Penile mass caused by the newly described organism Mycobacterium celatum

Penile Tuberculosis in a Bull

We describe a case of penile tuberculosis in a bull. The prepuce was thickened, firm and pale with multifocal to coalescent caseous nodules, and the inguinal and mesenteric lymph nodes were moderately enlarged. Lesions in the prepuce, penis and lymph nodes were characterized by multifocal to coalescent areas of caseous necrosis and marked granulomatous inflammation. Acid-fast bacilli were seen within necrotic foci and Langhans giant cells. Mycobacteriumtuberculosis var. bovis was identified in inguinal lymph nodes by the polymerase chain reaction technique and by bacterial isolation. Although rare, tuberculosis should be considered in the differential diagnosis of granulomatous lesions in the genital tract of bulls.

Tuberculosis of the Penis: A Review of the Literature

Background. Tuberculosis of the penis (TBP) is rare. Aim. To review the literature. Method. Various internet data bases were searched. Literature Review. TBP could be primary or secondary, may develop following circumcision performed by a person who had pulmonary Tb, and may be transmitted to the penis from ejaculation, contamination from clothing, or from contact with endometrial secretions, following an earlier pulmonary Tb or Tb elsewhere. TBP presents with a painless/painful small nodule, ulcer, mass on penis which gradually enlarges, and induration/swelling of penis, with or without erectile dysfunction. Inguinal lymph nodes may or may not be palpable. The patient's voiding is normal. There may or may not be history of circumcision, pulmonary Tb, and BCG immunization. TBP mimics penile carcinoma, granulomatous syphilis penile ulcer, genital herpes simplex, granuloma inguinale, and HIV infection. Diagnosis is established by microscopic examination finding of granulomas +/-AFB in penile discharge or biopsy of lesion or culture of Tb organism from discharge or biopsy specimens or positive Elisa serology/PCR for Tb. PTBs respond to first- or 2nd-line anti-Tb 6-month treatment. Close contacts should be screened. Extrapulmonary Tb should be excluded. Conclusions. Clinicians should consider possibility of PTB in cases of penile lesions and erectile failure.

Mycobacterium celatum, an emerging pathogen and cause of false positive amplified mycobacterium tuberculosis direct test

Mycobacterium celatum is a recently described organism. Herein we describe a case of M. celatum lymphadenitis in an immunocompetent child and the first reported case of a M. celatum infection (lung abscess) in a transplant recipient. A literature review identified 19 other cases of M. celatum infection. Fifteen occurred in patients with the acquired immunodeficiency syndrome. Of these, nine were disseminated and six were localized (primarily to the lungs). The remaining 4 patients were immunocompetent and had localized infection (pneumonitis or lymphadenitis). Diagnosis of M. celatum infection can be challenging as M. celatum can cause false-positive results with the current version of the Amplified Mycobacterium tuberculosis Direct Test (Gen-Probe, San Diego, CA.). Definitive identification is available by DNA sequencing or high-performance liquid chromatography. M. celatum can cause infection in immunocompromised and immunocompetent hosts.

Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s

The advancement of genetic techniques has greatly boosted taxonomic studies in recent years. Within the genus Mycobacterium, 42 new species have been detected since 1990, most of which were grown from clinical samples. Along with species for which relatively large numbers of strains have been reported, some of the new species of mycobacteria have been detected rarely or even only once. From the phenotypic point of view, among the new taxa, chromogens exceed nonchromogens while the numbers of slowly and rapidly growing species are equivalent. Whereas conventional identification tests were usually inconclusive, an important role was played by lipid analyses and in particular by high-performance liquid chromatography. Genotypic investigations based on sequencing of 16S rRNA gene have certainly made the most important contribution. The investigation of genetic relatedness led to the redistribution of the species previously included in the classically known categories of slow and rapid growers into new groupings. Within slow growers, the intermediate branch related to Mycobacterium simiae and the cluster of organisms related to Mycobacterium terrae have been differentiated; among rapid growers, the group of thermotolerant mycobacteria has emerged. The majority of species are resistant to isoniazid and, to a lesser extent, to rifampin. Many of the new species of mycobacteria are potentially pathogenic, and there are numerous reports of their involvement in diseases. Apart from disseminated and localized diseases in immunocompromised patients, the most frequent infections in immunocompetent people involve the lungs, skin, and, in children, cervical lymph nodes. The awareness of such new mycobacteria, far from being a merely speculative exercise, is therefore important for clinicians and microbiologists.

Cutaneous tuberculosis of the penis and sexual transmission of tuberculosis confirmed by molecular typing

A case of culture-positive primary cutaneous Mycobacterium tuberculosis infection of the penis was diagnosed in a male patient; 1 year later, endometrial tuberculosis was diagnosed in the patient's wife. These organisms were confirmed to be indistinguishable by use of molecular techniques.

Misidentification and diagnostic delay Caused by a false-positive amplified Mycobacterium tuberculosis direct test in an immunocompetent patient with a Mycobacterium celatum infection

The Gen-Probe amplified Mycobacterium tuberculosis direct test can give discrepant results directly in respiratory or cultured samples from patients infected with Mycobacterium celatum, leading to inappropriate therapy for, in our case, an immunocompetent patient.

False-positive results for Mycobacterium celatum with the AccuProbe Mycobacterium tuberculosis complex assay

Mycobacterium celatum type 1 was found to cross-react in the AccuProbe Mycobacterium tuberculosis complex assay. Subsequently, we found a statistically significant increase in the relative light units with lower temperatures, suggesting that it is necessary to perform this AccuProbe assay at between 60 and 61 degrees C. We also recommend the inclusion of M. celatum type 1 as a negative control.

Penile skin diseases

Many dermatoses become manifest in the genital region. Some of them are specific for this anatomical site; other lesions of the penis are associated with systemic dermatological diseases. Medical history, clinical inspection of the whole integument and optional microbiological or histological examination of the lesions will lead to a correct diagnosis. Dermatoses of the penis (glans penis and/or prepuce) may be symptoms of general diseases or specific alterations of the genital region. The differential diagnoses of penile dermatoses include infections, balanitides, neoplastic diseases, trauma, papulosqamous or systemic diseases, fixed drug reactions, allergic or irritant contact dermatitis and miscellaneous lesions. Since andrologists pay special attention to the inspection and palpation of the male genital region, they should possess knowledge of dermatologically relevant penile lesions.

Primary tuberculosis of the glans penis

A 60-year-old man presented with multiple superficial ulcers on the glans penis. Histopathology, a positive tuberculin test result, and therapeutic response to antituberculous therapy confirmed the diagnosis of penile tuberculosis. Examination was otherwise normal except for a solitary enlarged reactive lymph node on the right side. There was no evidence of coexistent tuberculous infection elsewhere.

Mycobacterium celatum infection in two HIV-infected patients treated prophylactically with rifabutin

Mycobacterium celatum is a recently described slow-growing species. It was identified on the basis of genomic sequencing that differentiates three types. The present report describes two cases of Mycobacterium celatum type 1 infection in patients with AIDS. Both patients had CD4+ lymphocyte counts of < 10/mm3, were receiving rifabutin prophylaxis, and had attended the same treatment units. The minimum inhibitory concentration of rifabutin for both strains was 8 mg/l, which may account for the failure of prophylaxis. As all type 1 strains have the same pulsed-field gel electrophoresis pattern, nosocomial transmission or acquisition from a common source could not be ruled out.