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Baker AW, Maged A, Haridy S, Stout JE, Seidelman JL, Lewis SS, Anderson DJ. Use of Statistical Process Control Methods for Early Detection of Healthcare Facility-Associated Nontuberculous Mycobacteria Outbreaks: A Single-Center Pilot Study. Clin Infect Dis 2023; 76:1459-1467. [PMID: 36444485 PMCID: PMC10319764 DOI: 10.1093/cid/ciac923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are emerging pathogens increasingly implicated in healthcare facility-associated (HCFA) infections and outbreaks. We analyzed the performance of statistical process control (SPC) methods in detecting HCFA NTM outbreaks. METHODS We retrospectively analyzed 3 NTM outbreaks that occurred from 2013 to 2016 at a tertiary care hospital. The outbreaks consisted of pulmonary Mycobacterium abscessus complex (MABC) acquisition, cardiac surgery-associated extrapulmonary MABC infection, and a bronchoscopy-associated pseudo-outbreak of Mycobacterium avium complex (MAC). We analyzed monthly case rates of unique patients who had positive respiratory cultures for MABC, non-respiratory cultures for MABC, and bronchoalveolar lavage cultures for MAC, respectively. For each outbreak, we used these rates to construct a pilot moving average (MA) SPC chart with a rolling baseline window. We also explored the performance of numerous alternative control charts, including exponentially weighted MA, Shewhart, and cumulative sum charts. RESULTS The pilot MA chart detected each outbreak within 2 months of outbreak onset, preceding actual outbreak detection by an average of 6 months. Over a combined 117 months of pre-outbreak and post-outbreak surveillance, no false-positive SPC signals occurred (specificity, 100%). Prospective use of this chart for NTM surveillance could have prevented an estimated 108 cases of NTM. Six high-performing alternative charts detected all outbreaks during the month of onset, with specificities ranging from 85.7% to 94.9%. CONCLUSIONS SPC methods have potential to substantially improve HCFA NTM surveillance, promoting early outbreak detection and prevention of NTM infections. Additional study is needed to determine the best application of SPC for prospective HCFA NTM surveillance in other settings.
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Affiliation(s)
- Arthur W Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Ahmed Maged
- Department of Advanced Design and Systems Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Mechanical Engineering, Benha University, Benha, Egypt
| | - Salah Haridy
- Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, United Arab Emirates
- Benha Faculty of Engineering, Benha University, Benha, Egypt
| | - Jason E Stout
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica L Seidelman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Sarah S Lewis
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
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Vietor FI, Nelson TB. Difficulty in Diagnosis and Management of Musculoskeletal Nontuberculous Mycobacterial Infections. IDCases 2022; 29:e01527. [PMID: 35706608 PMCID: PMC9189991 DOI: 10.1016/j.idcr.2022.e01527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022] Open
Abstract
We describe two cases of musculoskeletal nontuberculous mycobacterial (NTM) infection resulting in undesirable outcomes. These organisms can be difficult to identify and treat, potentially leading to significant morbidity. NTM should remain on the differential for culture negative bone and joint infections, especially with a prior surgical history or environmentally-acquired injuries. There is considerable difficulty in diagnosing NTM orthopedic infections. These infections can be prolonged and progressive. Consider NTM infection with negative cultures and failure of routine antibacterials. Surgical debridement is essential in combination with antimycobacterials. Treatment should be determined after culture results yield drug susceptibilities.
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Affiliation(s)
- Faith I. Vietor
- University of Missouri-Columbia School of Medicine, 1 Hospital Drive, Columbia, MO 65212, USA
- Corresponding authors.
| | - Taylor B. Nelson
- Division of Infectious Diseases, University of Missouri, 1 Hospital Drive, Columbia, MO 65212, USA
- Corresponding authors.
