Mycobacterium abscessus keratitis after LASIK surgery / Ceratite por Mycobacterium abscessus após cirurgia LASIK

ABSTRACT A 33-year-old male presented with unilateral subacute infectious keratitis 4 weeks after surgery. Corneal inflammation was resistant to standard topical antibiotic regimens. During diagnostic flap lifting and sampling, the corneal flap melted and separated. Through flap lifting, corneal scraping, microbiological diagnosis of atypical mycobacteria, and treatment with topical fortified amikacin, clarithromycin, and systemic clarithromycin, clinical improvement was achieved.

RESUMO Paciente do sexo masculino, 33 anos, apresentou ceratite infecciosa subaguda unilateral 4 semanas após a cirurgia. A inflamação da córnea foi resistente aos regimes de antibióticos tópicos padrão. A aba da córnea foi derretida e seccionada durante o levantamento e amostragem para diagnóstico. A melhora clínica só foi alcançada após levantamento do retalho, raspagem e diagnóstico microbiológico de micobactérias atípicas e tratamento com amicacina fortificada tópica, claritromicina e claritromicina sistêmica.

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.

Abscesos mamarios múltiples por Mycobacterium abscessus en mastopexia secundaria con implantes mamarios / Multiple breast abscesses due to Mycobacterium abscessus in secondary mastopexy with breast implant

Las infecciones periprotésicas son una complicación poco frecuente en cirugía de implantes mamarios, pero de difícil resolución si son causadas por gérmenes como las micobacterias. Mycobacterium abscessus es una micobacteria no tuberculosa de rápido crecimiento, que se presenta de manera atípica, generando abscesos y fístulas cutáneas. En este reporte presentamos el caso de una paciente que fue intervenida por recambio de implantes mamarios y mastopexia secundaria. La paciente presentó un seroma temprano como manifestación inicial y posteriormente desarrolló múltiples abscesos en todo el parénquima mamario. El tratamiento instaurado en la paciente fue la extracción del implante mamario,curaciones diarias de la herida, antibioticoterapia prolongada y punciones periódicas guiadas por ecografía, con cultivo del material obtenido. El objetivo de nuestro reporte fue presentar esta complicación generada por un germen poco frecuente, su forma de presentación, diagnóstico y el tratamiento establecido

Although periprosthetic infections are a rare complication in breast implant surgery, they are difficult to resolve if they entail germs like mycobacteria. Mycobacterium abscessus is a rapidly growing, nontuberculous mycobacterium that occurs atypically and generates abscesses and cutaneous fistulas. In this report, we present the case of a patient that underwent surgery for a breast implant replacement and a secondary mastopexy. The initial manifestation the patient evinced was an early seroma. Later, she developed multiple abscesses in all the breast parenchyma. The treatment established for the patient involved extracting the breast implant, daily cleaning and dressing of the wound, prolonged antibiotic therapy, and periodical punctures guided by ultrasound, accompanied by culture sampling. The aim of this report is to present this infrequent germ-generated complication, its form of manifestation, its diagnosis, and the established treatment.

Research progress of Mycobacterium abscessus complex diseases / 中华临床感染病杂志

Mycobacterium abscessus complex (MABC), a rapidly growing nontuberculous mycobacterium, has received increasing attention worldwide due to its rising isolation rate. The similarity of symptoms between MABC pulmonary disease and tuberculosis, different treatment methods required by different subtypes, as well as high levels of innate, adaptive and acquired antibiotic resistance, make MABC treatment more difficult and lead to unfavorable clinical outcomes of patients. This article reviews the basic characteristics, common antibiotic resistance mechanisms, as well as diagnosis and treatment of MABC, to provide reference for future research and clinical treatment of MABC lung disease.

"Shapeshifter of the mycobacterial world" : Discuss the mechanism of morphological transformation of Mycobacterium abscesses / 中华临床感染病杂志

Mycobacterium abscessesus (MAB) is the most common species of rapidly growing pathogenic nontuberculous mycobacteria (NTM). MAB is also an opportunistic pathogen with high drug resistance. The unique structure of cell wall enables it to exist in different forms and to undergo morphological transformation, making it the "shapeshifter of the mycobacterial world" , which facilitates its survival in natural environment in a saprophytic manner; and also facilitates its invasion into the host with long-term survival and being pathogenic. This article reviews research progress on the specific deformability of MAB and the mechanism associated with its phenotypic transformation; discusses the evolutionary characteristics of MAB to adapt environmental changes to provide reference for better understanding the biological characteristics and pathogenicity of MAB.

