A Case of Cutaneous Mycobacterium chelonae Infection Induced by Body Scurbbing

No abstract available.

Mycobacterium chelonae Skin Infection after Autologous Fat Transplantation / 대한피부과학회지

No abstract available.

A Case of Mycobacterium chelonae Infection at the Site of Acupuncture / 대한피부과학회지

No abstract available.

Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report

Atypical mycobacteria are saprophytic organisms not transmitted from person to person, which affect mainly immunosuppressed but also immunocompetent individuals. We present a case of atypical mycobacteriosis after a vascular procedure, with widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae was identified by the polymerase chain reaction (PCR) method. The patient showed improvement after treatment with three antibiotics. Mycobacterium chelonae causes skin lesions after invasive procedures. The clinical form depends on the immune state of the host and on the entry points. The diagnosis is based essentially on culture and the mycobacteria is identified by PCR. We highlight the importance of investigating atypical mycobacteriosis when faced with granulomatous lesions associated with a history of invasive procedures.

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).

Treatment of the Mycobacterium chelonae Infection after Fat Injection

For recent years, use of autologous fat injection has increased significantly in facial contouring surgery. Along with such increase in use, complications like atypical mycoplasma infection have been also on the increasing trend. The authors report two cases of Mycobacterium chelonae infection that occurred after autologous fat injection. Patients were treated as infection that resistant to common antibiotics and results were negative to routine culture and Gram staining. Acid-fast bacillus stain, polymerase chain reaction (PCR) test and mycobacterial cultures were conducted for diagnosis under suspicion of atypical mycoplasma infection. Then, combination antibiotics therapy, surgical treatment, and steroid injection were performed for treatment. Both patients were diagnosed with Mycobacterium chelonae in PCR test. They were positive to mycobacterial cultures. Combination antibiotics therapy was repeated to improvement of symptom. However, they could not be free from side effects such as deformation in facial contour, scar and pigmentation even after full recovery. When chronic wound infections after autologous fat injection, we must suspect atypical or mycobacterial infection and conduct examinations for a early diagnosis and proper antibiotic therapy that is effective to the nontuberculous mycobacteria.

Soft Tissue Infection Caused by Rapid Growing Mycobacterium following Medical Procedures: Two Case Reports and Literature Review

Non-tubecrulosis mycobacterium infections were increasingly reported either pulmonary or extrapulmonary in the past decades. In Taiwan, we noticed several reports about the soft tissue infections caused by rapid growing mycobacterium such as Mycobacterium abscessus, Mycobacterium chelonae, on newspaper, magazines, or the multimedia. Most of them occurred after a plastic surgery, and medical or non-medical procedures. Here, we reported two cases of these infections following medical procedures. We also discussed common features and the clinical course of the disease, the characteristics of the infected site, and the treatment strategy. The literatures were also reviewed, and the necessity of the treatment guidelines was discussed.

Disseminated Mycobacterium chelonae Infection in an Immunosuppressed Patient / 대한피부과학회지

No abstract available.

A Clinical, Microbiological, and Pathological Study of Cutaneous Nontuberculous Mycobacterial Infection / 대한피부과학회지