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Al Mamari A, Al Tamtami W, Al A’amri K, Al Lawati H, Al Kalbani S, Al Muqbali I. First report of disseminated Mycobacterium abscessus in an immunocompetent adult patient in Oman. IJID REGIONS 2022; 2:162-164. [PMID: 35757068 PMCID: PMC9216659 DOI: 10.1016/j.ijregi.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Abstract
This case report describes the first case of disseminated Mycobacterium abscessus in an immunocompetent adult, and the second reported case of M. abscessus causing native joint septic arthritis. Disseminated M. abscessus treatment was given.
Mycobacterium abscessus is a ubiquitous rapid-growing mycobacterium that belongs to a diverse group of non-tuberculous mycobacteria. It can cause frequent and serious infections in patients with or without risk factors. This article reports a case of disseminated M. abscessus in an immunocompetent Omani male with native joint septic arthritis.
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Abedi B, Akbari M, Azadi D, Habibi D, Khodashenas S, Shariatmadari F. Toxoplasmosis infection in newborn: A systematic review and meta-analysis. Adv Biomed Res 2022; 11:75. [DOI: 10.4103/abr.abr_24_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/04/2022] Open
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Lee BI, Jang BW, Choi HS, Lee JS, Kim YB. Arthroscopic treatment of Mycobacterium massiliense septic arthritis outbreak after intra-articular injection: A case-series report and literature review. Medicine (Baltimore) 2021; 100:e23839. [PMID: 33592840 PMCID: PMC7870196 DOI: 10.1097/md.0000000000023839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/21/2020] [Indexed: 01/05/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) comprise mycobacteria, with the exceptions of Mycobacterium (M.) leprae and the M. tuberculosis complex. Septic arthritis caused by NTM is so rare that there is no standardized treatment.Between April and September 2012, 27 patients were infected with M. massiliense in a single clinic following injection of steroid in the knee joint. Clinical data of 9 patients who received arthroscopic treatment in Seoul Hospital of Soonchunhyang University were analyzed retrospectively.Arthroscopic irrigation and debridement were performed average 2.6 times (1-3 times). As 6 out of 9 cases (67%) had joint contracture of the knee joint, arthroscopic adhesiolysis, and brisement were performed. After surgical procedures, Hospital for Special Surgery and Lysholm knee score showed improvement compared before the surgery, but a radiographic result evaluated by Kellgren-Lawrence revealed that 6 cases got deteriorated to stage 4 in the 4-year follow-up.NTM septic arthritis had a higher recurrence and a higher contracture incidence than septic arthritis caused by tuberculous mycobacteria or other bacteria. Treatment was possible with repeated arthroscopic debridement and intravenous antibiotics.
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Affiliation(s)
- Byung Ill Lee
- Department of Orthopedic Surgery, Smarton Hospital, Bucheon
| | - Byung-Woong Jang
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Hyung Suk Choi
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Jeong Seok Lee
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Yong Beom Kim
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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6
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Comparing the Utilities of Different Multilocus Sequence Typing Schemes for Identifying Outbreak Strains of Mycobacterium abscessus subsp. massiliense. J Clin Microbiol 2019; 58:JCM.01304-19. [PMID: 31619535 DOI: 10.1128/jcm.01304-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/11/2019] [Indexed: 12/31/2022] Open
Abstract
Outbreaks of infections by Mycobacterium abscessus, particularly subspecies massiliense, are increasingly reported worldwide. Several multilocus sequence typing (MLST) protocols for grouping international outbreak strains have been developed but not yet directly compared. Using the three-gene (hsp65, rpoB, and secA1), seven-gene (argH, cya, glpK, gnd, murC, pta, and purH) and thirteen-gene (all of the preceding genes plus gdhA, pgm, and pknA) MLST schemes, we identified 22, 38, and 40 unique sequence types (STs), respectively, among a total of 139 nonduplicated M. abscessus isolates. Among subspecies massiliense, three-gene MLST not only clustered all outbreak strains together (in 100% agreement with the seven-gene and thirteen-gene schemes), but it also distinguished between two new STs that would have been grouped together by the seven-gene MLST but were distinct by the thirteen-gene MLST owing to differences in hsp65, rpoB, and pknA Here, we show that an abbreviated MLST may be useful for simultaneous identification of M. abscessus the subspecies level and screening M. abscessus subsp. massiliense isolates with outbreak potential.
