérias e C. pseudotuberculosis em 1 (8,33%) caprino e 1 (3,57%) ovino. O isolamento de micobactéria do complexo M. tuberculosis em caprinos no presente trabalho levanta preocupações do ponto de vista de saúde pública, uma vez que profissionais envolvidos na manipulação destes animais, bem como a população consumidora de carne [...]

Micobacteriose por Mycobacterium marinum em "linguado" Paralichthys orbignyanus e em "barber goby" Elacatinus figaro: diagnóstico histopatológico e imuno-histoquímico / Micobacteriosis by Mycobacterium marinum in Brazilian flounder Paralichthys orbignyanus and barber goby Elacatinus figaro: histopathological and imunohistochemical diagnosis

As micobacterioses afetam várias espécies de peixes, tanto comerciais como ornamentais. É uma enfermidade sistêmica com formação de granulomas, conhecida como micobacteriose de peixes. O desenvolvimento da aquicultura tem aumentado o número de casos com essa enfermidade que muitas vezes é de difícil diagnóstico. Neste trabalho apresentamos dois casos de micobacterioses em Paralichthys orbignyanus e Elacatinus figaro provenientes do Laboratório de Piscicultura Estuarina e Marinha da Universidade Federal do Rio Grande (FURG). As micobactérias de peixes possuem menos ácidos graxos que as de mamíferos, por isso foi utilizado o protocolo de coloração de Fite-Faraco, uma vez que o protocolo de coloração clássico de Ziehl Neelsen pode resultar em falsos negativos. Para determinar o tipo de micobactéria foi utilizada a imuno-histoquímica com a qual se pode diagnosticar a presença de Mycobacterium marinum. A enfermidade pode ser transmitida para o homem e com esse trabalho ressalta-se a necessidade de fazer o diagnóstico correto e implantar medidas de proteção para as pessoas que estão em contato com os peixes infectados.

Mycobacteriosis affects various species of fish, including those cultured with commercial purposes. It is a chronic systemic with granuloma forming disease known as fish mycobacteriosis. In the last few years the interest of fish culture has been increasing due to the reduction of the natural fish stocks. However the intensification of fish culture has collaborated to the development of diseases such as mycobacteriosis, causing losses due to the chronic characteristics and difficult diagnosis. This study is to report two cases of mycobacteriosis observed at "Laboratório de Piscicultura Estuarina e Marinha of the Universidade Federal do Rio Grande (FURG)", one for Brazilian flounder Paralichthys orbignyanus and another for barber goby Elacatinus figaro. The Fite-Faraco staining protocol was used. Membranes of mycobacterial cells contain a waxy substance composed of mycolic acids. These are ß-hydroxy carboxylic acids with chain lengths of up to 90 carbon atoms. The property of acid fastness is related to the carbon chain length of the mycolic acid found in any particular species. The fish mycobacterium is much less acid and alcohol fast than the tubercle bacillus and the classic Ziehl-Neelsen Staining Protocol may give false results. The presence of mycobacterial antigen lesions was studied by immunohistological methods using monoclonal antibodies to Mycobacterium marinum. Humans may be infected by these bacteria and develop cutaneous granuloma. In this paper the necessity is stressed for a correct diagnosis of the disease, contributing to the prevention of its establishment in aquatic facilities, and thus, preserving cultured fish as well as human beings from infection.

Micobacterias no tuberculosas asociadas a procedimientos de mesoterapia en Colombia, 2004-2007 / Nontuberculous mycobacteria associated to mesotherapy treatment in Colombia, 2004-2007

Introducción: La mesoterapia es un procedimiento estético de amplio uso en nuestro país, por lo que se requiere una vigilancia de las infecciones posteriores a la administraciónde la misma. El objetivo de esteestudio fue describir la presencia de micobacterias no tuberculosas asociadas a los procedimientos de mesoterapia. Materiales y métodos: Se procesaron muestras de material purulento, biopsias y aislamientos provenientes de 80 pacientes con lesiones de piel posteriores a mesoterapia, de acuerdo con los protocolos estandarizados por el Laboratorio Nacional de Referencia del Instituto Nacional de Salud. Resultados: Se confirmó infección subcutánea por micobacterias no tuberculosas en 33 (41,2%) pacientes. El tipo de muestra de donde se aisló con mayor frecuencia fue la secreción de las lesiones de piel 31 (93,9%). Las especies de micobacterias identificadas fueron: Mycobacterium chelonae, 19 (57,5%);de la Mycobacterium fortuitum, 8 (24,2%), y Mycobacterium abscessus, 6 (18,2%). Discusión: El diagnóstico de micobacteriosis se establece por los antecedentes del paciente y por las manifestaciones clínicas. La presencia de micobacterias no tuberculosas como causa de enfermedad es cada vez másfrecuente; de ahí, la importancia de realizar el diagnóstico por cultivo e identificación de especie. Se debe sospechar la etiología por micobacterias en los casos con antecedentes de mesoterapia, abscesos dolorosos en lossitios de la inyección y una inadecuada respuesta a la terapia antibiótica convencional. Se evidenció que en el caso de lesiones causadas después de este tipo de procedimiento se obtenía un mayor número de cultivos positivos a partir de las muestras de materialpurulento, en comparación con las biopsias.

