Infección diseminada por Mycobacterium scrofulaceum en paciente en tratamiento con golimumab / Disseminated Mycobacterium scrofulaceum infection in a patient in treatment with golimumab

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An atypical deep neck infection in a two-year-old child.

Non-tuberculous mycobacteria are one of the major causes of lymphadenitis in children and seldom of deep neck infections. We reported the case of an immunocompetent two-year-old girl with adenitis and retropharyngeal abscess caused by an atypical mycobacterium. She had a positive tuberculin skin test, whereas the Quantiferon TB Gold test was negative. The child underwent a complete nodal excision. The search for acid fast bacilli was positive and Mycobacterium scrofulaceum was isolated from the surgically removed material. The retropharyngeal abscess was treated only with antimicrobial therapy, which resulted in an appreciable size reduction of the abscess. After two months antimicrobial treatment was interrupted, and complete resolution was achieved after twelve months. No relapse of disease or possible long-term complications were observed. The surgical wound healed completely, with normal overlying skin and a good aesthetic result. The clinical management of atypical mycobacteria lymphadenitis and retropharyngeal abscess in children is discussed.

Disseminated Mycobacterium scrofulaceum infection in a child with interferon-gamma receptor 1 deficiency.

Disseminated disease caused by non-tuberculous, environmental mycobacteria (EM) reflects impaired host immunity. Disseminated disease caused by Mycobacterium scrofulaceum has primarily been reported in patients with AIDS. Moreover, observing M. scrofulaceum as the agent of localized disease in childhood has become increasingly rare. We report the first case of disseminated disease caused by M. scrofulaceum in a child with inherited interferon-gamma receptor 1 (IFN-gammaR1) complete deficiency. As in this case, mycobacterial bone infections in IFN-gammaR1 deficiency can sometimes mimic the clinical picture of chronic recurrent multifocal osteomyelitis.

[A case of pulmonary Mycobacterium scrofulaceum infection and review of the tendency towards recent acid-fast bacilli infection].

A 47-year-old man presented to a local physician with a chief complaint of sputum and cough for 3 months. Chest X-ray showed bilateral consolidation in the upper lung fields, and the patient was suspected to have pulmonary tuberculosis: he was then referred to our hospital. Smear and culture of both sputum and gastric juice showed acid-fast bacilli, and we started administration of rifampicin, isoniazid, ethambutol, and pyrazinamide. Results of the culture and identification test showed the causative bacillus to be Mycobacterium scrofulaceum (M. scrofulaceum). We stopped pyrazinamide and added clarithromycin to the treatment regimen, which resulted in symptomatic relief and radiological improvement. The frequency of pulmonary nontuberculous mycobacteriosis is increasing: in contrast, pulmonary infection by M. scrofulaceum has been decreasing. Nevertheless, M. scrofulaceum infection should be considered in the differential diagnosis from tuberculosis when the results of radiological findings and sputum culture suggest pulmonary tuberculosis.

Flexor tenosynovitis caused by Mycobacterium scrofulaceum: case report.

Atypical hand infections with Mycobacterium species are uncommon, and Mycobacterium scrofulaceum infections are rare. We present a case of flexor tenosynovitis caused by M scrofulaceum in a 66-year-old man with hypertension and diabetes.

Genetic analysis of Mycobacterium avium complex strains used for producing purified protein derivatives.

For over a century, purified protein derivatives (PPD) have been used to detect mycobacterial infections in humans and livestock. Among these, reagents to detect infections by Mycobacterium avium complex organisms have been produced, but the utility of these reagents has not been clearly established due in part to limited biologic and immunologic standardization. Because there is little information about the strains used to produce these reagents (avian PPD, intracellulare PPD, scrofulaceum PPD, and Johnin), we have performed genetic characterizations of strains used to produce these products. Sequence analysis of 16S rRNA and the hsp65 gene provided results concordant with species designations provided for M. avium, Mycobacterium intracellulare, and Mycobacterium scrofulaceum organisms. For M. avium strains, comparative genomic hybridization was performed on a whole-genome DNA microarray, revealing one novel 7.9-kilobase genomic deletion in certain Johnin-producing strains, in addition to genomic variability inherent to the particular M. avium subspecies. Our findings indicate that considerable genomic differences exist between organisms used for reagents and the infecting organism being studied. These results serve as a baseline for potency studies of different preparations and should aid in comparative studies of newly discovered antigens for the diagnosis of infection and disease by M. avium complex organisms.

