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Cazals M, Bédard E, Soucy C, Savard P, Prévost M. How clean is your ice machine? Revealing microbial amplification and presence of opportunistic pathogens in hospital ice-water machines. J Hosp Infect 2023; 141:9-16. [PMID: 37604277 DOI: 10.1016/j.jhin.2023.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/18/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Ice machines in healthcare facilities have been suspected and even linked to outbreaks and pseudo-outbreaks. Guidelines exist for maintenance of these devices but there is no clear independent infection control standard, and little is known about their microbial contamination. AIM To evaluate the microbial contamination, amplification, and presence of opportunistic pathogens in ice-water machines in a healthcare facility. METHODS Concentrations of general microbial indicators (heterotrophic plate counts (HPC), total and intact cells), faecal indicators (enterococci) and opportunistic pathogens (Pseudomonas aeruginosa, non-tuberculous mycobacteria (NTM), Candida spp.) were measured in 36 ice-water machines on patient wards of a 772-bed hospital. Profile sampling was performed on five ice-water machines and adjacent faucets to identify sites of microbial proliferation. FINDINGS Candida spp. were found in half of ice-water samples while enterococci and P. aeruginosa were present in six and 11 drain inlets respectively. NTM were measured in all ice-water samples and 35 out of 36 biofilms. Pre-filters and ice machines are sites for additional amplification: NTM densities were on average 1.3 log10 higher in water of ice machine flushed 5 min compared to flushed adjacent tap water. CONCLUSION Ice machine design needs to be adapted to reduce microbial proliferation. The absence of correlation between HPC densities (current microbial indicators) and NTM concentrations suggests a need for cleaning efficiency indicators better correlated with opportunistic pathogens. Cleaning and disinfection guidelines of ice machines in healthcare facilities need to be improved, especially when ice is given to the most vulnerable patients, and NTM may be an efficiency indicator.
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Affiliation(s)
- M Cazals
- Civil, Geological and Mining Engineering Department, Polytechnique Montréal, Montreal, Canada.
| | - E Bédard
- Civil, Geological and Mining Engineering Department, Polytechnique Montréal, Montreal, Canada
| | - C Soucy
- Infection Prevention and Control, University of Montreal Hospital Centre (CHUM), Montreal, Canada
| | - P Savard
- Infection Prevention and Control, University of Montreal Hospital Centre (CHUM), Montreal, Canada; Department of Microbiology, Infectious Diseases and Immunology and University of Montreal Hospital Centre Research Centre (CRCHUM), University of Montreal, Canada
| | - M Prévost
- Civil, Geological and Mining Engineering Department, Polytechnique Montréal, Montreal, Canada
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Yan M, Brode SK, Marras TK. The Other Nontuberculous Mycobacteria: Clinical Aspects of Lung Disease Caused by Less Common Slowly Growing Nontuberculous Mycobacteria Species. Chest 2023; 163:281-291. [PMID: 36174743 DOI: 10.1016/j.chest.2022.09.025] [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: 03/08/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 01/14/2023] Open
Abstract
Slowly growing nontuberculous mycobacteria (NTM) comprise a diverse group of environmental organisms, many of which are important human pathogens. The most common and well-known member of this group is Mycobacterium avium, the leading cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) globally. This review focuses on the less common, but notable, species of slowly growing NTM with respect to lung disease. To prepare this article, literature searches were performed using each species name as the key word. Society guidelines were consulted, and relevant articles also were identified through the reference lists of key articles. The specific organisms highlighted include Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium malmoense, Mycobacterium simiae, and Mycobacterium szulgai. Although these organisms are closely related, they have distinct epidemiologic features and behavior as pathogens. Therefore, the diagnosis and management of NTM-PD require a nuanced approach that takes into consideration the unique characteristics of each species. There is limited evidence to inform the optimal treatment of NTM-PD. Antimicrobial therapy is often challenging because of the presence of drug resistance and few antibiotic options. Regimen selection should generally be guided by drug susceptibility testing, although the correlation between clinical outcomes and in vitro susceptibility thresholds has not been defined for most species.
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Affiliation(s)
- Marie Yan
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Clinician Investigator Program, University of British Columbia, Vancouver, BC, Canada
| | - Sarah K Brode
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, University Health Network, Toronto, ON, Canada; Division of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Theodore K Marras
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, University Health Network, Toronto, ON, Canada.
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Rodriguez C, Salas NM, Bruno M, Brett M, Byrd TF, Ruan L, Jakeman B. Treatment management of M. simiae infection complicated by severe immune reconstitution syndrome in two patients living with HIV. Int J STD AIDS 2023; 34:355-360. [PMID: 36629094 DOI: 10.1177/09564624221151090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Nontuberculosis mycobacterium are increasingly being identified as sources of disseminated infections in immunocompromised patients. These infections can be challenging to identify and treat due complexities of diagnosis and inherent resistance to many medications. We present two cases of patients with human immunodeficiency virus who had Mycobacterium simiae infections, complicated by immune reconstruction inflammatory syndrome (IRIS). We also present a review of the English literature surrounding the disease, including reported resistance patterns to antimicrobial therapy, which can be highly variable.
