A Case of Rapidly Growing Infected Left Atrial Myxoma / 日本心臓血管外科学会雑誌

A 62-year-old man was admitted to our hospital complaining of high fever and clouding of consciousness. His initial diagnosis was infective vegetative endocarditis involving the mitral valve with multiple hemorrhagic cerebral infarctions. We chose medical therapy because of cerebral hemorrhage and scheduled surgery two weeks after the hospital admission. During medical therapy, echocardiography showed rapid growth of the vegetation on the 6th hospital day, suggesting cardiac tumor. Surgery was performed on the 16th hospital day. We found an infected myxoma with vegetation on the mitral valve and annular abscess extending to the left ventricle. The myxoma was resected and the abscess carefully debrided. We replaced the mitral valve after the mitral annulus was reinforced with autologous pericardium. The patient underwent antibiotic therapy for 6 weeks after the surgery. He was discharged from the hospital with no sign of recurrence.

Pharmaceutical Consultation Practice for One Case of Rapidly by Growing Mycobacteria Bloodstream Infections / 中国药师

Objective: To investigate the diagnosis and treatment of rapidly growing mycobacteria bloodstream infections.Methods: Based on the two pharmaceutical consultation practice for one case of rapidly growing mycobacteria bloodstream infections after fracture operation, the paper summarized and analyzed the problems in different stages of treatment.Results: The first consultation optimized the dosage of vancomycin according to the patient''s serum concentration and creatinine clearance rate.The second consultation suggested doctors actively perform anti-infection treatment for rapidly growing mycobacteria after the patient''s clinical symptoms and examination results were improved significantly.It is recommended to withdraw anti TB drugs, and the use of clarithromycin combined with amikacin was suitable.The patient was discharged with improved health conditions.Conclusion: Positive intervention and correct diagnosis are the keys for the successful treatment of suspected or definite mycobacteria infection in surgical sites.

Skin and Soft Tissue Infection due to Rapidly Growing Mycobacteria: Case Series and Literature Review / 감염과화학요법

BACKGROUND: Nontuberculous mycobacteria (NTM) are ubiquitous in soil and water. Most NTM cause disease in humans only rarely unless some aspect of host defense is impaired. Recently, rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. RGM causes a wide spectrum of pulmonary and extrapulmonary diseases and has been shown as an important source for opportunistic infection. MATERIALS AND METHODS: We report 5 patients of skin and soft tissue infection due to RGM in tertiary medical center in Jeju Island and analyzed 21 patients of skin and soft tissue infection due to RGM in Republic of Korea. Clinical, microbiological and epidemiological data were collected from each patient. NTM isolates were identified using conventional and molecular methods including 16S rDNA gene sequencing. RESULTS: The mean age of the RGM patients (n=26) was 54.9 +/- 15.9 years and 73% were women. Mycobacterium fortuitum complex was the most common (12/26). Antimicrobial resistance for clarithromycin and quinolone were 12% and 60%, respectively. Clarithromycin based therapy was done in 46%. The mean duration of treatment was 21.2 +/- 8.7 weeks. CONCLUSIONS: Many cases can be cured after therapy for 4-7 month with at least 2 or 3 antibiotics according to in vitro susceptibility. Recent increasing of NTM cases suggests that species and subspecies identification is epidemiologically important, especially related to medical procedure, and surgery.

Pulmonary disease due to mycobacterium massiliense.

We report a case of a patient suffering from multidrug-resistant pulmonary tuberculosis (MDR-PTB) who later developed an invasive infection of the respiratory tract with a rapidly growing non-tuberculous mycobacteria (NTM), recently identified as Mycobacterium massiliense, closely related to M. abscessus. To the best of our knowledge, this is the first case of M. massiliense infection being reported from India.

Successfully treated Mycobacterium abscessus mastitis: A rare cause of breast masses.

Rapidly growing mycobacteria are pathogens responsible for cutaneous or subcutaneous infections especially occurring after injection, trauma or surgery. We describe a patient with Mycobacterium abscessus mastitis that presented as a mass lesion and haemorrhagical discharge. It was initially diagnosed and treated as fibrocystic disease and non-specific abscess. Full recovery was obtained with combination therapy of clarithromycin, linezolid and amikacin without surgical debridement followed by several abscess aspirations. Atypical mycobacteria should be considered in diagnosis of chronic breast lesions in endemic areas. This is the first reported case of mastitis due to M. abscessus in Turkey.

