Mycobacterium franklinii sp. nov., a species closely related to members of the Mycobacterium chelonae-Mycobacterium abscessus group.

Two isolates from water, D16Q19 and D16R27, were shown to be highly similar in their 16S rRNA, 16S-23S internal transcribed spacer (ITS), hsp65 and rpoB gene sequences to 'Mycobacterium franklinii' DSM 45524, described in 2011 but with the name not validly published. They are all nonpigmented rapid growers and are related phenotypically and genetically to the Mycobacterium chelonae-Mycobacterium abscessus group. Extensive characterization by phenotypic analysis, biochemical tests, drug susceptibility testing, PCR restriction enzyme analysis of the hsp65 gene and ITS, DNA sequencing of housekeeping genes and DNA-DNA hybridization demonstrated that 'M. franklinii' DSM 45524, D16Q19 and D16R27 belong to a single species that is separated from other members of the M. chelonae-M. abscessus group. On the basis of these results we propose the formal recognition of Mycobacterium franklinii sp. nov. Strain DSM 45524(T) ( = ATCC BAA-2149(T)) is the type strain.

Seguimiento de un brote de infección en tejido blando causado por Mycobacterium abscessus posterior a la mesoterapia en Venezuela / Follow-up on an outbreak in Venezuela of soft-tissue infection due to Mycobacterium abscessus associated with Mesotherapy

Introducción Las infecciones de la piel y los tejidos blandos causadas por micobacterias no tuberculosas (MNT) se han asociado a procedimientos como inyecciones, liposucción, cirugía plástica y acupuntura. Estudiamos un brote de infección en tejidos blandos, debido a MNT posterior a mesoterapia, un procedimiento cosmético que consiste en inyectar una mezcla de sustancias para reducir hipotéticamente el tejido adiposo localizado. Métodos Se entrevistó a pacientes con lesiones en la piel, con antecedentes de mesoterapia, que acudieron al Departamento de Dermatología del Hospital Público de la Ciudad de Barinas, Venezuela, en el período comprendido entre noviembre de 2004 y febrero de 2005. Se tomaron muestras clínicas y ambientales para el aislamiento de micobacterias. Resultados Las entrevistas revelaron que 68 pacientes se infectaron con MNT. Todos recibieron tratamiento en el mismo centro estético, a cargo del mismo terapeuta y con el mismo producto. De las muestras de 5 pacientes se aisló Mycobacterium abscessus. Ninguna de las soluciones utilizadas en la mesoterapia estuvo disponible para el análisis, pero se aisló M. abscessus de una muestra del ambiente tomada en el centro cosmético. La tipificación de las cepas con técnicas basadas en PCR (ERIC-PCR, BOXA1R y RAPD) mostró que los aislados de los pacientes fueron indistinguibles entre sí, pero diferentes del aislado del medio ambiente del centro. Conclusión Lo más probable es que este brote se haya causado por un producto contaminado utilizado en la mesoterapia y no por una micobacteria del ambiente del centro. Hacemos énfasis en la importancia de un mejor control microbiológico de estos productos. Este brote, que afectó al menos a 68 pacientes, es en nuestro conocimiento el más grande descrito en la literatura médica posterior a mesoterapia (AU)

Introduction Skin and soft tissue infections caused by nontuberculous mycobacteria (NMT) are reported to be associated with injections, liposuction, plastic surgery, and acupuncture. Herein, we describe an outbreak of soft tissue infection due to NMT following mesotherapy, a cosmetic procedure involving injection of poorly defined mixtures alleged to reduce local adiposity. Methods Patients with skin lesions and a history of mesotherapy treatment, who visited the dermatology department of the public hospital in Barinas, Venezuela, from November 2004 to February 2005 were interviewed. Clinical and environmental samples were taken for mycobacteria isolation. Results The interviews revealed that 68 patients who had been treated for cosmetic purposes at the same clinic by the same therapist had received injections with the same product and were infected with NMT. Clinical specimens from 5 patients grew Mycobacterium abscessus. No mesotherapy solution was available for analysis but M. abscessus was isolated from an environmental sample in the clinic. PCR-based strain typing techniques (ERIC-PCR, BOXA1R and RAPD) showed that the patient's isolates were undistinguishable from each other but different from the environmental isolate. Conclusions This outbreak was likely caused by a contaminated injectable mesotherapy product and not by mycobacteria from the clinic environment. We emphasize the importance of better microbiological control of these products. To our knowledge, this outbreak, which affected at least 68 patients, appears to be the largest ever associated with mesotherapy and described in the literature (AU)

[Follow-up on an outbreak in Venezuela of soft-tissue infection due to Mycobacterium abscessus associated with Mesotherapy]. / Seguimiento de un brote de infección en tejido blando causado por Mycobacterium abscessus posterior a la mesoterapia en Venezuela.