Micobacteriosis atípica post mesoterapia / Atypical mycobacteriosis post mesotherapy

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

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

Queratitis por Mycobaterium abscessus: comunicación del primer caso en Paraguay / Keratitis due to Mycobaterium abscessus: first case report in Paraguay

Resumen Se presenta un caso clínico de queratitis por Mycobacterium abscessus en una mujer de 76 años, residente en la ciudad de Asunción, sin traumatismo ni cirugía ocular previa y con antecedente de una queratouveitis herpética. Por tratarse de una queratitis causada por un agente etiológico poco frecuente y por la importancia de un diagnóstico correcto y oportuno para la instauración del tratamiento adecuado, se comunica el primer caso de queratitis por micobacterias en Paraguay.

Abstract We present a clinical case of keratitis caused by M. abscessus in a 76-year-old female patient, resident in the city of Asunción, without trauma or previous ocular surgery and with a history of herpetic keratouveitis. Because it is a keratitis caused by a rare etiological agent and because of the importance of a correct and timely diagnosis for the establishment of appropriate treatment, the present case is reported, the first of Mycobacteria keratitis in Paraguay.

Coinfección por Mycobacterium abscessus y Mycobacterium tuberculosis en un paciente con síndrome de Cushing exógeno y otras comorbilidades / Mycobacterium abscessus and Mycobacterium tuberculosis coinfection in a patient with exogenous Cushing syndrome and other comorbilities

RESUMEN Mycobacterium abscessus es una micobacteria no tuberculosa de crecimiento rápido, que produce infección pulmonar, cutánea, diseminada y otras, sobre todo en pacientes con comorbilidades. El diagnóstico se basa en la identificación de la micobacteria por medios de cultivo o por pruebas moleculares. El tratamiento con macrólidos y amikacina continúa siendo el ideal, aunque depende de la localización y de la gravedad de la infección, sin embargo, se han identificado genes de resistencia en algunas subespecies que limitan la eficacia antibiótica. Presentamos el caso de un paciente con coinfección cutánea por Mycobacterium abscessus y Mycobacterium tuberculosis, quien presenta un síndrome de Cushing exógeno, factor predisponente para estas infecciones. Además, se identificaron hidatidosis y aspergilosis pulmonares. El tratamiento antituberculoso del paciente se ajustó para manejar ambas micobacterias, y su evolución fue favorable.

ABSTRACT Mycobacterium abscessus is a fast-growing non-tuberculous mycobacterium that causes lung, skin, disseminated and other infections, mainly in patients with comorbidities. The diagnosis is based on the identification of the mycobacterium by culture media or molecular tests. Treatment with macrolides and amikacin remains the optimal choice, although it depends on the location and severity of the infection; however, resistance genes have been identified in some subspecies that limit antibiotic efficacy. We present the case of a patient with cutaneous coinfection by Mycobacterium abscessus and Mycobacterium tuberculosis, who presented exogenous Cushing syndrome, a predisposing factor for these infections. In addition, hydatidosis and pulmonary aspergillosis were identified. The patient's anti-tuberculosis treatment was adjusted to manage both mycobacteria, resulting in a favorable evolution.

Efficacy of Moxifloxacin against in Zebrafish Model / 生物医学与环境科学（英文）

Objective@#Moxifloxacin (MFX) shows good activity against and can be a possible antibiotic therapy to treat infection; however, other studies have shown a lower or no activity. We aimed to evaluate MFX activity against using zebrafish (ZF) model .@*Methods@#A formulation of labeled with CM-Dil was micro-injected into ZF. Survival curves were determined by recording dead ZF every day. ZF were lysed, and colony-forming units (CFUs) were enumerated. Bacteria dissemination and fluorescence intensity in ZF were analyzed. Inhibition rates of MFX and azithromycin (AZM, positive control) were determined and compared.@*Results@#Significantly increased survival rate was observed with different AZM concentrations. However, increasing MFX concentration did not result in a significant decrease in ZF survival curve. No significant differences in bacterial burdens by CFU loads were observed between AZM and MFX groups at various concentrations. Bacterial fluorescence intensity in ZF was significantly correlated with AZM concentration. However, with increasing MFX concentration, fluorescence intensity decreased slightly when observed under fluorescence microscope. Transferring rates at various concentrations were comparable between the MFX and AZM groups, with no significant difference.@*Conclusion@#MFX showed limited efficacy against using ZF model. Its activity needs to be confirmed.