Evaluation of INNO-LiPA mycobacteria v2 assay for identification of rapidly growing mycobacteria

A total of 54 rapidly growing mycobacteria (RGM) isolated from patients attended in the two hospitals of Cádiz Bay (Spain) were selected during a seven-year-period (2000-2006) in order to evaluate the INNO-LiPA Mycobacteria v2 assay for mycobacterial identification, based on the reverse hybridization principle. The strains were cultured in Lõwenstein-Jensen and Middlebrook 7H9 media and identified to the species level by sequencing of the 16S rRNA, PCR-restriction enzyme analysis of the hsp65 gene, conventional tests and INNO-LiPA Mycobacteria v2 assay. By the molecular methods we identified a total of 12 different species: 23 Mycobacterium fortuitum, 11 M. chelonae, 10 M. abscessus, 2 M. senegalense, 1 M. alvei, 1 M. brumae, 1 M. mageritense, 1 M. mucogenicum, 1 M. neoaurum, 1 M. peregrinum, 1 M. septicum and 1 M. smegmatis. Fifty two strains (96.3 percent) were correctly identified by conventional techniques and 47 strains (87.0 percent) by INNO-LiPA Mycobacteria v2 assay. We find INNO-LiPA Mycobacteria v2 assay simple to perform but it provides few advantages in comparison with conventional methods and sometimes needs complementary tests to identify Mycobacterium fortuitum complex, M. chelonae complex and specific species due to the great heterogeneity in the RGM group.

Antimicrobial susceptibility testing of rapidly growing mycobacteria by microdilution - Experience of a tertiary care centre.

Purpose: The objective of the study was to perform antimicrobial susceptibility testing of rapidly growing mycobacteria (RGM) isolated from various clinically suspected cases of extrapulmonary tuberculosis, from January 2007 to April 2008, at a tertiary care centre in Mumbai. Materials and Methods: The specimens were processed for microscopy and culture using the standard procedures. Minimum inhibitory concentrations (MIC) were determined by broth microdilution, using Sensititre CA MHBT. Susceptibility testing was also carried out on Mueller Hinton agar by the Kirby Bauer disc diffusion method. Results: Of the 1062 specimens received for mycobacterial cultures, 104 (9.79%) grew mycobacteria. Of the mycobacterial isolates, six (5.76%) were rapid growers. M. abscessus and M. chelonae appeared to be resistant organisms, with M. chelonae showing intermediate resistance to amikacin and minocycline. However, all the six isolates showed sensitivity to vancomycin and gentamicin by the disc diffusion test. Also all three isolates of M. abscessus were sensitive to piperacillin and erythromycin. Further studies are required to test their sensitivity to these four antimicrobials by using the microbroth dilution test, before they can be prescribed to patients. Conclusions: We wish to emphasize that reporting of rapidly growing mycobacteria from clinical settings, along with their sensitivity patterns, is an absolute need of the hour.

Micobactérias de crescimento rápido de importância médica no Brasil: eficácia antimicrobiana de desinfetantes e sistema de esterilização por plasma / Rapidly growing mycobacteria of medical importance in Brazil: antimicrobial efficacy of disinfectants and plasma sterilization system

Práticas inadequadas de descontaminação, desinfecção e esterilização de materiais médico-hospitalares têm propiciado o surgimento de inúmeros surtos de infecções por 'Micobactérias de Crescimento Rápido' (MCR), em todo o Brasil. Entre os anos de 2000 a 2008 foram relatados mais de 2000 casos confirmados de infecções por MCR, sendo que os procedimentos por vídeo se constituíram como os maiores veiculadores destes microrganismos. O aumento do emprego de dispositivos de natureza polimérica em procedimentos médico-cirúrgicos e ausência/não cumprimento de protocolos de processamento destes materiais podem estar envolvidos na disseminação, principalmente, pela capacidade de MCR produzirem e sobreviverem em sistemas de biofilmes. Desta forma, este trabalho teve como objetivo a avaliação da susceptibilidade de cepas de Mycobacterium abscessus subsp. bolettii (suspensão e biofilmes), causadoras ou não de surto, frente a desinfetantes químicos constituídos de: Glutaraldeído 2%, Ácido Peracético 0,2%, Peróxido de Hidrogênio 35%, Solução Alcoólica de Digluconato de Clorexidina 0,5%, Solução Aquosa de Clorexidina 0,2%, Compostos de Amônio Quaternário 1,2%, Iodo 1% e Fenol 5% e Sistemas de Esterilização por Plasma (RIE e ICP) empregando mistura gasosa O2-H2O2. Paralelamente, suportes poliméricos (PVC, PEAD, PP, PUR e PC) empregados como carreadores de MCR foram analisados por Espectroscopia Fotoacústica no Infravermelho (PAS-FTIR), Microscopia Eletrônica de Varredura (MEV), microanálise em Sistema Energy Dispersive Spectroscopy (EDS) e Perfilometria. Resultados destas investigações demonstraram a resistência das cepas de M. abscessus subsp. bolettii, isolada do surto ocorrido em Belém, frente a Glutaraldeído 2%, Solução Alcoólica de Digluconato de Clorexidina 0,5%, Solução Aquosa de Clorexidina 0,2%, Compostos de Amônio Quaternário 1,2% e Iodo 1%. Entretanto, estas cepas foram altamente sensíveis à Ácido Peracético 0,2%, Peróxido de Hidrogênio 35% e Fenol 5% e Sistema...