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Affiliation(s)
- Chelsea Rodriguez
- Department of Pharmacy, 21764University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Natalie Mariam Salas
- Department of Internal Medicine, Division of Infectious Diseases, 1104University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Matthew Bruno
- Department of Pharmacy Practice and Administrative Sciences, 15520University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Meghan Brett
- Department of Internal Medicine, Division of Infectious Diseases, 1104University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Tom F Byrd
- Department of Internal Medicine, Division of Infectious Diseases, 1104University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Lucy Ruan
- Department of Internal Medicine, Division of Infectious Diseases, 1104University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Bernadette Jakeman
- Department of Pharmacy Practice and Administrative Sciences, 15520University of New Mexico College of Pharmacy, Albuquerque, NM, USA
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Chaptal M, Andrejak C, Bonifay T, Beillard E, Guillot G, Guyomard-Rabenirina S, Demar M, Trombert-Paolantoni S, Jacomo V, Mosnier E, Veziris N, Djossou F, Epelboin L. Epidemiology of infection by pulmonary non-tuberculous mycobacteria in French Guiana 2008–2018. PLoS Negl Trop Dis 2022; 16:e0010693. [PMID: 36084148 PMCID: PMC9491559 DOI: 10.1371/journal.pntd.0010693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/21/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Unlike diseases caused by Mycobacterium tuberculosis, M. leprae and M. ulcerans, the epidemiology of pulmonary non-tuberculous mycobacteria (PNTM) has not received due attention in French Guiana. The main objective of the current study was to define the incidence of these PNTM infections: NTM pulmonary diseases (NTM-PD) and casual PNTM isolation (responsible of latent infection or simple colonization). The secondary objectives were to determine species diversity and geographic distribution of these atypical mycobacteria. Methods A retrospective observational study (2008–2018) of French Guiana patients with at least one PNTM positive respiratory sample in culture was conducted. Patients were then classified into two groups: casual PNTM isolation or pulmonary disease (NTM-PD), according to clinical, radiological and microbiological criteria defined by the American Thoracic Society / Infectious Disease Society of America (ATS / IDSA) in 2007. Results 178 patients were included, out of which 147 had casual PNTM isolation and 31 had NTM-PD. Estimated annual incidence rate of respiratory isolates was 6.17 / 100,000 inhabitants per year while that of NTM-PD was 1.07 / 100,000 inhabitants per year. Among the 178 patients, M. avium complex (MAC) was the most frequently isolated pathogen (38%), followed by M. fortuitum then M. abscessus (19% and 6% of cases respectively), the latter two mycobacteria being mainly found in the coastal center region. Concerning NTM-PD, two species were mainly involved: MAC (81%) and M. abscessus (16%). Discussion/Conclusion This is the first study on the epidemiology of PNTM infections in French Guiana. PNTM’s incidence looks similar to other contries and metropolitan France and NTM-PD is mostly due to MAC and M.abscessus. Although French Guiana is the French territory with the highest tuberculosis incidence, NTM should not be overlooked.
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Affiliation(s)
- Milène Chaptal
- Tropical and Infectious Diseases Department, Andrée Rosemon Hospital, Cayenne, French Guiana
- Pneumology Department, University Hospital of Guadeloupe, Pointe-à-Pitre, France
- * E-mail:
| | | | - Timothée Bonifay
- Penitentiary ambulatory care and consultation unit, Andrée Rosemon Hospital, Cayenne, French Guiana
| | | | - Geneviève Guillot
- Medical Department, Andrée Rosemon Hospital, Cayenne, Guyane française
| | | | - Magalie Demar
- Laboratory, Andrée Rosemon Hospital, Cayenne, French Guiana
| | | | | | - Emilie Mosnier
- Tropical and Infectious Diseases Department, Andrée Rosemon Hospital, Cayenne, French Guiana
| | - Nicolas Veziris
- Sorbonne Université, INSERM U1135, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Département de Bactériologie, Groupe hospitalier APHP, Sorbonne Université, Site Saint-Antoine, Paris, France
| | - Felix Djossou
- Tropical and Infectious Diseases Department, Andrée Rosemon Hospital, Cayenne, French Guiana
| | - Loïc Epelboin
- Tropical and Infectious Diseases Department, Andrée Rosemon Hospital, Cayenne, French Guiana
- Centre d’investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Andrée Rosemon, Cayenne, French Guiana
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A Comparison of Three Culture Media for the Detection of Rapid-Growing Nontuberculous Mycobacteria in Environmental Samples. Appl Microbiol 2022. [DOI: 10.3390/applmicrobiol2020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nontuberculous mycobacteria (NTM) are common in the environment and certain species can cause serious infections. Improved environmental surveillance methods are needed to combat the increased incidence of NTM disease. Recently, two methods were developed to improve NTM detection. The MYChrOme™ Culture Plate (patent-pending, Phigenics, LLC, Reno, NV, USA) is the first chromogenic medium for rapid-growing NTM detection in water samples. NTM Elite agar (Biomerieux, Marcy-l’Étoile, France), was developed for rapid-growing NTM detection in clinical samples. Fifty water samples (25 potable and 25 non-potable) with three technical replicates were analyzed by each method and Middlebrook 7H11 selective medium (7H11S) (ASTM E2563-07 method modified for water). The MYChrOme method was overall equivalent to or better than 7H11S medium and NTM Elite agar for the detection of rapid-growing NTM in potable water. All three methods detected similar amounts of NTM in non-potable water samples. The chromogenic property of MYChrOme allowed NTM colonies to be quickly identified and differentiated from other bacteria. Additional analysis is required for colony confirmation on 7H11S medium and NTM Elite agar. The use of innovative environmental NTM diagnostics, in addition to proper water management, can greatly reduce the risk of NTM disease.
