1
|
Liu X, Hu J, Wang W, Yang H, Tao E, Ma Y, Sha S. Mycobacterial Biofilm: Mechanisms, Clinical Problems, and Treatments. Int J Mol Sci 2024; 25:7771. [PMID: 39063012 PMCID: PMC11277187 DOI: 10.3390/ijms25147771] [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: 06/02/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Tuberculosis (TB) remains a threat to human health worldwide. Mycobacterium tuberculosis (Mtb) and other nontuberculous mycobacteria (NTM) can form biofilms, and in vitro and animal experiments have shown that biofilms cause serious drug resistance and mycobacterial persistence. Deeper investigations into the mechanisms of mycobacterial biofilm formation and, consequently, the exploration of appropriate antibiofilm treatments to improve the efficiency of current anti-TB drugs will be useful for curing TB. In this review, the genes and molecules that have been recently reported to be involved in mycobacterial biofilm development, such as ABC transporter, Pks1, PpiB, GroEL1, MprB, (p)ppGpp, poly(P), and c-di-GMP, are summarized. Biofilm-induced clinical problems, including biofilm-related infections and enhanced virulence, as well as their possible mechanisms, are also discussed in detail. Moreover, we also illustrate newly synthesized anti-TB agents that target mycobacterial biofilm, as well as some assistant methods with high efficiency in reducing biofilms in hosts, such as the use of nanoparticles.
Collapse
Affiliation(s)
- Xining Liu
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Junxing Hu
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Wenzhen Wang
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Hanyu Yang
- The Queen’s University of Belfast Joint College, China Medical University, Shenyang 110122, China;
| | - Erning Tao
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Yufang Ma
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| | - Shanshan Sha
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian 116044, China; (X.L.); (J.H.); (W.W.); (E.T.)
| |
Collapse
|
2
|
Yamamoto K, Torigoe S, Kobayashi H. Formative evaluation and structural analysis of non-tuberculosis mycobacterial biofilm using material pieces. Cell Surf 2024; 11:100125. [PMID: 38799511 PMCID: PMC11126951 DOI: 10.1016/j.tcsw.2024.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
Non-tuberculosis mycobacteria (NTM) can form biofilms on diverse artificial surfaces. In the present study, we induced NTM biofilm formation on materials used in various medical devices, evaluated the total amount of biofilm, and observed the ultrastructure by scanning electron microscopy.
Collapse
Affiliation(s)
- Kentaro Yamamoto
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Aoba-cho, Higashimurayama, Tokyo, Japan
| | - Shota Torigoe
- Department of Mycobacteriology, Leprosy Research Center, National Institute of Infectious Diseases, Aoba-cho, Higashimurayama, Tokyo, Japan
- Research Center for Biosafety, Laboratory Animal, and Pathogen Bank, National Institute of Infectious Diseases, Toyama, Shinjuku-ku, Tokyo, Japan
| | - Hirotaka Kobayashi
- Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
3
|
González P, Domínguez J, Del Cid P, Rosas S, Magallón-Tejada A. Non-Tuberculous Mycobacterial isolates from Panama: A retrospective 5-year analysis (2017-2021). J Infect Public Health 2024; 17:780-788. [PMID: 38518684 DOI: 10.1016/j.jiph.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND The genus Mycobacterium includes well-known bacteria such as M. tuberculosis causing tuberculosis and M. leprae causing leprosy. Additionally, various species collectively termed non-tuberculous mycobacteria (NTM) can cause infections in humans and animals, affecting individuals across all age groups and health conditions. However, information on NTM infection prevalence in Panama is limited. METHODS This study conducted a retrospective analysis of clinical records from 2017 to 2021, specifically focusing on patients with NTM isolates. Data were categorized by variables like sex, age, HIV status, and sample source. RESULTS Among the 4430 clinical records analyzed, 698 were linked to patients with NTM isolates. Of these patients, 397 were male, and 301 were female. Most female patients with NTM isolates (n = 190) were aged >45 to 85 years, while most male patients (n = 334) fell in the >25 to 75 years age group. A noteworthy proportion of male patients (n = 65) were aged 25-35 years. A significant age difference between male (median [min-max] = 53 years [3-90]) and female (median [61 years [6-94]) patients was observed (p < 0.001). Regarding HIV status, 77 positive individuals were male, and 19 were female (p < 0.001). Most samples (n = 566) were sputum samples, with additional pulmonary-associated samples such as broncho-alveolar lavage, tracheal secretions, and pleural fluid samples. Among extrapulmonary isolates (n = 48), sources included catheter secretions, intracellular fluids, peritoneal fluid, blood cultures, cerebrospinal fluid, bone marrow samples, and capillary transplant lesions. Specifically, the analysis identified the pathogenic microorganisms responsible for mycobacteriosis in Panama during the specific period 2017-2021, as M. fortuitum (34.4%), M. intracellulare (20.06%), and M. abscessus (13.75%), respectively. CONCLUSIONS This study highlights the growing public health concern of NTM infections in Panama. The research provides valuable insights into the prevalence and distribution of NTM species in the country, offering a foundation for the development and implementation of effective prevention and control strategies for NTM infections in Panama.
Collapse
Affiliation(s)
- Prudencio González
- Laboratorio Central de Referencia en Salud Pública - Sección de Micobacteriología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | - Juan Domínguez
- Laboratorio Central de Referencia en Salud Pública - Sección de Micobacteriología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | - Pedro Del Cid
- Laboratorio Central de Referencia en Salud Pública - Sección de Micobacteriología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama
| | - Samantha Rosas
- Laboratorio Central de Referencia en Salud Pública - Sección de Micobacteriología, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama.
| | - Ariel Magallón-Tejada
- Estación de Biomédica Experimental, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panama.
| |
Collapse
|
4
|
Meliefste HM, Mudde SE, Ammerman NC, de Steenwinkel JEM, Bax HI. A laboratory perspective on Mycobacterium abscessus biofilm culture, characterization and drug activity testing. Front Microbiol 2024; 15:1392606. [PMID: 38690364 PMCID: PMC11058659 DOI: 10.3389/fmicb.2024.1392606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Mycobacterium abscessus is an emerging opportunistic pathogen causing severe pulmonary infections in patients with underlying lung disease and cystic fibrosis in particular. The rising prevalence of M. abscessus infections poses an alarming threat, as the success rates of available treatment options are limited. Central to this challenge is the absence of preclinical in vitro models that accurately mimic in vivo conditions and that can reliably predict treatment outcomes in patients. M. abscessus is notorious for its association with biofilm formation within the lung. Bacteria in biofilms are more recalcitrant to antibiotic treatment compared to planktonic bacteria, which likely contributes to the lack of correlation between preclinical drug activity testing (typically performed on planktonic bacteria) and treatment outcome. In recent years, there has been a growing interest in M. abscessus biofilm research. However, the absence of standardized methods for biofilm culture, biofilm characterization and drug activity testing has led to a wide spectrum of, sometimes inconsistent, findings across various studies. Factors such as strain selection, culture medium, and incubation time hugely impact biofilm development, phenotypical characteristics and antibiotic susceptibility. Additionally, a broad range of techniques are used to study M. abscessus biofilms, including quantification of colony-forming units, crystal violet staining and fluorescence microscopy. Yet, limitations of these techniques and the selected readouts for analysis affect study outcomes. Currently, research on the activity of conventional antibiotics, such as clarithromycin and amikacin, against M. abscessus biofilms yield ambiguous results, underscoring the substantial impact of experimental conditions on drug activity assessment. Beyond traditional drug activity testing, the exploration of novel anti-biofilm compounds and the improvement of in vitro biofilm models are ongoing. In this review, we outline the laboratory models, experimental variables and techniques that are used to study M. abscessus biofilms. We elaborate on the current insights of M. abscessus biofilm characteristics and describe the present understanding of the activity of traditional antibiotics, as well as potential novel compounds, against M. abscessus biofilms. Ultimately, this work contributes to the advancement of fundamental knowledge and practical applications of accurate preclinical M. abscessus models, thereby facilitating progress towards improved therapies for M. abscessus infections.
Collapse
Affiliation(s)
| | - Saskia Emily Mudde
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nicole Christine Ammerman
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Hannelore Iris Bax
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
5
|
Naito M, Fukushima K, Kusakabe S, Endo T, Shiroyama T, Ohira K, Azuma K, Tanizaki S, Yamamoto Y, Hosono Y, Naito Y, Futami S, Miyake K, Hirata H, Takeda Y, Kumanogoh A. Disseminated non-tuberculous mycobacterial infection caused by Mycobacterium obuense in an immunocompromised patient: a case report. BMC Infect Dis 2023; 23:517. [PMID: 37550642 PMCID: PMC10408174 DOI: 10.1186/s12879-023-08510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Mycobacterium obuense (M. obuense) is a rapidly growing mycobacterium (RGM) which has been considered nonpathogenic. Here, we report a case of disseminated non-tuberculous mycobacterial (NTM) infection caused by M. obuense in an immunocompromised patient. CASE PRESENTATION A 16-year-old boy was referred to our hospital due to acute myeloid leukemia. During the treatment of leukemia, the patient exhibited continuous fever, and diffuse miliary nodules with random distribution were found on chest computed tomography. Repeated examinations of bacterial culture tests revealed sputum and urine samples to be smear-positive for acid-fast bacillus, and blood culture from a peripherally inserted central catheter line showed the growth of NTM. The NTM species was identified as M. obuense by mass spectrometry and confirmed by genome sequencing. Combination therapy with amikacin, rifampicin, azithromycin, and moxifloxacin significantly improved the patient's symptoms and radiological findings. CONCLUSION We report a case of disseminated NTM infection caused by M. obuense for which combination anti-microbial therapy was effective. An immunocompromised host indwelling catheter is at risk of RGM bloodstream infections. Although relatively rare, M. obuense may be considered as a potential pathogen causing infectious diseases, especially in high-risk patients.