Numerous outbreaks of Rapid Growth of Mycobacteria (RGM) have been associated with decontamination, disinfection and sterilization malpractices, in Brazil. Between 2000-2008 were reported more than 2,000 confirmed cases due to RGM infections, and the video procedures were considered to carry these microorganisms. The increased use of medical devices in surgical procedures may be involved in the RGM spreading by its ability to grow and survive in biofilm systems. The aim of this study was evaluate the susceptibility of Mycobacterium abscessus subsp. bolletii (outbreak and nonoutbreak strains) to chemical disinfectants: Glutaraldehyde 2%, Peracetic Acid 0.2%, Hydrogen Peroxide 35%, Chlorhexidine Digluconate 0.5%, Chlorhexidine 0.2%, Iodine 1%, Quaternary Ammonium Compounds 1.2%, and Phenol 5%. Plasma Sterilization Technologies (Reactive Ion Etching and Inductively Coupled Plasma) were also evaluated. Polymers employed in medical devices (Polyvinyl chloride, High-Density Polyethylene, Polycarbonate, Polypropylene, and Polyurethane) were analyzed by Photoacoustic Infrared Spectroscopy (PAS-FTIR), Scanning Electron Microscopy (SEM), System Energy Dispersive Spectroscopy (EDS) and Profilometry. The results have demonstrated the resistance of Mycobacterium abscessus subsp. bolletii isolated from the Belém (PA) outbreak considering chemical exposition to Glutaraldehyde 2%, Chlorhexidine Digluconate 0.5%, Chlorhexidine 0.2%, Quaternary Ammonium Compounds 1.2%, and Iodine 2%. However, these strains were highly sensitive to Peracetic Acid 0.2%, Hydrogen Peroxide 35%, and Phenol 5%. The M. abscessus subsp. bolletii strains have been presented resistant to all disinfectants studied, in biofilm systems. Studies involving polymer integrity demonstrated changes in surface (oxidation and roughness) on all processed materials, and the ICP system was more aggressive in contrast to Reactive Ion Etching.

Post-traumatic Infrapatellar Bursitis due to Mycobacterium fortuitum in an Immunocompetent Patient / 감염과화학요법

Mycobacterium fortuitum is a rare pathogen, frequently found in water, soil, animals and plant materials. It can cause infections involving skin, soft tissue and skeletal system after direct inoculation of the pathogen through surgical traumas, punctures and injections. We report a case of infrapatellar bursitis caused by M. fortuitum in an immunocompetent, 42-year-old female, which occurred after bicycle trauma. She experienced marked improvement after surgical excision and debridement of the wound site and antimicrobial therapy.

Post-traumatic Infrapatellar Bursitis due to Mycobacterium fortuitum in an Immunocompetent Patient / 감염과화학요법

Mycobacterium fortuitum is a rare pathogen, frequently found in water, soil, animals and plant materials. It can cause infections involving skin, soft tissue and skeletal system after direct inoculation of the pathogen through surgical traumas, punctures and injections. We report a case of infrapatellar bursitis caused by M. fortuitum in an immunocompetent, 42-year-old female, which occurred after bicycle trauma. She experienced marked improvement after surgical excision and debridement of the wound site and antimicrobial therapy.

