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Mycobacterium fortuitum and Mycobacterium abscessus infections in the foot and ankle in two immunocompetent patients. Biomedicine (Taipei) 2020; 10:52-56. [PMID: 33854936 PMCID: PMC7735975 DOI: 10.37796/2211-8039.1021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/17/2019] [Indexed: 10/31/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) infections of the musculoskeletal system are commonly missed due to its rarity and the absence of systemic symptoms. A high clinical index of suspicion is required to recognize such infections as they may occur in immunocompetent hosts. We present two cases of foot and ankle NTM infections involving Mycobacterium fortuitum and Mycobacterium abscessus in two such patients. The first case involves an 83-year old lady who presented with a two-month history of multiple foot abscesses initially treated at a rural hospital. She underwent drainage and debridement of her foot, with eventual cultures growing Pseudomonas aeruginosa and Mycobacterium abscessus. She was initially treated with clarithromycin and doxycycline. At one year follow-up review, her wound healed completely. The second case involves a 55-year old man who presented with infection following midfoot fusion and anterolateral thigh flap for an open complex fracture dislocation of his right foot. Cultures eventually grew Mycobacterium fortuitum and he was treated with cefoxitin, clarithromycin and doxycycline. 10 months after his initial injury, the infection has cleared and his flap was clean. Through these 2 cases, we hope to highlight the unusual presentations of such infections and illustrate that with a high initial index of suspicion and appropriate treatment, these infections can be treated successfully.
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Tang S, Tang A, Lam W, Cheng Y, Ho YW. Successful Treatment of Mycobacterium Fortuitum Peritonitis Without Tenckhoff Catheter Removal in CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686080302300318] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Tang
- Division of Nephrology Department of Medicine, United Christian Hospital Hong Kong SAR, People's Republic of China
| | - A.W. Tang
- Division of Nephrology Department of Medicine, United Christian Hospital Hong Kong SAR, People's Republic of China
| | - W.O. Lam
- Division of Nephrology Department of Medicine, United Christian Hospital Hong Kong SAR, People's Republic of China
| | - Y.Y. Cheng
- Division of Nephrology Department of Medicine, United Christian Hospital Hong Kong SAR, People's Republic of China
| | - Y. W. Ho
- Division of Nephrology Department of Medicine, United Christian Hospital Hong Kong SAR, People's Republic of China
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Diaz MAA, Huff TN, Libertin CR. Nontuberculous mycobacterial infections of the lower extremities: A 15-year experience. J Clin Tuberc Other Mycobact Dis 2019; 15:100091. [PMID: 31720418 PMCID: PMC6830119 DOI: 10.1016/j.jctube.2019.100091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Nontuberculous mycobacterial infection (NTMI), which is increasing in prevalence, is challenging to diagnose and manage despite the availability of capable laboratories because of subtle and nonspecific clinical findings and nonstandardized treatment guidelines. We aimed to present our experience with lower-extremity NTMI and to compare clinical characteristics and treatment outcomes between immunocompetent and immunocompromised patients. Methods To determine clinical presentations and outcomes, we reviewed electronic health records of all patients with lower-extremity NTMI treated and followed up at our institution from January 2002 through December 2017. Results Twenty-four patients were included in this study. Mean (SD) age was 58 (19) years. Eighteen patients (75%) were men; 13 (54%) were immunocompetent; and 9 (37%) had bone and joint involvement. No significant differences existed between immunocompetent and immunocompromised patients, except immunocompetent patients had significantly more infections at the hip, thigh, and toe. Bone and joint infection required significantly longer treatment time than skin and soft-tissue infection. Conclusions Regardless of immune status, patients with lower-extremity NTMI had similar characteristics, treatments, and outcomes. However, immunosuppression can be a major risk factor in the development of disseminated NTMI and associated complications. Acid-fast bacilli culture is strongly recommended for evaluation of delayed or nonhealing lesions. Aggressive medical and surgical management can be associated with good clinical outcomes.
