Disseminated Mycobacterium fortuitum Infection Associated with Venous Access Device.

Mycobacterium fortuitum is an important opportunistic pathogen among the rapidly growing Mycobacteria. Disseminated disease occurs as a consequence of bacteremia linked to vascular catheters, which carry high morbidity and mortality when they occur in immuno-compromised patients. Conventional culture methods often miss these organisms since they may grow more slowly (after 48 h) and are dismissed as skin contaminants because of their morphological resemblance to diphtheroids on grams staining. We report a case of 10 months old child with primitive neuroectodermal tumor who developed disseminated disease with M. fortuitum that was related to an indwelling intravascular device. The isolates were confirmed as M. fortuitum by polymerase chain reaction based DNA sequencing targeting heat shock protein 65 gene. The child was treated with, rifampicin, ethambutol and azithromycin. The patient improved remarkably and became afebrile 2 days after institution of therapy and removal of the catheter. The treatment was given for 3 months.

Successful Treatment of Mycobacterium celatum Pulmonary Disease in an Immunocompetent Patient Using Antimicobacterial Chemotherapy and Combined Pulmonary Resection

Mycobacterium celatum is a nontuberculous mycobacterium that rarely causes pulmonary disease in immunocompetent subjects. We describe the successful treatment of M. celatum lung disease with antimicobacterial chemotherapy and combined pulmonary resection. A 33-year-old woman was referred to our hospital with a 3-month history of a productive cough. Her medical history included pulmonary tuberculosis 14 years earlier. Her chest X-ray revealed a large cavitary lesion in the left upper lobe. The sputum smear was positive for acid-fast bacilli, and M. celatum was subsequently identified in more than three sputum cultures, using molecular methods. After 1 year of therapy with clarithromycin, ethambutol, and ciprofloxacin, the patient underwent a pulmonary resection for a persistent cavitary lesion. The patient was considered cured after receiving 12 months of postoperative antimycobacterial chemotherapy. There has been no recurrence of disease for 18 months after treatment completion. In summary, M. celatum is an infrequent cause of potentially treatable pulmonary disease in immunocompetent subjects. Patients with M. celatum pulmonary disease who can tolerate resectional surgery might be considered for surgery, especially in cases of persistent cavitary lesions despite antimycobacterial chemotherapy.

Standardized Combination Antibiotic Treatment of Mycobacterium avium Complex Lung Disease

PURPOSE: The optimal treatment regimen for Mycobacterium avium complex (MAC) lung disease has not yet been fully established. We evaluated the efficacy of standardized combination antibiotic therapy and the factors that might affect unfavorable microbiologic responses in patients with MAC pulmonary disease. MATERIALS AND METHODS: This retrospective study reviewed data from 96 patients (56 females; median age 59 years) treated with newly diagnosed MAC lung disease between January 2003 and December 2006. RESULTS: All patients received standardized combination antibiotic therapy, consisting of clarithromycin, rifampicin, and ethambutol. Streptomycin was additionally given in 72 patients (75%) for a median duration of 4.5 months. The overall favorable microbiologic response rate was 79% (76/96); 20 patients (21%) had unfavorable microbiologic responses, including failure to sputum conversion (n = 13), relapse (n = 3), and MAC-related death (n = 4). A positive sputum acid-fast bacillus smear at the start of treatment was an independent predictor of an unfavorable microbiologic response. CONCLUSION: Standardized combination antibiotic therapy consisting of clarithromycin, rifampicin, and ethambutol with or without initial use of streptomycin is effective in treating patients with newly diagnosed MAC lung disease.

Tratamiento antirretroviral en pacientes con sida y micobacteriosis / Anti-retroviral treatment in patients with AIDS and mycobacterial diseases

La tuberculosis y otras micobacteriosis constituyen asociaciones o coinfecciones frecuentes en pacientes con sida y se asocian con una elevada mortalidad. En esta revisión se actualizan los tratamientos de las principales enfermedades micobacterianas asociadas al sida (tuberculosis y micobacteriosis por Mycobacterium avium), con especial énfasis en las interacciones farmacológicas entre antimicobacterianos, principalmente rifampicina y claritromicina, y fármacos antirretrovirales. Se analizan los esquemas de tratamiento, su duración, la quimioprofilaxis primaria y secundaria y el momento óptimo de iniciación del tratamiento antirretroviral. Finalmente se describe el síndrome inflamatorio de reconstitución inmune y su tratamiento.

In vitro and in vivo antimycobacterial activity of antiinflammatory drug, diclofenac sodium.

The non-steroidal antiinflammatory drug diclofenac sodium exhibited remarkable inhibitory action against both drug sensitive and drug resistant clinical isolates of Mycobacterium tuberculosis, as well as other mycobacteria. This agent was tested in vitro against 45 different strains of mycobacteria, most of which were inhibited by the drug at 10-25 microg/ml concentration. When tested in vivo, diclofenac, injected at 10 mg/kg body weight of a Swiss strain of white mice, could significantly protect them when challenged with a 50 median lethal dose of M. tuberculosis H37 Rv102. According to Chi-square test, the in vivo data were highly significant (P<0.01).

Nontuberculous mycobacterial skin infections: clinical and bacteriological studies.