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Clinical characteristics and imaging features of patients with nontuberculous mycobacteria in a tertiary care center. J Clin Tuberc Other Mycobact Dis 2022; 26:100294. [PMID: 35028436 PMCID: PMC8739879 DOI: 10.1016/j.jctube.2021.100294] [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] [Indexed: 11/23/2022] Open
Abstract
Background Non-tuberculous mycobacteria (NTM) are ubiquitous organisms that occasionally causes invasive diseases in humans, but they are under-reported in Saudi Arabia. We aimed to describe NTM infections and apply the American Thoracic Society/Infectious Diseases Society of America ATS/IDSA criteria. Method Positive laboratory reports for NTM between January 2006 and December 2017 were retrospectively reviewed, and then classified into respiratory and non-respiratory specimens. ATS/IDSA criteria were applied to all respiratory specimens. Host status, clinical presentation, species identification, imaging, treatment, and outcome data were collected using a standardized form and analyzed. Cases with duplication or incomplete data were excluded. Results 183 unique patients with positive NTM culture were included. Median age was 52 years and males represented 59%. Majority of cases were in the respiratory specimens group (n = 146), of which only 15 cases have met the ATS/IDSA criteria. Overall, cases were primarily known to have non-immunocompromising condition but 27% had either an active malignancy (n = 35), HIV (n = 13), or primary immunodeficiency (n = 8). 68.3% of cases presented with respiratory symptoms with or without fever. Among the identified NTM species (51.9%), slowly growing NTM were predominant. Anti-NTM therapy was provided in only 22.4% of this cohort. Death was documented only in 5 cases; all were in the respiratory group and were not treated. Conclusion Though uncommon to isolate, only one in every ten respiratory NTM isolates was found potentially true pathogen in a single center in Saudi Arabia. Future studies on NTM prevalence in Saudi Arabia are recommended.
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Gnanadurai R, Ninan MM, Arul AO, Sam AS, James P, Gupta R, Michael JS. Challenges in the management of slowly growing non-tuberculous mycobacteria causing pulmonary disease: Perspectives from a high burden country. Indian J Med Microbiol 2021; 39:446-450. [PMID: 34389186 DOI: 10.1016/j.ijmmb.2021.07.005] [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: 01/09/2021] [Revised: 06/14/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is a dearth of data on epidemiology, diagnosis and management of slow growing non tuberculous mycobacteria(NTM) in India, despite being a TB endemic country. This study aims to describe the geographic distribution, risk factors, and the challenges in management of slow growing NTM causing pulmonary infections. METHODS Over a period of 3 years, all slow growing NTM received from pulmonary specimens at a tertiary care centre were further studied from electronic hospital records to correlate non tuberculous mycobacteria species with demographics, geographic location, describe comorbidities including immunosuppression, radiologic findings and treatment regimes. RESULTS M.intracellullare was found in the majority of isolates with significant geographic variation and M.simiae the second commonest found exclusively in southern states. Common comorbidities included a previous history of treatment for tuberculosis, structural lung disease as well as systemic risk factors. Disseminated disease only occurred in immunocompromised hosts as was expected, but at a high rate of 44%. Treatment completion and outcomes were difficult to attain in our population. CONCLUSION The burden of NTM infection and its management in India remain a challenge. Ensuring it is made a notifiable disease may improve the current situation.
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Affiliation(s)
- Roshina Gnanadurai
- Specialist Registrar, Infectious Disease and Microbiology, National Infection Service, Public Health England, Colindale, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Marilyn M Ninan
- Dept of Clinical Microbiology, CMC Vellore, Tamil Nadu, India.
| | | | - Ann Susan Sam
- Dept of Clinical Microbiology, CMC Vellore, Tamil Nadu, India.
| | - Prince James
- Department of Respiratory Medicine, CMC Vellore, Tamil Nadu, India.
| | - Richa Gupta
- Department of Respiratory Medicine, CMC Vellore, Tamil Nadu, India.
| | - Joy S Michael
- Dept of Clinical Microbiology, CMC Vellore, Tamil Nadu, India.
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Bachofner JA, Ikenberg K, Schulthess B, Nemeth J. Disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a female patient with HIV infection. BMJ Case Rep 2021; 14:14/5/e241037. [PMID: 34049891 PMCID: PMC8166601 DOI: 10.1136/bcr-2020-241037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case study discusses the management of a disseminated Mycobacterium simiae and Mycobacterium avium infection causing an immune reconstitution inflammatory syndrome in a 52-year-old woman with HIV infection. Disseminated M. avium infections have extensively been described in HIV patients; however, reports of infections with M. simiae are rare. Treatment of M. simiae infections is challenging due to its high rates of natural drug resistances, and thus far, no standard treatment regimen exists.
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Affiliation(s)
| | - Kristian Ikenberg
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Bettina Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Johannes Nemeth
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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Ho D, Belmonte O, Andre M, Gazaille V, Perisson C, Gachelin E, Allyn J, Payet A, Coolen-Allou N. High Prevalence of Nontuberculous Mycobacteria in Cystic Fibrosis Patients in Tropical French Reunion Island. Pediatr Infect Dis J 2021; 40:e120-e122. [PMID: 33427803 DOI: 10.1097/inf.0000000000002999] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reunion Island is a French overseas department located in a tropical area, where cystic fibrosis incidence is high. Cystic fibrosis (CF) patients are at risk of developing nontuberculous mycobacteria (NTM) infection. Epidemiologic studies are lacking in Reunion Island. METHODS From 2002 to 2015, a retrospective review was performed in university hospitals on Reunion Island. All CF patients having at least 1 positive NTM isolate were included. Clinical, radiologic, and microbiologic data were collected from patient records. RESULTS Fifty-one CF patients were included. The overall estimated prevalence of NTM was 26.4% in total CF population and 36.9% in patients over 12 years of age. Mycobacterium abscessus and Mycobacterium avium were the most frequently identified species found in 31 patients (60.8%) and 14 patients (27.4%), respectively. A rare NTM species: Mycobacterium simiae was found in 4 patients (7.8%). Twenty-nine patients (56.9%) met the American Thoracic Society (ATS) criteria for infection. They were more likely younger with a low body mass index and more frequently infected by Mycobacterium abscessus (22/29). CONCLUSION The overall prevalence of NTM in tropical Reunion Island is 3 times higher than in metropolitan France. A different environmental exposure in a tropical climate or risk factors related to cystic fibrosis or its treatment in Reunion patients could explain it.