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Affiliation(s)
- Mark Anthony A. Diaz
- Division of Infectious Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, United States
| | - Tamara N. Huff
- St. Francis Orthopaedic Institute, St. Francis Medical Group, Columbus, GA, United States
| | - Claudia R. Libertin
- Division of Infectious Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, United States
- Corresponding author.
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Ledwoń A, Dolka I, Dolka B, Cegiełkowska M, Czopowicz M, Szeleszczuk P. Multidrug therapy of Mycobacterium avium subsp. avium infection in experimentally inoculated budgerigars (Melopsittacus undulatus). Avian Pathol 2015; 44:470-4. [PMID: 26364975 DOI: 10.1080/03079457.2015.1086973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the study was to determine whether the four-month experimental therapy of mycobacteriosis in budgerigars may cause a complete recovery. A group of nine budgerigars was infected with a Mycobacterium avium subsp. avium isolate with proven pathogenicity for budgerigars. Five weeks post-inoculation, multidrug therapy was started. Another group comprising six birds received the same treatment but no infection, and the third group also comprising six birds was kept without infection or treatment as a control. The adopted antibiotic regimen included clarithromycin 61 mg/kg b.w., moxifloxacin 25 mg/kg b.w. and ethambutol 60 mg/kg b.w. administered by crop gavage every 12 h for 18 weeks. Despite a significant improvement in the condition of the infected, treated birds, the four-month therapy was not sufficient for the complete recovery of all.
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Affiliation(s)
- A Ledwoń
- a Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine , Warsaw University of Life Sciences , 159c Nowoursynowska St., 02-776 Warsaw , Poland
| | - I Dolka
- a Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine , Warsaw University of Life Sciences , 159c Nowoursynowska St., 02-776 Warsaw , Poland
| | - B Dolka
- a Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine , Warsaw University of Life Sciences , 159c Nowoursynowska St., 02-776 Warsaw , Poland
| | - M Cegiełkowska
- a Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine , Warsaw University of Life Sciences , 159c Nowoursynowska St., 02-776 Warsaw , Poland
| | - M Czopowicz
- b Laboratory of Veterinary Epidemiology and Economics Faculty of Veterinary Medicine , Warsaw University of Life Sciences , 159c Nowoursynowska St., 02-776 Warsaw , Poland
| | - P Szeleszczuk
- a Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine , Warsaw University of Life Sciences , 159c Nowoursynowska St., 02-776 Warsaw , Poland
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Lima CTD, Magalhães V. Abscess resulting from Mycobacterium kansasii in the left thigh of AIDS patient. An Bras Dermatol 2014; 89:478-80. [PMID: 24937823 PMCID: PMC4056707 DOI: 10.1590/abd1806-4841.20142741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/18/2013] [Indexed: 11/21/2022] Open
Abstract
A case of abscess resulting from Mycobacterium kansasii, in the
left thigh of a 53-year-old woman infected with the Human Immunodeficiency
virus, is reported. Curiously, there was no pulmonary or systemic involvement as
is usual with these Mycobacterium infections. The patient had CD4 T lymphocyte
count of 257 cells/µL and a viral load of 60,154 copies. Despite presenting a
relatively preserved immunity, the patient also presented Criptococcic
meningoencephalitis and Esophageal candidiasis. The patient responded
satisfactorily to treatment for infections and after 51 days was discharged.