BACKGROUND: As the immunocompromised population has increased in recent years, the number of cutaneous nontuberculous mycobacterial (NTM) infections has also risen. However, since this affliction has no pathognomonic clinical or histological features, the diagnosis and treatment of cutaneous NTM infections are often delayed. OBJECTIVE: The aim of this study was to investigate the microbiological, clinical, and histological findings of cutaneous NTM infections. METHODS: We reviewed medical records and histologic slides of 10 patients diagnosed with cutaneous NTM infections confirmed by culture or polymerase chain reaction. RESULTS: All patients except one were immunocompetent, and 5 of 10 patients had preceding factors including trauma, liposuction, and intralesional triamcinolone injection. Microbiologically, of the 10 infections, 5 were caused by Mycobacterium marinum, 3 by Mycobacterium fortuitum, and 1 each by Mycobacterium chelonae and Mycobacterium ulcerans, respectively. Of the 5 patients with M. marinum, 2 had a fish-related job and 1 reared fish at a home aquarium. The most common clinical presentation was erythematous nodules (7/10). Histologically, irregular acanthosis (4/10), mixed cell infiltrate of lymphocytes, histiocytes, neutrophils (9/10), suppurative granuloma (7/10), microcysts lined by neutrophils (5/10), fibrosis (4/10), and panniculitis (7/10) were identified. CONCLUSION: We found microcysts lined by neutrophils in 50% of the samples and considered this finding to be a diagnostic marker of NTM infection. These clinicopathologic features will assist clinicians in diagnosing NTM infection more rapidly and accurately.

Novel species including Mycobacterium fukienense sp. is found from tuberculosis patients in Fujian Province, China, using phylogenetic analysis of Mycobacterium chelonae/abscessus complex / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To identify the novel species 'Mycobacterium fukienense' sp. nov of Mycobacterium chelonae/abscessus complex from tuberculosis patients in Fujian Province, China.</p><p><b>METHODS</b>Five of 27 clinical Mycobacterium isolates (Cls) were previously identified as M. chelonae/abscessus complex by sequencing the hsp65, rpoB, 16S-23S rRNA internal transcribed spacer region (its), recA and sodA house-keeping genes commonly used to describe the molecular characteristics of Mycobacterium. Clinical Mycobacterium isolates were classified according to the gene sequence using a clustering analysis program. Sequence similarity within clusters and diversity between clusters were analyzed.</p><p><b>RESULTS</b>The 5 isolates were identified with distinct sequences exhibiting 99.8% homology in the hsp65 gene. However, a complete lack of homology was observed among the sequences of the rpoB, 16S-23S rRNA internal transcribed spacer region (its), sodA, and recA genes as compared with the M. abscessus. Furthermore, no match for rpoB, sodA, and recA genes was identified among the published sequences.</p><p><b>CONCLUSION</b>The novel species, Mycobacterium fukienense, is identified from tuberculosis patients in Fujian Province, China, which does not belong to any existing subspecies of M. chelonea/abscessus complex.</p>

Nontuberculous Mycobacterial Lung Disease Caused by Mycobacterium chelonae: A Case Report / 결핵및호흡기질환

Mycobacterium chelonae lung disease is very rare. We report a case of lung disease caused by M. chelonae in a previously healthy woman. A 69-year-old woman was referred to our hospital because of hemoptysis. A computed tomography (CT) scan of the chest revealed bronchiolitis associated with bronchiectasis in the lingular division of the left upper lobe. Nontuberculous mycobacteria were isolated three times from sputum specimens. All isolates were identified as M. chelonae by various molecular methods that characterized rpoB and hsp65 gene sequences. Although some new lesions including bronchiolitis in the superior segment of the left lower lobe developed on the chest CT scan 35 months after diagnosis, she has been followed up without antibiotic therapy because of her mild symptoms. To the best of our knowledge, this is the first case of M. chelonae lung disease in Korea in which the etiologic organisms were confirmed using molecular techniques.

Molecular characterization of environmental non-Tuberculous mycobacteria using PCR- RFLP analysis of 441 Bp heat shock protein 65 fragments

