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).

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.

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.

Infección cutánea por Mycobacterium chelonae asociada a lipoaspiración / Cutaneous infection with Mycobacterium chelonae associated with liposuction

La infección de micobacterias atípicas de rápido crecimiento ha sido asociada a diversos procedimientos invasivos como mamoplastia, acupuntura, microcirugía de Mohs y lipoaspiración. Reportamos el caso de una paciente que presentó una infección por Mycobacterium chelonae, un mes después de haber sido sometida a una lipoaspiración en muslos. Fue tratada con claritromicina durante seis meses con remisión completa de las lesiones y sin evidencia de recidiva luego de trece meses de seguimiento.

Infections with atypical mycobacteria in renal transplant recipients.

Infections due to atypical mycobacteria are infrequent in renal transplant recipients but they cause serious morbidity. These pathogens are common in patients with acquired immune deficiency syndrome (AIDS). We report four proven cases of infections caused with atypical mycobacteriae from 1997 to 2003, by different organisms namely, M. chelonei, M.fortuitum, M. abcessus and M. terrae in renal transplant recipients. Infection with M. terrae documented here is the first occurrence in a renal transplant patient. Histopathological examination of aspirates or biopsy specimens from involved areas and staining and culture for mycobacteriae are essential for diagnosis. Treatment involves antimycobacterial therapy, reduction in immunosuppression and surgery, if indicated. Atypical mycobacterial infections, though currently uncommon, are significant and could prove to be an emerging pathogen in renal transplant recipients in the context of the AIDS epidemic in India.

Association of mycobacteria with Eales' disease.

BACKGROUND & OBJECTIVES: Eales' disease is an idiopathic disease resulting in retinal neovascularization, recurrent haemorrhages, with or without retinal detachment predominantly affecting healthy young males (97.6%) in the Indian subcontinent. Inspite of several studies, the aetiology of Eales' disease is not clear. The isolation of Mycobacterium fortuitum from the aqueous humour of a patient with classical Eales' disease, led us to hypothesize that rapid growing nontuberculous mycobacteria (RGNTM), particularly M. fortuitum and M. chelonae could be associated with Eales' disease. We therefore undertook this study to detect DNA of these RGNTM and also of M. tuberculosis in vitreous fluids (VFs) from patients with Eales' disease and non-Eales' disease. METHODS: We developed and optimized seminested polymerase chain reactions (SnPCRs) to detect DNAs of M. fortuitum and M. chelonae on archival ERMs (33) and VFs (19) of Eales' and control patients along with conventional mycobacteriological investigations. RESULTS: In the retrospective study, 70 per cent ERM samples were positive for one or more Mycobacterium spp. tested by snPCR. M. fortuitum and M. chelonae were isolated from two VFs, which were also positive by sn PCR in the prospective study. Statistical evaluation of the results of both retrospective and prospective investigations showed a statistically significant association of Mycobacterium spp. with Eales' disease. INTERPRETATION & CONCLUSION: The results of the present study suggested the involvement of Mycobacterium spp. in the aetiopathogenesis of Eales' disease. Further studies on a larger sample will be required to confirm these findings.

Postoperative infection of laparoscopic surgery wound due to Mycobacterium chelonae.

We report a case of postoperative wound infection due to Mycobacterium chelonae. A 35-year-old woman presented with multiple erythematous nodules, plaques and discharging sinuses over the abdomen, 45 days after she had undergone laparoscopic ovarian cystectomy. The seropurulent discharge from the wound showed acid-fast bacilli on Ziehl- Neelsen stain and culture yielded Mycobacterium chelonae. The patient responded to clarithromycin and doxycycline. The source of infection was probably contaminated water or disinfectant solution used for sterilization of laparoscopic instruments.

Delayed post-operative wound infections due to non-tuberculous Mycobacterium.

BACKGROUND & OBJECTIVE: The non-tuberculous mycobacteria (NTM) have emerged as important opportunistic pathogens of human beings in the recent years. The NTM are rapid growing mycobacteria (RGM), which include Mycobacterium fortuitum and M. chelonae and grouped as M. fortuitum-chelonae complex. Though there are reports on isolation of NTM from various parts of India, information on its occurrence in northeastern India is lacking. We therefore undertook this preliminary investigation to report on the occurrence of NTM-associated with non-healing postoperative wound infections that did not respond to antibiotics used for pyogenic infections and having sterile routine aerobic cultures in patients from northeastern part of India. METHODS: Pus/discharge from 25 patients with delayed onset of post-operative wound infections not responding to antibiotics used for pyogenic infections were collected and examined for isolation and identification of the causative agents. RESULTS: Of the 25 pus/discharge specimens examined, 20 revealed growth of non-tuberculous Mycobacterium spp. All the isolates were identified as M. fortuitum-chelonae complex. Of these only 10 samples revealed acid-fast bacilli (AFB) on direct examination of Ziehl-Neelsen stained smears from the specimens. All cases where direct smear was positive for AFB were also positive for Mycobacterium culture. INTERPRETATION & CONCLUSION: The results of the present study indicated that non-tuberculous mycobacterial post-operative wound infection was fairly common in northeastern India. Thus, mycobacterial infections should be considered in wounds that show delayed healing and do not respond to antibiotics used for acute pyogenic infections. Further, 80 per cent of the specimens yielded the growth of AFB in cultures as against only 40 per cent positive in the ZN stained direct smears. This indicates the possibility of missing a mycobacterial wound infection if only direct smears are taken for diagnosis.