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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: 2.8] [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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PALM MELANIED, BUTTERWICK KIMBERLYJ, GOLDMAN MITCHELP. Mycobacterium chelonae Infection After Fractionated Carbon Dioxide Facial Resurfacing (Presenting as an Atypical Acneiform Eruption): Case Report and Literature Review. Dermatol Surg 2010; 36:1473-81. [DOI: 10.1111/j.1524-4725.2010.01663.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lu K, Grigg A, Leslie D, Finlay M, Sasadeusz J. Mycobacterium genavenseduodenitis following allogeneic peripheral blood stem cell transplantation. Transpl Infect Dis 2009; 11:534-6. [DOI: 10.1111/j.1399-3062.2009.00431.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Esteban J, Z. Martín-de-Hijas N, García-Almeida D, Bodas-Sánchez Á, Gadea I, Fernández-Roblas R. Prevalence of erm methylase genes in clinical isolates of non-pigmented, rapidly growing mycobacteria. Clin Microbiol Infect 2009; 15:919-23. [DOI: 10.1111/j.1469-0691.2009.02757.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peres E, Khaled Y, Krijanovski OI, Mineishi S, Levine JE, Kaul DR, Riddell J. Mycobacterium chelonae necrotizing pneumonia after allogeneic hematopoietic stem cell transplant: report of clinical response to treatment with tigecycline. Transpl Infect Dis 2008; 11:57-63. [PMID: 18983415 DOI: 10.1111/j.1399-3062.2008.00351.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of progressive Mycobacterium chelonae ssp. chelonae necrotizing pneumonia after hematopoietic stem cell transplantation (HSCT) in the presence of chronic graft-versus-host disease. The patient failed to respond to standard combination therapy with multiple agents and developed resistance to most drugs over the course of treatment. Tigecycline, a new glycylcycline antimicrobial agent with in vitro activity against M. chelonae, was then used with a clinical response to treatment. To our knowledge, this is the first reported case demonstrating tigecycline to have a degree of clinical effectiveness to treat refractory pulmonary infection with M. chelonae in an HSCT recipient.
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Affiliation(s)
- E Peres
- Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109-5941, USA.
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da Costa HCG, Malaspina AC, de Mello FAF, Leite CQF. Tuberculosis in a psychiatric hospital in the state of Goiás, Brazil. J Bras Pneumol 2007; 32:566-72. [PMID: 17435908 DOI: 10.1590/s1806-37132006000600015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 03/21/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of infection, disease and eventual institutional outbreak of tuberculosis in a psychiatric hospital using the PPD test, as well as testing for mycobacteria in material collected from the respiratory tree and using molecular tracking technique based on insertion sequence 6110 (IS6110). METHODS Between February and August of 2002, PPD tests were given to 74 inpatients and 31 staff members at a psychiatric hospital in the city of Rio Verde, located in the state of Goiás, Brazil. In addition, respiratory tree material collected from the inpatients was submitted to testing for Mycobacterium tuberculosis. RESULTS Among the patients analyzed, mycobacteria were isolated from five (6.8%): four identified as M. tuberculosis and one as M. chelonae. The M. tuberculosis isolates were sensitive to isoniazid and rifampicin, and, when submitted to the restriction fragment length polymorphism/IS6110 technique, presented unique genetic profiles, totally distinct from one another, suggesting that all of the tuberculosis cases were due to endogenous reactivation. It was not possible to characterize this group of cases as an institutional outbreak. Performing the two-step tuberculin test in the patients, the infection rates were 23% and 31%, compared with 42% among staff members, who were submitted to the one-step test. CONCLUSION The results indicate a high incidence of tuberculosis infection among inpatients and hospital staff, as well as a high occurrence of the disease among inpatients.
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Cruz Höfling C, Costa Panunto A, Alves Bensi EP, Gonçalves SA, De Carvalho Ramos M, Ribeiro Rienzo AA. Infection of Polypropylene Threads for Face-Lifting with Mycobacterium Fortuitum. Dermatol Surg 2007; 33:492-5. [PMID: 17430386 DOI: 10.1111/j.1524-4725.2007.33104.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christian Cruz Höfling
- Laboratory of Bacterial Pathogenesis, Campinas State University, São Paulo, and Infection Control Unit, Mário Gatti County Hospital, São Paulo, Brazil.
