Localized primary cutaneous Mycobacterium kansasii infection in an immunocompromised patient

Cutaneous Mycobacteriosis Caused by Mycobacterium kansasii in a Yellow-naped Amazon Parrot (Amazona auropalliata)

An approximately 25-year-old, female, yellow-naped Amazon parrot (Amazona auropalliata) was evaluated for a chronic, raised, ulcerative mass on the lateral aspect of the left thigh. Histopathology of an excisional biopsy revealed severe, chronic, multifocal-to-coalescing, ulcerated dermal and subcutaneous granulomas. No infectious organisms were observed on Ziehl-Neelsen or Gomori methenamine silver stains. The parrot was treated with oral sulfamethoxazoletrimethoprim and meloxicam. When reexamined 2 weeks later, the biopsy site had healed. Surgical biopsies were resubmitted 14 months after the original presentation due to recurrence of similar ulcerative lesions on the right leg. Histopathology revealed a similar inflammatory pattern, and hematoxylin-eosin, Ziehl-Neelsen, and silver stains on the biopsy samples were all negative. A Fite-Faraco stain revealed rare acid-fast bacilli throughout the lesion. Tissue polymerase chain reaction test was negative for Mycobacterium avium and Mycobacterium genavense. Mycobacterial culture and subsequent genotyping revealed Mycobacterium kansasii. Mycobacterium kansasii is a significant cause of mycobacteriosis in humans and, therefore, should be considered a potential zoonotic organism. This report describes an unusual primary cutaneous presentation of avian mycobacteriosis.

Non-tuberculous mycobacterial infections in solid organ transplant recipients: An update

Non-tuberculous mycobacteria are ubiquitous environmental organisms that are now increasingly recognized as important causes of clinical disease in solid organ transplant recipients. Risk factors of non-tuberculous mycobacteria infection are severe immunologic defects and structural abnormalities. Lung transplant recipients are at higher risk for non-tuberculous mycobacterial disease compared to recipients of other solid organs. The clinical presentation could be skin and soft tissue infection, osteoarticular disease, pleuropulmonary infection, bloodstream (including catheter-associated) infection, lymphadenitis, and disseminated or multi-organ disease. Management of non-tuberculous mycobacteria infection is complex due to the prolonged treatment course with multi-drug regimens that are anticipated to interact with immunosuppressive medications. This review article provides an update on infections due to non-tuberculous mycobacteria after solid organ transplantation, and discusses the epidemiology, risk factors, clinical presentation, and management.

Nontuberculous mycobacterial infection in hematopoietic stem cell and solid organ transplant recipients

Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms. In immunocompetent hosts, they are a rare cause of disease. In immunocompromised hosts, disease due to NTM is well documented. Reports of NTM disease have increased in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. This increase may reflect increased numbers of transplants, intensification of immune suppressive regimens, prolonged survival of transplant recipients, and/or improved diagnostic techniques. The difficulty of diagnosis and the impact associated with infections due to NTM in HSCT and SOT recipients necessitates that, to ensure prompt diagnosis and early initiation of therapy, a high level of suspicion for NTM disease be maintained. The most common manifestations of NTM infection in SOT recipients include cutaneous and pleuropulmonary disease, and, in HSCT recipients, catheter-related infection. Skin and pulmonary lesions should be biopsied for histologic examination, special staining, and microbiologic cultures, including cultures for bacteria, Nocardia species, fungi, and mycobacteria. Mycobacterial infections associated with catheters may be documented by tunnel or blood (isolator) cultures. Susceptibility testing of mycobacterial isolates is an essential component of optimal care. The frequent isolation of NTM other than Mycobacterium avium complex (MAC) from transplant recipients limits the extrapolation of therapeutic data from human immunodeficiency virus-infected individuals to the population of transplant recipients. Issues involved in the management of NTM disease in transplant recipients are characterized by a case of disseminated infection due to Mycobacterium avium complex in a lung transplant recipient, with a review of the relevant literature.

Dermatologic infections in the immunocompromised (non-HIV) host

The immunocompromised host's susceptibility to infections often present a difficult diagnostic challenge to the physician. A working knowledge of the host immune defenses and microbiologic complications that can occur when these functions are compromised provides a more focused framework for further evaluation and management. Infections in these patients are often morbid and life-threatening, creating an urgent need for prompt diagnosis. The skin may manifest the first clue(s) of a serious underlying infection. Appropriate workup and diagnosis of cutaneous lesions provide an expeditious, noninvasive, and potentially life-saving approach to the immunocompromised host with a dermatologic infection.

Cutaneous infection due to Mycobacterium kansasii

A patient presented with chronic leg ulcers after a mowing accident. He received several courses of antibiotics for presumed cellulitis, underwent surgical debridement, and was treated empirically with cyclosporin for presumed pyoderma gangrenosum, all without improvement. Cultures from prior debridement revealed Mycobacterium kansasii, and he was successfully treated with triple antituberculous regimen. Cutaneous infections due to this slow growing Mycobacterium are rare and may resemble cellulitis or sporotrichosis. Mycobacterium kansasii should be included in the differential diagnosis of skin infections with an indolent course and lack of response to antibiotics.