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7
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Nengue L, Diaz MAA, Sherman CE, Bhasin A, Libertin CR. Mycobacterium abscessus Prosthetic Joint Infections of the Knee. J Bone Jt Infect 2019; 4:223-226. [PMID: 31700770 PMCID: PMC6831809 DOI: 10.7150/jbji.36286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/04/2019] [Indexed: 01/24/2023] Open
Abstract
M. abscessus complex prosthetic joint infections (PJI) of the knee are rare. We present a patient with an M. abscessus subsp. massiliense, a nontuberculous mycobacterium (NTM), peri-prosthetic knee infection who presented with wound drainage followed by sepsis. The published peer-reviewed literature on knee PJIs due to this organism is reviewed to highlight its clinical presentation,symptomatology, microbiology, surgical interventions, antimicrobial regimens, and outcomes.
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Affiliation(s)
- Lydie Nengue
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Courtney E Sherman
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Arveen Bhasin
- Division of Allergy, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
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8
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Lee HI, Choi JE, Choi SJ, Ko EB. Medication Injection Safety Knowledge and Practices among Health Service Providers in Korea. ACTA ACUST UNITED AC 2019. [DOI: 10.14371/qih.2019.25.1.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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Kim HT, Lim SW, Yim KH, Park SH, Choi JH, Bae YM, Shin ID, Shin YD. Antibacterial effect of lidocaine in various clinical conditions. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.2.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Hyeon Tae Kim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Woon Lim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyoung Hoon Yim
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Hi Park
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jung Hee Choi
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yoo-Mee Bae
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Il Dong Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Abstract
Although less common as causes of musculoskeletal infection than pyogenic bacteria, both Mycobacterium tuberculosis and nontuberculous mycobacteria can infect bones and joints. Although tuberculous arthritis and osteomyelitis have been recognized for millennia, infections caused by nontuberculous mycobacteria are being identified more often, likely because of a more susceptible host population and improvements in diagnostic capabilities. Despite advances in modern medicine, mycobacterial infections of the musculoskeletal system remain particularly challenging to diagnose and manage. This article discusses clinical manifestations of musculoskeletal infections caused by Mycobacterium tuberculosis and nontuberculous mycobacteria. Pathogenesis, unique risk factors, and diagnostic and therapeutic approaches are reviewed.
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Affiliation(s)
- John I Hogan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Rocío M Hurtado
- Mycobacterial Diseases Center, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandra B Nelson
- Program in Musculoskeletal Infections, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA.