Non- Tuberculous Mycobacteria are environmental opportunistic pathogens that can be found in various terrestrial and aquatic habitats. There are an epidemiological links between species isolated in tap water and those isolated from patients. hsp65 gene has more variability in its sequences, compared to the some more conserved genes in NTM, for identification of mycobacteria to species level. In this study, the prevalence of NTM in Isfahan City water samples was determined using culture, biochemical tests and PCR-RFLP analyses of hsp65 gene. Eighty-five water samples were collected and cultured. The mycobacterial isolates were identified by conventional biochemical tests. A 441 bp fragment of hsp65 genes was amplified and digested by two restriction enzymes, BstEII and HaeII. Digested products were analyzed using polyacrilamid gel electrophoresis [PAGE]. 25.9% of the water samples contained different species of NTM. Dominant isolates were M. fortuitum [26.7%], M. chelonae like organism [13.3%] and M. mucogenicum [13.3%]. Nineteen isolates of Mycobacteria were differentiated using hsp65 genes PCR-RFLP. Three isolates could not be identified at the species level because their RFLP patterns were different from other known PCR-RFLP profiles. There were different hsp65 gene PCR-RFLP profiles produced by digestion with BstEII and HaeIII. This study showed that PCR-RFLP of hsp65 gene in mycobacteria is more reliable method for identification of NTM at the specie level than conventional phenotypic methods [P<0.05]. In comparing of RFLP patterns of this study to other investigation, some minor differences were negligible

Efecto micobactericida del ácido hipocloroso en tres especies ambientales potencialmente patógenas y en Mycobacterium tuberculosis / Mycobactericidal effect of hypochlorous acid in three potentially pathogenic environmental species and in Mycobacterium tuberculosis

Objetivo. Evaluar el efecto micobactericida del ácido hipocloroso siguiendo las normas internacionales de desarrollo de nuevos desinfectantes. Materiales y métodos. Se evaluó la efectividad del ácido hipocloroso en Mycobacterium chelonae, M. fortuitum, M. intracellulare y M. tuberculosis en diferentes concentraciones en cuatro intervalos de tiempo, a 225 ppm, 450 ppm, 750 ppm y 1.500 ppm, durante 5, 10, 15 y 20 minutos. Las pruebas desarrolladas fueron: exposición directa al desinfectante en condiciones limpias, exposición con interferencia (condiciones sucias), exposición en superficies en condiciones limpias y prueba de corrosión del desinfectante. Resultados. Todas las concentraciones evaluadas del ácido hipocloroso en condiciones limpias, es decir, en exposición directa y en superficies, resultaron ser efectivas durante todos los intervalos de tiempo, mientras que para la prueba con interferencia, fue necesario aumentar el tiempo, la concentración o ambos para tener, al menos, un 99,9 % de efectividad del desinfectante sobre la concentración bacteriana usada; estos resultados probablemente dependieron de la reducción de la concentración del ácido hipocloroso, causada por la interferencia con albúmina y de la resistencia intrínseca de cada especie micobacteriana. Conclusiones. El ácido hipocloroso es 100 % efectivo en todos los intervalos de tiempo y a todas las concentraciones evaluadas en condiciones limpias, y demostró ser efectivo después de lavados que arrastren con la mayoría de materia orgánica en una superficie, debido a que, en condiciones sucias, sólo es efectivo con las concentraciones más altas (900 y 1.500 ppm) y en tiempos mayores de 15 minutos.

Objective: to evaluate the mycobactericidal effect of hypochlorous acid according to the international standards for the development of new disinfectants. Materials and methods: the effectiveness of hypochlorous acid in M. chelonae, M. fortuitum, M. intracellulare and M. tuberculosis was evaluated at different disinfectant concentrations in 4 time intervals, at 225 ppm, 450 ppm, 750 ppm and 1500 ppm for 5, 10, 15 and 20 minutes. The main tests Results: all concentrations of hypochlorous acid tested in clean conditions, i.e. in direct exposure and in surfaces, were found to be effective at all the time intervals, while for the test with interference it was necessary to increase the time and/or concentration of the disinfectant for it to be at least 99.9% effective in the bacterial concentration used; these results were likely due to the reduction of acid concentration caused by the albumin used as interference and the intrinsic resistance of each mycobacterial species. Conclusions: hypochlorous acid is 100% effective in clean conditions at all the time intervals and in all the concentrations tested, proving to be effective after performing washes that drag away most organic matter on a surface, as in contaminated conditions its effectiveness is reduced to just higher disinfectant concentrations (900 and 1500 ppm) and times longer than 15 minutes.