Successful treatment of localized cutaneous infection caused by Mycobacterium scrofulaceum with clarithromycin.

Cutaneous infection arising from Mycobacterium scrofulaceum, a nontuberculous mycobacteria, has rarely been reported, and most of the reported infections were disseminated forms in patients with AIDS or other immunocompromising illness. We describe an occurrence of localized mycobacterial skin infection caused by M. scrofulaceum in a previously healthy child that manifested as a red nodule on the cheek. A biopsy specimen of the lesion demonstrated granulomatous infiltration in the dermis. M. scrofulaceum was isolated from culture of a tissue specimen. Polymerase chain reaction amplified specific fragments for M. scrofulaceum. The patient was treated successfully with clarithromycin as monotherapy for 6 months, leading to complete healing without recurrence during a follow-up period of 2 years.

Adenitis cervical por Micobacterium scrofulaceum / No disponible

La incidencia de adenitis cervical por micobacterias atípicas ha aumentado en los últimos años, especialmente por el complejo Micobacterium avium-intracellulare y Micobacterium scrofulaceum. Presentamos dos casos clínicos de dos niñas con adenopatía submandibular unilateral de más de 2 semanas de evolución. En ambos casos se inició un ciclo antibiótico con amoxicilina-ácido clavulánico sin objetivarse mejoría. En su evolución ambas pacientes desarrollaron una adenitis cervical supurada. El hemograma, las serología y la radiografía de tórax, no aportaron datos de interés. El Mantoux fue positivo; de 8 y 12 mm, respectivamente. En el estudio microbiológico de las adenitis se obtuvo tinción de ziehl-auramina positiva y en el cultivo de micobacterias crecieron colonias de Micobacterium scrofulaceum. Ambos casos recidivaron tras una cirugía parcial inicial. Finalmente se trataron mediante extirpación quirúrgica de todos los ganglios afectados, añadiendo en una de las pacientes tratamiento antibiótico (AU)

The incidence of cervical adenitis caused by atypical mycobacteria has increased in recent years, especially due to the Mycobacterium avium-intracellulare complex and Mycobacterium scrofulaceum. We present two clinical cases of two female children with unilateral submandibular adenopathy having more than 2 week´s evolution. In both cases, an antibiotic cycle was initiate with amoxicillin-clavulanic acid without observing improvement. In their course, both patients developed supurative cervical adenitis. The complete blood count, serologies and chest X-ray did not provide any data of interest. Mantoux was positive: from 8 and 12 mm respectively. Zichl-auramine staining was positive in the microbiologic study of adenitis and Mycobacterium scrofulaceum colonies grew in mycobacteria culture. Both cases reoccurred after initial partial surgery. Finally, they were treated with surgical excision of all the lymph nodes involved, adding antibiotic medical treatment in one of the patients (AU)

Discordant molecular characterization results in a Mycobacterium avium complex strain isolated from an AIDS patient.

This report describes an unusual strain of Mycobacterium avium complex isolated from the sputum of an immunocompromised AIDS patient, which did not react with the MAC probe of the BDProbe Tec system, but was identified as Mycobacterium intracellulare by 16S rRNA gene sequencing. Its PCR restriction-enzyme analysis pattern was compatible with an allelic variant of M. avium. It was scotochromogenic, slow-growing and phenotypically identified as Mycobacterium scrofulaceum. Its clinical significance is not certain.