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13
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Infection of Polypropylene Threads for Face-Lifting with Mycobacterium Fortuitum. Dermatol Surg 2007. [DOI: 10.1097/00042728-200704000-00018] [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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Grubb B. Think again about that pedicure. JAAPA 2005; 18:62. [PMID: 16184875 DOI: 10.1097/01720610-200509000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Bethany Grubb
- Dermatology Department of the Springer Clinic, Tulsa, Okla, USA
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Kuehne JJ, Yu ALT, Holland GN, Ramaswamy A, Taban R, Mondino BJ, Yu F, Rayner SA, Giese MJ. Corneal pharmacokinetics of topically applied azithromycin and clarithromycin. Am J Ophthalmol 2004; 138:547-53. [PMID: 15488779 DOI: 10.1016/j.ajo.2004.04.071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2004] [Indexed: 11/22/2022]
Abstract
PURPOSE To determine corneal levels of topically administered azithromycin and clarithromycin in a rabbit model. DESIGN Experimental animal study. METHODS Corneas of New Zealand albino rabbits were treated with topical azithromycin (2 mg/ml or 4 mg/ml) or clarithromycin (10 mg/ml). Topical azithromycin was prepared from an intravenous solution and topical clarithromycin from a suspension for oral use. All rabbits received one drop every 2 hours on the right eye. Groups of rabbits were treated for the following intervals: 6, 12, 24, and 48 hours (four rabbits for each combination of time point, drug, and dose). Corneal tissue was removed 1 hour after the last application. To investigate stability of tissue azithromycin levels, an additional group of four rabbits was treated for 24 hours, but corneal tissue was not removed until 24 hours later. Samples were homogenized, and drug concentrations were measured using high-pressure liquid chromatography (HPLC) analysis and bioactivity assay. RESULTS Corneal concentrations of azithromycin increased with drug dosage and duration of application. Rabbits treated with azithromycin tolerated the drug well without signs of irritation. Clarithromycin was undetectable in corneal tissue by HPLC and bioactivity assay for all rabbits. Some rabbits treated with clarithromycin had signs of ocular surface irritation. CONCLUSION Measurable concentrations of azithromycin are achieved in corneal tissue after topical application in a rabbit model, and the drug is well tolerated. Azithromycin may be a useful antibiotic for the topical treatment of human corneal infections, but clarithromycin, in currently available formulations, may not be effective because of poor tissue penetration.
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Affiliation(s)
- Jonas J Kuehne
- Ocular Inflammatory Disease Center, Jules Stein Eye Institute, and Department of Ophthalmology, David Geffen School of Medicine at UCLA, 90095-7003, USA
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Saggese D, Compadretti GC, Burnelli R. Nontuberculous mycobacterial adenitis in children: diagnostic and therapeutic management. Am J Otolaryngol 2003; 24:79-84. [PMID: 12649820 DOI: 10.1053/ajot.2003.21] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We reviewed a series of 45 patients affected by nontuberculous mycobacterial adenitis of the neck observed in the Ear, Nose, and Throat Institute of S. Orsola-Malpighi Hospital-Bologna over a 20-year period between 1981 and 2001. The mean age was 5.5 years. Patients were tested by using the differential Mantoux test, which was the principal diagnostic tool in the case of atypical mycobacterial infections. Forty-two patients were surgically treated by total excision of infected nodes, whereas parotidectomy with sparing of facial nerve was performed in those 3 cases with intraparotid nodes involvement. In all cases, the histopathological diagnosis was tubercular granulomatous lymphadenitis. The culture growth of nontuberculous mycobacteria was positive in 13 cases with a marked prevalence of the avium-intracellular germs. The disease was eradicated in all patients. The diagnostic and therapeutic management of nontuberculous mycobacterial adenitis is discussed in this retrospective study.