An emergence of Mycobacterium abscessus in blood cultures of Thai patients

@#Aims: Tuberculosis and other mycobacterial infections occur worldwide especially in patients with immunodeficiency. Typically, an empirical treatment for disseminated disease is required for initial therapy due to slow growing nature of most mycobacterial species. Therefore, species distribution and average time to positivity of blood culture is crucial. However, such information is limited for blood culture and, therefore, were determined. Methodology and results: The blood culture data using the BACTEC FX system and drugs susceptibility testing (DST) pattern was recovered during 2012-2017 from a large teaching hospital in Bangkok, Thailand. Overall, 7.8% of 4,838 blood and 6.4% of 1,056 bone marrow (BM) samples were positive for mycobacterial growth. Mycobacterium tuberculosis complex (MTBC), M. avium, and M. abscessus, were the most three common species to be isolated from blood (3.8%, 2.1%, and 0.9%, respectively) and BM (2.4%, 2.4%, and 0.9%, respectively). The average time to positivity for MTBC, M. avium, and M. abscessus was 25.7, 16.1, and 3.8 days, respectively. From 209 antimycobacterial susceptibility testing (AST)-available MTBC strains, 6 (2.87%) strains were multi-drugs resistant (MDR-TB). From 35 AST-available M. avium complex (MAC) isolates, 6 (17.14%), 33 (94.29%), and 28 (80%) isolates were resistant to clarithromycin, moxifloxacin, and linezolid, respectively. BM MAC isolates were significantly more resistant to clarithromycin than the blood isolates (44.5% vs 7.69%; p= 0.027). Conclusion, significance and impact of study: In summary, an emergence of M. abscessus and unusually high moxifloxacin and linezolid resistance of MAC isolates were reported in this study. Additional information of this study benefits physicians for anti-mycobacterial drug selection for initial treatment of mycobacteremia while blood and BM culture is pending.

Fever work-up unfolds a rare diagnosis of native valve endocarditis caused by Mycobacterium abscessus

Endocarditis caused by Mycobacterium abscessus is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Accurate identification and sensitivity, combination therapy, and prolonged duration of antibiotics are, therefore, important for a successful outcome.

A prospective study of non-tuberculous mycobacterial disease among tuberculosis suspects at a tertiary care centre in north India

Background & objectives: The burden of non-tuberculous mycobacterial (NTM) disease is increasing worldwide. The disease shares clinicoradiological features with tuberculosis (TB), Nocardia and several fungal diseases, and its diagnosis is frequently delayed. The present study was performed to determine the frequency of NTM disease among TB suspects in a tertiary care centre in north India. Methods: In this prospective study, mycobacterial culture isolates from pulmonary and extrapulmonary specimens among TB suspects were tested with immunochromatographic assay (ICA). All ICA-negative isolates were considered as NTM suspects and further subjected to 16S-23S rRNA internal transcribed spacer gene sequencing for confirmation and species identification. Patients with active disease were treated with drug regimen as per the identified NTM species. Follow up of patients was done to determine clinical, radiological and microbiological outcomes. Results: Of the 5409 TB suspects, 42 (0.77%) were diagnosed with NTM disease. Patients with active disease consenting for treatment were treated and followed up. Thirty four patients had NTM pulmonary disease (NTM-PD) and the remaining eight had extrapulmonary NTM (EP-NTM) disease. Mycobacterium intracellulare and M. abscessus, respectively, were most frequently isolated from NTM-PD and EP-NTM patients. Fifteen NTM-PD and seven EP-NTM patients successfully completed the treatment. Ten patients died due to unrelated causes, five were lost to follow up and another four declined the treatment. Interpretation & conclusions: Our study showed that the frequency of NTM disease was low among TB suspects at a large tertiary care centre in north India and this finding was similar to other Indian studies. More studies need to be done in other parts of the country to know the geographical variation in NTM disease, if any.