Use of the INNO-LiPA-MYCOBACTERIA assay (version 2) for identification of Mycobacterium avium-Mycobacterium intracellulare-Mycobacterium scrofulaceum complex isolates.

Using INNO-LiPA-MYCOBACTERIA (Lipav1; Innogenetics) and the AccuProbe (Gen-Probe Inc./bioMérieux) techniques, 35 Mycobacterium avium-Mycobacterium intracellulare-Mycobacterium scrofulaceum (MAC/MAIS) complex strains were identified between January 2000 and December 2002. Thirty-four of 35 isolates were positive only for the MAIS complex probe by Lipav1 and were further analyzed by INNO-LiPA-MYCOBACTERIA version 2 (Lipav2), hsp65 PCR restriction pattern analysis (PRA), and ribosomal internal transcribed spacer (ITS), hsp65, and 16S rRNA sequences. Lipav2 identified 14 of 34 strains at the species level, including 11 isolates positive for the newly specific MAC sequevar Mac-A probe (MIN-2 probe). Ten of these 11 isolates corresponded to sequevar Mac-A, which was recently defined as Mycobacterium chimerae sp. nov. Among the last 20 of the 34 MAIS isolates, 17 (by hsp65 PRA) and 18 (by hsp65 sequence) were characterized as M. avium. Ten of the 20 were identified as Mac-U sequevar. All these 20 isolates were identified as M. intracellulare by 16S rRNA sequence except one isolate identified as Mycobacterium paraffinicum by 16S rRNA and ITS sequencing. One isolate out of 35 isolates that was positive for M. avium by AccuProbe and that was Mycobacterium genus probe positive and MAIS probe negative by Lipav1 and Lipav2 might be considered a new species. In conclusion, the new INNO-LiPA-MYCOBACTERIA allowed the identification of 40% of the previously unidentified MAIS isolates at the species level. The results of the Lipav2 assay on the MAIS isolates confirm the great heterogeneity of this group and suggest the use of hsp65 or ITS sequencing for precise identification of such isolates.

Nontuberculous mycobacterial infection in children: a 2-year prospective surveillance study in the Netherlands.

We performed a prospective, 2-year nationwide study to assess incidence and disease characteristics of suspected infections with nontuberculous mycobacteria (NTM) in children, via the Netherlands Pediatric Surveillance Unit. Data for 61 children were reported (median age, 31 months; interquartile range, 22-50 months; female sex, 37 subjects); 2 subjects had an underlying disease. Most children (53 [87%] of 61) had cervical lymph node enlargement, with abscess in 25 (47%) and fistula in 11 (21%). The estimated annual incidence of NTM infection was 77 cases per 100,000 children. In 16 children, the diagnosis was based solely on the results of skin tests with mycobacterial antigens. Cultures were performed in 36 cases and yielded mycobacteria in 27 (75%); Mycobacterium avium was isolated from 18 cultures. Children with a culture positive for mycobacteria did not differ in presentation, complications, or treatment from those whose cultures showed no growth. Thirty children underwent surgery, and chemotherapy was the single treatment in 24 (39%) of the cases. The treatment of localized NTM infection in immunocompetent children by antimycobacterial drugs should be evaluated further.

Infección pulmonar por "Micobacterium scrofulaceum" en huésped inmunocompetente / Pulmonary infection due ti "Mycobacterium scrofulaceum" in an immunocompetent host

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Infección pulmonar por "Mycobacterium" en huésped inmunocompetente / Pulmonary infection due to "Mycobacterium scrofulaceum" in an immunocompetent host