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Affiliation(s)
- Domenico Saggese
- Dipartimento Neuro-Senso-Motorio, Clinica Otorinolaringoiatrica, Policlinico S Orsola-Malpighi. Università di Bologna, Via Massarenti 9, 40138 Bologna, Italy
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Safdar A. Clinical microbiological case: infection imitating lymphocutaneous sporotrichosis during pregnancy in a healthy woman from the south-eastern USA. Clin Microbiol Infect 2003. [DOI: 10.1046/j.1469-0691.2003.00586.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ubiali D, Pagani G, Pregnolato M, Piersimoni C, Pedraz Muñoz JL, Rodríguez Gascón A, Terreni M. New N-alkyl-1,2-dihydro-2-thioxo-3-pyridinecarbothioamides as antituberculous agents with improved pharmacokinetics. Bioorg Med Chem Lett 2002; 12:2541-4. [PMID: 12182855 DOI: 10.1016/s0960-894x(02)00490-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Infections caused by multidrug-resistant Mycobacterium tuberculosis (MT) and non-tuberculous mycobacteria are difficult to treat and, indeed, new therapeutic agents are being sought. As a part of an ongoing research in our laboratories, novel N-alkyl-1,2-dihydro-2-thioxo-3-pyridinecarbothioamides have been synthesized and evaluated against several strains of MT and Mycobacterium avium complex (MAC). The pharmacokinetics and relative bioavailability after intravenous administration of three derivatives have been investigated. Introduction of a hydroxyl or a tertiary amino group in the N-alkyl chain resulted in an improved pharmacokinetic profile without affecting sensitively the antituberculous potency.
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Affiliation(s)
- Daniela Ubiali
- Dipartimento di Chimica Farmaceutica, Via Taramelli 12, Università degli Studi, I-27100, Pavia, Italy
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Porte L, Sailler L, Bonnet E, Bauriaud R, Massip P, Marchou B. Abcès des parties molles à Mycobacterium fortuitum par inoculation iatrogène chez une patiente immunocompétente. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00408-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Malik R, Hughes MS, James G, Martin P, Wigney DI, Canfield PJ, Chen SCA, Mitchell DH, Love DN. Feline leprosy: two different clinical syndromes. J Feline Med Surg 2002; 4:43-59. [PMID: 11869054 DOI: 10.1053/jfms.2001.0151] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Feline leprosy refers to a condition in which cats develop granulomas of the subcutis and skin in association with intracellular acid-fast bacilli that do not grow on routine laboratory media. In this study, the definition was extended to include cases not cultured, but in which the polymerase chain reaction (PCR) identified amplicons characteristic of mycobacteria. Tissue specimens from 13 such cases from eastern Australia were obtained between 1988 and 2000. This cohort of cats could be divided into two groups on the basis of the patients' age, histology of lesions, clinical course and the sequence of 16S rRNA PCR amplicons. One group consisted of four young cats (less than 4 years) which initially developed localised nodular disease affecting the limbs. Lesions progressed rapidly and sometimes ulcerated. Sparse to moderate numbers of acid-fast bacilli were identified using cytology and/or histology, typically in areas of caseous necrosis and surrounded by pyogranulomatous inflammation. Organisms did not stain with haematoxylin and ranged from 2 to 6 microm (usually 2 to 4 microm). Mycobacterium lepraemurium was diagnosed in two cases based on the sequence of a 446 bp fragment encompassing the V2 and V3 hypervariable regions of the 16S rRNA gene a different sequence was obtained from one additional case, while no PCR product could be obtained from the remaining case. The clinical course was considered aggressive, with a tendency towards local spread, recurrence following surgery and development of widespread lesions over several weeks. The cats resided in suburban or rural environments. A second group consisted of nine old cats (greater than 9 years) with generalised skin involvement, multibacillary histology and a slowly progressive clinical course. Seven cats initially had localised disease which subsequently became widespread, while two cats allegedly had generalised disease from the outset. Disease progression was protracted (compared to the first group of cats), typically taking months to years, and skin nodules did not ulcerate. Microscopically, lesions consisted of sheets of epithelioid cells containing large to enormous numbers of acid-fast bacilli 2 to 8 microm (mostly 4 to 6 microm) which stained also with haematoxylin. A single unique sequence spanning a 557 bp fragment of the 16S rRNA gene was identified in six of seven cases in which it was attempted. Formalin-fixed paraffin-embedded material was utilised by one laboratory, while fresh tissue was used in another. The same unique sequence was identified despite the use of different primers and PCR methodologies in the two laboratories. A very slow, pure growth of a mycobacteria species was observed on Lowenstein-Jensen medium (supplemented with iron) and semi-solid agar in one of three cases in which culture was attempted at a reference laboratory. Affected cats were domicile in rural or semi-rural environments. These infections could generally be cured using two or three of rifampicin (10-15 mg/kg once a day), clofazimine (25 to 50 mg once a day or 50 mg every other day) and clarithromycin (62.5 mg per cat every 12 h). These findings suggest that feline leprosy comprises two different clinical syndromes, one tending to occur in young cats and caused typically by M lepraemurium and another in old cats caused by a single novel mycobacterial species.