Infección Cutánea por Mycobacterium chelonae / Cutaneous infection by Micobacterium chelonae

Mycobacterium chelonae es una micobacteria atípica, de rápido crecimiento, ampliamente distribuida en la naturaleza. Germen oportunista del humano y causante de infecciones de diversa gravedad. Suele ser resistente a los métodos habituales de desinfección y esterilización. Es fundamentalpara su diagnóstico y tratamiento el aislamiento del mismo y la obtención del antibiograma, ya que presenta resistencia a diferentes antibióticos. Se presentan dos casos clínicos de infección cutánea por Mycobacterium chelonae. El primero, un paciente inmunocompetente, con aislamiento de la micobacteria por punción-aspiración de las lesiones; tratado con antibióticos según antibiograma, con curación de las mismas. El segundo, una paciente inmunocomprometida no HIV, quien fue tratada con múltiples esquemas antibióticos, criocirugía, termoterapia y resección quirúrgica de las lesiones, con respuesta parcial. El presente artículo intenta actualizar conceptos sobre esta micobacteria y sus diferentes manifestaciones clínicas según el estado inmune del paciente que infecta.

Mybacterium chelonae Infection Occurring at the Site of Bee Sting Therapy / 대한피부과학회지

Mycobacterium chelonae is a rapidly growing atypical mycobacterium found in soil and water. In a healthy person, it causes cutaneous infection after an invasive procedure or surgery. Herein, we present a case of a 52-year-old man with multiple erythematous plaques and nodules on the back and left arm, and these occurred at the site of bee sting therapy by a herbal medical doctor. The histologic findings showed a granulomatous infiltration composed of numerous neutrophils, lymphocytes, eosinophils, histiocytes and multinucleated giant cells. Acid fast bacilli were detected by Ziehl-Neelsen stain and Mycobacterium chelonae infection was confirmed by an INNO-LiPA mycobacteria kit. The patient was treated with 1 g of clarithromycin and 200 mg of doxycycline for 6 months and his condition improved considerably.

Nontuberculous mycobacteria: susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An increasing incidence of disease caused by nontuberculous mycobacteria (NTM) is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai.</p><p><b>METHODS</b>All NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system.</p><p><b>RESULTS</b>A total of 21,221 specimens were cultured, of which 4868 (22.94%) grew acid fast bacilli (AFB), and 248 (5.09%) of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae (26.7%), followed by M. fortuitum (15.4%), M. kansasii (14.2%), M. avium-intracellulare complex (13.1%) and M. terrae (6.9%). The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. gordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance.</p><p><b>CONCLUSIONS</b>The prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.</p>

Disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess

Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.

Outbreak of persistent cutaneous abscesses due to Mycobacterium chelonae after mesotherapy sessions, Lima, Peru

Outbreaks of rapidly growing mycobacteria have been occasionally described. The article reports an outbreak of cutaneous abscesses due to Mycobacterium chelonae following mesotherapy in Lima, Peru. From December 2004 through January 2005, 35 subjects who had participated in mesotherapy training sessions presented with persistent cutaneous abscesses. Thirteen (37 percent) of these suspected cases consented to underwent clinical examination. Skin punch-biopsies were collected from suspicious lesions and substances injected during mesotherapy were analyzed. Suspected cases were mainly young women and lesions included subcutaneous nodules, abscesses and ulcers. Mycobacterium chelonae was isolated from four patients and from a procaine vial. In conclusion, it is important to consider mesotherapy as a potential source of rapidly growing mycobacteria infections.