Use of MALDI-TOF MS in diagnostic microbiology for identification of species that conventional methods usually fail to identify

(MALDI-TOF MS) has been used in clinical diagnostic laboratories for the identification of microorganisms. It has a relevant advantage compared to other methods in terms of speed to provide results, being an alternative for addressing restrictions in clinical diagnosis as it may replace or complement existing identification techniques. This is especially important because some rare microorganisms would be identified only by higher cost techniques which are not widely available, such as genetic sequencing. Thus, the present paper reports two cases in which uncommon microorganisms were identified effectively and quickly. (AU)

Avaliação da limpeza e esterilização de cânulas de lipoaspiração após contaminação com gordura, Mycobacteroides abscessus subespécie bolletii e Geobacillus stearothermophilus: estudo experimental / Evaluation of liposuction cannulas cleaning and sterilization after contamination with fat, Mycobacteroides abscessus subspecies bolletii and Geobacillus stearothermophilus: an experimental study

Introdução: A lipoaspiração ou lipossucção é a intervenção cirúrgica destinada a remover depósitos superficiais e profundos de gordura subcutânea do tecido adiposo localizado. Em alguns casos, para obter o resultado estético desejado, é realizada a lipoenxertia. Neste processo, faz-se um transplante autólogo de tecido gorduroso para preencher, aumentar ou modelar as estruturas flácidas, depressões ou áreas com pouco tecido adiposo. As cânulas utilizadas para realizar a lipoaspiração apresentam um design desafiador para os processos de limpeza, favorecendo o acúmulo de resíduos de gordura em seu interior. Há registros de surtos infecciosos causados por microrganismos que sobreviveram ao processo de esterilização, relacionados à falha na limpeza dos instrumentais cirúrgicos, reforçando a premente necessidade de investigar se os resíduos de gordura no lúmen das cânulas são passíveis de remoção, garantindo assim, a eficácia da esterilização e a segurança em seu reuso. Objetivos: Fase I - avaliar a eficácia da remoção da gordura humana do lúmen das cânulas submetidas a seis diferentes Procedimentos Operacionais Padrão (POP) de limpeza, comparando-os com os grupos controle positivos e negativos. Fase II - Avaliar o alcance do nível de segurança de esterilidade de 10-6 , quando submetida à esterilização por vapor saturado sob pressão as cânulas de lipoaspiração intencionalmente contaminadas com 6 L(residual mínimo após limpeza) e 50 L (residual máximo após limpeza) de gordura ----------------|a humana, ao serem desafiados frente à cepa de Mycobacteroides abscessus subespécie massiliense (INCQS no 00594) e a cepa do esporo Geobacillus stearothermophilus (ATCC no 7.953). Método: a pesquisa caracterizou-se como pesquisa experimental laboratorial. A Fase I dos experimentos consistiu em submeter as cânulas de lipoaspiração de 3mm e 5mm de diâmetro com lúmen intencionalmente contaminado com gordura humana, a seis distintos POP de limpeza com variações na inclusão/exclusão/sequência dos passos básicos de limpeza, atualmente, adotados pela Enfermagem em Centros de Material e Esterilização (CME), quais sejam: 1. Flush inicial com água por meio de seringa de 10mL com detergente no lúmen das cânulas; 2. Flush automatizado a alta pressão e alta temperatura por meio do sistema de vapor fluente; 3. Imersão em solução de detergente enzimático com lipase e alternativamente no detergente alcalino; 4. Limpeza manual como o método que antecedeu a limpeza automatizada; 5. Limpeza automatizada em lavadora ultrassônica com retrofluxo intermitente com conectores para canulados. A gordura contaminante nos corpos de prova permaneceu por 120 minutos de contato, e após a drenagem do contaminante as cânulas ficaram expostas ao ar ambiente por 60 minutos. Após a aplicação dos seis distintos POP de limpeza, procedeu-se a extração e quantificação dos resíduos de gordura humana pela técnica de extração com solvente éter de petróleo a quente. A partir dos resultados obtidos nesta fase, realizou-se a Fase II caracterizada como microbiológica - utilizando a maior (50 L) e a menor (6,0 L ) média dos valores obtidos do resíduo de gordura para avaliar se esses quantitativos constituir-se-iam como fator protetor para os microrganismos no processo de esterilização por vapor saturado sob pressão alcançando o nível de segurança de esterilidade de 10-6 . Resultados: a Fase I da pesquisa demonstrou que mesmo utilizando todos os recursos atualmente, disponíveis no CME, não foi possível remover totalmente os resíduos de gordura inoculada nas cânulas de lipoaspiração restando valores residuais mínimos e máximos de gordura de 6,00 mg e 52 mg respectivamente. O POP que apresentou melhor desempenho na remoção de resíduo de gordura foi o método que empregou os seguintes recursos e sequência: 1. Flush inicial com água por meio de seringa de 10mL com detergente enzimático com lipase no lúmen das cânulas; 2. Imersão em solução de detergente enzimático com lipase; 3. Limpeza manual como o método que antecedeu a limpeza automatizada; 4. Limpeza automatizada em lavadora ultrassônica com retrofluxo intermitente com conectores para canulados; 5. Flush automatizado a alta pressão e alta temperatura por meio do sistema de vapor fluente. Os resultados microbiológicos da Fase II comprovaram a premissa de que a sujidade pode proteger microrganismos, constatando-se a sobrevivência, tanto da Mycobacteroides abscessus subespécie massiliense como do Geobacillus stearothermophilus, em ciclos de esterilização por vapor saturado sob pressão a 134o C, nos tempos de 1,30 minuto (meio ciclo) e 3 minutos (ciclo completo). Conclusões: As cânulas de lipoaspiração não são passíveis de limpeza pelos recursos atuais disponíveis pelos CME e houve recuperação dos microrganismos testados Mycobacteroides abscessus subespécie massiliense e Geobacillus stearothermophilus, demonstrando o risco de infecção relacionada ao reuso deste produto para saúde (PPS). Ressalta-se que dentre resíduos de matéria orgânica a serem removidos dos PPS, a gordura merece uma atenção especial porquanto há evidências de que os microrganismos em presença de óleos e gorduras necessitam de um tempo de exposição ao agente esterilizante até oito vezes maior que se estivesse na presença de água.