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Affiliation(s)
| | - Olivier Belmonte
- Service de Microbiologie, CHU La Réunion site Félix Guyon, Saint Denis, Réunion
| | | | | | - Caroline Perisson
- Service de Pédiatrie, CHU La Réunion Site Sud Réunion, Saint Pierre, Réunion
| | | | - Jérôme Allyn
- Service de Réanimation Médicale, CHU La Réunion site Félix Guyon, Saint Denis, Réunion
| | - Annabelle Payet
- Service de Pneumologie, CHU La Réunion Site Sud Réunion, Saint Pierre, Réunion
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Lotfi H, Sankian M, Meshkat Z, Khalifeh Soltani A, Aryan E. Mycobacterium simiae pulmonary infection: a case series and literature review. Respirol Case Rep 2021; 9:e00719. [PMID: 33628451 PMCID: PMC7898274 DOI: 10.1002/rcr2.719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 01/16/2021] [Indexed: 11/24/2022] Open
Abstract
Incidence of Mycobacterium simiae pulmonary infection is increasing and diagnosis and treatment are challenging. We surveyed the clinical features, risk factors, diagnosis, and management in 20 patients from northeastern Iran diagnosed by line probe assay and confirmed by sequencing the ITS (16S-23S) rRNA region and carried out a literature review using the keywords "pulmonary infection" and "Mycobacterium simiae." The mean age of patients was 55.1 years, with 80% female and 90% diagnosed by sputum. Clinical symptoms included severe cough (90%), sputum production (70%), haemoptysis (50%), and chest pain (35%). Comorbidities included a history of tuberculosis (60%), smoking (40%), or chronic obstructive pulmonary disease (20%). Patients were treated with levofloxacin, clarithromycin, and co-trimoxazole. Except for two patients, the clinical symptoms improved. Mycobacterium simiae pulmonary infection is increasing in people with underlying diseases. Although choosing the most appropriate treatment remains a challenge, combining successful treatments could be useful in treating these patients.
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Affiliation(s)
- Hadi Lotfi
- Antimicrobial Resistance Research CenterMashhad University of Medical SciencesMashhadIran
- Laboratory of Microbiology, Department of Medical MicrobiologyGhaem University Hospital, Mashhad University of Medical SciencesMashhadIran
| | - Mojtaba Sankian
- Immunobiochemistry LaboratoryImmunology Research Center, Mashhad University of Medical SciencesMashhadIran
| | - Zahra Meshkat
- Antimicrobial Resistance Research CenterMashhad University of Medical SciencesMashhadIran
- Laboratory of Microbiology, Department of Medical MicrobiologyGhaem University Hospital, Mashhad University of Medical SciencesMashhadIran
| | - Ahmad Khalifeh Soltani
- Department of Infectious Diseases and Tropical Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Ehsan Aryan
- Antimicrobial Resistance Research CenterMashhad University of Medical SciencesMashhadIran
- Laboratory of Microbiology, Department of Medical MicrobiologyGhaem University Hospital, Mashhad University of Medical SciencesMashhadIran
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Affiliation(s)
- Jean-Francois Jabbour
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amal Hamieh
- Division of Infectious Diseases, Department of Internal Medicine, Al Rassoul Al Azam Hospital, Beirut, Lebanon
| | - Sima L. Sharara
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Souha S. Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- * E-mail:
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Clusters of nontuberculous mycobacteria linked to water sources at three Veterans Affairs medical centers. Infect Control Hosp Epidemiol 2019; 41:320-330. [DOI: 10.1017/ice.2019.342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractObjective:To characterize nontuberculous mycobacteria (NTM) associated with case clusters at 3 medical facilities.Design:Retrospective cohort study using molecular typing of patient and water isolates.Setting:Veterans Affairs Medical Centers (VAMCs).Methods:Isolation and identification of NTM from clinical and water samples using culture, MALDI-TOF, and gene population sequencing to determine species and genetic relatedness. Clinical data were abstracted from electronic health records.Results:An identical strain of Mycobacterium conceptionense was isolated from 41 patients at VA Medical Centers (VAMCs A, B, and D), and from VAMC A’s ICU ice machine. Isolates were initially identified as other NTM species within the M. fortuitum clade. Sequencing analyses revealed that they were identical M. conceptionense strains. Overall, 7 patients (17%) met the criteria for pulmonary or nonpulmonary infection with NTM, and 13 of 41 (32%) were treated with effective antimicrobials regardless of infection or colonization status. Separately, a M. mucogenicum patient strain from VAMC A matched a strain isolated from a VAMC B ICU ice machine. VAMC C, in a different state, had a 4-patient cluster with Mycobacterium porcinum. Strains were identical to those isolated from sink-water samples at this facility.Conclusion:NTM from hospital water systems are found in hospitalized patients, often during workup for other infections, making attribution of NTM infection problematic. Variable NTM identification methods and changing taxonomy create challenges for epidemiologic investigation and linkage to environmental sources.
