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Kobashi Y, Mitarai S, Oga T. A Case of Pulmonary Mycobacterium heckeshornense Infection in which the Causative Microorganism was Difficult to Identify. Intern Med 2024:3837-24. [PMID: 39198172 DOI: 10.2169/internalmedicine.3837-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2024] Open
Abstract
A 44-year-old woman underwent a follow-up examination for Crohn's disease 9 years ago. Chest computed tomography (CT) showed an infiltration shadow with a cavity in the right upper lobe. After a CT-guided lung biopsy, epitheloid granuloma was noted, and an acid-fast bacilli examination was smear-positive, but a culture examination was negative. Because the abnormal chest shadow with cavity gradually increased and right shoulder pain appeared, we performed bronchoscopy again six months later. Mycobacterium heckeshornense was isolated from the bronchoalveolar lavage fluid specimen, so we diagnosed her with pulmonary M. heckeshornense disease. Isoniazid, rifampicin, and ethambutol were administered, and the abnormal chest shadow improved.
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Affiliation(s)
| | - Satoshi Mitarai
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Japan
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Othmer JT, Schoenfeld N, Roth A, Vesenbeckh MS, Bauer T, Mauch H. [Cavernous Nontuberculous Mycobacterial Lung Infection in an HIV-positive Patient]. Pneumologie 2022; 76:568-572. [PMID: 35488173 DOI: 10.1055/a-1770-9393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Since we first described Mycobacterium heckeshornense, a rare species of mycobacteria in 2000, only 21 cases of infection with this mycobacterium have been described in humans. We relate the diagnosis and therapy of another case of this uncommon nontuberculous mycobacterium in an immune-suppressed patient.
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Affiliation(s)
- Johannes Till Othmer
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring Berlin-Zehlendorf, Berlin, Deutschland
| | - Nicolas Schoenfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring Berlin-Zehlendorf, Berlin, Deutschland
| | - Andreas Roth
- Institut für Mikrobiologie, Helios Klinikum Emil von Behring Berlin-Zehlendorf, Berlin, Deutschland
| | | | - Torsten Bauer
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring Berlin-Zehlendorf, Berlin, Deutschland
| | - Harald Mauch
- Institut für Mikrobiologie, Helios Klinikum Emil von Behring Berlin-Zehlendorf, Berlin, Deutschland
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Kinoshita H, Ono M, Nagatomo Y, Takeda Y, Nakamura H, Aoshiba K. Diagnosis of pulmonary Mycobacterium heckeshornense infection using matrix-assisted laser desorption ionization time-of-flight mass spectroscopy. IDCases 2021; 26:e01296. [PMID: 34621620 PMCID: PMC8482422 DOI: 10.1016/j.idcr.2021.e01296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hayato Kinoshita
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.,Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Mariko Ono
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.,Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yoko Nagatomo
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan.,Department of Respiratory Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yukihisa Takeda
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0395, Japan
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Performance of lipid fingerprint-based MALDI-ToF for the diagnosis of mycobacterial infections. Clin Microbiol Infect 2021; 27:912.e1-912.e5. [PMID: 32861860 PMCID: PMC8186428 DOI: 10.1016/j.cmi.2020.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Bacterial diagnosis of mycobacteria is often challenging because of the variability of the sensitivity and specificity of the assay used, and it can be expensive to perform accurately. Although matrix-assisted laser desorption/ionization mass spectrometry (MALDI MS) has become the workhorse of clinical laboratories, the current MALDI methodology (which is based on cytosolic protein profiling) for mycobacteria is still challenging due to the number of steps involved (up to seven) and potential biosafety concerns. Knowing that mycobacteria produce surface-exposed species-specific lipids, we here hypothesized that the detection of those molecules could offer a rapid, reproducible and robust method for mycobacterial identification. METHODS We evaluated the performance of an alternative methodology based on characterized species-specific lipid profiling of intact bacteria, without any sample preparation, by MALDI MS; it uses MALDI-time-of-flight (ToF) MS combined with a specific matrix (super-2,5-dihydroxybenzoic acid solubilized in an apolar solvent system) to analyse lipids of intact heat-inactivated mycobacteria. Cultured mycobacteria are heat-inactivated and loaded directly onto the MALDI target followed by addition of the matrix. Acquisition of the data is done in both positive and negative ion modes. Blinded studies were performed using 273 mycobacterial strains comprising both the Mycobacterium tuberculosis (Mtb) complex and non-tuberculous mycobacteria (NTMs) subcultured in Middlebrook 7H9 media supplemented with 10% OADC (oleic acid/dextrose/catalase) growth supplement and incubated for up to 2 weeks at 37°C. RESULTS The method we have developed is fast (<10 mins) and highly sensitive (<1000 bacteria required); 96.7% of the Mtb complex strains (204/211) were correctly assigned as MTB complex and 91.7% (22/24) NTM species were correctly assigned based only on intact bacteria species-specific lipid profiling by MALDI-ToF MS. CONCLUSIONS Intact bacterial lipid profiling provides a biosafe and unique route for rapid and accurate mycobacterial identification.