Introduction: Mesotherapy is an aesthetic treatment widely used in our country; therefore, surveillance of subcutaneous infection after mesotherapy is required. The purposeof this study is to describe the presence of nontuberculous mycobacteria associated with mesotherapy treatments. Material and methods: Samples of purulent material, biopsies and isolates from 80 patients with skin lesions caused by mesotherapy wereprocessed according to protocols approved by the Laboratorio Nacional de Referencia, LNR, (National Reference Laboratory) of Instituto Nacional de Salud (Health National Institute.)Results: Nontuberculous mycobacterial infection in 33 (41.2%) patients was confirmed. The sample type where it was most frequently isolated was skin lesion secretion in 31 (93.9%) patients. Mycobacteria species identified were:Mycobacterium chelonae 19 (57.5%), Mycobacterium fortuitum 8 (24.2%) and Mycobacterium abscessus 6 (18.2%). Discussion: Clinical diagnosis of mycobacteriosis is difficult; it is established by the patient’s history and his/her clinical manifestations. The presence of nontuberculousmycobacteria as a disease agent isvery frequent; for that reason, it is important to perform sample cultures for diagnosis and species identification. Special attention must be paid to possible mycobacterial infection when there is previous report ofmesotherapy treatment injections, presence of painful abscesses in injection sites, and an inadequate clinical outcome from antibioticconventional therapies. It has been confirmed that, in case of skin lesions caused after this kind of treatment, the sample obtained from purulent material shows higher positivity than the biopsies.

Evaluation of the histopathological hepatic lesions and opportunistic agents in Brazilian HIV patients / Avaliação das alterações histológicas hepáticas e infecções oportunistas em pacientes brasileiros infectados pelo HIV

INTRODUCTION: to evaluated the type histopathological hepatic lesions and opportunistic agents in Brazilian HIV-infected patients. METHODS: we examined 52 percutaneous liver biopsies of 50 HIV-infected patients who had at least two of the following conditions: fever of unknown origin, unexplained severe emaciation, hepatomegaly or abnormal liver chemistry. The specimens were cultured for mycobacteria and fungi and stained by standard procedures. RESULTS: reactive patterns, granulomatous hepatitis and chronic active hepatitis were verified in 28 (54 percent), 11 (21 percent) and 8 (15 percent) of the patients respectively. Opportunistic infections were diagnosed in 18 (36 percent) patients: mycobacteria in 12 (24 percent), Cryptococcus neoformans in 5 (10 percent) patients and mycobacteria and yeast was isolated from the same liver fragment in one patient. CONCLUSIONS: mycobacteriosis was the most common opportunistic infection and liver tissue culture is an important method to detect opportunistic agents, even in the absence of histological lesions.

INTRODUÇÃO: avaliar os tipos de lesões histopatológicas e infecções oportunistas de Brasileiros infectados pelo HIV. MÉTODOS: Foram analisadas 52 biópsias hepáticas percutâneas de 50 pacientes que apresentavam pelo menos duas das alterações: febre de origem indeterminada, emagrecimento inexplicado, hepatomegalia ou anormalidades na bioquímica hepática. O fragmento de tecido hepático foi submetido a histopatologia por métodos habituais e cultura para micobacteria e fungo. RESULTADOS: padrão reacional, hepatite granulomatosa e hepatite crônica ativa foram encontrados em 28 (54 por cento), 11 (21 por cento) e 8 (15 por cento) dos pacientes respectivamente. Infecções oportunistas foram diagnosticadas em 18 (36 por cento) dos pacientes: micobacteria em 12 (24 por cento), Cryptococcus neoformans em 5 (10 por cento) pacientes e micobacteria e fungo foram isolados no mesmo fragmento em um paciente. CONCLUSÕES: micobacteriose foi a infecção oportunista mais comum e a cultura de tecido hepático foi um importante método para detecção de infecções, mesmo na ausência de lesões histológicas.

A Case of Cutaneous Infection due to Mycobacterium abscessus / 대한피부과학회지

We report a case of cutaneous Mycobacterium abscessus infection in a 30-year-old woman who had two, tender, erythematous subcutaneous nodules on the upper extremitiy. A skin biopsy specimen revealed a neutrophilic and histiocytic lobular, with septal panniculitis as well as some acid-fast bacilli in the dermis. The culture from a tissue specimen on Ogawa media for 7 days, yielded yellow-colored colonies. The microorganism was identified as M. abscessus by a polymerase chain reaction. The patient was treated with incision and drainage, followed by administration of proper antibiotics. After 2 months the skin lesions were resolved without recurrence.

Cutaneous Lesion due to Mycobacterium Fortuitum

Nontuberculous mycobacteria usually cause systemic disease and often appear as a primary pulmonary infection. However, a cutaneous lesion may be the first or only sign of infection. The most frequent human diseases caused by Mycobacterium fortuitum are cutaneous or soft tissue infections, usually preceded by injection, trauma or surgery. We report a case of a cutaneous lesion due to Mycobacterium(M.) fortuitum occuring in a 50-year-old man with a subcutaneous flat nodule on his left anterior tibia. He had received a small injury to his left shin in a swimming pool. The culture from the skin biopsy specimen on Lowenstein-Jensen medium yielded clolnies after 5 days. The microorganism was subsequently identified as M. fortuitum by selected biochemical reactions. Therapy was instituted with minocycline for 5 months.

Dissertation of reported cases of nontuberculous mycobacteriosis in Thailand.

During the period from 1967 to 1988, there were 10 published reports of 44 patients from whom mycobacteria other than tubercle bacilli had been isolated clinic specimens. This communication presents results of a scrupulous review of each of the papers which revealed that some of the patients cited in the reports did not meet with the criteria for diagnosis, and some of the cases might have been the same patients as those documented by different investigators.