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11
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Abdulfattah O, Rahman EU, Shweta FNU, Datar P, Alnafoosi Z, Trauber D, Sam M, Enriquez D, Schmidt F. Severe hypercalcemia in a patient with extrapulmonary Mycobacterium abscessus: granuloma or immune reconstitution inflammatory syndrome? First case of Mycobacterium abscessus presenting as retroperitoneal lymphadenopathy with severe hypercalcemia: a case report and literature review. J Community Hosp Intern Med Perspect 2018; 8:331-338. [PMID: 30559940 PMCID: PMC6292348 DOI: 10.1080/20009666.2018.1539057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Nontuberculous mycobacterium is a recognized cause of hypercalcemia, particularly in patients with acquired immunodeficiency syndrome (AIDS). Here we describe a case of severe hypercalcemia secondary to Mycobacterium abscessus (M. abscessus) in a patient with AIDS. To the best of our knowledge this is the first case report describing a case of M. abscessus presenting as retroperitoneal lymphadenopathy and severe hypercalcemia. Case description: A 56-year-old man with AIDS presented with altered mental status and somnolence for four days. Laboratory investigations were significant for calcium 16.49 mg/dL (RI 8.9-10.3 mg/dL), 1,25 dihydroxyvitamin D level 44.1 pg/ml (RI 19.9-79.3 pg/ml) and parathyroid hormone (PTH) 4 pg/mL (RI 15-65 pg/mL). CT scan of Abdomen and Pelvis showed hepatosplenomegaly with large retroperitoneal, retrocrural, and mesenteric lymphadenopathy which had an intense focal uptake on Gallium scan. Bone marrow biopsy revealed mild plasmacytosis (5%) with no evidence of myelodysplasia, acute leukemia or lymphoma. A subsequent lymph node biopsy showed fragments of fibrous tissue with lymphohistiocytic infiltrate and many acid-fast bacilli. Pre-antibiotic blood cultures grew Mycobacterium which was identified later as M. abscessus at four weeks. Conclusion: hypercalcemia in HIV-infected patients may suggest malignancy or infectious etiology, among other causes. Clinicians should be aware of the risk of hypercalcemia with nontuberculous mycobacterium (NTM) infection, whether as first manifestation or a late presenter in the disease course after initiating antiretroviral therapy (ART). We suggest careful monitoring of serum calcium level upon diagnosis of NTM infection and after initiation of ART, NTM therapy or vitamin D supplementation.
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Affiliation(s)
- Omar Abdulfattah
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Ebad Ur Rahman
- Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - FNU Shweta
- Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - Praveen Datar
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Zainab Alnafoosi
- Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA
| | - David Trauber
- Medicine Department, Hematology/Oncology Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Mirela Sam
- Medicine Department, Infection disease Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Danilo Enriquez
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Frances Schmidt
- Medicine Department, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA
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Grocott HP. Does an Iatrogenic Immunocompromised State Contribute to Healthcare-Associated Mycobacterium chimaera Infection From Heater-Cooler Devices? J Cardiothorac Vasc Anesth 2018; 32:e69. [DOI: 10.1053/j.jvca.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Indexed: 11/11/2022]
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13
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Grocott HP. Nontuberculous Mycobacterium Infection From Heater-Cooler Devices: Potential Impact of Steroid Use. Ann Thorac Surg 2018; 105:1865. [DOI: 10.1016/j.athoracsur.2017.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/21/2017] [Indexed: 12/01/2022]
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14
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Rapidly Growing Mycobacterial Infections of the Skin and Soft Tissues Caused by M. fortuitum and M. chelonae. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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15
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Donohue MJ. Increasing nontuberculous mycobacteria reporting rates and species diversity identified in clinical laboratory reports. BMC Infect Dis 2018; 18:163. [PMID: 29631541 PMCID: PMC5891905 DOI: 10.1186/s12879-018-3043-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/12/2018] [Indexed: 01/15/2023] Open
Abstract
Background Nontuberculous Mycobacteria (NTM) are environmental microorganisms that can affect human health. A 2009–2010 occurrence survey of NTM in potable tap water samples indicated an increased recovery rate for many clinically significant species such as M. avium (30%) and M. abscessus (12%). To determine if these trends by species were mirrored in human infections, isolation rates of NTM species identified in clinical laboratory reports from four states were evaluated. Method Clinical laboratory reports from the Mississippi, Missouri, Ohio, and Wisconsin Health Departments were used to investigate the species of NTM isolated from human specimens in 2014. The NTM positive specimen reports were tabulated for each species and complex/group. The number of reports by month were used to investigate seasonal trends. The 2014 isolation rates were compared to historic values to examine longitudinal trends. Results The positive rate of NTM specimens increased from 8.2 per 100,000 persons in 1994 to 16 per 100,000 persons in 2014 (or 13.3 per 100,000 after excluding Mycobacterium gordonae). Changes in NTM diversity were observed in complex/groups known to be clinically significant. Between 1994 and 2014 the rate implicating M. abscesses-chelonae group and M. avium complex increased by 322 and 149%, respectively. Conclusions Based on public health data supplied by the four State’s Health Departments and the 2014 U.S. population, 50,976 positive NTM specimen reports per year were projected for the nation; serving as an indicator for the national potential disease burden that year. Electronic supplementary material The online version of this article (10.1186/s12879-018-3043-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maura J Donohue
- United States Environmental Protection Agency, 26 W. Martin Luther King Dr. Mail Stop 587, Cincinnati, Ohio, 45268, USA.
