ABSTRACT
Lung infections with Mycobacterium abscessus, a species of multidrug-resistant nontuberculous mycobacteria, are emerging as an important global threat to individuals with cystic fibrosis (CF), in whom M. abscessus accelerates inflammatory lung damage, leading to increased morbidity and mortality. Previously, M. abscessus was thought to be independently acquired by susceptible individuals from the environment. However, using whole-genome analysis of a global collection of clinical isolates, we show that the majority of M. abscessus infections are acquired through transmission, potentially via fomites and aerosols, of recently emerged dominant circulating clones that have spread globally. We demonstrate that these clones are associated with worse clinical outcomes, show increased virulence in cell-based and mouse infection models, and thus represent an urgent international infection challenge.
Subject(s)
Communicable Diseases, Emerging/microbiology , Cystic Fibrosis/microbiology , Drug Resistance, Multiple, Bacterial , Mycobacterium Infections, Nontuberculous/microbiology , Nontuberculous Mycobacteria/classification , Animals , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/pathology , Communicable Diseases, Emerging/transmission , Cystic Fibrosis/epidemiology , Cystic Fibrosis/pathology , Genome, Bacterial , Genomics , Humans , Incidence , Lung/microbiology , Lung/pathology , Mice , Mice, SCID , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/pathology , Mycobacterium Infections, Nontuberculous/transmission , Nontuberculous Mycobacteria/genetics , Nontuberculous Mycobacteria/isolation & purification , Phylogeny , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/pathology , Pneumonia, Bacterial/transmission , Polymorphism, Single Nucleotide , Sequence Analysis, DNAABSTRACT
We present a 19-year-old woman with severe encephalitis and raised intracranial pressure requiring decompressive craniectomy. Her clinical features were consistent with encephalitis in the context of acute primary Epstein-Barr virus (EBV) infection (infectious mononucleosis). Serology, bone marrow aspirate and PCR of blood and cerebrospinal fluid confirmed the diagnosis. She was treated with corticosteroids and aciclovir. She was critically unwell for 3 weeks, requiring artificial ventilation but eventually made a good recovery. EBV encephalitis is uncommon, making the diagnosis and decisions about clinical management challenging.