INTRODUCTION: Skin and soft tissue infections caused by nontuberculous mycobacteria (NMT) are reported to be associated with injections, liposuction, plastic surgery, and acupuncture. Herein, we describe an outbreak of soft tissue infection due to NMT following mesotherapy, a cosmetic procedure involving injection of poorly defined mixtures alleged to reduce local adiposity. METHODS: Patients with skin lesions and a history of mesotherapy treatment, who visited the dermatology department of the public hospital in Barinas, Venezuela, from November 2004 to February 2005 were interviewed. Clinical and environmental samples were taken for mycobacteria isolation. RESULTS: The interviews revealed that 68 patients who had been treated for cosmetic purposes at the same clinic by the same therapist had received injections with the same product and were infected with NMT. Clinical specimens from 5 patients grew Mycobacterium abscessus. No mesotherapy solution was available for analysis but M. abscessus was isolated from an environmental sample in the clinic. PCR-based strain typing techniques (ERIC-PCR, BOXA1R and RAPD) showed that the patient's isolates were undistinguishable from each other but different from the environmental isolate. CONCLUSIONS: This outbreak was likely caused by a contaminated injectable mesotherapy product and not by mycobacteria from the clinic environment. We emphasize the importance of better microbiological control of these products. To our knowledge, this outbreak, which affected at least 68 patients, appears to be the largest ever associated with mesotherapy and described in the literature.

Detection of mixed infections with Mycobacterium lentiflavum and Mycobacterium avium by molecular genotyping methods.

Three mycobacterial isolates, one from the blood of an HIV-infected patient and two consecutive isolates from a woman with unknown HIV status, had been identified as belonging to the Mycobacterium avium complex by conventional procedures. In both patients, using genetic analysis procedures such as PCR-restriction enzyme analysis (PRA) of the hsp65 gene, a commercially available reverse hybridization-based assay (INNO-LiPA mycobacteria) and/or sequencing analysis of the 16S-23S internal transcribed spacer (ITS), the presence of Mycobacterium lentiflavum was also demonstrated. At the time of detection, both cases were also infected with M. avium, suggesting an underestimation of infection with M. lentiflavum and co-infection with different Mycobacterium species.

Pseudomonas aeruginosa clonal dissemination in Brazilian intensive care units.

OBJECTIVE: Investigate clonal dissemination of nosocomial multidrug-resistant Pseudomonas aeruginosa isolates within and between Brazilian intensive care units, which participated in the MYSTIC Program Brazil 2002. METHODS: Thirty-six P. aeruginosa isolates resistant to meropenem or imipenem plus at least two of the following drugs: ciprofloxacin, cefepime, ceftazidime or piperacillin/tazobactam were isolated during 2002 at 4 centres in São Paulo and 1 centre in Brasília. Chromosomal restriction fragments obtained with SpeI were separated by pulsed-field gel electrophoresis (PFGE). Electrophoretic patterns were analyzed with GelCompar II v. 2.5. RESULTS: Five major clones were identified (A, B, C, D, G). Clone A was constituted by 8 isolates with indistinguishable PFGE pattern present in 2 centres. Clone B was constituted by 4 indistinguishable isolates predominant in centre 6. Clone C had 3 indistinguishable isolates, with closely related clones (C1-3). Also, Clone D had 3 indistinguishable isolates, with closely related (D1) and possibly related (D2/D3) clones. Clones C and D were present in centre 1. Clone G was constituted by 2 indistinguishable isolates and was present in centre 7. Finally, 8 isolates were unique. Isolates from Centre 4 were unique. CONCLUSIONS: Clonal dissemination was detected within (clones A, B, C, D, and G) and between centres (clone A). These findings are important when analyzing surveillance data, since susceptibility rates may be significantly affected by the dissemination of a resistant clone.

Diseminación clonal de Pseudomonas aeruginosa en unidades de cuidados intensivos brasileñas / Pseudomonas aeruginosa clonal dissemination in Brazilian intensive care units