Introduction: Liposuction is the surgical intervention intended to remove superficial and deep deposits of subcutaneous fat from localized adipose tissue. In some cases, fat grafting is used to achieve the desired aesthetic result. In this process, an autologous fat tissue transplant is performed to fill, augment, or model flaccid structures, depressions, or areas with little adipose tissue. The cannulas used to perform liposuction have a challenging design for the cleaning processes, favoring the accumulation of fat residues inside. There are records of infectious outbreaks from microorganisms that survived the sterilization process, related to failure in cleaning surgical instruments, reinforcing the urgent need to investigate whether fat residues in the cannula lumen can be removed, thus ensuring the efficacy of sterilization and safety in its reuse. Objectives: Phase I to evaluate the efficacy of removing human fat from the cannula lumen undergoing six different cleaning standard operating procedures (SOPs), comparing them with the positive and negative control groups. Phase II - to evaluate the safety level of sterility reached of 10-6 , when liposuction cannula intentionally contaminated with 6 L (minimum residual after cleaning) and 50 L (maximum residual after cleaning) of human fat undergo sterilization with saturated steam, and are challenged with a strain of Mycobacteroides abscessus subspecies massiliense (INCQS no. 00594) and a strain of Geobacillus stearothermophilus spore (ATCC no. 7953). Method: the research was characterized as laboratorial and experimental. Phase I of the experiments consisted of submitting the 3mm- and 5mm- diameter liposuction cannula - with lumen intentionally contaminated with human fat, to six different cleaning SOPs with variations in the inclusion/exclusion/sequence of basic cleaning steps currently adopted by the nursing staff in sterile processing department, namely: 1. Initial flush with water using a 10mL syringe with detergent in the cannula lumen; 2. High-pressure, high-temperature automated flush through a flowing steam system; 3. Immersion in an enzymatic detergent solution with lipase, and alternatively in an alkaline detergent; 4. Manual cleaning as the method that preceded the automated cleaning; 5. Automated cleaning in ultrasonic washer with intermittent backflow with connectors for cannula. The contaminant fat in the specimens remained for 120 minutes of contact, and after draining the contaminant the cannulas were exposed to ambient air for 60 minutes. After the application of the six different cleaning SOPs, extraction and quantification of human fat residues were carried out using the hot petroleum ether extraction technique. Based on the results obtained in this phase, Phase II - characterized as microbiological - was performed using the largest (52L) and the lowest (6.0 L) average of values obtained from the fat residue to evaluate whether these quantitative values were a protective factor for microorganisms in the saturated steam sterilization process, reaching the sterile assurance level of 10-6 . Results: Phase I of the research demonstrated that even using all the currently available technologies in sterile processing department, it was not possible to completely remove fat residues inoculated in the liposuction cannula, with remaining minimum and maximum fat residual values of 6.0 mg and 52 mg, respectively. The SOP presenting better performance in the removal of fat residues was the method that used the following features and sequence: 1. Initial flush with water using a 10mL syringe with enzymatic detergent with lipase in the lumen of the cannula; 2. Immersion in an enzymatic detergent solution with lipase; 3. Manual cleaning using the method that preceded the automated cleaning; 4. Automated cleaning in ultrasonic washer with intermittent backflow with cannula connectors; 5. High-pressure and high-temperature automated flush using fluent steam system. The minimum and maximum residual fat values extracted were 6.0 mg and 52 mg. The microbiological results of Phase II have confirmed the premise that soil can protect microorganisms, with survival of both Mycobacteroides abscessus subspecies massiliense and Geobacillus stearothermophilus being observed after steam sterilization cycles under pressure at 134o C for 1,30 minute (half cycle) and 3 minutes (complete cycle). Conclusions: Liposuction cannula cannot be cleaned with the current resources available in Sterile Processing Departments, and the microorganisms tested, and Mycobacteroides abscessus subspecies massiliense and Geobacillus stearothermophilus, were recovered, demonstrating risk of infection related to the reuse of this health product. It should be emphasized that among the residues of organic matter to be removed from health products, fat deserves special attention because there is evidence that microorganisms in the presence of oils and fats need a time of exposure to the sterilizing agent up to eight times greater than if they were in the presence of water.