Collapse
Affiliation(s)
- Maiko Naito
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kentaro Fukushima
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinsuke Kusakabe
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takaya Endo
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takayuki Shiroyama
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kika Ohira
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koji Azuma
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Tanizaki
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yumiko Yamamoto
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuki Hosono
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yujiro Naito
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinji Futami
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kotaro Miyake
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshito Takeda
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
6
|
Chen X, Zhu J, Liu Z, Ye J, Yang L, Zhang Z. Mixed infection of three nontuberculous mycobacteria species identified by metagenomic next-generation sequencing in a patient with peritoneal dialysis-associated peritonitis: a rare case report and literature review. BMC Nephrol 2023; 24:95. [PMID: 37055720 PMCID: PMC10099677 DOI: 10.1186/s12882-023-03156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Peritonitis caused by nontuberculous mycobacteria (NTM) is an infrequent but important complication in patients undergoing peritoneal dialysis (PD). There has been no report of mixed infections with multiple NTM. Peritoneal dialysis-associated peritonitis (PDAP) caused by Mycobacterium abscessus is more common than that caused by M. smegmatis and M. goodii. CASE PRESENTATION This case concerns a patient with PDAP caused by gram-positive bacilli, which could not be identified at the species level in successive detections of initial peritoneal effluent. Later, M. smegmatis was detected with no sensitivity results in bacterial culture. However, metagenomic next-generation sequencing (mNGS) and first whole-genome sequences indicated that there were three species coexisting in the culture, including M. smegmatis (24,708 reads), M. abscessus (9224 reads), and M. goodii (8305 reads). This is the first case of PDAP with specific evidence that conventional detection methods isolated a poorly pathogenic NTM, whereas mNGS and first whole-genome sequences identified multiple NTM. Pathogenic bacteria might not be detected using conventional methods due to their lower abundance. This case report is the first description of mixed infections with more than two species of NTM during PDAP. CONCLUSIONS PDAP caused by multiple NTM is rare, and the diagnosis is difficult. When NTM are isolated by conventional tests in patients who are suspected of infection, clinicians should be vigilant, and further tests should be performed to determine the presence of rare or even previously unknown bacteria, for which the quantity is relatively low, but the pathogenicity is high. The rare pathogen may be a primary agent in causing such complications.
Collapse
Affiliation(s)
- Xiangfeng Chen
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jie Zhu
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhou Liu
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Ye
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liqi Yang
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenhua Zhang
- Department of Infectious Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| |
Collapse
|
7
|
Muñoz-Egea MC, Akir A, Esteban J. Mycobacterium biofilms. Biofilm 2023; 5:100107. [PMID: 36798742 PMCID: PMC9925856 DOI: 10.1016/j.bioflm.2023.100107] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
The genus Mycobacterium includes some of the deadliest pathogens of History (Mycobacterium tuberculosis, Mycobacterium leprae), but most of the species within the genus are environmental microorganisms. Because some of these nontuberculous mycobacteria (NTM) species can be human pathogens, the study of these mycobacterial biofilms has increased during the last decades, and the interest in this issue increased as well as the growing number of patients with diseases caused by NTM. Different molecular mechanisms have been described, being especially well known the importance of glycopeptidolipids. Moreover, the knowledge of the extracellular matrix has shown important differences with other microorganisms, especially because of the presence of lipidic molecules as a key component of this structure. The clinical importance of mycobacterial biofilms has been described for many chronic diseases, especially lung diseases and implant-related ones, both in vitro and in vivo, and even in patients. Moreover, the biofilm-producing capacity has been proven also in M. tuberculosis, while its importance is not well understood. Biofilm studies have also shown the increasing resistance of mycobacteria in sessile form, and the importance of this resistance in the management of the patients is beyond doubt, being surgery necessary in some cases to cure the patients. Diagnosis of mycobacterial diseases is still based on culture-based techniques designed for the detection of M. tuberculosis. Molecular biology-based methods are also broadly used but again designed for tuberculosis diagnosis. Antimicrobial susceptibility testing is also well developed for tuberculosis, but only some species of NTM have standardized techniques for this purpose. New tools or approaches are necessary to treat these patients, whose importance is increasing, as the number of potential hosts is also increasing throughout the world.
Collapse
Affiliation(s)
- Maria-Carmen Muñoz-Egea
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain,CIBERINFEC - CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Arij Akir
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain,CIBERINFEC - CIBER de Enfermedades Infecciosas, Madrid, Spain,Corresponding author. Dept. of Clinical Microbiology, IIS-Fundacion Jimenez Diaz, UAM. Av. Reyes Católicos 2, 28040, Madrid, Spain.
| |
Collapse
|
8
|
Shin HS, Yang B, Kim SR, Kim HS, Shin KS, Shin YM. Disseminated nontuberculous mycobacteria infection in an immunocompetent host: A case report. Medicine (Baltimore) 2023; 102:e32416. [PMID: 36607850 PMCID: PMC9829286 DOI: 10.1097/md.0000000000032416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Disseminated nontuberculous mycobacterial (NTM) infections are rare and occur primarily in immunocompromised hosts. Mycobacterium abscessus complex (MABC), including M abscessus subsp. massiliense (hereafter M massiliense) is a complex of rapidly growing mycobacterial (RGM) species of NTM. Here, we present a rare case of disseminated NTM infection with RGM bacteremia caused by M massiliense in an immunocompetent host. PATIENT CONCERNS A 64-year-old woman with a recent history of spine fracture and septic pneumonia was transferred to our emergency room for dyspnea and fever. A peripherally inserted central catheter (PICC) had been placed over 6 months prior. DIAGNOSES Chest computed tomography (CT) showed multifocal patchy consolidations and ground-glass opacity in both lungs. NTM suspected of RGM was isolated from the blood cultures. During hospitalization, multiple erythematous and hemorrhagic crusted nodules developed on the patient's upper and lower extremities, which were confirmed as disseminated NTM infection on skin biopsy. INTERVENTIONS After NTM suspected of RGM was isolated from the blood cultures, the patient was empirically treated with antibiotics used for NTM infection, and the PICC was removed. Thereafter, the subspecies of NTM was reported as M massiliense and she was treated according to the antibiotic susceptibility testing results. OUTCOME Although skin lesions and inflammatory markers improved gradually during antibiotic treatment over 10 weeks, NTM could still be isolated from the blood culture. LESSONS Disseminated NTM infections with RGM bacteremia in an immunocompetent host have rarely been reported. In this case, PICC placement for more than 6 months was suspected to be an important risk factor for RGM bacteremia in an immunocompetent patient. To date, there are only insufficient case reports, moreover no clear guidelines regarding the optimal choice of antibiotics or length of treatment for disseminated NTM infection. Therefore, it is necessary to establish treatment guidelines for patients with disseminated NTM infection and bacteremia.
Collapse
Affiliation(s)
- Hye Soon Shin
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - So Rae Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hee-Sung Kim
- Division of Infectious Disease, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- * Correspondence: Yoon Mi Shin, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea (e-mail address: )
| |
Collapse
|
9
|
Ranson EL, Tsevat RK, von Bredow B, Kamau E, Yang S, Prabaker KK. Catheter-Related Bloodstream Infection Caused by Mycolicibacterium iranicum, California, USA. Emerg Infect Dis 2023; 29:217-219. [PMID: 36573647 PMCID: PMC9796217 DOI: 10.3201/eid2901.220851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We describe a case of catheter-related bacteremia caused by Mycolicibacterium iranicum in the United States. The case highlights the value of using next-generation sequencing to identify infrequent and emerging pathogens and the challenges associated with choosing appropriate treatments because of limited knowledge of drug resistance mechanisms in those emerging pathogens.
Collapse
|
10
|
Kemp N, Malpas T, Bate J. Accentuate the Gram positive: an unusual infection in an oncology patient. Arch Dis Child Educ Pract Ed 2022; 107:364-365. [PMID: 33619066 DOI: 10.1136/archdischild-2020-321259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/06/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Natalie Kemp
- Paediatrics, Jersey General Hospital, Saint Helier, Jersey
| | - Tim Malpas
- Paediatrics, Jersey General Hospital, Saint Helier, Jersey
| | - Jessica Bate
- Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| |
Collapse
|
11
|
Singh M, Krishnan M, Ruiz ME, Sheikh FH. Nontuberculous Mycobacterial Infections Associated With Left Ventricular Assist Devices in 3 Patients. Tex Heart Inst J 2022; 49:483734. [PMID: 35838643 DOI: 10.14503/thij-20-7498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Durable left ventricular assist devices (LVADs) provide circulatory support in patients with end-stage heart failure; however, complications include infection of the driveline exit site. Nontuberculous mycobacterial infections are rare in patients with LVADs, but they should be considered in those who have undergone device exchanges and have bacterial infections with driveline exit-site discharge but no fever or leukocytosis. We reviewed the charts of patients who had an LVAD implanted at our institution from January 2009 through December 2019, to identify those with a device-related nontuberculous mycobacterial infection. Collected data included patient demographics, premorbid conditions, infection type, previous device complications, treatment, and outcomes. We identified infections in 3 patients (mean age, 41 yr): Mycobacterium abscessus in 2 and M. chimaera in 1. All had a HeartMate II device and had undergone device exchanges for pump thrombosis or for driveline fault or infections. All presented with driveline exit-site discharge without fever or leukocytosis. The mean time between initial device implantation and diagnosis of a nontuberculous mycobacterial infection was 55 months. All 3 patients were treated with antibiotics and underwent localized surgical débridement; one underwent an additional device exchange. The M. abscessus infections disseminated, and both patients died; the patient with M. chimaera infection continued to take suppressive antibiotics. Nontuberculous mycobacterial infections are associated with high morbidity and mortality rates, warranting prompt diagnosis and treatment.
Collapse
Affiliation(s)
- Manavotam Singh
- Division of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Mrinalini Krishnan
- Division of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| | - Maria Elena Ruiz
- Section of Infectious Diseases, Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Farooq H Sheikh
- Division of Cardiology, MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
| |
Collapse
|
12
|
NonTuberculous Mycobacteria Blood Stream Infection in Pediatric and Adult Patients: 15 Years Surveillance. Pediatr Infect Dis J 2022; 41:e216-e219. [PMID: 35093997 DOI: 10.1097/inf.0000000000003473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nontuberculous Mycobacteria (NTM) are rare causes of bloodstream infection (BSI). This study addresses the management and prognosis of NTM BSI and the differences between adult and pediatric patients. METHODS We retrospectively reviewed the medical charts of patients at any age with NTM BSI, from January 1, 2005, to June 30, 2020. Data on demographics, underlying conditions, clinical manifestations, NTM species, antibiotic treatments and outcomes were retrieved. RESULTS Positive blood cultures for NTM were detected in 43 patients, 30 children and 13 adults. Median age: 10.37 years (IQR 6.692-39.864). Thirty-seven (86%) patients had an active malignant disease. Fever was the chief sign in 23 (53.5%) patients and pulmonary manifestations in 14 (32.6%). Rapidly growing NTM comprised 39 (90.7%) of the isolates. Central venous catheter (CVC) was documented in 39 (90.7%) cases, 31 (79.5%) of which were removed as part of treatment. Antibiotic treatment directed against NTM was documented in 26 (60.5%) patients. CVC was removed in 7/17 patients who were not treated with antibiotics. Relapse occurred in 3 cases; no 30-days mortality was reported. Children and adults had similar clinical characteristics. However, children had a higher rate of CVC at the time of bacteremia and a higher chance to receive treatment. CONCLUSION NTM BSI was seen mainly in oncologic patients with CVC. Children and adults had a similar disease course and outcome. Relapse was rare and NTM-related mortality was not reported.