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Affiliation(s)
- R Malik
- Faculty of Veterinary Science, The University of Sydney, New South Wales 2006, Australia.
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Chaves A, Torrelo A, Mediero IG, Menéndez-Rivas M, Ortega-Calderón A, Zambrano A. Primary cutaneous Mycobacterium kansasii infection in a child. Pediatr Dermatol 2001; 18:131-4. [PMID: 11358554 DOI: 10.1046/j.1525-1470.2001.018002131.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 6-year-old girl with a primary cutaneous form of Mycobacterium kansasii infection is presented. Disseminated infection and immune deficiency were excluded in our patient. She was successfully treated with surgical excision and oral erythromycin. Primary cutaneous M. kansasii is an exceedingly rare infection in children.
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Affiliation(s)
- A Chaves
- Department of Dermatology, Hospital del Niño Jesus, Madrid, Spain
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Zaballos P, Ara M, José Carapeto F. Infección cutánea por Mycobacterium chelonae y M. abscessus. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0213-9251(01)72486-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Malik R, Martin P, Wigney D, Swan D, Slatter PS, Cibilic D, Allen J, Mitchell DH, Chen SC, Hughes MS, Love DN, Sattler PS. Treatment of canine leproid granuloma syndrome: preliminary findings in seven dogs. Aust Vet J 2001; 79:30-6. [PMID: 11221566 DOI: 10.1111/j.1751-0813.2001.tb10635.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine effective treatment strategies for patients with refractory canine leproid granuloma syndrome. DESIGN Multi-institutional retrospective/prospective case series using client-owned dogs. PROCEDURE Seven dogs (four Boxers, one Dobermann, one Bullmastiff and one Bullmastiff cross-bred; ages 3 to 11 years) with leproid granulomas were treated successfully using a variety of treatment regimens. These cases were recruited because: lesions were either widely distributed over the dog; progressive, despite routine therapy, or were associated with particularly disfiguring lesions. The treatment regimen evolved during the course of the clinical study. RESULTS Combination therapy using rifampicin (5 to 15 mg/kg p.o., every 24 h) and clarithromycin (8 to 24 mg/kg p.o. daily; dose divided every 8 or every 12 h) was used most frequently and proved to be effective and free from side effects. Total daily doses of clarithromycin in excess of 14 mg/kg were considered optimal and long treatment courses, in the order of 1 to 3 months, were used. Combination therapy using rifampicin (25 mg/kg; that is, higher than the recommended dose) and clofazimine was effective in one case, but resulted in hepatotoxicity. A topical formulation of clofazimine in petroleum jelly was used as an adjunct to oral rifampicin and doxycycline in another patient treated successfully. CONCLUSION Based on our evolving clinical experience, a combination of rifampicin (10 to 15 mg/kg p.o., every 24 h) and clarithromycin (15 to 25 mg/kg p.o. total daily dose; given divided every 8 to 12 h) is currently recommended for treating severe or refractory cases of canine leproid granuloma syndrome. Treatment should be continued (typically for 4 to 8 weeks) until lesions are substantially reduced in size and ideally until lesions have resolved completely. A topical formulation, containing clofazimine in petroleum jelly may be used as an adjunct to systemic drug therapy. Further work is required to determine the most cost effective treatment regimen for this condition.
