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Vilstrup E, Dahl VN, Fløe A, Degn KB. Disseminated Mycobacterium genavense infection in a patient with a history of sarcoidosis. BMJ Case Rep 2023; 16:e254792. [PMID: 37147106 PMCID: PMC10163504 DOI: 10.1136/bcr-2023-254792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
We present a case of Mycobacterium genavense infection in a man in his 60s with a history of sarcoidosis, treated for 24 years with systemic corticosteroids and later methotrexate as monotherapy. He presented with low grade fever, dyspnoea and right-sided thoracic pain and was admitted due to a treatment-refractory infection. After a prolonged period of symptoms and diagnostics, acid-fast bacilli were demonstrated in pleural fluid and PCR revealed M. genavense The patient was treated with intravenous amikacin, peroral azithromycin, rifampicin and ethambutol for a total of 18 months, with a good clinical and radiological treatment response. Infection with M. genavense is rare in HIV-negative immunocompromised hosts. Diagnosing and treating mycobacterial infections, especially for more rare species, remains a challenge as clinical evidence is sparse. Nonetheless, the disease-causing infection must be considered in symptomatic and immunocompromised patients.
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Affiliation(s)
- Emil Vilstrup
- Department of Internal Medicine Viborg, Viborg Regional Hospital, Viborg, Denmark
| | - Victor Næstholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
| | - Kristine Bruun Degn
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
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Ekermans P, de Gama R, Kock C, Hoosien E, Slavik T, Marshall T, Corcoran C, van Ingen J. An unusual case of abdominal mycobacterial infection: Case report and literature review. South Afr J HIV Med 2019; 20:993. [PMID: 31534791 PMCID: PMC6739527 DOI: 10.4102/sajhivmed.v20i1.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/13/2019] [Indexed: 11/30/2022] Open
Abstract
This article presents a case of an HIV-infected paediatric patient with an unusual Mycobacterium genavense infection with predominantly abdominal organ involvement.
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Affiliation(s)
- Pieter Ekermans
- Department of Microbiology, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Rene de Gama
- Department of Paediatrics, Netcare Unitas Hospital, Centurion, South Africa
| | - Celeste Kock
- Department of Paediatrics, Mediclinic Midstream Hospital, Midstream, South Africa
| | - Ebrahim Hoosien
- Department of Microbiology, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Tomas Slavik
- Department of Histology, AMPATH Laboratories, Pretoria, South Africa
| | - Terry Marshall
- Department of Molecular Medicine, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Craig Corcoran
- Department of Molecular Medicine, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Mahmood M, Ajmal S, Abu Saleh OM, Bryson A, Marcelin JR, Wilson JW. Mycobacterium genavense infections in non-HIV immunocompromised hosts: a systematic review. Infect Dis (Lond) 2017; 50:329-339. [PMID: 29157060 DOI: 10.1080/23744235.2017.1404630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Mycobacterium genavense is a non-tuberculous mycobacterium which can rarely cause disease in non-HIV immunocompromised hosts. We describe our experience with this unusual infection and perform a systematic review of the literature to describe the features of M. genavense infection in non-HIV immunocompromised hosts. METHODS All cases of Mycobacterium genavense infection in non-HIV patients at our institution were reviewed. In addition, we conducted a systematic review of the literature to identify previously published cases of M. genavense infections in non-HIV hosts. FINDINGS Two cases of M. genavense were identified at our center; a 51-year-old renal transplant recipient with a prosthetic knee joint infection and a 66-year-old woman with idiopathic CD4 lymphocytopenia with gastrointestinal tract disease. The systematic review identified 44 cases of M. genavense infection in non-HIV hosts. The most common underlying conditions were solid organ transplantation (40%), sarcoidosis (14%) and hematopoietic stem cell transplantation (7%). Disease most commonly involved the gastrointestinal tract, spleen, liver or bone marrow. Diagnosis was challenging with PCR required for identification in nearly all cases. Over one-third of patients died, which may reflect the combination of infection and underlying comorbidities. Overall cure was achieved in 61% with a mean duration of antimycobacterial therapy of 15.5 months (range 10-24). CONCLUSION M. genavense infection is a rare mycobacterial infection in non-HIV immunocompromised hosts. It should be suspected in immunocompromised patients presenting with disseminated mycobacterial infection, acid fast bacilli on smear or histopathologic examination, with poor or no growth in mycobacterial cultures.