Treatment of Mycobacterium Abscessus Pulmonary Disease / 대한내과학회지

Mycobacterium abscessus is the second most important pathogen in pulmonary disease caused by nontuberculous mycobacteria (NTM), following Mycobacterium avium. Mycobacterium abscessus is classified into three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Mycobacterium abscessus is the most difficult to treat NTM due to its resistance to many antibiotics. Treatment should include an initial regimen of 2–3 injectable and oral antibiotics for several weeks or months, followed by inhaled amikacin and 1–3 oral antibiotics, depending on the subspecies and drug susceptibility patterns, including macrolide susceptibility. The continuation phase should be continued for a minimum of 12 months after culture conversion. Suitable injectable antibiotics include amikacin, imipenem, cefoxitin, and tigecycline, while oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and moxifloxacin. Surgery can be a useful adjunctive therapy for some patients with refractory disease. However, the overall treatment prognosis is still unsatisfactory. Therefore, novel and more effective interventions are required for the treatment of M. abscessus pulmonary disease.

An unusual case of unresolving tunnel infection in a patient on continuous ambulatory peritoneal dialysis

Atypical mycobacteria remain a rare cause of peritoneal dialysis catheter-related tunnel infection (TI) and poses serious risk because of the resistant nature to most antibiotic therapy. Non-tubercular mycobacterial infections lead to chronicity requiring peritoneal dialysis catheter removal. We report an 82-year-old male, with diabetic nephropathy who had a coinfection with Staphylococcus hominis and Mycobacterium abscessus who presented with pus discharge at exit site and TI. He was treated with relocation of the extraperitoneal part of the catheter with a new exit site without catheter removal and multidrug mycobacterial therapy.

Infección de puertos laparoscópicos por Micobacterias Atípicas / Laparoscopic Post-sites Infections by Atypical Mycobacteria

Introducción. Las Micobacterias Atípicas habitan normalmente aguas, suelos y ambientes quirúrgicos pudiendo infectar a personas con inmunidad comprometida o no comprometida afectando a prácticamente cualquier órgano. La especie Mycobactrium Abscessus Complex se describe frecuentemente como agente infeccioso de heridas quirúrgicas en puertos de cirugía laparoscópica siendo su tratamiento complejo y difícil. Materiales y Métodos. Estudio descriptivo de características clínicas, etiológicas y terapéuticas de pacientes con infección de los puertos quirúrgicos laparoscópicos causados por Micobacterias atípicas en cirugías consecutivas. Resultados. Once pacientes operados consecutivamente en el mismo medio y condiciones quirúrgicas desarrollaron infección de los puertos laparoscópicos. La incorrecta desinfección de instrumentos laparoscópicos fue la causa. Todos estos casos se registraron en un lapso de 43 días. El seguimiento fue de entre 10 a 14 meses. Las formas de presentación clínica fueron; fístulas, nódulos y seudotumores, en ese orden. Seis pacientes presentaron síntomas sistémicos como fiebre y sudoración nocturna. Se aislaron Micobacterias de crecimiento rápido caracterizados como M. Abscessus, M. Bolletii, M. Massiliense, especies del Complejo M. Abscessus. Los antibióticos utilizados fueron Claritromicina y Ciprofloxacino guiados por sensibilidad. Conclusiones. Los protocolos de desinfección deben ser estrictos. El tratamiento debe ser precoz y agresivo.