La existencia de micobacterias distintas a M. tuberculosis y M. leprae es conocida desde hace un centenar de años. Estudiadas más ampliamente desde los años cincuenta, su papel patógeno fue reconocido a partir de los años setenta. Entre las micobacterias atípicas se encuentra Mycobacterium scrofulaceum, que es el microorganismo causante de linfadenitis en niños, así como de infecciones en otras localizaciones en individuos inmunodeprimidos o con enfermedad pulmonar subyacente. Existen, no obstante, raros casos descritos en la bibliografía de afectación diferente a la ganglionar en individuos inmunocompetentes. Presentamos el caso de una niña de 11 años previamente sana, sin afectación del sistema inmune, con clínica pulmonar, prueba de la tuberculina positiva, afectación radiológica y aislamiento de Mycobacterium scrofulaceum. La resolución del cuadro clínico y radiológico se produjo con antituberculosos habituales, a pesar de que, in vitro, el microorganismo era resistente a todos ellos (AU)

[Pulmonary mycobacterioses--frequency of occurrence, clinical spectrum and predisposing factors]. / Postaci plucne mykobakterioz--czestosc wystepowania, obrazy kliniczne i czynniki predysponujace.

Various types of non-tuberculous mycobacteria can be the aetiologic factors of chronic lung infections especially in patients with underlying chronic lung diseases. The aim of this study is to present the cases of pulmonary mycobacterioses observed in Institute of Tuberculosis and Lung Diseases in the years 1995-2001. There were 23 patients, 12 men and 11 women in the age between 35-77 years, mean 56 years. 16 out of 23 patients had underlying respiratory problems, mainly healed tuberculosis (7) and COPD (6). Two additional patients suffered from other diseases with potential immunosuppression (leukopenia). In 5 patients no disease other than mycobacteriosis was found, but they were chronic smokers. In 19 cases cough and expectoration of purulent sputum lasting from several months to several years was observed. In 5 patients onset of disease was acute or subacute with high fever. Eight patients had haemoptysis. In chest X-ray pathological lesions including (18 cases) lung cirrhosis (10) and cavities (15) were found. In 4 cases disseminated bronchiectases with small nodules were the main radiologic feature. Mycobacteriosis was caused by M. kansasii in 11 cases, by M. intracellularae in 6, by M. xenopi in 5 and by M. scrofulaceum in 1 case.

Skin indurations in response to tuberculin testing in patients with nontuberculous mycobacterial lymphadenitis.

Mantoux results were examined for 29 children with culture-proven nontuberculous mycobacterial lymphadenitis, and 4 species were isolated: Mycobacterium avium-intracellulare complex (from 14 patients [48%]), Mycobacterium haemophilum (from 12 [41%]), Mycobacterium simiae (from 2 [7%]), and Mycobacterium scrofulaceum (from 1 [3%]); the median indurations for each species were 15.5 mm, 14.5 mm, 20 mm, and 23 mm, respectively, and in 17 cases (59%), they were > or =15 mm. In regions with a low incidence of tuberculosis, lymphadenitis thought to be due to nontuberculous mycobacteria should be managed as such, regardless of Mantoux results, thereby avoiding antituberculosis treatment.

Nontuberculous mycobacteria in patients with cystic fibrosis.

The prevalence and clinical implications of colonization with nontuberculous mycobacteria were prospectively studied in 37 patients who had cystic fibrosis. Sputum samples were cultured on Coletsos and Löwenstein-Jensen selective media after decontamination with sodium hydroxide and oxalic acid. Oxalic acid-decontaminated fractions were also cultured in selective liquid medium. Nontuberculous mycobacteria were isolated from 6 patients (16.1%). Mycobacterium chelonae and Mycobacterium avium-intracellulare complex were the most common species. Three patients with positive results of culture had at least 1 positive result by acid-fast smear. Oxalic acid decontamination and culture in liquid medium had the lowest contamination rate (6.7%). Colonization with nontuberculous mycobacteria was associated with humoral response to mycobacteria (immunoglobulin G titers against antigen A60) in patients with samples that tested positive by acid-fast smear. An improvement in pulmonary function was observed in 2 patients after they received a course of antimycobacterial therapy. Screening for nontuberculous mycobacteria in patients with cystic fibrosis will contribute to understanding the relevance of these pathogens with regard to deterioration of pulmonary function in patients with cystic fibrosis.