Drug Susceptibility and Clinical Significance of Rapidly Growing Mycobacteria Isolated from Patients with Non-Tuberculous Mycobacteriosis / 대한임상미생물학회지

BACKGROUND: It is recommended that all rapidly growing mycobacteria (RGM) isolated from patients with mycobacteriosis are subjected to antimicrobial susceptibility testing. The current study was aimed to perform susceptibility test on clinical strains of RGM isolated from patients with mycobacteriosis and to determine the clinical significance of the isolates. METHODS: For 17 patients with RGM infection from 2002 to 2006 at Ulsan University Hospital, medical records were reviewed retrospectively and anti-mycobacterial susceptibility test was performed for the clinical isolates by broth microdilution method. RESULTS: Rates of susceptible strains of RGMs against individual drugs were as follows: amikacin 100%, cefoxitin 59%, ciprofloxacin 82%, clarithromycin 71%, doxycycline 18%, imipenem 91% (M. fortuitum), sulfamethoxazole 71%, and tobramycin 100% (M. chelonae). Ten of the 17 nontuberculous mycobacteria (NTM) patients had been treated with anti-tuberculosis drugs initially. Anti-tuberculosis drugs were continued in 3 patients and changed to other antimicrobial agents effective to NTM in 4 patients, all of whom were cured. Five of 7 NTM patients who had been treated with anti-NTM treatment were cured. All isolates from the patients treated with anti-NTM drugs were susceptible to at least one of the drugs administered. CONCLUSION: Clinical isolates of RGMs showed fully susceptible to amikacin, while highly resistant to doxycycline and variable to other drugs depending on the species.

Clinical Significance and Species Identification of Rapidly Growing Mycobacteria Isolated from Routine Blood Cultures / 대한진단검사의학회지

BACKGROUND: Rapidly growing mycobacteria (RGM) are ubiquitous in the environment such as water and soil. Recently, infections by RGM are described in increasing frequency, but isolation from blood cultures has been rarely reported in Korea. The aim of this study was to identify blood culture isolates by 16S rDNA sequencing and to determine their clinical significance. METHODS: Blood cultures were performed using an automated blood culture instrument (BacT/ Alert 3D, Organon Teknika, Durham, USA), and the isolates were identified by nucleotide sequencing for the 16S rDNA after PCR amplification. The clinical significance was determined by patient's symptoms, laboratory findings, radiologic findings, underlying diseases, clinical course, and response to therapy etc. RESULTS: RGM were isolated from 16 patients: the organisms were identified as Mycobacterium mucogenicum in 12 patients, and M. cosmeticum in 4 patients. Ten isolates were considered clinically significant and the remaining four as contaminants. CONCLUSIONS: RGM can be detected in routine blood cultures; therefore, they should not be confused with other gram-positive bacilli such as Corynebacteria, and the possibility of RGM in blood stream infections must be considered. It is necessary to identify RGM up to the species level for proper diagnosis and treatment. The clinical significance of RGM from blood cultures must be carefully assessed with the consideration of contamination.

Clinical Manifestations of Pulmonary Infection Due to Rapidly Growing Nontuberculous Mycobacteria / 결핵

INTRODUCTION: Rapidly growing nontuberculous mycobacteria (RGM) can produce numerous types of manifestations including a pulmonary infection. Managing a pulmonary infection due to RGM is unusually difficult to treat because the organism is invariably resistant to traditional antituberculous drugs and has a varying susceptibility to other antibiotics. The experiences of treatments for a RGM pulmonary infection with various antibiotics are also limited. This study evaluated the clinical manifestations, treatment, and the therapeutic outcomes of a RGM pulmonary infection. SUBJECT AND METHOD: Fifty-four cases with RGM from respiratory specimens were identified between November of 1996 and September of 2002 in the Asan medical center. The medical records and radiographic findings in 20 patients who fulfilled the diagnostic criteria of nontuberculous mycobacteria (NTM) pulmonary disease by ATS guidelines. The clinical, laboratory, and radiological parameters between subgroups. RESULTS: Of the 20 patients, 15 were female. The mean age was 57.7 yrs (+/-7.5), and all of the patients had a history of pulmonary tuberculosis. Most (90%) had an underlying lung disease. The majority of the isolates (80%) were M. abscessus. Chest radiography showed bilateral involvement in 80% of the patients. Bronchiectasis and multiple nodules were the main findings. Cavitation was present in 35% of the patients. Even though 70 % of the patients received antituberculous drugs prior to the correct diagnosis, all of the patients eventually received antibiotics. A mean of 3.5 antibiotics were given for an average of 439 days(+/-168). After completing treatment, nine patients showed improvement after a mean 591(+/-311) days of treatment, whereas the antibiotic treatment was unsuccessful in 2 patients. CONCLUSION: Many patients with a RGM pulmonary infection show an atypical pattern of radiological findings (bronchiectasis and multiple centrilobular nodules). It is very important to differentiate between M. tuberculosis and NTM and to identify the causative organisms among the NTM because a misdiagnosis can lead to an inappropriate and prolonged treatment. Combined antibiotic treatment yielded promising results, and is recommended for treating patients with a RGM pulmonary infection.