Introduction. Atypical Mycobacteria contaminates water, soil and surgical sets letting them to cause infections in people independent of their immunological status. Mycobacterium Abscessus Complex species frequently cause laparoscopic port sites infections turning about natural outcome in complex and hard to treat issues. Materials and Methods. Consecutive cases of patients affected with laparoscopic port sites infections by Atypical Mycobacterias are described. Etiological, clinical and therapeutic features are exposed. Results. Eleven patients acquired laparoscopic port site infections, all of them were consecutively operated at the same surgical background. Wrong proceedings in disinfection of laparoscopic devices were the causes. All of the surgeries were performed in a 43 days gap. Ten to fourteen months follow up is recorded. Fistulae was the most frequent lesion followed by nodules and pseudo tumors. Systemic symptoms like fever and nocturnal sweating were present in six patients. Rapid growing Mycobacterias were isolated by culture and labeled as M. Abscessus, M. Bolletii and M. Massiliense. Sensibility for antibiotics was tested and it commands therapeutic. Claritromicyn and Ciprofloxacyn were the most used antibiotics. Conclusions. Disinfection procedures there must be carefully controlled. Early and aggressive treatment have to be the rule.

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.

Micobacterias no tuberculosas en pacientes con fibrosis quística / Non-tuberculous mycobacteria in cystic fibrosis patients

In recent years there has been a global increase in nontuberculous mycobacteria isolates, especially in patients with cystic fibrosis. As its clinical and radiological characteristics overlap with other infectious agents, diagnostic guidelines were generated based on evidence from patients who do not present cystic fibrosis. A long-term treatment is necessary, involving multiple antibiotics, and the response rate is low. There are variations in the criteria adopted by different centers with regard to lung transplantation in this group of patients.

En los últimos años se ha producido un aumento a nivel mundial del aislamiento de micobacterias no tuberculosas, especialmente en pacientes con fibrosis quística. Como sus características clínicas y radiológicas se superponen con las de otros agentes infecciosos se generaron orientaciones diagnósticas basadas en evidencia de pacientes que no presentan fibrosis quística. El tratamiento es prolongado, involucra múltiples antibióticos y la tasa de respuesta es baja. Existen variaciones en los criterios adoptados por los distintos centros con respecto al trasplante pulmonar en este grupo de pacientes.

Detection of 16S rRNA gene and biological characteristics of Mycobacterium abscessus / 中华皮肤科杂志

Objective To identify a clinical isolate of Mycobacterium abscessus.Methods A pus sample was collected from a patient with suspected nontuberculous mycobacterial infection who visited the Affiliated Hospital of Weifang Medical University on December 18,2017,and was subjected to bacterial culture,Gram staining and acid-fast staining.Drug sensitivity test was conducted by the proportion method.The genome DNA of the strain was extracted and amplified by PCR with the universal primer of 16S rRNA.The PCR products were sequenced after collection and purification,and were compared with the known sequence of Mycobacterium abscessus in GenBank database.The isolate was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).Results The clinical isolate was identified as Mycobacterium abscessus both by MALDI-TOF MS and 16S rRNA gene sequencing.The drug sensitivity test showed that the strain was sensitive to amikacin,moxifloxacin,levofloxacin,but was resistant to streptomycin,isoniazid,rifampicin,ethambutol,ofloxacin,kanamycin,capreomycin,aminosalicylic acid,protionamide and rifabutin.The patient was diagnosed with subcutaneous soft tissue infection in the left knee joint.According to the results of drug sensitivity test,the patient was treated with amikacin and levofloxacin,and her condition was improved after treatment.Conclusion The 16S rRNA gene detection and MALDI-TOF MS both can be applied in the identification of Mycobacterium abscessus.