Collapse
|
13
|
Piersigilli F, Auriti C, Dotta A, Goffredo BM, Cairoli S, Savarese I, Campi F, Corsetti T, Bersani I. Use of Meropenem and Other Antimicrobial Lock Therapy in the Treatment of Catheter-Related Blood Stream Infections in Neonates: A Retrospective Study. CHILDREN 2022; 9:children9050614. [PMID: 35626791 PMCID: PMC9140042 DOI: 10.3390/children9050614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/03/2022]
Abstract
(1) Background: Newborns admitted to Neonatal Intensive Care Units (NICUs) often require the placement of central vascular catheters (CVC), which are a major risk factor for hospital infection. Numerous strategies exist to prevent central line-associated blood stream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs), with only a few offering options to save the catheter when it is impossible to replace. CRBSIs continue to be a major problem for neonates in NICUs. Most CRBSIs are resistant to systemic antibiotics due to the presence of intraluminal bacterial biofilm. Therefore, catheter removal is frequently necessary when a CRBSI occurs. The so-called Antibiotic Lock Therapy (ALT) is an antimicrobial therapeutic strategy which seems to be promising in neonates when catheter removal is difficult due to critical conditions. To date, evidence about the use of ALT in the neonatal period is still fragmentary, since only poor and heterogeneous data exist. (2) Methods: We report our successful experience with ALT in seriously ill neonates with CRBSI for whom the replacement of the catheter could have been life threatening. (3) Results: ALT repetitively performed for at least 12 h was effective in 11 out of 13 infants (84.6%). It was not effective in two infants in whom ALT was performed for only 6 h. Moreover, we present new data about the stability testing of meropenem for its use during ALT in neonates. (4) Conclusions: When CRBSI occurs—bearing in mind that the optimal management is catheter removal if antibiotic therapy is not effective within 48 h—ALT seems to be a valid alternative therapy when removal is impractical due to critical conditions.
Collapse
Affiliation(s)
- Fiammetta Piersigilli
- Department of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Bruxelles, Belgium
- Correspondence: ; Tel.: +32-4-7167-6903
| | - Cinzia Auriti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.A.); (A.D.); (I.S.); (F.C.); (I.B.)
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.A.); (A.D.); (I.S.); (F.C.); (I.B.)
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (B.M.G.); (S.C.)
| | - Sara Cairoli
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (B.M.G.); (S.C.)
| | - Immacolata Savarese
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.A.); (A.D.); (I.S.); (F.C.); (I.B.)
| | - Francesca Campi
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.A.); (A.D.); (I.S.); (F.C.); (I.B.)
| | - Tiziana Corsetti
- Unit of Clinical Pharmacy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Iliana Bersani
- Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (C.A.); (A.D.); (I.S.); (F.C.); (I.B.)
| |
Collapse
|
14
|
Narayanaswamy VP, Townsend SM, Loughran AJ, Wiesmann W, Baker S. Polycationic Glycopolymer Demonstrates Activity Against Persisters and Biofilms of Non-tuberculosis Mycobacteria Cystic Fibrosis Clinical Isolates in vitro. Front Microbiol 2022; 13:821820. [PMID: 35265060 PMCID: PMC8900536 DOI: 10.3389/fmicb.2022.821820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/31/2022] [Indexed: 01/15/2023] Open
Abstract
Non-tuberculosis Mycobacterium (NTM) is a group of opportunistic pathogens associated with pulmonary infections that are difficult to diagnose and treat. Standard treatment typically consists of prolonged combination antibiotic therapy. Antibiotic resistance and the role of biofilms in pathogen communities, such as NTM persister cells, is an important unmet challenge that leads to increased toxicity, frequent relapse, poor clinical management, and an extended treatment period. Infection recurrence and relapse are not uncommon among individuals with cystic fibrosis (CF) or chronic obstructive pulmonary disease (COPD), where thick mucus supports bacterial biofilm production and impairs mucociliary clearance. The study evaluates a membrane-active cationic glycopolymer [poly (acetyl, arginyl) glucosamine (PAAG)] being developed to support the safe and effective treatment of NTM biofilm infections. PAAG shows antibacterial activity against a wide range of pathogenic bacteria at concentrations non-toxic to human epithelial cells. Time-kill curves demonstrated PAAG’s rapid bactericidal potential at concentrations as low as 1X MIC against all NTM strains tested and compared to the standard of care. PAAG treatment prevents persister formation and eradicates antibiotic-induced persister cells in planktonic NTM cultures below the limit of detection (10 colony-forming unit (CFU)/ml). Further, PAAG showed the ability to penetrate and disperse NTM biofilms formed by both rapidly and slowly growing strains, significantly reducing the biofilm biomass (p < 0.0001) compared to the untreated NTM biofilms. Microscopical examination confirmed PAAG’s ability to disrupt and disperse mycobacterial biofilms. A single PAAG treatment resulted in up to a 25-fold reduction in live-labeled NTM and a 78% reduction in biofilm thickness. Similar to other polycationic molecules, PAAG’s bactericidal and antibiofilm activities employ rapid permeabilization of the outer membrane of the NTM strains, and subsequently, reduce the membrane potential even at concentrations as low as 50 μg/ml (p < 0.001). The outcomes of these in vitro analyses suggest the importance of this polycationic glycopolymer, PAAG, as a potential therapeutic agent for opportunistic NTM infections.
Collapse
Affiliation(s)
| | | | | | | | - Shenda Baker
- Synedgen, Inc., Claremont, CA, United States.,Synspira Therapeutics, Inc., Framingham, MA, United States
| |
Collapse
|
15
|
Successful treatment of rapid growing mycobacterial infections with source control alone: Case series. IDCases 2021; 26:e01332. [PMID: 34815937 PMCID: PMC8592859 DOI: 10.1016/j.idcr.2021.e01332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Rapid growing mycobacteria have been increasingly recognized as pathogens, both in immunocompromised and immunocompetent population, and their incidence has increased over the last decade significantly. Pulmonary infections are the most common, however, any organ can be affected. The treatment of these infections is costly, prolonged, and often antimicrobial resistance poses a significant challenge to a successful outcome. The source control together with antimicrobials is the cornerstone of treatment. We report a case series of 3 patients with extrapulmonary rapid growing mycobacterial infections in whom the successful treatment was achieved with source control alone.
Collapse
|
16
|
Sharma A, Vashistt J, Shrivastava R. Response surface modeling integrated microtiter plate assay for Mycobacterium fortuitum biofilm quantification. BIOFOULING 2021; 37:830-843. [PMID: 34503352 DOI: 10.1080/08927014.2021.1974846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
In this study, the effects of agitation, temperature, and pH on biofilm formation by Mycobacterium fortuitum were studied and quantified through response surface modeling. The microtiter plate assay was optimized to achieve conditions favoring maximum mycobacterial biofilm quantification. Optical density (OD) measurement using a crystal violet assay was performed to estimate the amount of biofilm formed. Response surface methodology (RSM) results revealed an R2 value of 96.18%, exhibiting a maximum OD of 2.119 (λ570 nm) at a temperature of 37 °C and pH 7.0, under a static environment. The conditions were experimentally validated. Statistically significant results showed that the maximum biofilm was produced 96 h after mycobacterial inoculation. Thus, the results provide a basis for using RSM as an efficient optimization method for M. fortuitum biofilm assays. This approach can also be incorporated into strategies for screening anti-biofilm compounds, synthetic chemicals, drugs, or inhibitors against pathogenic mycobacteria.
Collapse
Affiliation(s)
- Ayushi Sharma
- Department of Biotechnology & Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan (H.P.), India
| | - Jitendraa Vashistt
- Department of Biotechnology & Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan (H.P.), India
| | - Rahul Shrivastava
- Department of Biotechnology & Bioinformatics, Jaypee University of Information Technology, Waknaghat, Solan (H.P.), India
| |
Collapse
|
17
|
Baker AW, Maziarz EK, Lewis SS, Stout JE, Anderson DJ, Smith PK, Schroder JN, Daneshmand MA, Alexander BD, Wallace RJ, Sexton DJ, Wolfe CR. Invasive Mycobacterium abscessus Complex Infection After Cardiac Surgery: Epidemiology, Management, and Clinical Outcomes. Clin Infect Dis 2021; 72:1232-1240. [PMID: 32133489 DOI: 10.1093/cid/ciaa215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We recently mitigated a clonal outbreak of hospital-acquired Mycobacterium abscessus complex (MABC), which included a large cluster of adult patients who developed invasive infection after exposure to heater-cooler units during cardiac surgery. Recent studies have detailed Mycobacterium chimaera infections acquired during cardiac surgery; however, little is known about the epidemiology and clinical courses of cardiac surgery patients with invasive MABC infection. METHODS We retrospectively collected clinical data on all patients who underwent cardiac surgery at our hospital and subsequently had positive cultures for MABC from 2013 through 2016. Patients with ventricular assist devices or heart transplants were excluded. We analyzed patient characteristics, antimicrobial therapy, surgical interventions, and clinical outcomes. RESULTS Ten cardiac surgery patients developed invasive, extrapulmonary infection from M. abscessus subspecies abscessus in an outbreak setting. Median time from presumed inoculation in the operating room to first positive culture was 53 days (interquartile range [IQR], 38-139 days). Disseminated infection was common, and the most frequent culture-positive sites were mediastinum (n = 7) and blood (n = 7). Patients received a median of 24 weeks (IQR, 5-33 weeks) of combination antimicrobial therapy that included multiple intravenous agents. Six patients required antibiotic changes due to adverse events attributed to amikacin, linezolid, or tigecycline. Eight patients underwent surgical management, and 6 patients required multiple sternal debridements. Eight patients died within 2 years of diagnosis, including 4 deaths directly attributable to MABC infection. CONCLUSIONS Despite aggressive medical and surgical management, invasive MABC infection after cardiac surgery caused substantial morbidity and mortality. New treatment strategies are needed, and compliance with infection prevention guidelines remains critical.