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Review on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the rapid screening of microbial species: A promising bioanalytical tool. Microchem J 2020. [DOI: 10.1016/j.microc.2020.105387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nicolás-de Blas R, Garijo-Bufort M, Nebreda-Mayoral T, Guerra-Laso JM. Synovitis due to Mycobacterium heckeshornense in a patient with rheumatoid arthritis and treatment with infliximab. Enferm Infecc Microbiol Clin 2020; 38:448-449. [PMID: 32098703 DOI: 10.1016/j.eimc.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Reyes Nicolás-de Blas
- Servicio de Análisis Clínicos, Complejo Asistencial Universitario de León, León, España
| | - Marta Garijo-Bufort
- Servicio de Reumatología, Complejo Asistencial Universitario de León, León, España
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Iitoh E, Tominaga M, Okamoto M, Sakazaki Y, Nakamura M, Kinoshita T, Kawayama T, Hoshino T. A case of pulmonary Mycobacterium heckeshornense infection in a healthy Japanese man. Respir Med Case Rep 2020; 30:101093. [PMID: 32489849 PMCID: PMC7256317 DOI: 10.1016/j.rmcr.2020.101093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 10/29/2022] Open
Abstract
A 72-year-old man, healthy, smoker, with long-standing cough, was referred to our hospital and his chest X-ray (CXR) revealed a cavity lesion in the right upper lobe. Direct sputum smears, but not culture in solid medium, were positive for acid-fast bacilli (AFB) without tuberculosis DNA. The preliminary diagnosis was of a non-tuberculosis infection that progressed slowly, and the CXR showed the condition to worsen daily. Four years later, a commercialized mycobacteria growth indicator tube system was used to culture the colonies of AFB successfully in liquid medium, and the species Mycobacterium heckeshornense was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The patient responded well to triple therapy with rifampicin, ethambutol, and clarithromycin, the sputum cultures remained negative and the roentgenogram showed minor improvement over the following 6 months.
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Key Words
- AFB, acid-fast bacilli
- CAM, clarithromycin
- CT, computed tomography
- CXR, chest x-ray
- DDH, DNA–DNA hybridization
- EB, ethambutol
- M, Mycobacterium
- MAC, Mycobacterium avium complex
- MALDI-TOF MS
- MALDI-TOF MS, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry
- MGIT, mycobacteria growth indicator tube
- MIC, minimum inhibitory concentration
- MTB, Mycobacterium tuberculosis
- Matrix assisted laser desorption ionization-time of flight mass spectrometry
- Mycobacterium heckeshornense
- Mycobacterium xenopi
- NTM, nontuberculous mycobacteria
- Non-tuberculous mycobacterium infection
- PCR, polymerase chain reaction
- RE, rifampicin plus ethambutol
- RFP, rifampicin
- rRNA, ribosomal RNA
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Affiliation(s)
- Eriko Iitoh
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Yuki Sakazaki
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Masayuki Nakamura
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Takashi Kinoshita
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, 830-0011, Japan
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