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Affiliation(s)
- Maryam Mahmood
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Saira Ajmal
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Omar M Abu Saleh
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Alexandra Bryson
- b Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | - Jasmine R Marcelin
- c Divison of Infectious Disease, Department of Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - John W Wilson
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
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Shaharir SS, Sulaiman Sahari N, Mohamed Fuad Z, Zukiman WZHW, Mohd Yusof NH, Sulong A, Periasamy P. Non-tuberculous mycobacterium bacteraemia in a pregnant systemic lupus erythematosus (SLE) patient: a case review and pooled case analysis. Clin Rheumatol 2017; 37:837-847. [DOI: 10.1007/s10067-017-3855-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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Holland SM, Pierce VM, Shailam R, Glomski K, Farmer JR. Case 28-2017. A 13-Month-Old Girl with Pneumonia and a 33-Year-Old Woman with Hip Pain. N Engl J Med 2017; 377:1077-1091. [PMID: 28902581 DOI: 10.1056/nejmcpc1706097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Steven M Holland
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Virginia M Pierce
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Randheer Shailam
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Krzysztof Glomski
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Jocelyn R Farmer
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
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Ombelet S, Van Wijngaerden E, Lagrou K, Tousseyn T, Gheysens O, Droogne W, Doubel P, Kuypers D, Claes K. Mycobacterium genavenseinfection in a solid organ recipient: a diagnostic and therapeutic challenge. Transpl Infect Dis 2016; 18:125-31. [DOI: 10.1111/tid.12493] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- S. Ombelet
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - E. Van Wijngaerden
- Department of General Internal Medicine; University Hospitals Leuven; Leuven Belgium
| | - K. Lagrou
- Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - T. Tousseyn
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - O. Gheysens
- Department of Nuclear Medicine; University Hospitals Leuven; Leuven Belgium
| | - W. Droogne
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - P. Doubel
- Department of Nephrology; AZ Groeninge; Kortrijk Belgium
| | - D. Kuypers
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - K.J. Claes
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
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Mycobacterium genavense Infections in a Tertiary Hospital and Reviewed Cases in Non-HIV Patients. PATHOLOGY RESEARCH INTERNATIONAL 2014; 2014:371370. [PMID: 24693456 PMCID: PMC3945967 DOI: 10.1155/2014/371370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/10/2014] [Indexed: 11/18/2022]
Abstract
Mycobacterium genavense is a relatively new species of nontuberculous mycobacterium reported to cause disseminated infections in patients with AIDS and later on in non-HIV immunosuppressed patients. We describe clinical and laboratory features and response to therapy in 7 patients, three of them with HIV infection and four non-HIV-three organ transplant recipients and one with hyper-IgE syndrome-in Valencia, Spain, in a ten years period. We then summarize the published cases of M. avium complex infection, with invasion of peripheral blood, liver, spleen, bone marrow, lymph nodes, and lungs. In clinical samples a large number of acid-fast bacilli were observed. M. genavense grew only from liquid media and after a prolonged incubation period. Its identification was accomplished through molecular methods. Patients were treated with prolonged combinations of antimicrobial agents. There was clinical favourable outcome in 4 patients.
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Brackers de Hugo L, Ffrench M, Broussolle C, Sève P. Granulomatous lesions in bone marrow: clinicopathologic findings and significance in a study of 48 cases. Eur J Intern Med 2013; 24:468-73. [PMID: 23414770 DOI: 10.1016/j.ejim.2012.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Granulomas in bone marrow are an infrequent finding related to various disorders. The aim of this study was to review our clinical experience with granulomatous bone marrow disease and to describe the contributions of recent diagnostic tools, such as (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and molecular biology. METHODS Clinical, laboratory and morphological data on patients with a granuloma based on bone marrow biopsy analysed in the University Hospital Lyon from May 2004 to July 2010 were reviewed. RESULTS We identified 57 cases among 9641 bone marrow biopsies, representing an incidence of 0.59% in the series and an annual incidence of 9.5 cases per year. Nine biopsies performed for staging a known pathology were excluded from further analysis. Among the 48 remaining patients, associated disease was demonstrated in 79%, with infections being the most common (33%), following by sarcoidosis (21%), malignancy (19%) and therapy-induced granulomas (6%). One previously unpublished entity is described: infection with Bartonella henselae diagnosed using molecular biology from node and skin biopsies in two renal transplant patients. (18)F-FDG-PET, performed in 13 cases, showed hypermetabolic foci consistent with sarcoidosis in two cases. Positive PCR result for an infectious pathogen was obtained in three bone marrow samples (Mycobacterium tuberculosis, n=1; Mycobacterium genavense, n=2). CONCLUSION In comparison to previous research, our study reports high proportions of cases caused by sarcoidosis and unknown causes. (18)F-FDG-PET could show signs consistent with sarcoidosis and molecular biology is useful for the detection of fastidious bacteria in immunocompromised patients.