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Retrospective Analysis of Nontuberculous Mycobacterial Infection and Monochloramine Disinfection of Municipal Drinking Water in Michigan. mSphere 2019; 4:4/4/e00160-19. [PMID: 31270167 PMCID: PMC6609225 DOI: 10.1128/msphere.00160-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Infections by nontuberculous mycobacteria (NTM) result in significant morbidity, mortality, and health care costs. NTM are primarily acquired from environmental sources, including exposure to municipally treated drinking water. Higher levels of NTM have been reported in drinking water disinfected with monochloramine than in drinking water disinfected with chlorine. Our results suggest that municipal drinking water disinfection with monochloramine compared to chlorine is not associated with higher risk of NTM infection. This is important given that regulations that limit drinking water concentrations of disinfection by-products, which are formed primarily when chlorine disinfection is used, incentivize drinking water utilities to change from chlorine disinfection to monochloramine disinfection. Infections by nontuberculous mycobacteria (NTM) are primarily acquired from environmental sources, including exposure to municipally treated drinking water. Higher levels of NTM have been reported in drinking water disinfected with monochloramine than in that disinfected with chlorine. However, the relationships between water treatment practices and NTM infection are unclear. The objective of this study was to examine a possible relationship between residual disinfectant used for municipal drinking water treatment (monochloramine or chlorine) and NTM infection. We retrospectively reviewed NTM diagnostic tests performed at a single health care center during a 15-year period. Information on municipal water treatment practices, including disinfectant and primary source water type, was obtained for 140 cities. Based on a logistic regression model, municipal drinking water disinfection with monochloramine compared to chlorine was not associated with NTM infection (P = 0.24). An additional model variable examining water source showed that the likelihood of having an NTM infection was 1.46 times higher for patients residing in cities with drinking water derived from surface water than for those residing in cities with drinking water derived from groundwater (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.03 to 2.08; P = 0.04). In an inverse propensity score weighted regression, monochloramine disinfection was also not associated with NTM infection. A moderate effect on NTM infection rates was observed in the weighted regression for municipal drinking water derived from surface water, though the results were not statistically significant (OR, 1.24; 95% CI, 0.92 to 1.69; P = 0.17). IMPORTANCE Infections by nontuberculous mycobacteria (NTM) result in significant morbidity, mortality, and health care costs. NTM are primarily acquired from environmental sources, including exposure to municipally treated drinking water. Higher levels of NTM have been reported in drinking water disinfected with monochloramine than in drinking water disinfected with chlorine. Our results suggest that municipal drinking water disinfection with monochloramine compared to chlorine is not associated with higher risk of NTM infection. This is important given that regulations that limit drinking water concentrations of disinfection by-products, which are formed primarily when chlorine disinfection is used, incentivize drinking water utilities to change from chlorine disinfection to monochloramine disinfection.
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Nasiri M, Heidary M, Azimi T, Goudarzi H, Tabarsi P, Darban-Sarokhalil D, Feizabadi M. Mycobacterium simiae pulmonary disease in Iran: systematic review and meta-analysis. New Microbes New Infect 2018; 26:118-123. [PMID: 30370055 PMCID: PMC6199180 DOI: 10.1016/j.nmni.2018.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 02/05/2023] Open
Abstract
Mycobacterium simiae is one of the most common nontuberculous mycobacteria (NTM) microorganisms causing lung disease in many countries in the world. A reliable estimate of the extent of M. simiae pulmonary disease has not been well investigated in Iran. We systematically searched multiple databases to identify relative studies. Studies were excluded if they did not use the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) diagnostic criteria for NTM diseases. Data were extracted independently and in duplicate. We assessed pooled estimate by using a random model effect, and sources of heterogeneity were assessed by using Cochran's Q and the I 2 statistic. The potential for publication bias was explored by using Begg's and Egger's tests. All analyses were conducted with Stata 14.0 (StataCorp, College Station, TX, USA). Of 172 articles identified, seven met the inclusion criteria. Of 355 patients who were culture positive for NTM, 82 had M. simiae pulmonary disease according to the ATS/IDSA diagnostic criteria. The pooled frequency of M. simiae pulmonary disease among patients with NTM was 25.0% (95% confidence interval, 16.8-33.2). No evidence of publication bias was observed among the included studies (p >0.05 for Begg's and Egger's tests). Clinical isolates of M. simiae are increasingly being recognized as a cause of pulmonary disease in Iran and need further attention by health authorities.
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Affiliation(s)
- M.J. Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M. Heidary
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - T. Azimi
- Department of Medical Microbiology, School of Public Health, Tehran, Iran
| | - H. Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - P. Tabarsi
- Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - D. Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - M.M. Feizabadi
- Department of Medical Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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15
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Clinical, Radiological, and Microbiological Characteristics of Mycobacterium simiae Infection in 97 Patients. Antimicrob Agents Chemother 2018; 62:AAC.00395-18. [PMID: 29760130 DOI: 10.1128/aac.00395-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/05/2018] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium simiae is a rare species of slow-growing nontuberculous mycobacteria (NTM). From 2002 to 2017, we conducted a retrospective study that included all patients with NTM-positive respiratory samples detected in two university hospitals of the French overseas department of Reunion Island. We recorded the prevalence of M. simiae in this cohort, as well as the clinical, radiological, and microbiological features of patients with at least 1 sample positive for M. simiae In our cohort, 97 patients (15.1%) were positive for M. simiae Twenty-one patients (21.6%) met the American Thoracic Society (ATS) criteria for infection. M. simiae infection was associated with bronchiectasis, micronodular lesions, and weight loss. Antibiotic susceptibility testing was performed for 60 patients, and the isolates were found to have low susceptibility to antibiotics, except for amikacin, fluoroquinolones, and clarithromycin. Treatment failed for 4 of the 8 patients treated for M. simiae infection. Here, we describe a specific cluster corresponding to a large cohort of patients with M. simiae, a rare nontuberculous mycobacterium associated with low pathogenicity and poor susceptibility to antibiotics.
