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Ogata R, Kido T, Takeda K, Nemoto K, Heima R, Takao M, Miyashita R, Ozasa M, Tokito T, Okuno D, Ito Y, Yura H, Koga T, Hashimoto K, Takemoto S, Takazono T, Ishimoto H, Sakamoto N, Fukuda K, Sasaki Y, Obase Y, Ishimatsu Y, Yatera K, Izumikawa K, Mukae H. Disseminated Mycobacterium genavense Infection Mimicking Sarcoidosis: A Case Report and Review of Literature on Japanese Patients. Microorganisms 2023; 11:2145. [PMID: 37763989 PMCID: PMC10535052 DOI: 10.3390/microorganisms11092145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease characterized by noncaseating epithelioid cell granulomas. However, certain infections can exhibit similar histological findings. We present a case of a 69-year-old man who was initially diagnosed with sarcoidosis and later was confirmed, through 16S rRNA sequencing, to have disseminated Mycobacterium genavense infection. Acid-fast bacteria were detected in the bone marrow biopsy using Ziehl-Neelsen staining, but routine clinical tests did not provide a definitive diagnosis. The patient tested negative for HIV, anti-interferon-gamma antibodies, and genetic immunodeficiency disorders. He was treated with multiple drugs, including aminoglycosides and macrolides, but showed no improvement in fever and pancytopenia. However, these clinical signs responded favorably to steroid therapy. We reviewed 17 Japanese cases of M. genavense infection. All cases were in males; 7/17 (41%) were HIV-negative; and 12/17 (71%) had a decreased CD4 count. Genetic analysis confirmed M. genavense isolation, and macrolides were used universally. Mycobacterium genavense infection is challenging to identify and mimics other systemic inflammatory diseases such as sarcoidosis. There are no standard treatment protocols. Our case report and Japanese case review contribute to understanding this rare disease.
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Affiliation(s)
- Ryo Ogata
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Kazuki Nemoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu 807-8556, Japan; (K.N.); (K.Y.)
| | - Riko Heima
- Clinical Genomics Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.H.); (M.T.)
| | - Mami Takao
- Clinical Genomics Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.H.); (M.T.)
| | - Ritsuko Miyashita
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Mutsumi Ozasa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Takatomo Tokito
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Daisuke Okuno
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Yuya Ito
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Hirokazu Yura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Kunio Hashimoto
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Shinnosuke Takemoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Kazumasa Fukuda
- Department of Microbiology, University of Occupational and Environmental Health, Japan, Kitakyusyu 807-8556, Japan;
| | - Yuka Sasaki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo 204-8585, Japan;
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan;
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu 807-8556, Japan; (K.N.); (K.Y.)
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
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Watanabe N, Ohno SI, Sakuma M, Kuriwaki M, Miura M, Kuroda M. A case report on death from acute bacterial cholangitis accompanied by von Meyenburg complexes: Use of 16S rRNA gene sequencing to identify pathogenic microbes from postmortem formalin-fixed, paraffin-embedded tissue. Medicine (Baltimore) 2021; 100:e25526. [PMID: 33847675 PMCID: PMC8051965 DOI: 10.1097/md.0000000000025526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE In some cases, autopsy is the first opportunity to find a previously unrecognized critical infection. Pathogens are identified by various methods, such as microscopic examination, special stains, culture tests, and immunohistochemistry. Here, we report a case of 16S ribosomal RNA (rRNA) gene sequencing using a postmortem formalin-fixed, paraffin-embedded (FFPE) tissue, which was useful for identifying pathogenic microbes. PATIENT CONCERNS Autopsy was performed on an 87-year-old man who had chronic renal failure and had developed sepsis from a central venous catheter infection 10 days before his death. Prior to these events, von Meyenburg complexes (VMCs) were also found during regular checkups. DIAGNOSIS Postmortem microscopic examination revealed acute purulent cholangitis with numerous microabscesses, accompanied by VMCs. Gram-negative rods were observed in some microabscesses, which were considered causative pathogens. INTERVENTIONS 16S rRNA gene sequencing using postmortem FFPE tissue. OUTCOMES Pseudomonas aeruginosa was identified, different from the one detected in the central venous catheter culture while alive. LESSONS 16S rRNA gene sequencing is a useful tool for identifying pathogenic microbes in postmortem FFPE tissues. This technique may be useful for amplicon sizes of approximately 100 bp or less.
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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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Cornelis G, Reynders M, Deprez J, Vankeerberghen A, Orlent H. Disseminated Mycobacterium genavense infection in an immunocompetent adult: a case report. Clin Microbiol Infect 2018; 24:1355-1356. [PMID: 30036670 DOI: 10.1016/j.cmi.2018.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022]
Affiliation(s)
- G Cornelis
- Department of Gastroenterology and Hepatology, Medical Microbiology, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
| | - M Reynders
- Department of Laboratory Medicine, Medical Microbiology, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
| | - J Deprez
- Department of Gastroenterology and Hepatology, AZ Sint Rembert, Torhout, Belgium
| | - A Vankeerberghen
- Department of Laboratory Medicine, Medical Microbiology, OLV Aalst, Aalst, Belgium
| | - H Orlent
- Department of Gastroenterology and Hepatology, Medical Microbiology, AZ Sint Jan Brugge-Oostende, Brugge, Belgium.
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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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Ogawa Y, Koizumi Y, Watanabe D, Hirota K, Ikuma M, Yajima K, Kasai D, Nishida Y, Uehira T, Shirasaka T. [A Case of Disseminated Mycobacterium genavense Infection in an AIDS Patient. A Case Report and a Review of the Literature]. ACTA ACUST UNITED AC 2016; 89:259-64. [PMID: 26552123 DOI: 10.11150/kansenshogakuzasshi.89.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 44-year-old male, who was HIV seropositive, developped weight loss, high grade fever, and multiple lymphadenopathies. Bone marrow biopsy revealed a granuloma lesion, and at the same part of the specimen, Ziehl Neelsen staining showed multiple mycobacterium diffusely arranged in the histocytes. The culture did not show positive after 6 to 8 weeks. Finally we diagnosed disseminated Mycobacterium genavense using a house-keeping gene analysis including 16S rRNA sequencing of lymph punctate with fine needle aspiration and the specimen from the biopsy of the lymph node. If a specimen tests positive for Ziehl Neelsen staining smear positive, culture negative, and PCR negative for tuberculosis and Mycobacterium avium complex, we should consider M. genavense infection as one of the differential diagnoses.
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Buur J, Saggese MD. Taking a rational approach in the treatment of avian mycobacteriosis. Vet Clin North Am Exot Anim Pract 2012; 15:57-70, vi. [PMID: 22244113 DOI: 10.1016/j.cvex.2011.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Treatment for avian mycobacteriosis is still in its infancy and based on extrapolations from human medicine. The optimum drug choice, dose, or length of treatment has yet to be determined for most exotic animal species. Treatment should include multiple drugs for extended periods of time with appropriate monitoring of both drug levels and overall animal health. Risk to owners and handlers needs to be minimized through appropriate identification of the species of mycobacteri causing disease. More research is necessary on the pharmacokinetics of these drugs in other animal species and antibiotic resistance. Currently, euthanasia remains the most common action in the face of active mycobacteriosis.
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Affiliation(s)
- Jennifer Buur
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91766, USA.
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