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Lhuillier E, Brugière O, Veziris N, Danel C, Mourvilliers B, Mal H, Dauriat G. Relapsing Mycobacterium Genavense Infection as a Cause of Late Death in a Lung Transplant Recipient: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2012; 10:618-20. [DOI: 10.6002/ect.2012.0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hoefsloot W, van Ingen J, Peters EJG, Magis-Escurra C, Dekhuijzen PNR, Boeree MJ, van Soolingen D. Mycobacterium genavense in the Netherlands: an opportunistic pathogen in HIV and non-HIV immunocompromised patients. An observational study in 14 cases. Clin Microbiol Infect 2012; 19:432-7. [PMID: 22439918 DOI: 10.1111/j.1469-0691.2012.03817.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mycobacterium genavense is an opportunistic non-tuberculous mycobacterium previously mostly associated with HIV-infected patients with CD4 counts below 100/μL. In this retrospective observational study of medical charts we studied all Dutch patients in whom M. genavense was detected between January 2002 and January 2010. Of the 14 patients identified, 13 (93%) showed clinically relevant M. genavense disease. All patients with M. genavense disease were severely immunocompromised, including HIV-infected patients, solid organ transplant recipients, those with chronic steroid use in combination with other immune modulating drugs, recipients of chemotherapy for non-Hodgkin lymphoma, and those with immunodeficiency syndromes. Two patients had non-disseminated pulmonary M. genavense disease. Of the 12 patients treated, eight (75%) showed a favourable outcome. Four patients died in this study, three despite treatment for M. genavense disease. We conclude that M. genavense is a clinically relevant pathogen in severely immunocompromised patients that causes predominantly disseminated disease with serious morbidity and mortality. M. genavense is increasingly seen among non-HIV immunocompromised patients.
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Affiliation(s)
- W Hoefsloot
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Delayed Diagnosis of Disseminated Mycobacterium genavense Infection in a Human Immunodeficiency Virus-Negative Young Woman. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2011. [DOI: 10.1097/ipc.0b013e3181fc6e92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Charles P, Lortholary O, Dechartres A, Doustdar F, Viard JP, Lecuit M, Gutierrez MC. Mycobacterium genavense infections: a retrospective multicenter study in France, 1996-2007. Medicine (Baltimore) 2011; 90:223-230. [PMID: 21694645 DOI: 10.1097/md.0b013e318225ab89] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mycobacterium genavense, a nontuberculous mycobacterium, led to devastating infections in patients with acquired immunodeficiency syndrome (AIDS) before highly active antiretroviral therapy (HAART) was available, as well as in other immunocompromised patients. We conducted the current study to describe the features of this infection in patients infected with human immunodeficiency virus (HIV) in the HAART era and in non HIV-infected patients.We conducted a retrospective cohort survey in France. All patients with M. genavense infection diagnosed from 1996 to 2007 at the National Reference Center, Institut Pasteur, Paris, were identified and their clinical, laboratory, and microbiologic data were centralized in a single database. Twenty-five cases of M. genavense infection originating from 19 centers were identified. Twenty patients had AIDS, 3 had solid organ transplantation, and 2 had sarcoidosis. Sixty-four percent (n = 16) were male, mean age was 42 years, and median CD4 count was 13/mm (range, 0-148/mm) in patients with AIDS. Twenty-four patients had disseminated infection with fever (75%, n = 18), weight loss (79%, n = 19), abdominal pain (71%, n = 17), diarrhea (62.5%, n = 15), splenomegaly (71%, n = 17), hepatomegaly (62.5%, n = 15), or abdominal adenopathy (62.5%, n = 15). M. genavense was isolated from the lymph node (n = 13), intestinal biopsy (n = 9), blood (n = 6), sputum (n = 3), stool (n = 3), and bone marrow (n = 5). Eleven patients (44%) died, 8 (32%) were considered cured with no residual symptoms, and 6 (24%) had chronic symptoms. The 1-year survival rate was 72%.The prognosis of M. genavense infection in HIV-infected patients has dramatically improved with HAART. Clinical presentations in HIV and non-HIV immunocompromised patients were similar.
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Affiliation(s)
- Pierre Charles
- From Université Paris Descartes, Hôpital Necker-Enfants Malades (APHP), Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur (PC, OL, JPV, ML), Paris; Hôpital Foch, Service de Médecine Interne (PC), Suresnes; Institut Pasteur, Département Infection et Epidémiologie (OL, FD, ML, MCG), Paris; INSERM U 738, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique (APHP), Université Paris V (AD), Paris; Inserm (ML), Avenir U 604
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Doggett J, Strasfeld L. Disseminated Mycobacterium genavense with pulmonary nodules in a kidney transplant recipient: case report and review of the literature. Transpl Infect Dis 2011; 13:38-43. [DOI: 10.1111/j.1399-3062.2010.00545.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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