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16
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Dal Molín-Veglia MA, Sánchez-Martínez F, Fernández-Alarza AF, Domínguez-Álvarez M. Micobacteriosis pulmonar en un paciente en tratamiento crónico con metotrexato. Arch Bronconeumol 2018; 54:225-226. [DOI: 10.1016/j.arbres.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/31/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
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17
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Javeri H, Vélez-Mejía C, Cadena J. Disseminated Mycobacterium simiae infection in a non-immunosuppressed patient in the USA. IDCases 2018; 11:58-60. [PMID: 29379726 PMCID: PMC5780574 DOI: 10.1016/j.idcr.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Heta Javeri
- Department of Medicine/Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, USA
- Corresponding author.
| | | | - Jose Cadena
- Department of Medicine/Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Healthcare System, USA
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18
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Baker AW, Lewis SS, Alexander BD, Chen LF, Wallace RJ, Brown-Elliott BA, Isaacs PJ, Pickett LC, Patel CB, Smith PK, Reynolds JM, Engel J, Wolfe CR, Milano CA, Schroder JN, Davis RD, Hartwig MG, Stout JE, Strittholt N, Maziarz EK, Saullo JH, Hazen KC, Walczak RJ, Vasireddy R, Vasireddy S, McKnight CM, Anderson DJ, Sexton DJ. Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation. Clin Infect Dis 2017; 64:902-911. [PMID: 28077517 DOI: 10.1093/cid/ciw877] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) commonly colonize municipal water supplies and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital. Methods Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation. Results The incidence rate of M. abscessus increased from 0.7 cases per 10000 patient-days during the baseline period (January 2013-July 2013) to 3.0 cases per 10000 patient-days during phase 1 of the outbreak (August 2013-May 2014) (incidence rate ratio, 4.6 [95% confidence interval, 2.3-8.8]; P < .001). Thirty-six of 71 (51%) phase 1 cases were lung transplant patients with positive respiratory cultures. We eliminated tap water exposure to the aerodigestive tract among high-risk patients, and the incidence rate decreased to baseline. Twelve of 24 (50%) phase 2 (December 2014-June 2015) cases occurred in cardiac surgery patients with invasive infections. Phase 2 resolved after we implemented an intensified disinfection protocol and used sterile water for heater-cooler units of cardiopulmonary bypass machines. Molecular fingerprinting of clinical isolates identified 2 clonal strains of M. abscessus; 1 clone was isolated from water sources at a new hospital addition. We made several water engineering interventions to improve water flow and increase disinfectant levels. Conclusions We investigated and mitigated a 2-phase clonal outbreak of M. abscessus linked to hospital tap water. Healthcare facilities with endemic NTM should consider similar tap water avoidance and engineering strategies to decrease risk of NTM infection.
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Affiliation(s)
- Arthur W Baker
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Sarah S Lewis
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Barbara D Alexander
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina.,Duke University Clinical Microbiology Laboratory, Durham, North Carolina
| | - Luke F Chen
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Richard J Wallace
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina
| | | | - Pamela J Isaacs
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina
| | - Lisa C Pickett
- Division of Trauma and Critical Care, Duke University Hospital, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Peter K Smith
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, North Carolina
| | - Jill Engel
- Duke University Hospital, Durham, North Carolina
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Carmelo A Milano
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Robert D Davis
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, North Carolina
| | - Jason E Stout
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Nancy Strittholt
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina
| | - Eileen K Maziarz
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Jennifer Horan Saullo
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina
| | - Kevin C Hazen
- Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Richard J Walczak
- Perfusion Services, Duke University Hospital, Durham, North Carolina
| | - Ravikiran Vasireddy
- Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler
| | - Sruthi Vasireddy
- Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center, Tyler
| | - Celeste M McKnight
- Duke University Clinical Microbiology Laboratory, Durham, North Carolina
| | - Deverick J Anderson
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
| | - Daniel J Sexton
- Duke Program for Infection Prevention and Healthcare Epidemiology, Duke University Hospital, Durham, North Carolina.,Division of Infectious Diseases, Duke University Hospital, Durham, North Carolina
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19
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Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are ubiquitous organisms with variable disease-causing potential. Bloodstream infections caused by NTM in children are poorly described. METHODS We describe a retrospective case series of children with culture-confirmed mycobacterial disease managed at the Children's Hospital at Westmead between July 2005 and June 2015. RESULTS Sixty-five patients had 149 positive NTM cultures; 55 (83.0%) episodes in 54 patients were considered clinically significant. Of the 54 children who met criteria for NTM disease, 25 (46.3%) had lymphadenitis, 13 (24.1%) lung disease, 8 (14.8%) had soft tissue infection or osteomyelitis and 8 (14.8%) had bacteremia. All children with bacteremia had a central venous catheter; those with pulmonary infection had underlying lung disease and all children with soft tissue infection or osteomyelitis had a history of recent penetrating injury. Disease caused by Mycobacterium avium-intracellulare complex was most common, accounting for 19 (76.0%) and 7 (53.8%) lymph node and lung infections, respectively. The most frequently isolated rapid growing mycobacteria were Mycobacterium fortuitum (8; 15%) and Mycobacterium abscessus (6; 11%), with M. fortuitum accounting for the majority (6; 75%) of bloodstream infections. Six (75%) patients with bacteremia had their intravenous catheter removed and all had a favorable outcome. A single disease relapse was reported in 1 of 2 patients with a retained catheter. CONCLUSION Lymphadenitis was the most common NTM disease manifestation and not associated with comorbidity. NTM bacteremia was always associated with a central line and catheter removal with cure. We were unable to assess the added value of various antibiotic regimens.