Collapse
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
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, 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
| | - Jason E Stout
- Division of Infectious Diseases, Duke University School of Medicine, 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
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mani A Daneshmand
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.,Duke University Clinical Microbiology Laboratory, Durham, North Carolina, USA
| | - Richard J Wallace
- Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler, Texas, USA
| | - Daniel J Sexton
- 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
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
18
|
López-López JP, Posada-Martínez EL, Saldarriaga C, Wyss F, Ponte-Negretti CI, Alexander B, Miranda-Arboleda AF, Martínez-Sellés M, Baranchuk A. Tuberculosis and the Heart. J Am Heart Assoc 2021; 10:e019435. [PMID: 33733808 PMCID: PMC8174360 DOI: 10.1161/jaha.120.019435] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acquired tuberculosis continues to be a challenge worldwide. Although tuberculosis has been considered a global public health emergency, it remains poorly controlled in many countries. Despite being primarily a pulmonary disease, tuberculosis could involve the heart. This systematic review is part of the "Neglected Tropical Diseases and Other Infectious Diseases Involving the Heart" (the NET-Heart Project) initiative from the Interamerican Society of Cardiology. This project aims to review the cardiovascular involvement of these heterogeneous diseases, advancing original algorithms to help healthcare providers diagnose and manage cardiovascular complications. In tuberculosis, pericardium involvement is relatively common, especially in AIDS, and tuberculosis is the most common cause of constrictive pericarditis in endemic countries. Myocarditis and aortitis by tuberculosis are rare. Clinical manifestations of cardiovascular involvement by tuberculosis differ from those typically found for bacteria or viruses. Prevailing systemic symptoms and the pericarditis diagnostic index should be taken into account. An echocardiogram is the first step for diagnosing cardiovascular involvement; however, several image modalities can be used, depending on the suspected site of infection. Adenosine deaminase levels, gamma interferon, or polymerase chain reaction testing could be used to confirm tuberculosis infection; each has a high diagnostic performance. Antituberculosis chemotherapy and corticosteroids are treatment mainstays that significantly reduce mortality, constriction, and hospitalizations, especially in patients with HIV. In conclusion, tuberculosis cardiac involvement is frequent and could lead to heart failure, constrictive pericarditis, or death. Early detection of complications should be a cornerstone of overall management.
Collapse
Affiliation(s)
- José Patricio López-López
- Department of Medicine Fundación Oftalmológica de Santander (FOSCAL) Bucaramanga Colombia.,Instituto de Investigaciones Masira Universidad de Santander (UDES) Bucaramanga Colombia
| | | | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic Clínica Cardiovascular Santa MariaUniversidad of Antioquia Medellín Colombia
| | - Fernando Wyss
- Technology and Cardiovascular Service of Guatemala - Cardiosolutions Guatemala City Guatemala
| | | | - Bryce Alexander
- Division of Cardiology Kingston Health Science CenterQueen's University Kingston Canada
| | | | - Manuel Martínez-Sellés
- Servicio de Cardiología Hospital Universitario Gregorio MarañónCIBERCVUniversidad EuropeaUniversidad Complutense Madrid Spain
| | - Adrian Baranchuk
- Division of Cardiology Kingston Health Science CenterQueen's University Kingston Canada
| | | |
Collapse
|
19
|
Pérez-Cortés Villalobos A, Rotstein C. Mycobacterium mucogenicum and Mycobacterium neoaurum bacteremia in immunocompromised hosts. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:55-62. [PMID: 36340214 PMCID: PMC9612434 DOI: 10.3138/jammi-2020-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mycobacterium mucogenicum and Mycobacterium neoaurum are infrequent causes of bacteremia in humans. When they are isolated from blood, it is not unusual for them to initially be considered contaminants. METHODS A retrospective chart review of patients diagnosed with M. mucogenicum and M. neoaurum bacteremia from January 1998 to December 2018 was conducted at the University Health Network, Toronto, Ontario, Canada. RESULTS We identified 28 patients who had bacteremia caused by these organisms. These patients were primarily immunocompromised, had chronically indwelling vascular access devices, or used intravenous drugs. For 29% of the patients, the isolation of these mycobacteria was considered colonization, whereas 82% of the patients received antimicrobial therapy and 95% had the central line removed. CONCLUSIONS The removal of the vascular access device and treatment with either single or combination antimicrobial therapy produced successful outcomes for people with these infections.
Collapse
Affiliation(s)
- Armelle Pérez-Cortés Villalobos
- Immunocompromised Host Infectious Diseases Service and Division of Infectious Diseases, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Coleman Rotstein
- Immunocompromised Host Infectious Diseases Service and Division of Infectious Diseases, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Bae JY, Yun IS, Roh TS, Kim YS. Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2021. [DOI: 10.14730/aaps.2020.02327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
Mycobacterium neoaurum Bloodstream Infection Associated with a Totally Implanted Subclavian Port in an Adult with Diabetes and History of Colon Cancer. Case Rep Infect Dis 2021; 2020:8878069. [PMID: 33489390 PMCID: PMC7790582 DOI: 10.1155/2020/8878069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background. Mycobacterium neoaurum is a rapidly growing nontuberculosis mycobacterium (NTM) that was first isolated from soil in 1972 and is ubiquitous in soil, water, and dust. The first reported case of human infection by M. neoaurum was published in 1988, presenting as a Hickman catheter-related bacteremia in a patient with ovarian cancer. M. neoaurum has since been recognized as a source of predominantly opportunistic bloodstream infections in immunocompromised hosts. We report the case of an adult diabetic male with M. neoaurum bloodstream infection secondary to an infected venous-access port that had been implanted nearly six years prior for temporary chemotherapy. Case Presentation. A 66-year-old male with schizophrenia, type 2 diabetes mellitus, and a history of excision and chemotherapy to treat adenocarcinoma of the colon 6 years prior, presented with fever and behavioral changes. He was found to have a M. neoaurum bloodstream infection secondary to his implanted subclavian port. Multiple preoperative blood cultures, as well as the removed catheter tip culture, were positive for M. neoaurum. The patient's condition improved to near premorbid levels after port removal and 6 weeks of targeted antimicrobial therapy. Discussion and Conclusions. Bloodstream infections due to rapidly growing NTM, such as M. neoaurum, have been infrequently reported; however, improved isolation and identification techniques based on genomic testing are resulting in a more in-depth recognition of these widely scattered environmental microbes in human infections. Nonetheless, lengthy identification and susceptibility processes remain a diagnostic and treatment barrier. Patients such as ours who have a history of malignancy and an indwelling foreign body have most often been reported as acquiring M. neoaurum bacteremia. Fortunately, device removal and appropriate antimicrobial therapy guided by susceptibility data is often enough to manage these atypical mycobacterial infections.
Collapse
|
22
|
Mycobacterium mucogenicum bacteremia in an immunocompetent host: A case report and concise review. IDCases 2021; 23:e01032. [PMID: 33384930 PMCID: PMC7770553 DOI: 10.1016/j.idcr.2020.e01032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022] Open
Abstract
M. mucogenicum should be considered as a potential etiology of bacteremia in the setting of an inserted catheter, even in immunocompetent hosts. M. mucogenicum is one of the most common causes of rapidly growing mycobacterium bloodstream infection in patients with catheters in place. Catheter removal is critical in the management of patients with M. mucogenicum bacteremia since mycobacteria is notorious for biofilm formation. M. mucogenicum is naturally resistant to anti-tuberculous drugs. M. mucogenicum is susceptible to numerous antibiotics, making early recognition and diagnosis important to tailor appropriate therapy.
Rapidly growing mycobacterium (RGM) bloodstream infections (BSI) have been described in the literature mostly in immunocompromised patients such as those with malignancies. Here, we describe a case of a RGM, Mycobacterium mucogenicum, bloodstream infection in an immunocompetent host who was receiving antibiotics via a peripherally inserted central catheter (PICC).
Collapse
|
23
|
Boodman C, Smith C, von Kuster K, Lagacé-Wiens P, Wuerz T. Mycobacterium Mucogenicum Bacteremia and Nodular Soft Tissue Infection in a Person Who Uses Tap Water to Inject Drugs. Open Forum Infect Dis 2020; 8:ofaa580. [PMID: 33447641 PMCID: PMC7793457 DOI: 10.1093/ofid/ofaa580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
The ongoing North American epidemic of intravenous opioid and methamphetamine use increases the occurrence of bacteremia from environmental organisms. In this study, we report a case of Mycobacterium mucogenicum bacteremia and associated nodular soft tissue infection in a person who uses tap water to inject drugs.
Collapse
Affiliation(s)
- Carl Boodman
- Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Smith
- Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Community IV Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Ken von Kuster
- Department of Pathology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Shared Health, Winnipeg, Manitoba, Canada
| | - Philippe Lagacé-Wiens
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Shared Health, Winnipeg, Manitoba, Canada
| | - Terence Wuerz
- Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
24
|
Jheeta AS, Rangaiah J, Clark J, Makanjuola D, Somalanka S. Mycobacterium abscessus - an uncommon, but important cause of peritoneal dialysis-associated peritonitis - case report and literature review. BMC Nephrol 2020; 21:491. [PMID: 33203375 PMCID: PMC7672848 DOI: 10.1186/s12882-020-02146-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is a form of therapy for end-stage kidney disease (ESKD), and peritonitis is a known complication. Mycobacterium (M) species associated peritonitis in PD patients is uncommon. Our experience of managing PD associated peritonitis caused by M abscessus in a middle-aged man with ESKD due to focal segmental glomerulosclerosis is shared in this article with a review of the literature on this condition. CASE PRESENTATION A 49-year old man presented to our unit with symptoms of peritonitis and cloudy PD effluent. Initial analysis of PD fluid showed Gram stain was negative, with no organism grown. Empirical PD peritonitis treatment with intra-peritoneal antibiotics did not improve his symptoms and he required intravenous antibiotics, PD catheter removal and a switch to haemodialysis. Cultures of the PD fluid later grew M abscessus, and the antibiotic regimen was changed appropriately, leading to clinical improvement. CONCLUSION M abscessus associated peritonitis in PD patients is rare. It needs to be borne in mind when clinical improvement is not seen with standard broad-spectrum antibiotics, especially in situations where the PD fluid is initially deemed to be culture negative. PD fluid samples should be sent for acid-fast bacillus and if detected, should be further analysed with genome-wide sequencing to confirm the species of the Mycobacterium. Prompt removal of the catheter with peritoneal washout is critical for clinical improvement.