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Jeong SH, Kim SY, Huh HJ, Ki CS, Lee NY, Kang CI, Chung DR, Peck KR, Shin SJ, Koh WJ. Mycobacteriological characteristics and treatment outcomes in extrapulmonary Mycobacterium abscessus complex infections. Int J Infect Dis 2017; 60:49-56. [PMID: 28522316 DOI: 10.1016/j.ijid.2017.05.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/30/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The differentiation between Mycobacterium abscessus subspecies abscessus (M. abscessus) and Mycobacterium abscessus subspecies massiliense (M. massiliense) and determination of the presence of inducible resistance to macrolide antibiotics are important factors in the management of patients with Mycobacterium abscessus complex (MABC) infections. Unlike pulmonary MABC infections, little information on extrapulmonary MABC infections is available. METHODS The molecular identification of clinical isolates was performed, and the clinical characteristics and treatment outcomes of 20 consecutive patients with extrapulmonary MABC infections were assessed. RESULTS M. abscessus and M. massiliense each caused 10 (50%) of the cases. Eight (80%) M. abscessus isolates that had inducible resistance to clarithromycin harbored an intact erm(41) gene of the T28 variant, whereas two (20%) M. abscessus isolates had the C28 erm(41) variant and were susceptible to clarithromycin. All M. massiliense isolates had a truncated erm(41) gene and were susceptible to clarithromycin. The drug susceptibility profiles other than clarithromycin were similar for the M. abscessus and M. massiliense isolates. Of the 20 patients, 17 (85%) showed a favorable outcome, including all patients with M. massiliense infection and 70% (7/10) of patients with M. abscessus infection. Favorable outcomes were associated with M. massiliense and M. abscessus isolates with a non-functional erm(41) gene (p=0.049). CONCLUSIONS Precise species and subspecies identification and the determination of macrolide susceptibility are recommended for the optimal treatment of extrapulmonary MABC infections.
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Affiliation(s)
- Suk Hyeon Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Fedrizzi T, Meehan CJ, Grottola A, Giacobazzi E, Fregni Serpini G, Tagliazucchi S, Fabio A, Bettua C, Bertorelli R, De Sanctis V, Rumpianesi F, Pecorari M, Jousson O, Tortoli E, Segata N. Genomic characterization of Nontuberculous Mycobacteria. Sci Rep 2017; 7:45258. [PMID: 28345639 PMCID: PMC5366915 DOI: 10.1038/srep45258] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
Mycobacterium tuberculosis and Mycobacterium leprae have remained, for many years, the primary species of the genus Mycobacterium of clinical and microbiological interest. The other members of the genus, referred to as nontuberculous mycobacteria (NTM), have long been underinvestigated. In the last decades, however, the number of reports linking various NTM species with human diseases has steadily increased and treatment difficulties have emerged. Despite the availability of whole genome sequencing technologies, limited effort has been devoted to the genetic characterization of NTM species. As a consequence, the taxonomic and phylogenetic structure of the genus remains unsettled and genomic information is lacking to support the identification of these organisms in a clinical setting. In this work, we widen the knowledge of NTMs by reconstructing and analyzing the genomes of 41 previously uncharacterized NTM species. We provide the first comprehensive characterization of the genomic diversity of NTMs and open new venues for the clinical identification of opportunistic pathogens from this genus.