OBJECTIVE: Nontuberculous mycobacterial (NTM) skin infections were analysed in terms of clinical manifestation in different species to provide clues for the clinical diagnosis and sensitivity patterns of these species were studied for planning appropriate therapy. DESIGN: A retrospective study was performed in 123 suspected cases of NTM infections from January 1994 to December 2000. NTM infection was documented by culture result of the infected tissue obtained by skin biopsy. Drug susceptibility test was done as requested. RESULT: Rapid growers (M. fortuitum-chelonae) were found in 26 cases (65%) and M. marinum was responsible for 12 cases (30%) and caused only localized skin lesions on arms or legs as indurated plaque, Disseminated skin infections manifested as multiple abscesses were found in 2 cases caused by M. avium in an HIV-infected male patient and mixed infection of M. szulgai and M. terrae in an immunocompetent female patient after a dental procedure. Both sexes were affected equally in overall number but male predominated in M. marinum infection and females predominated in rapid growers. All ages can be affected but most cases were middle aged. Scrofuloderma-like cervical lymphadenitis and cutaneous abscesses were the common manifestation of rapid grower infections. Hyperkeratotic verrucous plaques (tuberculosis verrucosa cutis-like) and sporotrichoid lesions were the common manifestations of M. marinum infection. M. marinum is sensitive to minocyclin, clarithromycin, amikacin, rifampicin and ethambutol and a good clinical response was obtained with doxycyclin 100 mg orally twice a day for 3 months. Clarithromycin and amikacin showed in vitro activity against the same strain of M. fortuitum but most strains of rapid growers resisted antituberculous drugs and also various antibiotics. CONCLUSION: Clinical manifestations can be used as clues for diagnosis. Medical therapy is recommended for M. marinum infection and surgical treatment is recommended for rapid growers.

Mycobacterium fortuitum wound infection following laparoscopy.

During a six week period in 1999, seven patients who underwent laparoscopic tubectomies at small town health centres near Chandigarh developed chronic discharging sinuses at the site of incision. Mycobacterium fortuitum was isolated from wound discharge of the five patients by standard methods and two patients were smear positive. Environmental samples e.g., tap water, and a variety of fluids did not yield any mycobacteria and swabs from different parts of the laparoscope were sterile. All patients responded to ciprofloxacin and amikacin therapy. Our observation demonstrates that M. fortuitum is a clinically important nosocomial pathogen in setting of surgical wound infection in our country.

Resistencia a fármacos antibacilares en tubeculosis y microbacteriosis en enfermos VIH+/SIDA / Resistance to antibacillary drugs in tuberculosis and mycobacteriosis in HIV+/AIDS patients

Desde 1989 hasta Julio de 1994 el Laboratorio de Referencia Nacional de Micobacterias procesó cepas de 99 pacientes VIH/SIDA con enfermedades por micobacterias. En 87 se efectuaron las pruebas de tipificación; 73 (83.9 porciento) resultaron M. tuberculosis y 14 (16.1 porciento) M. no tuberculosis, 12 de ellas del complejo MAI. El test de sensibilidad a drogas antituberculosas se realizó en 81 casos, 69 del complejo M. tuberculosis y en los 12 MAI; estos últimos fueron todos resistentes, la mayoría a 5 de las 8 drogas probadas. De los 69 casos de TBC, 42 eran nuevos, vírgenes a tratamiento y en ellos se encontró un 11.9 porciento de resistencia inicial global. Este porcentaje es semejante a las cifras históricas nacionales, determinadas en enfermos VIH (-). Se concluye que la resistencia en estos pacientes no guarda relación con su condición biológica de VIH+/SIDA, sino con su pobre adherencia al tratamiento, por sus condiciones socioculturales

Nontuberculous mycobacterial infection of the lung in a chest hospital in Thailand.

In a continuing study on the occurrence of nontuberculous mycobacterial lung disease by screening sputum cultures and from clinical judgement, from 1979 to 1987, a second series of 42 patients were suspected of having pulmonary infection caused by nontuberculous mycobacteria. As identified by the WHO Collaborating Center for Mycobacteria in Prague, Mycobacterium avium complex was isolated from the greatest number of patients (21 or 50%); M. scrofulaceum from seven; M. kansasii from six, and M. gorgonae from four. The remaining four patients yielded one strain each of M. fortuitum, M. asiaticum, M. szulgai, and one with suspected M. simiae. However, clinical significance was confirmed in only 30 patients, 20 of whom had M. avium complex; three had M. scrofulaceum; three had M. kansasii, and one each had M. gordonae, M. asiaticum, M. szulgai, and suspected M. simiae. Retrospective analysis revealed that 24 of the 30 patients had pre-existing disease, including 20 who had tuberculosis. Blood examinations of 10 patients recalled so far proved negative for HIV infection. Diseases caused by nontuberculous mycobacteria is still rare in Thailand.

Infección de pie por Mycobacterium chelonei: informe de un caso y revisión de la literatura / Foot infection by Mycobacterium chelonei: a case report and literature review

Presentamos el caso de un niño de occho años que desarrolló una infección del pie despues de un trauma plantar. El estudio bacteriológico demostró la presencia de Mycobacterium chelonei ssp. abscessus en el exudado de la lesión. Se hace una reseña de ña evolución clínica, que finalmente fue satisfactoria después del tatamiento por varias semanas con antimicrobianos y drenajes quirúrgicos. Se hace uma revisión de la literatura para llamar la atención sobre este tipo de infecciones en nuestro medio