Rapidly growing mycobacteria in King Chulalongkorn Memorial Hospital and review of the literature in Thailand.

Rapidly growing mycobacteria (RGM) have emerged as important human pathogens that can cause a variety of diseases. Thirty isolates of the pathogenic RGM were recovered from patients who attended King Chulalongkorn Memorial Hospital during 1997 and 2003. There were 16 isolates of Mycobacterium chelonae, ten isolates of M. fortuitum and four isolates of M. abscessus. Clinical data was available in only nine patients (five males and four females) including six M. chelonae, two M. abscessus, and one M. fortuitum. The mean age was 37 years (range: 13-62 years). The associated conditions were present in five patients including two diabetes, one HIV infection, one pregnancy, one SLE and one chronic renal failure. A wide spectrum of clinical features was observed. These included two chronic pulmonary infections, two post-traumatic wound infections, two disseminated infections, one lymphadenitis, one keratitis and respiratory colonization. AFB staining was positive in six patients (66.67%). The MIC of one M. chelonae and one M. abscessus were determined by Epsilon test. For M. chelonae, the MIC of clarithromycin, amikacin, ciprofloxacin, sulfamethoxazole and imipenem were 0.25, 2.0, 1.00, > 64, and 0.54 microg/ml, respectively. For M. abscessus, the MIC of clarithromycin, amikacin, ciprofloxacin, tetracycline and sulfamethoxazole were 0.016, 0.016, 0.038, > 16 and 0.002 microg/ml, respectively. Six of eight patients (75%) were initially treated with four first-line antituberculous drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) before obtaining the culture result. Of these, three patients with pulmonary and disseminated infections improved after a prolonged course of these combinations. The patients improved after switching to specific anti-RGM antibiotics. One patient died after 10 months of therapy of four anti-tuberculous drugs. One patient with post-traumatic wound infection was cured with surgical debridement and dicloxacillin. One patient improved after treatment as acute bronchitis with oral amoxicillin. An extensive review of the literature of RGM infections in Thailand is also presented.

Endocardite por Mycobacterium chelonei em prótese valvar / Endocarditis in Valvular Prosthesis Caused by Mycobacterium Chelonei

Male aged 40 year, with infective endocarditis in valvular prosthesis caused by Mycobacterium chelonei. This agent is unusual in this situation and rarely identified by the blood cultures

Rapid grower mycobacteria in pulmonary tuberculosis

Mycobacterium fortuitum and Mycobacterium cheloni are two species of the M. fortuitum complex presently considered to be pathogenic for humans. Out of 60 suspected cases of pulmonary tuberculosis with no previous antituberculous treatment, there were 17 strains [28.33%] of rapid growers acid fast bacilli, showed growth on Lowenstein-Jensen mediun within 7 days at 27degree. Using biochemical reactions [catalase, arylsulfatase, nitrate reduction, iron uptake, tellurite reduction] and growth on MacConkey agar without crystal violet, they were distinguished into 9 strains [52.94%] M. fortuitum, 5 strains [29.41%] M. cheloni and 3 strains [17.64%] M. phlei

Un brote por Mycobacterium chelonae, subespecie abscessus asociado a hiposensibilización en pacientes alérgicos

Se estudiaron trece pacientes sometidos a hiposensibilización, quienes presentaron abcesos subcutáneos después de la inyección aeroalergenos (A.E.A). El examen microbiológico del material obtenido permitió identificar Mycobacterium chelonae subespecies abscessus, en 11 de ellos: A estas cepas se le practicaron pruebas de sensibilidad a diferentes drogas. La evolución de los pacientes dependió del tamaño, tipo y número de lesiones, además del tipo de tratamiento empleado. No se presentaron manifestaciones sistémicas en ningún paciente. M. chelonae puede ser introducido iatrogénicamente a las personas que se someten a cualquier tipo de procedimiento invasivo.