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Affiliation(s)
- R Malik
- Department of Veterinary Clinical Sciences, University of Sydney, New South Wales 2006.
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Stengem J, Grande KK, Hsu S. Localized primary cutaneous Mycobacterium kansasii infection in an immunocompromised patient. J Am Acad Dermatol 1999; 41:854-6. [PMID: 10534669 DOI: 10.1016/s0190-9622(99)70344-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mycobacterium Kansasii is a rare primary cutaneous pathogen, most commonly affecting persons exposed to contaminated water, particularly after local trauma. Most patients who present with localized primary cutaneous M kansasii infection are immunocompetent, whereas the majority of patients with disseminated or pulmonary infection are immunocompromised. We describe a primary cutaneous M kansasii infection in an iatrogenically immunosuppressed patient.
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Affiliation(s)
- J Stengem
- Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA
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Abe Y, Nakamura M, Suzuki K, Hashizume T, Tanigaki T, Saito T, Fujino T, Kikuchi K. Massive hemoptysis due to Mycobacterium fortuitum infection controlled with bronchial artery embolization - a case report. Clin Imaging 1999; 23:361-3. [PMID: 10899418 DOI: 10.1016/s0899-7071(00)00163-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We reported a case of first reported pulmonary infection due to Mycobacterium fortuitum (M. fortuitum) with massive hemoptysis, successfully treated by bronchial artery embolization (BAE). A 78-year-old male was admitted to our hospital complaining of massive hemoptysis. A biochemical examination and DNA/DNA hybridization revealed M. fortuitum in the culture of his sputum. He was treated by BAE, and antituberculous agents and levofloxacin. The patient remains well without recurrence more than one and a half years after the admission.
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Affiliation(s)
- Y Abe
- Department of Respiratory Disease, National Sanatorium Kanagawa Hospital, Ochiai 666-1, 257-8585, Kanagawa, Japan
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Abstract
In addition to erythromycin, macrolides now available in the United States include azithromycin and clarithromycin. These two new macrolides are more chemically stable and better tolerated than erythromycin, and they have a broader antimicrobial spectrum than erythromycin against Mycobacterium avium complex (MAC), Haemophilus influenzae, nontuberculous mycobacteria, and Chlamydia trachomatis. All three macrolides have excellent activity against the atypical respiratory pathogens (C. pneumoniae and Mycoplasma species) and the Legionella species. Azithromycin and clarithromycin have pharmacokinetics that allow shorter dosing schedules because of prolonged tissue levels. Both azithromycin and clarithromycin are active agents for MAC prophylaxis in patients with late-stage acquired immunodeficiency syndrome (AIDS), although azithromycin may be the preferable agent because of fewer drug-drug interactions. Clarithromycin is the most active MAC antimicrobial agent and should be part of any drug regimen for treating active MAC disease in patients with or without AIDS. Although both azithromycin and clarithromycin are well tolerated by children, azithromycin has the advantage of shorter treatment regimens and improved tolerance, potentially improving compliance in the treatment of respiratory tract and skin or soft tissue infections. Intravenously administered azithromycin has been approved for treatment of adults with mild to moderate community-acquired pneumonia or pelvic inflammatory diseases. An area of concern is the increasing macrolide resistance that is being reported with some of the common pathogens, particularly Streptococcus pneumoniae, group A streptococci, and H. influenzae. The emergence of macrolide resistance with these common pathogens may limit the clinical usefulness of this class of antimicrobial agents in the future.
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Affiliation(s)
- S Alvarez-Elcoro
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic Jacksonville, Florida, USA
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Jong J, Gelder T, IJzermans J, Endtz H, Weimar W. Atypical mycobacterium infection with dermatological manifestation in a renal transplant recipient. Transpl Int 1999. [DOI: 10.1111/j.1432-2277.1999.tb00579.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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