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20
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Species diversity and molecular characterization of nontuberculous mycobacteria in hospital water system of a developing country, Iran. Microb Pathog 2016; 100:62-69. [PMID: 27616445 DOI: 10.1016/j.micpath.2016.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital environment is of crucial importance in cross-transmission of opportunistic pathogens to the patients. Nontuberculous mycobacteria have the remarkable capability to withstand the adverse condition of hospital environments and pose a potential threat to the health of patients. The current study aimed to assess the frequency and diversity of mycobacteria in hospital water of a developing country using a combination of conventional and molecular methods. METHODS A total of 148 hospital water samples collected from 38 hospitals were analyzed for the presence of mycobacteria using standard protocols for isolation and characterization of the isolates. The conventional tests were used for preliminary identification and Runyon's classification, the PCR amplification of hsp65 gene and sequence analysis of 16S rRNA were applied for the genus and species identification. RESULTS A total of 71 [48%] isolates including 30 rapidly growing and 41 slowly growing mycobacteria were recovered. The three most prevalent species were M. lentiflavum, 28.2%, M. paragordonae, 21.1%, and M. fredriksbergense, 9.8%, followed by M. simiae and M. novocastrense, 7%, M. canariasense and M. cookii like, 5.6%, M. setense, 4.2%, M. fortuitum and M. gordonae, 2.8%, and the single isolates of M. austroafricanum, M. massiliense, M. obuense, and M. phocaicum like. CONCLUSION The results of our study show that the hospital water resources, drinking or non-drinking can be the reservoir of a diverse range of mycobacteria. This reaffirms the fact that these organisms due to intrinsic resistance to common antiseptic and disinfectant solutions persist in hospitals and create a threat to the patient's health and in particular to those that suffer from weakness of immunity.
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21
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Khosravi AD, Hashemi Shahraki A, Hashemzadeh M, Sheini Mehrabzadeh R, Teimoori A. Prevalence of Non-Tuberculous Mycobacteria in Hospital Waters of Major Cities of Khuzestan Province, Iran. Front Cell Infect Microbiol 2016; 6:42. [PMID: 27148491 PMCID: PMC4829604 DOI: 10.3389/fcimb.2016.00042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/26/2016] [Indexed: 11/13/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are among the emerging pathogens in immunocompromised individuals including hospitalized patients. So, it is important to consider hospitals water supplies as a source for infection. The aim of this study was to determine the prevalence of NTM in the hospital aquatic systems of Khuzestan, South west of Iran. In total, 258 hospital water samples were collected and examined. After initial sample processing, sediment of each sample were inoculated into two Lowenstein-Jensen medium. The positive cultures were studied with phenotypic tests including growth rate, colony morphology, and pigmentation, with subsequent PCR- restriction enzyme analysis (PRA) and rpoB gene sequence analysis. Mycobacterial strains were isolated from 77 samples (29.8%), comprising 52 (70.1%) rapid growing, and 25 (32.4%) slow growing mycobacteria. Based on the overall results, M. fortuitum (44.1%) was the most common mycobacterial species in hospital water samples, followed by M. gordonae (n = 13, 16.8%) and M. senegalense (n = 5, 7.7%). In conclusion, current study demonstrated the NTM strains as one of the major parts of hospital water supplies with probable potential source for nosocomial infections. This finding also help to shed light on to the dynamics of the distribution and diversity of NTM in the water system of hospitals in the region of study.
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Affiliation(s)
- Azar Dokht Khosravi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Abdolrazagh Hashemi Shahraki
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Department of Epidemiology, Pasteur Institute of IranTehran, Iran
| | - Mohammad Hashemzadeh
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Rasa Sheini Mehrabzadeh
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical SciencesAhvaz, Iran
| | - Ali Teimoori
- Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical ScienceAhvaz, Iran
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22
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Jeong SH, Kim SY, Lee H, Ham JS, Hwang KB, Hwang S, Shin SH, Chung MJ, Lee SH, Shin SJ, Koh WJ. Nontuberculous Mycobacterial Lung Disease Caused by Mycobacterium simiae: The First Reported Case in South Korea. Tuberc Respir Dis (Seoul) 2015; 78:432-5. [PMID: 26508940 PMCID: PMC4620346 DOI: 10.4046/trd.2015.78.4.432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/10/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022] Open
Abstract
This is a report of the first South Korean case of a lung disease caused by Mycobacterium simiae. The patient was a previously healthy 52-year-old female. All serial isolates were identified as M. simiae by multi-locus sequencing analysis, based on hsp65, rpoB, 16S-23S rRNA internal transcribed spacer, and 16S rRNA fragments. A chest radiography revealed deterioration, and the follow-up sputum cultures were persistently positive, despite combination antibiotic treatment, including azithromycin, ethambutol, and rifampin. To the best of our knowledge, this is the first confirmed case of a lung disease caused by M. simiae in South Korea.
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Affiliation(s)
- Suk Hyeon Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Soo Ham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keum Bit Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Subin Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Sung Jae Shin
- Department of Microbiology, Yonsei University College of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gaspard W, N'Gampolo I, Rivière F, Lefloch H, Margery J, Marotel C, Soler C, Vaylet F. [Mycobacterial pulmonary infection due to Mycobacterium simiae]. Rev Mal Respir 2015; 33:248-52. [PMID: 26282361 DOI: 10.1016/j.rmr.2015.06.005] [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: 09/18/2014] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Mycobacterium simiae pulmonary infections remain exceptional in France. CASE REPORT We report a case of M. simiae lung infection and a 10-year follow-up in a non-immunocompromised host. CONCLUSION This case emphasizes the difficulties of choosing the appropriate drugs and their side effects in the absence of any existing gold standard.