Collapse
Affiliation(s)
- Anup Singh Jheeta
- South West Thames Renal & Transplantation Unit, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK
| | - Jayakeerthi Rangaiah
- Department of Microbiology, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK
| | - John Clark
- Department of Microbiology, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK
| | - David Makanjuola
- South West Thames Renal & Transplantation Unit, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK
| | - Subash Somalanka
- South West Thames Renal & Transplantation Unit, Epsom & St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, UK.
| |
Collapse
|
25
|
Labuda SM, Garner K, Cima M, Moulton-Meissner H, Laufer Halpin A, Charles-Toney N, Yu P, Bolton E, Pierce R, Crist MB, Gomes D, Gable P, McAllister G, Lawsin A, Houston H, Patil N, Wheeler JG, Bradsher R, Vyas K, Haselow D. Bloodstream Infections With a Novel Nontuberculous Mycobacterium Involving 52 Outpatient Oncology Clinic Patients-Arkansas, 2018. Clin Infect Dis 2020; 71:e178-e185. [PMID: 31872853 PMCID: PMC7938859 DOI: 10.1093/cid/ciz1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In July 2018, the Arkansas Department of Health (ADH) was notified by hospital A of 3 patients with bloodstream infections (BSIs) with a rapidly growing nontuberculous Mycobacterium (NTM) species; on 5 September 2018, 6 additional BSIs were reported. All were among oncology patients at clinic A. We investigated to identify sources and to prevent further infections. METHODS ADH performed an onsite investigation at clinic A on 7 September 2018 and reviewed patient charts, obtained environmental samples, and cultured isolates. The isolates were sequenced (whole genome, 16S, rpoB) by the Centers for Disease Control and Prevention to determine species identity and relatedness. RESULTS By 31 December 2018, 52 of 151 (34%) oncology patients with chemotherapy ports accessed at clinic A during 22 March-12 September 2018 had NTM BSIs. Infected patients received significantly more saline flushes than uninfected patients (P < .001) during the risk period. NTM grew from 6 unused saline flushes compounded by clinic A. The identified species was novel and designated Mycobacterium FVL 201832. Isolates from patients and saline flushes were highly related by whole-genome sequencing, indicating a common source. Clinic A changed to prefilled saline flushes on 12 September as recommended. CONCLUSIONS Mycobacterium FVL 201832 caused BSIs in oncology clinic patients. Laboratory data allowed investigators to rapidly link infections to contaminated saline flushes; cooperation between multiple institutions resulted in timely outbreak resolution. New state policies being considered because of this outbreak include adding extrapulmonary NTM to ADH's reportable disease list and providing more oversight to outpatient oncology clinics.
Collapse
Affiliation(s)
- Sarah M Labuda
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Kelley Garner
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Michael Cima
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Public Health Service, Rockville, Maryland, USA
| | - Nadege Charles-Toney
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter Yu
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Erin Bolton
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Reid Pierce
- Jefferson Regional Medical Center, Pine Bluff, Arkansas, USA
| | - Matthew B Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danica Gomes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - J Gary Wheeler
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Robert Bradsher
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Keyur Vyas
- University of Arkansas for the Medical Sciences, Little Rock, Arkansas, USA
| | - Dirk Haselow
- Arkansas Department of Health, Little Rock, Arkansas, USA
| |
Collapse
|
26
|
Mizusawa M, Vindenes T, Buckley S, Armstrong C. A case series of rapidly growing mycobacterial catheter-related bloodstream infections among immunocompetent patients. J Clin Tuberc Other Mycobact Dis 2020; 21:100196. [PMID: 33195824 PMCID: PMC7642862 DOI: 10.1016/j.jctube.2020.100196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rapidly growing mycobacteria (RGM) are ubiquitous in the environment and can cause a variety of human infections. Catheter-related bloodstream infections (CRBSI) caused by RGM have been reported predominantly among immunocompromised patients. Removal of central lines and antimicrobial therapy with at least 2 active agents are generally recommended for immunocompromised patients. RGM bloodstream infections (BSIs) are rare in immunocompetent patients and clinical data are very limited. Retrospective medical record review was conducted on patients with blood cultures positive for RGM from July 2012 through March 2015 at Lemuel Shattuck Hospital, a public teaching hospital in Jamaica Plain, Massachusetts, United States. RGM was suspected by presence of beaded Gram-positive bacilli on Gram staining of positive conventional blood cultures and it was confirmed as RGM by Massachusetts State Public Health Laboratory. Nineteen episodes of RGM BSI were identified in 17 patients who had no known immunocompromised conditions that predispose them to opportunistic pathogens. They were predominantly young male with history of intravenous drug use. Peripherally inserted central catheter (PICC) was present in all episodes of RGM BSI and 74% of them clinically improved with PICC removal alone without specific antibiotic therapy for RGM. They were followed up for median duration of 45 days (interquartile range 25–385). The patients remained alive and asymptomatic until the end of follow-up periods. In immunocompetent patients, removal of catheters alone without adding specific antibiotics may be sufficient for RGM CRBSI.
Collapse
Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, MO, USA
| | - Tine Vindenes
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Sarah Buckley
- Microbiology Laboratory, The Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Catharina Armstrong
- Division of Infectious Diseases, The Newton-Wellesley Hospital, Newton, MA, USA
| |
Collapse
|
27
|
Kirolikar S, Pandrowala A, Joshi S, Misra R, Mushrif S. False-positive blood cultures: The need for follow-up. Indian J Med Microbiol 2020; 38:469-471. [PMID: 33154266 DOI: 10.4103/ijmm.ijmm_20_402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The diagnosis of blood-borne infections in immunocompromised patients is a major challenge for the clinical microbiology laboratory. Isolation of bloodborne pathogens in these patients has profound clinical implications, yet is fraught with technical problems, including the presence of unusual and difficult to isolate pathogens. Coupled with this is the problem of false-positive blood culture signals from automated blood culture systems which further delays the definitive diagnosis. Here, we present a case of an 8-year-old boy with Ph +ve acute lymphoblastic leukaemia who has repeated 'false positive' blood cultures and later grew an uncommon organism.
Collapse
Affiliation(s)
- Suverna Kirolikar
- Department of Microbiology, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
| | - Ambreen Pandrowala
- Department of Paediatric Infectious Disease, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
| | - Sangeeta Joshi
- Department of Microbiology, Manipal Hospital, Delhi, India
| | - Ruchira Misra
- Hematology and Bone Marrow Transplantation, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
| | - Sujata Mushrif
- Hemato-Oncology, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
| |
Collapse
|
28
|
Nagata A, Sekiya N, Najima Y, Horiuchi M, Fukushima K, Toya T, Igarashi A, Kobayashi T, Kakihana K, Ohashi K, Doki N. Nontuberculous mycobacterial bloodstream infections after allogeneic hematopoietic stem cell transplantation. Int J Infect Dis 2020; 97:131-134. [PMID: 32474198 DOI: 10.1016/j.ijid.2020.05.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 11/27/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) bacteremia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare, and limited data exist. We described the features of NTM bacteremia following allo-HSCT recipients in our hospital with a comprehensive review of the literature. Among the four cases of NTM bacteremia after allo-HSCT recipients in our hospital, two were catheter-related bloodstream infections (CRBSI), one was disseminated, and one was an unknown source of infection. Based on our report and the past literature, the incidence rate of NTM bacteremia was 0.1-1.3%. CRBSI (57%) was more common than disseminated infection (29%). Most cases with CRBSI were caused by rapidly growing mycobacteria (88%) and showed good prognoses under appropriate antimicrobial therapies. In contrast, slowly growing mycobacteria (71%) was more common than rapidly growing mycobacteria in disseminated NTM bacteremia. Although disseminated NTM bacteremia can remain stable with appropriate long-term management, three out of seven cases died of multi-organ failure. Background immunodeficiency after allo-HSCT and transplant-related comorbidities may be attributable to subsequent poor prognosis.
Collapse
Affiliation(s)
- Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan; Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masao Horiuchi
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan; Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuaki Fukushima
- Department of Infectious disease, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuhiko Kakihana
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| |
Collapse
|
29
|
Ueda Y, Tokumasu K, Hagiya H, Iio K, Fujimori T, Kakehi A, Okura M, Minabe H, Otsuka F. Mycobacterium chelonae bloodstream infection induced by osteomyelitis of toe: A case report. J Infect Chemother 2020; 26:843-846. [PMID: 32402735 DOI: 10.1016/j.jiac.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
Mycobacterium chelonae is a rapidly growing mycobacterium that has the potential to cause refractory infections in humans. Mycobacteremia resulting from the organism is extremely rare, and its clinical features are yet to be uncovered. We herein present a case of M. chelonae bloodstream infection involving an immunocompromised older patient. A 79-year-old woman, on a long-term treatment with prednisolone plus tacrolimus for rheumatoid arthritis, visited our outpatient department complaining of deteriorating pain and swelling at her right 1st toe. Laboratory parameters showed elevated C-reactive protein and leukocytosis, and magnetic resonance imaging indicated osteomyelitis at the proximal phalanx of her right 1st toe. Considering the refractory course, the infected toe was immediately amputated. M. chelonae was isolated from bacterial cultures of the resected tissue and blood (BD BACTEC™ FX blood culture system, Becton Dickinson, Sparks, MD, USA), leading to a diagnosis of disseminated M. chelonae infection. We treated the patient with an antibiotic combination of clarithromycin, minocycline, and imipenem (2 weeks), which was converted to oral therapy of clarithromycin, doxycycline, and levofloxacin. This case highlighted the potential pathogenesis of M. chelonae to cause mycobacteremia in an immunocompromised patient.
Collapse
Affiliation(s)
- Yayoi Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Iio
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Takumi Fujimori
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Ayaka Kakehi
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Mami Okura
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Minabe
- Microbiology Division, Clinical Laboratory, Okayama University Hospital, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
30
|
García-Coca M, Aguilera-Correa JJ, Ibáñez-Apesteguía A, Rodríguez-Sevilla G, Romera-García D, Mahíllo-Fernández I, Reina G, Fernández-Alonso M, Leiva J, Muñoz-Egea MC, Del Pozo JL, Esteban J. Non-pigmented rapidly growing mycobacteria smooth and rough colony phenotypes pathogenicity evaluated using in vitro and experimental models. Pathog Dis 2020; 77:5568367. [PMID: 31583400 DOI: 10.1093/femspd/ftz051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022] Open
Abstract
Non-pigmented rapidly growing mycobacteria (NPRGM) are widely distributed in water, soil and animals. It has been observed an increasing importance of NPRGM related-infections, particularly due to the high antimicrobial resistance. NPRGM have rough and smooth colony phenotypes, and several studies have showed that rough colony variants are more virulent than smooth ones. However, other studies have failed to validate this observation. In this study, we have performed two models, invitro and in vivo, in order to assess the different pathogenicity of these two phenotypes. We used collection and clinical strains of Mycobacteriumabscessus, Mycobacterium fortuitum and Mycobacteriumchelonae. On the invitro model (macrophages), phagocytosis was higher for M. abscessus and M. fortuitum rough colony variant strains when compared to smooth colony variants. However, we did not find differences with colonial variants of M. chelonae. Survival of Galleriamellonella larvae in the experimental model was lower for M. abscessus and M. fortuitum rough colony variants when compared with larvae infected with smooth colony variants. We did not find differences in larvae infected with M. chelonae.Results of our in vivo study correlated well with the experimental model. This fact could have implications on the interpretation of the clinical significance of the NPRGM isolate colonial variants.