Surtos de micobactérias de crescimento rápido têm sido relatados ocasionalmente. O estudo relata um surto de abscessos cutâneos por Mycobacterium chelonae após sessões de mesoterapia em Lima, Peru. De dezembro de 2004 a janeiro de 2005, 35 pessoas que haviam passado por sessões de mesoterapia apresentaram esses abscessos cutâneos. Treze (37 por cento) desses casos suspeitos concordaram em realizar exames clínicos. Foram realizadas biópsias de punção de pele de lesões suspeitas e examinadas substâncias injetadas durante a mesoterapia. Os casos suspeitos eram predominantemente mulheres jovens e as lesões incluíram nódulos subcutâneos, abscessos e úlceras. Mycobacterium chelonae foi isolada de quatro pacientes e de um frasco de procaína. Em conclusão, é importante considerar a mesoterapia como fonte potencial de infecções de micobactérias de crescimento rápido.

Estudo fenotípico e molecular de micobactérias de crescimento rápido de interesse em Saúde Pública / Phenotypic and molecular study of mycobacteria fast-growing interest in Public Health

Os complexos Mycobacterium chelonae – M. abscessus e Mycobacterium fortuitum – M. peregrinum são compostos por espécies bacterianas de crescimento rápido e potencialmente patogênicas. Sua distribuição é ubíqua no ambiente, são resistentes a cloração da água e a sua replicação ocorre mesmo em condições de escassez de nutrientes. Estão envolvidos em casos de infecção pulmonar e extrapulmonar, e causam infecções em pacientes imunocomprometidos e submetidos a procedimentos cirúrgicos invasivos. Os objetivos do presente trabalho foram: confirmar através de testes fenotípicos e com as técnicas de PRA hsp65 e sequenciamento do fragmento do rpoB, a identificação de micobactérias de crescimento rápido, incluídas dos complexos M. chelonae-M.abcessus e M. fortuitum-M.peregrinum. Foram incluídos no estudo os isolados provenientes de pacientes com dois ou mais isolamentos provenientes de sítio não estéril ou um isolamento de sítio estéril. O estudo de 38isolados demonstrou que as provas fenotípicas disponíveis atualmente não permitem a identificação de todas as espécies de micobactérias de crescimento rápido já descritas na literatura. O PRA hsp65 possibilitou a identificação rápida e precisa de 63 por cento das espécies de micobactérias e demonstrou um perfil compartilhado pelas espécies M. abcessus 2; M. bolletti 1 e M. massiliense 1. O sequenciamento do gene rpoB confirmou a identificação das espécies citadas. Nossos resultados demonstram que o PRA-hsp65 e o sequenciamento do gene rpoB são ferramentas úteis para fornecer a identificação das espécies de micobactérias com mais acurácia. O uso dessas técnicas poderiam ser consideradas em laboratório de referência para identificar Micobactérias de crescimento rápido uma vez que elas são patógenos emergentes implicados em surtos e isolados de pacientes em centros de referência para tratamento de tuberculose multirresistente.

A Case of Mycobacterium chelonae Infection with Foreign Body Granuloma after Injection of Filler / 대한피부과학회지

Although injectable soft-tissue augmentation materials are extremely well-tolerated, undesirable effects sometimes occur. Whereas minor adverse events such as erythema, edema or bruising are generally reversible, the formation of foreign body granuloma, atypical mycobacterial infections or tissue necrosis may cause serious irreversible damages and disfigurement. We present here the case of a 50-year-old woman with an indurated painful nodule and patch on the right cheek, and this occurred after an unlicensed nonspecialist injected filler of unknown ingredients. The histopathologic findings showed granulomatous inflammation composed of lymphocytes, histiocytes and multinucleated giant cells with a Swiss cheese appearance. Although any acid-fast bacilli were not observed on Ziehl-Neelsen staining, the mycobacterial culture demonstrated an ivory-colored wet colony that was identified as M. chelonae by polymerase chain reaction-restriction fragment length polymorphism. The patient was treated with 1 g of clarithromycin for seven weeks, and the lesion improved considerably.