Objetivo. Investigar la diseminación clonal de cepas nosocomiales multirresistentes de Pseudomonas aeruginosa en y entre unidades de cuidados intensivos brasileñas participantes en el MYSTIC Program Brazil 2002.Métodos. Durante 2002, se aislaron en cuatro hospitales de São Paulo y en un hospital de Brasilia 36 cepas de P. aeruginosa resistentes a meropenem o imipenem y a al menos dos de los siguientes: ciprofloxacino, cefepima, ceftazidima o piperacilina/tazobactam. Los fragmentos de restricción cromosómica obtenidos mediante Spel se separaron con electroforesis en campo pulsado (PFGE) y se analizaron mediante GelCompar II v.2.5. Resultados. Se identificaron cinco clones principales (A, B, C, D y G). El clon A constaba de ocho cepas con un patrón PFGE indistinguible, aisladas en dos centros. El clon B estaba formado por cuatro cepas indistinguibles, predominantes en el centro 6. El clon C estaba formado por tres cepas indistinguibles con clones estrechamente relacionados (C1-3). Además, el clon D estaba formado por tres cepas indistinguibles con clones estrechamente (D1) o posiblemente relacionados (D2/D3). Los clones C y D se detectaron en el centro 1. El clon G estaba formado por dos cepas indistinguibles y se observó en el centro 7. Finalmente, ocho cepas fueron específicas. Las cepas del centro 4 fueron específicas. Conclusiones. Se detectó diseminación clonal en los propios centros (clones A, B, C, D y G) y entre centros (clon A). Estos hallazgos son importantes para evaluar los datos de vigilancia epidemiológica pues la diseminación de un clon resistente puede influir de manera significativa en las tasas de sensibilidad (AU)

Objective. Investigate clonal dissemination of nosocomial multidrug-resistant Pseudomonas aeruginosa isolates within and between Brazilian intensive care units, which participated in the MYSTIC Program Brazil 2002. Methods. Thirty-six P. aeruginosa isolates resistant to meropenem or imipenem plus at least two of the following drugs: ciprofloxacin, cefepime, ceftazidime or piperacillin/tazobactam were isolated during 2002 at 4 centres in São Paulo and 1 centre in Brasília. Chromosomal restriction fragments obtained with SpeI were separated by pulsed-field gel electrophoresis (PFGE). Electrophoretic patterns were analyzed with GelCompar II v. 2.5.Results. Five major clones were identified (A, B, C, D, G). Clone A was constituted by 8 isolates with indistinguishable PFGE pattern present in 2 centres. Clone B was constituted by 4 indistinguishable isolates predominant in centre 6. Clone C had 3 indistinguishable isolates, with closely related clones (C1-3). Also, Clone D had 3 indistinguishable isolates, with closely related (D1) and possibly related (D2/D3) clones. Clones C and D were present in centre 1. Clone G was constituted by 2 indistinguishable isolates and was present in centre 7. Finally, 8 isolates were unique. Isolates from Centre 4 were unique. Conclusions. Clonal dissemination was detected within (clones A, B, C, D, and G) and between centres (clone A). These findings are important when analyzing surveillance data, since susceptibility rates may be significantly affected by the dissemination of a resistant clone (AU)

Distribución de patrones PRA en aislamientos clínicos del complejo Mycobacterium avium procedentes de España y Suramérica

La infección por el complejo Mycobacterium avium (MAC) es la infección sistémica más frecuente en la fase terminal del SIDA. Las sondas de ADN disponibles en el mercado para la identificación de micobacterias son muy precisas pero extremadamente costosas. Por eso, la mayoría de los laboratorios clínicos de Latinoamérica aún tipifican micobacterias mediante pruebas fenotípicas que son lentas, laboriosas y poco precisas. En este trabajo se aplicó el análisis del polimorfismo de los fragmentos de restricción del gen hsp65 (PRA) a la identificación de MAC en 163 aislamientos clínicos procedentes de España y Suramérica. El genotipo PRA predominante en cada país fue: M. avium tipo I en Argentina (23/42, 55%) y Brasil (48/72, 67%), M. avium tipo II en España (18/26, 69%) y M. avium tipo III en Colombia (10/23, 43%). Este último genotipo, que aún no fue descrito fuera del continente americano, resultó muy infrecuente en los otros tres países del estudio. Se discuten ventajas e inconvenientes de la aplicación del PRA al diagnóstico micobacteriológico.

Distribution of PRA patterns of clinical isolates of the Mycobacterium avium complex from Spain and South America Mycobacterium avium complex (MAC) infections are the most frequent systemic infections associated with advanced AIDS. DNA probes for accurate identification of mycobacteria are available but are very expensive in many Latin American settings. Consequently, most Latin American diagnostic laboratories employ inaccurate and outdated tests for mycobacteria identification. Therefore, PCR restriction analysis (PRA) of the hsp65 gene was evaluated for the identification of 163 MAC human isolates originated from Spain and South America. The predominant PRA type in each country was: M. avium type I in Argentina (23/42, 55%) and Brazil (48/72, 67%), M. avium type II in Spain (18/26, 69%) and M. avium type III in Colombia (10/ 23, 43%). The Colombia frequency is noteworthy, since the PRA type III was quite infrequent in the other three countries. Furthermore, its presence has not been reported outside the Americas. The advantages and disadvantages of PRA in diagnostic mycobacteriology are discussed.