Collapse
Affiliation(s)
- Marta García-Coca
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, 28040, Madrid, Spain
| | | | | | | | - David Romera-García
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, 28040, Madrid, Spain
| | | | - Gabriel Reina
- Microbiology Service, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | | | - José Leiva
- Microbiology Service, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | | | - José Luis Del Pozo
- Microbiology Service and Infectious Diseases Area, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, 28040, Madrid, Spain
| |
Collapse
|
31
|
Alvarenga DJ, Matias LMF, Oliveira LM, Leão LPMDO, Hawkes JA, Raimundo BVB, Castro LDFD, Campos MMAD, Siqueira FDS, Santos TD, Carvalho DT. Exploring how structural changes to new Licarin A derivatives effects their bioactive properties against rapid growing mycobacteria and biofilm formation. Microb Pathog 2020; 144:104203. [PMID: 32304794 DOI: 10.1016/j.micpath.2020.104203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/05/2020] [Accepted: 04/10/2020] [Indexed: 12/18/2022]
Abstract
Several species of rapidly growing mycobacteria (RGM) have been associated with biofilms in areas such as biomedical devices, water distribution systems, cosmetic surgery, and catheter-related blood infections. Biofilms which exhibit antimicrobial resistance such as those formed by the genus Mycobacterium pose a significant risk to health and are of particular interest to researchers. Licarin A (a neolignan found in numerous plant species e.g. nutmeg) has been reported to show a wide range of biological actions including anti-inflammatory, antioxidant, and antibacterial properties. The aim of this study was to prepare a set of Licarin A derivatives and investigate the impact of specific structural changes on its antimycobacterial ability, and its effect on the biofilm formation of RGM species. Initially, the phenolic sub-unit and alkenyl side chain of Licarin A were modified to create derivatives with a higher partition coefficient; as the activity of a compound against mycobacteria seems to be strongly influenced by its hydrophobicity. Further, polar groups were inserted into the side chain to change the hydrophilic-lipophilic profile of the molecules. Results showed variability in the susceptibility profile of mycobacteria against the Licarin A derivatives under analysis. A number of the derivatives showed significant inhibitory activity of planktonic growth of the three strains of mycobacteria used, with even lower MIC values than those observed with reference drugs and Licarin A itself. Cytotoxicity assays showed they also have low toxicity, confirming that structural modifications to the Licarin A have made improvements to its antimycobacterial properties.
Collapse
Affiliation(s)
- Dalila Junqueira Alvarenga
- Faculdade de Ciências Farmacêuticas, Departamento de Alimentos e Medicamentos, Universidade Federal de Alfenas, MG, 37130-001, Brazil
| | - Laira Maria Faria Matias
- Faculdade de Ciências Farmacêuticas, Departamento de Alimentos e Medicamentos, Universidade Federal de Alfenas, MG, 37130-001, Brazil
| | - Lucas Martins Oliveira
- Faculdade de Ciências Farmacêuticas, Departamento de Alimentos e Medicamentos, Universidade Federal de Alfenas, MG, 37130-001, Brazil
| | | | - Jamie Anthony Hawkes
- Faculdade de Ciências Farmacêuticas, Departamento de Alimentos e Medicamentos, Universidade Federal de Alfenas, MG, 37130-001, Brazil
| | - Breno Vilas Boas Raimundo
- Instituto de Ciências Biomédicas, Departamento de Microbiologia e Imunologia, Universidade Federal de Alfenas, MG, 37130-001, Brazil
| | - Lívia de Figueiredo Diniz Castro
- Instituto de Ciências Biomédicas, Departamento de Microbiologia e Imunologia, Universidade Federal de Alfenas, MG, 37130-001, Brazil
| | | | - Fallon Dos Santos Siqueira
- Departamento de Análises Clínicas e Toxicológicas, Universidade Federal de Santa Maria, RS, 9710590, Brazil
| | - Thiago Dos Santos
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, SP, 14040-903, Brazil
| | - Diogo Teixeira Carvalho
- Faculdade de Ciências Farmacêuticas, Departamento de Alimentos e Medicamentos, Universidade Federal de Alfenas, MG, 37130-001, Brazil.
| |
Collapse
|
32
|
Radcliffe C, Doilicho N, Grant M. Nontuberculous mycobacterial infections in left ventricular assist device patients. J Card Surg 2020; 35:1138-1141. [PMID: 32253770 DOI: 10.1111/jocs.14530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Left ventricular assist devices (LVADs) are integral for the management of medically refractory heart failure, and LVAD infections are common following device placement. Most infections are caused by Staphylococcal spp. and Gram-negative enteric bacteria but nontuberculous mycobacterial (NTM) infections have been reported. We present the second-ever reported case of a driveline infection caused by Mycobacterium fortuitum in a 75-year-old male with a continuous-flow LVAD. After receiving meropenem, azithromycin, and ciprofloxacin, he underwent device exchange and ultimately died after failing to recover neurologically. Management of NTM infections presents a clinical challenge due to the propensity for rapidly growing mycobacterial species to form biofilms and the possibility of negative cultures delaying diagnosis. To address the literature gap surrounding NTM infections in LVAD patients, we performed a systematic review and present all previously reported cases.
Collapse
Affiliation(s)
| | | | - Matthew Grant
- Yale School of Medicine, New Haven, Connecticut.,Department of Internal Medicine, Section of Infectious Diseases, Yale New Haven Hospital, New Haven, Connecticut
| |
Collapse
|
33
|
Muñoz-Egea MC, Carrasco-Antón N, Esteban J. State-of-the-art treatment strategies for nontuberculous mycobacteria infections. Expert Opin Pharmacother 2020; 21:969-981. [PMID: 32200657 DOI: 10.1080/14656566.2020.1740205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Non-tuberculous Mycobacteria (NTM) are a group of organisms whose importance in medicine seems to be increasing in recent times. The increasing number of patients susceptible to these diseases make it necessary to expand our knowledge of therapeutic options and to explore future possibilities for the development of a therapeutic arsenal. AREAS COVERED In this review, the authors provide a brief introduction about the present importance of NTM and describe the present recommendations of the available guidelines for their treatment. They include a description of the future options for the management of these patients, especially focusing on new antibiotics. The authors also look at possibilities for future therapeutic options, such as antibiofilm strategies. EXPERT OPINION No actual changes have been made to the current recommendations for the management of most NTM infections (except perhaps the availability of nebulized amikacin). However, it is also true that we have increased the number of available antibiotic treatment options with good in vitro activity against NTM. The use of these drugs in selected cases could increase the therapeutic possibilities. However, some problems are still present, such as the knowledge of the actual meaning of a NTM isolate, and will probably be a key part of future research.
Collapse
Affiliation(s)
| | | | - Jaime Esteban
- Departments of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM , Madrid, Spain
| |
Collapse
|
34
|
Bersani I, Piersigilli F, Goffredo BM, Santisi A, Cairoli S, Ronchetti MP, Auriti C. Antifungal Drugs for Invasive Candida Infections (ICI) in Neonates: Future Perspectives. Front Pediatr 2019; 7:375. [PMID: 31616647 PMCID: PMC6764087 DOI: 10.3389/fped.2019.00375] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/02/2019] [Indexed: 12/26/2022] Open
Abstract
Fungal infections may complicate the neonatal clinical course, and the spectrum of therapies for their treatment in the perinatal period is limited. Polyenes, Azoles and Echinocandins represent the three classes of antifungal drugs commonly used in the neonatal period. The present review provides an overview about the most recent therapeutic strategies for the treatment of fungal infections in neonates.
Collapse
Affiliation(s)
- Iliana Bersani
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Fiammetta Piersigilli
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sara Cairoli
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| |
Collapse
|
35
|
Shelton A, Giurgea L, Moshgriz M, Siegel M, Akselrod H. A case of Mycobacterium goodii infection related to an indwelling catheter placed for the treatment of chronic symptoms attributed to Lyme disease. Infect Dis Rep 2019; 11:8108. [PMID: 31579470 PMCID: PMC6761459 DOI: 10.4081/idr.2019.8108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/25/2019] [Indexed: 11/23/2022] Open
Abstract
Mycobacterium goodii has only rarely been reported to cause invasive disease in humans. Previously reported cases of M. goodii infection have included prosthetic joint infections, pacemaker pocket infections, and pneumonia. We present a case of M. goodii bacteremia with concomitant pulmonary septic emboli that developed in a 32-year-old woman with an indwelling central venous catheter (CVC). The CVC had been placed one year previously for intermittent treatment with intravenous, broadspectrum antibiotics, administered by an outside physician for the treatment of symptoms attributed to chronic Lyme disease. Despite our recommendations, the patient declined follow-up in our Infectious Diseases clinic, opting to continue care under her chronic Lyme disease physician. This case clearly demonstrates the potential for serious medical complications that can arise from the inappropriate use of longterm intravenous antibiotics using a CVC to treat non-specific symptoms attributed to Lyme disease and patients should be counseled regarding these risks.
Collapse
Affiliation(s)
- Andrew Shelton
- Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Luca Giurgea
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Mahdi Moshgriz
- Department of Pathology, George Washington University Medical Center, Washington, DC
| | - Marc Siegel
- Department of Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Hana Akselrod
- Department of Medicine, George Washington University Medical Faculty Associates, Washington, DC, USA
| |
Collapse
|
36
|
Xie O, Khan S, Globan M, Lea K, Bajel A, Slavin M. Mycobacterium abscessus bloodstream infection: Unexpected catheter tunnel infection localized by PET/CT. Transpl Infect Dis 2019; 21:e13147. [PMID: 31306546 DOI: 10.1111/tid.13147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/25/2019] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Abstract
Mycobacterium abscessus is an emerging cause of invasive infection in the immunosuppressed population. We report a case of M. abscessus bloodstream and catheter tunnel infection localized by positron emission tomography/computer tomography (PET/CT) in an allogeneic haematopoietic stem cell transplant recipient. This case highlights the difficulties in treating invasive M. abscessus infection and the potential role of PET/CT in localizing infection and guiding therapy in this population.