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Affiliation(s)
| | - Conor J Meehan
- Mycobacteriology unit, Department of Biomedical Science, Institute of Tropical Medicine, Antwerp, Belgium
| | - Antonella Grottola
- Microbiology and Virology Unit, University Hospital Polyclinic, Modena, Italy
| | | | | | - Sara Tagliazucchi
- Microbiology and Virology Unit, University Hospital Polyclinic, Modena, Italy
| | - Anna Fabio
- Microbiology and Virology Unit, University Hospital Polyclinic, Modena, Italy
| | - Clotilde Bettua
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | - Roberto Bertorelli
- NGS Facility, Laboratory of Biomolecular Sequence and Structure Analysis for Health, Centre for Integrative Biology, University of Trento, Italy
| | - Veronica De Sanctis
- NGS Facility, Laboratory of Biomolecular Sequence and Structure Analysis for Health, Centre for Integrative Biology, University of Trento, Italy
| | - Fabio Rumpianesi
- Microbiology and Virology Unit, University Hospital Polyclinic, Modena, Italy
| | - Monica Pecorari
- Microbiology and Virology Unit, University Hospital Polyclinic, Modena, Italy
| | - Olivier Jousson
- Centre for Integrative Biology, University of Trento, Trento, Italy
| | - Enrico Tortoli
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Nicola Segata
- Centre for Integrative Biology, University of Trento, Trento, Italy
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18
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Abstract
Although less common as causes of musculoskeletal infection than pyogenic bacteria, both Mycobacterium tuberculosis and nontuberculous mycobacteria can infect bones and joints. Although tuberculous arthritis and osteomyelitis have been recognized for millennia, infections caused by nontuberculous mycobacteria are being identified more often, likely because of a more susceptible host population and improvements in diagnostic capabilities. Despite advances in modern medicine, mycobacterial infections of the musculoskeletal system remain particularly challenging to diagnose and manage. This article discusses clinical manifestations of musculoskeletal infections caused by Mycobacterium tuberculosis and nontuberculous mycobacteria. Pathogenesis, unique risk factors, and diagnostic and therapeutic approaches are reviewed.
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Affiliation(s)
- John I Hogan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Rocío M Hurtado
- Mycobacterial Diseases Center, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandra B Nelson
- Program in Musculoskeletal Infections, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA.
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Lee H, Hwang D, Jeon M, Lee E, Kim T, Yu SN, Kim Y, Lee BI. Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report. BMC Res Notes 2016; 9:443. [PMID: 27629994 PMCID: PMC5024515 DOI: 10.1186/s13104-016-2245-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/06/2016] [Indexed: 09/12/2023] Open
Abstract
Background There are increasing reports on nosocomial Mycobacterium massiliense infection, but septic arthritis and osteomyelitis because of that microorganism is rare. This report focuses on the clinical aspects of M. massiliense arthritis outbreak concurrent with soft tissue infection. Case presentation An outbreak of septic arthritis among patients who had been injected at a single clinic occurred in South Korea between April and September 2012. This may be associated with repeated injection of triamcinolone contaminated with M. massiliense. Nine of the Korean patients visited our hospital complaining of painful swelling of the knees. During treatment course, patients are suffered from soft tissue abscess around the injection site. Acid-fast bacilli culture for infected tissue was positive in five patients, and polymerase chain reaction for non-tuberculous mycobacteria was positive in four patients. They were treated with antibiotics, repeated arthroscopic surgeries, incision and drainage for a long time. All patients were eventually cured but three patients have suffered from a decreased range of motion. Conclusion Early clinical suspicion and microbiological diagnosis are key factors in reducing morbidity since septic arthritis with M. massiliense manifests late after the injection and treatment of it is a laborious process.
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Affiliation(s)
- Haekyung Lee
- Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Dohui Hwang
- Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Minchul Jeon
- Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea.
| | - Taehyong Kim
- Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Shi Nae Yu
- Department of Internal Medicine, Soonchunhyang University Hospital, 17 Soonchunhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, Korea
| | - Yongbeom Kim
- Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Byung-Ill Lee
- Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, Korea
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