Collapse
Affiliation(s)
- Ouli Xie
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sadid Khan
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kerrie Lea
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Ashish Bajel
- Department of Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Monica Slavin
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
37
|
Varghese B, Enani M, Shoukri M, AlJohani S, AlThawadi S, Al-Hajoj S. Burden of non-tuberculous mycobacterial diseases in Saudi Arabian children: The first nationwide experience. J Infect Public Health 2019; 12:803-808. [PMID: 31078494 DOI: 10.1016/j.jiph.2019.04.004] [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: 02/07/2019] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Non-tuberculous mycobacteria (NTM) causing pulmonary and extra-pulmonary diseases are increasing worldwide. A large paucity of data related to pediatric NTM diseases exists globally and particularly in Saudi Arabia. METHODS The first nationwide exploratory study on existence of NTM diseases among Saudi Arabian children (0-14 years old) has been carried out during 2016-2017. Suspected NTM isolates with clinical and demographical data were enrolled from regional reference laboratories. Species level identification of isolates was carried out by commercial line probe assays and gene sequencing. RESULTS In 12 months, 52 culture positive cases with 44(84.6%) confirmed disease incidences were identified. Demographically, Saudi nationals (86.5%) were dominated and 77.3% cases have different comorbid conditions. Lymphadenitis (40.4%) followed by 26.9% of pulmonary cases with 42.8% of confirmed clinical relevance were mainly reported. Species identification showed Mycobacterium simiae (31.8%), M. abscessus (23.1%) and nine other species including rarely encountering M. riyadhense. Ascites caused by M. monacense, pulmonary disease caused by M. riyadhense and M. monacense were rarest clinical events and reported for the first time globally in a pediatric cohort. CONCLUSIONS Diverse NTM diseases even in immunocompetent children are an upcoming challenge in Saudi Arabia. Lack of awareness on NTM disease must be addressed with immediate development of management plans.
Collapse
Affiliation(s)
- Bright Varghese
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.
| | - Mushira Enani
- Medical Specialties Department, King Fahad Medical City, Riyadh, 12231, Saudi Arabia.
| | - Mohammed Shoukri
- National Biotechnology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia.
| | - Sameera AlJohani
- Department of Pathology and Laboratory Medicine, King Abdul Aziz Medical City, Riyadh, 14611, Saudi Arabia.
| | - Sahar AlThawadi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and research Centre, Riyadh, 11211, Saudi Arabia.
| | - Sahal Al-Hajoj
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, 1153, Saudi Arabia.
| |
Collapse
|
38
|
Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
Collapse
|
39
|
Pradier M, Boucher A, Robineau O, Chachaty E, Meybeck A, Senneville E. Mycobacterium mucogenicum bacteremia: major role of clinical microbiologists. BMC Infect Dis 2018; 18:646. [PMID: 30541469 PMCID: PMC6292041 DOI: 10.1186/s12879-018-3545-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/23/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Mycobacterium mucogenicum is a rare but emerging cause of infections, especially in immunocompromised patients. Case presentation We describe a new case of M. mucogenicum catheter-related bloodstream infection in a 34-year-old woman with ovarian cancer. M. mucogenicum was at first considered as a contaminant, and susceptibility testing was not performed. Usual susceptibility of M. mucogenicum motivated prescription of clarithromycin and moxifloxacin. Finally, our isolate was confirmed susceptible to both drugs. Clinical outcome was favorable with no relapse of infection after antibiotics discontinuation despite concomitant chemotherapy. Conclusion Our case illustrates the need for a clinician-microbiologist dialogue in case of suspected M. mucogenicum infection to avoid delaying appropriate management.
Collapse
Affiliation(s)
- Maxime Pradier
- Service Universitaire des Maladies Infectieuses et du voyageur, Centre Hospitalier Dron, 135 avenue du Président Coty, 59200, Tourcoing, France
| | - Anne Boucher
- Service Universitaire des Maladies Infectieuses et du voyageur, Centre Hospitalier Dron, 135 avenue du Président Coty, 59200, Tourcoing, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du voyageur, Centre Hospitalier Dron, 135 avenue du Président Coty, 59200, Tourcoing, France
| | - Elisabeth Chachaty
- Laboratoire de Microbiologie, Institut Gustave Roussy, Villejuif, France
| | - Agnès Meybeck
- Service Universitaire des Maladies Infectieuses et du voyageur, Centre Hospitalier Dron, 135 avenue du Président Coty, 59200, Tourcoing, France.
| | - Eric Senneville
- Service Universitaire des Maladies Infectieuses et du voyageur, Centre Hospitalier Dron, 135 avenue du Président Coty, 59200, Tourcoing, France
| |
Collapse
|
40
|
All in The Name of Vanity. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
41
|
Tejura N, Bontempo G, Chew D. Disseminated Mycobacterium abscessus Infection Secondary to an Infected Vascular Stent: Case Report and Review of the Literature. Open Forum Infect Dis 2018; 5:ofy207. [PMID: 30186890 PMCID: PMC6120099 DOI: 10.1093/ofid/ofy207] [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: 05/22/2018] [Accepted: 08/20/2018] [Indexed: 11/14/2022] Open
Abstract
Mycobacterium abscessus is a rapidly growing, multidrug-resistant mycobacteria, commonly associated with pulmonary, skin, and soft tissue infections. We describe a rare case of M abscessus endovascular stent infection; only 3 cases of graft infections have previously been reported.
Collapse
Affiliation(s)
- Nilesh Tejura
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark
| | - Gilda Bontempo
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York
| | - Debra Chew
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark
| |
Collapse
|
42
|
YE H, Zeng J, Qin W, Yang Z, Yang L, Wu Z, Du G. A totally implantable venous access port associated with bloodstream infection caused by Mycobacterium fortuitum: A case report. Medicine (Baltimore) 2018; 97:e11493. [PMID: 30024528 PMCID: PMC6086552 DOI: 10.1097/md.0000000000011493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Rapidly growing mycobacteria (RGM) are well-known causative agents of human infections, particularly in immunocompromised hosts. However, Mycobacterium fortuitum, a predominant organism, in catheter-associated infections, has rarely been documented in totally implantable venous access port (TVIAP)-associated bloodstream infections. PATIENT CONCERNS A 25-year-old woman with breast cancer presented to hospital with repeated fever for several days. The patient first refused to remove the TVIAP in her body, and had a relapse of M. fortuitum bacteraemia four months later. DIAGNOSES Bacteria isolated from patient's blood and TVIAP were identified as M. fortuitum by Matrix-assisted laser desorption/ionization-time of flight spectrometry and bacterial 16s rDNA sequencing. The patient was diagnosed as a TVIAP-associated bloodstream infection. INTERVENTIONS The TVIAP was eventually surgically removed, and M. fortuitum was found to have localized on the tip of the catheter. The patient was treated by anti-infection therapy. OUTCOMES The patient was treated with 4 weeks of intravenous amikacin and levofloxacin followed by 4 weeks of oral levofloxacin. No episodes of fever occurred during the follow-up to date. LESSONS RGM infections remain a challenging issue for TIVAPs. Accurate species identification, timely intravascular catheter removal and appropriate antibiotic therapy are recommended to ensure successful outcomes.
Collapse
Affiliation(s)
| | - Junshao Zeng
- Department of Oncology, Guigang City People's Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi, People's Republic of China
| | | | | | | | | | | |
Collapse
|
43
|
Nunez Breton JD, Hernandez G, Simkins J, Chaparro SV. Mycobacterium abscessus Left Ventricle Assist Device Driveline Infections: An Emerging Pathogen? Transpl Infect Dis 2018; 20:e12957. [PMID: 29896814 DOI: 10.1111/tid.12957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/26/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
The use of left ventricular assist device is associated with improvement in survival in patients with refractory heart failure. However, driveline infection limits the success of its use as it is associated with significant mortality. We describe the first 2 cases of Mycobacterium abscessus driveline infection. Both patients had persistent infection despite of aggressive antibiotic treatment and local debridement, and only improved after removal of their left ventricular assist devices.
Collapse
Affiliation(s)
| | - Gabriel Hernandez
- Cardiology Division, University of Miami School of Medicine, Miami, FL, USA
| | - Jacques Simkins
- Infectious Diseases Division, University of Miami School of Medicine, Miami, FL, USA
| | | |
Collapse
|
44
|
Prendergast KA, Daniels NJ, Petersen TR, Hermans IF, Kirman JR. Langerin + CD8α + Dendritic Cells Drive Early CD8 + T Cell Activation and IL-12 Production During Systemic Bacterial Infection. Front Immunol 2018; 9:953. [PMID: 29867941 PMCID: PMC5949331 DOI: 10.3389/fimmu.2018.00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/17/2018] [Indexed: 12/18/2022] Open
Abstract
Bloodstream infections induce considerable morbidity, high mortality, and represent a significant burden of cost in health care; however, our understanding of the immune response to bacteremia is incomplete. Langerin+ CD8α+ dendritic cells (DCs), residing in the marginal zone of the murine spleen, have the capacity to cross-prime CD8+ T cells and produce IL-12, both of which are important components of antimicrobial immunity. Accordingly, we hypothesized that this DC subset may be a key promoter of adaptive immune responses to blood-borne bacterial infections. Utilizing mice that express the diphtheria toxin receptor under control of the langerin promoter, we investigated the impact of depleting langerin+ CD8α+ DCs in a murine model of intravenous infection with Mycobacterium bovis bacille Calmette–Guerin (BCG). In the absence of langerin+ CD8α+ DCs, the immune response to blood-borne BCG infection was diminished: bacterial numbers in the spleen increased, serum IL-12p40 decreased, and delayed CD8+ T cell activation, proliferation, and IFN-γ production was evident. Our data revealed that langerin+ CD8α+ DCs play a pivotal role in initiating CD8+ T cell responses and IL-12 production in response to bacteremia and may influence the early control of systemic bacterial infections.
Collapse
Affiliation(s)
- Kelly A Prendergast
- Malaghan Institute of Medical Research, Wellington, New Zealand.,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Naomi J Daniels
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | | | - Ian F Hermans
- Malaghan Institute of Medical Research, Wellington, New Zealand.,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
| | - Joanna R Kirman
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand.,Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
| |
Collapse
|
45
|
Desai AN, Hurtado RM. Infections and outbreaks of nontuberculous mycobacteria in hospital settings. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018; 10:169-181. [PMID: 30662371 DOI: 10.1007/s40506-018-0165-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose of review Non-tuberculous mycobacterial [NTM] infections in the hospital setting are a complex and often challenging entity. The goal of this review is to discuss diagnostic and treatment strategies for established as well as emerging nosocomial NTM infections. Recent findings NTM outbreaks have been documented in a variety of hospital settings. Contamination of medical devices or aqueous solutions is often implicated in the spread of infection. More recently, the slow grower M. chimaera has been reported in the setting of contaminated heater-cooler devices used for cardiopulmonary bypass and extracorporeal membrane oxygenation. In addition, increases in medical tourism for cosmetic surgery have led to outbreaks of rapidly growing mycobacteria. Summary Diagnosis and treatment of nosocomial NTM pose many challenges for the clinician. Surgical resection or debridement as well as combination antimycobacterial therapy are a mainstay in therapeutic management. Strict infection control and prevention practices are critical to the identification and cessation of outbreaks.
Collapse
Affiliation(s)
- Angel N Desai
- Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Boston, MA 02114 USA
| | - Rocío M Hurtado
- Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Boston, MA 02114 USA.,Harvard Medical School, 25 Shattuck St, Boston MA 02115 USA
| |
Collapse
|
46
|
Abstract
The genus Mycobacterium includes human pathogens (Mycobacterium tuberculosis and Mycobacterium leprae) and environmental organisms known as non-tuberculous mycobacteria (NTM) that, when associated with biomaterials and chronic disease, can cause human infections. A common pathogenic factor of mycobacteria is the formation of biofilms. Various molecules are involved in this process, including glycopeptidolipids, shorter-chain mycolic acids, and GroEL1 chaperone. Nutrients, ions, and carbon sources influence bacterial behavior and have a regulatory role in biofilm formation. The ultrastructure of mycobacterial biofilms can be studied by confocal laser scanning microscopy, a technique that reveals different phenotypic characteristics. Cording is associated with NTM pathogenicity, and is also considered an important property of M. tuberculosis strains. Mycobacterial biofilms are more resistant to environmental aggressions and disinfectants than the planktonic form. Biofilm-forming mycobacteria have been reported in many environmental studies, especially in water systems. NTM cause respiratory disease in patients with underlying diseases, such as old tuberculosis scars, bronchiectasis, and cystic fibrosis. Pathogens can be either slowly growing mycobacteria, such as Mycobacterium avium complex, or rapidly growing species, such as Mycobacterium abscessus. Another important biofilm-related group of infections are those associated with biomaterials, and in this setting the most frequently isolated organisms are rapidly growing mycobacteria. M. tuberculosis can develop a biofilm which plays a role in the process of casseous necrosis and cavity formation in lung tissue. M. tuberculosis also develops biofilms on clinical biomaterials. Biofilm development is an important factor for antimicrobial resistance, as it affords protection against antibiotics that are normally active against the same bacteria in the planktonic state. This antibiotic resistance of biofilm-forming microorganisms may result in treatment failure, and biofilms have to be physically eradicated to resolve the infection. New strategies with potential antibiofilm molecules that improve treatment efficacy have been developed. A novel antibiofilm approach focuses on Methylobacterium sp. An understanding of biofilm is essential for the appropriate management of patients with many NTM diseases, while the recent discovery of M. tuberculosis biofilms opens a new research field.
Collapse
Affiliation(s)
- Jaime Esteban
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain
| | | |
Collapse
|
47
|
Treatment of infections caused by nontuberculous mycobacteria. Enferm Infecc Microbiol Clin 2017; 36:586-592. [PMID: 29217094 DOI: 10.1016/j.eimc.2017.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022]
Abstract
Nontuberculous mycobacteria are a heterogeneous group of microorganisms that can often cause human infection, although they may also be considered to be contaminants or colonisers on occasions. The management of these infections must necessarily take into account the identification of isolated species and their in vitro susceptibility testing (although not for all of them), as well as the characteristics of the patient, because these treatments are usually prolonged and must be carried out by experts in the management of these infections. Classically divided into slowly growing mycobacteria and rapidly growing mycobacteria, the treatment regimens and the antibiotics used are different for both groups. In addition, in certain circumstances, this treatment must necessarily be linked to other measures (removal of foreign bodies, surgery) in order to maximise the likelihood of curing the patient.
Collapse
|
48
|
Paniz-Mondolfi AE, Greninger AL, Ladutko L, Brown-Elliott BA, Vasireddy R, Jakubiec W, Vasireddy S, Wallace RJ, Simmon KE, Dunn BE, Jackoway G, Vora SB, Quinn KK, Qin X, Campbell S. Mycobacterium grossiae sp. nov., a rapidly growing, scotochromogenic species isolated from human clinical respiratory and blood culture specimens. Int J Syst Evol Microbiol 2017; 67:4345-4351. [PMID: 28984546 DOI: 10.1099/ijsem.0.002216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A previously undescribed, rapidly growing, scotochromogenic species of the genus Mycobacterium (represented by strains PB739T and GK) was isolated from two clinical sources - the sputum of a 76-year-old patient with severe chronic obstructive pulmonary disease, history of tuberculosis exposure and Mycobacterium avium complex isolated years prior; and the blood of a 15-year-old male with B-cell acute lymphoblastic leukaemia status post bone marrow transplant. The isolates grew as dark orange colonies at 25-37 °C after 5 days, sharing features in common with other closely related species. Analysis of the complete 16S rRNA gene sequence (1492 bp) of strain PB739T demonstrated that the isolate shared 98.8 % relatedness with Mycobacterium wolinskyi. Partial 429 bp hsp65 and 744 bp rpoB region V sequence analyses revealed that the sequences of the novel isolate shared 94.8 and 92.1 % similarity with those of Mycobacterium neoaurum and Mycobacterium aurum, respectively. Biochemical profiling, antimicrobial susceptibility testing, HPLC/gas-liquid chromatography analyses and multilocus sequence typing support the taxonomic status of these isolates (PB739T and GK) as representatives of a novel species. Both isolates were susceptible to the Clinical and Laboratory Standards Institute recommended antimicrobials for susceptibility testing of rapidly growing mycobacteria including amikacin, ciprofloxacin, moxifloxacin, doxycycline/minocycline, imipenem, linezolid, clarithromycin and trimethropin/sulfamethoxazole. Both isolates PB739T and GK showed intermediate susceptibility to cefoxitin. We propose the name Mycobacterium grossiae sp. nov. for this novel species and have deposited the type strain in the DSMZ and CIP culture collections. The type strain is PB739T (=DSM 104744T=CIP 111318T).
Collapse
Affiliation(s)
| | | | - Lynn Ladutko
- Department of Pathology and Laboratory Medicine, VA Connecticut Healthcare, West Haven, CT, USA
| | - Barbara A Brown-Elliott
- Department of Microbiology, The University of Texas Health Science Center, Mycobacteria/Nocardia Laboratory, Tyler, TX, USA
| | - Ravikiran Vasireddy
- Department of Microbiology, The University of Texas Health Science Center, Mycobacteria/Nocardia Laboratory, Tyler, TX, USA
| | - Wesley Jakubiec
- Department of Pathology and Laboratory Medicine, VA Connecticut Healthcare, West Haven, CT, USA
| | - Sruthi Vasireddy
- Department of Microbiology, The University of Texas Health Science Center, Mycobacteria/Nocardia Laboratory, Tyler, TX, USA
| | - Richard J Wallace
- Department of Microbiology, The University of Texas Health Science Center, Mycobacteria/Nocardia Laboratory, Tyler, TX, USA
| | - Keith E Simmon
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Bruce E Dunn
- Pathology and Laboratory Medicine, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | | | - Surabhi B Vora
- Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Kevin K Quinn
- Pediatric Infectious Diseases, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Xuan Qin
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale School of Medicine/Yale-New Haven Hospital, New Haven, CT, USA.,Department of Pathology and Laboratory Medicine, VA Connecticut Healthcare, West Haven, CT, USA
| |
Collapse
|
49
|
Shaharir SS, Sulaiman Sahari N, Mohamed Fuad Z, Zukiman WZHW, Mohd Yusof NH, Sulong A, Periasamy P. Non-tuberculous mycobacterium bacteraemia in a pregnant systemic lupus erythematosus (SLE) patient: a case review and pooled case analysis. Clin Rheumatol 2017; 37:837-847. [DOI: 10.1007/s10067-017-3855-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
|
50
|
Gera R, Singh V, Mitra S, Sharma AK, Singh A, Dasgupta A, Singh D, Kumar M, Jagdale P, Patnaik S, Ghosh D. Arsenic exposure impels CD4 commitment in thymus and suppress T cell cytokine secretion by increasing regulatory T cells. Sci Rep 2017; 7:7140. [PMID: 28769045 PMCID: PMC5541098 DOI: 10.1038/s41598-017-07271-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/27/2017] [Indexed: 01/31/2023] Open
Abstract
Arsenic is globally infamous for inducing immunosuppression associated with prevalence of opportunistic infection in exposed population, although the mechanism remains elusive. In this study, we investigate the effect of arsenic exposure on thymocyte lineage commitment and the involvement of regulatory T cells (Treg) in arsenic-induced immunosuppression. Male Balb/c mice were exposed to 0.038, 0.38 and 3.8 ppm sodium arsenite for 7, 15 and 30 days through oral gavage. Arsenic exposure promoted CD4 lineage commitment in a dose dependent manner supported by the expression of ThPOK in thymus. Arsenic also increased splenic CD4+ T cells and promoted their differentiation into Treg cells. In parallel, arsenic exposure induced immunosuppression characterized by low cytokine secretion from splenocytes and increased susceptibility to Mycobacterium fortuitum (M. fortuitum) infection. Therefore, we linked arsenic-induced rise in Treg cells with suppressed Th1 and Th2 related cytokines, which has been reversed by inhibition of Treg cells in-vivo using wortmannin. Other parameters like body weight, kidney and liver function, histoanatomy of thymus and spleen as well as thymocyte and splenocytes viability were unaltered by arsenic exposure. Taken together our findings indicated that environmentally relevant dose of arsenic enhanced differentiation of Treg cells which in turn induce immunosuppression in experimental animals.
Collapse
Affiliation(s)
- Ruchi Gera
- Immunotoxicology Laboratory, Food, Drug & Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India.,Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR campus, Lucknow, 226001, India
| | - Vikas Singh
- Immunotoxicology Laboratory, Food, Drug & Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India.,Academy of Scientific and Innovative Research (AcSIR), CSIR-IITR campus, Lucknow, 226001, India
| | - Sumonto Mitra
- Immunotoxicology Laboratory, Food, Drug & Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India
| | - Anuj Kumar Sharma
- Immunotoxicology Laboratory, Food, Drug & Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India
| | - Alok Singh
- Microbiology, CSIR- Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Arunava Dasgupta
- Microbiology, CSIR- Central Drug Research Institute, Lucknow, Uttar Pradesh, India
| | - Dhirendra Singh
- Regulatory toxicology, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India
| | - Mahadeo Kumar
- Regulatory toxicology, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India
| | - Pankaj Jagdale
- Regulatory toxicology, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India
| | - Satyakam Patnaik
- Water Analysis Laboratory, Nanotherapeutics and Nanomaterial Toxicology Group, CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, India
| | - Debabrata Ghosh
- Immunotoxicology Laboratory, Food, Drug & Chemical Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, 31 Mahatma Gandhi Marg, Lucknow, 226001, Uttar Pradesh, India.
| |
Collapse
|