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Affiliation(s)
- W Gaspard
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - I N'Gampolo
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - F Rivière
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - H Lefloch
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - J Margery
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Marotel
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Soler
- Service de biologie, hôpital d'instruction des armées Percy, 92023 Clamart, France
| | - F Vaylet
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
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24
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Sax H, Bloemberg G, Hasse B, Sommerstein R, Kohler P, Achermann Y, Rössle M, Falk V, Kuster SP, Böttger EC, Weber R. Prolonged Outbreak of Mycobacterium chimaera Infection After Open-Chest Heart Surgery. Clin Infect Dis 2015; 61:67-75. [PMID: 25761866 DOI: 10.1093/cid/civ198] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/26/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Invasive Mycobacterium chimaera infections were diagnosed in 2012 in 2 heart surgery patients on extracorporeal circulation. We launched an outbreak investigation to identify the source and extent of the potential outbreak and to implement preventive measures. METHODS We collected water samples from operating theaters, intensive care units, and wards, including air samples from operating theaters. Mycobacterium chimaera strains were characterized by randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). Case detection was performed based on archived histopathology samples and M. chimaera isolates since 2006, and the patient population at risk was prospectively surveyed. RESULTS We identified 6 male patients aged between 49 and 64 years with prosthetic valve endocarditis or vascular graft infection due to M. chimaera, which became clinically manifest with a latency of between 1.5 and 3.6 years after surgery. Mycobacterium chimaera was isolated from cardiac tissue specimens, blood cultures, or other biopsy specimens. We were able also to culture M. chimaera from water circuits of heater-cooler units connected to the cardiopulmonary bypass, and air samples collected when the units were in use. RAPD-PCR demonstrated identical patterns among M. chimaera strains from heater-cooler unit water circuits and air samples, and strains in 2 patient clusters. CONCLUSIONS The epidemiological and microbiological features of this prolonged outbreak provided evidence for the airborne transmission of M. chimaera from contaminated heater-cooler unit water tanks to patients during open-heart surgery.
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Affiliation(s)
- Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Guido Bloemberg
- Institute of Medical Microbiology, National Centre for Mycobacteria, University of Zurich
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Rami Sommerstein
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | | | - Volkmar Falk
- Division of Cardiac Surgery, University Hospital Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Erik C Böttger
- Institute of Medical Microbiology, National Centre for Mycobacteria, University of Zurich
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
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25
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Minogue E, Tuite NL, Smith CJ, Reddington K, Barry T. A rapid culture independent methodology to quantitatively detect and identify common human bacterial pathogens associated with contaminated high purity water. BMC Biotechnol 2015; 15:6. [PMID: 25888294 PMCID: PMC4342816 DOI: 10.1186/s12896-015-0124-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/06/2015] [Indexed: 02/06/2023] Open
Abstract
Background Water and High Purity Water (HPW) distribution systems can be contaminated with human pathogenic microorganisms. This biocontamination may pose a risk to human health as HPW is commonly used in the industrial, pharmaceutical and clinical sectors. Currently, routine microbiological testing of HPW is performed using slow and labour intensive traditional microbiological based techniques. There is a need to develop a rapid culture independent methodology to quantitatively detect and identify biocontamination associated with HPW. Results A novel internally controlled 5-plex real-time PCR Nucleic Acid Diagnostics assay (NAD), was designed and optimised in accordance with Minimum Information for Publication of Quantitative Real-Time PCR Experiments guidelines, to rapidly detect, identify and quantify the human pathogenic bacteria Stenotrophomonas maltophilia, Burkholderia species, Pseudomonas aeruginosa and Serratia marcescens which are commonly associated with the biocontamination of water and water distribution systems. The specificity of the 5-plex assay was tested against genomic DNA isolated from a panel of 95 microorganisms with no cross reactivity observed. The analytical sensitivities of the S. maltophilia, B. cepacia, P. aeruginosa and the S. marcescens assays are 8.5, 5.7, 3.2 and 7.4 genome equivalents respectively. Subsequently, an analysis of HPW supplied by a Millipore Elix 35 water purification unit performed using standard microbiological methods revealed high levels of naturally occurring microbiological contamination. Five litre water samples from this HPW delivery system were also filtered and genomic DNA was purified directly from these filters. These DNA samples were then tested using the developed multiplex real-time PCR NAD assay and despite the high background microbiological contamination observed, both S. maltophilia and Burkholderia species were quantitatively detected and identified. At both sampling points the levels of both S. maltophilia and Burkholderia species present was above the threshold of 10 cfu/100 ml recommended by both EU and US guidelines. Conclusions The novel culture independent methodology described in this study allows for rapid (<5 h), quantitative detection and identification of these four human pathogens from biocontaminated water and HPW distribution systems. We propose that the described NAD assay and associated methodology could be applied to routine testing of water and HPW distribution systems to assure microbiological safety and high water quality standards. Electronic supplementary material The online version of this article (doi:10.1186/s12896-015-0124-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Minogue
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Nina L Tuite
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Cindy J Smith
- Marine Microbial Ecology Laboratory, Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Kate Reddington
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Thomas Barry
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
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Conger NG, O'Connell RJ, Laurel VL, Olivier KN, Graviss EA, Williams-Bouyer N, Zhang Y, Brown-Elliott BA, Wallace RJ. Mycobacterium simiaeOutbreak Associated With a Hospital Water Supply. Infect Control Hosp Epidemiol 2015; 25:1050-5. [PMID: 15636291 DOI: 10.1086/502342] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractObjective:Mycobacterium simiaeis found primarily in the southwestern United States, Israel, and Cuba, with tap water as its suspected reservoir. Our institution saw an increase inM. simiaeisolates in 2001. An investigation into possible contaminated water sources was undertaken.Design:Environmental cultures were performed from water taps in the microbiology laboratory, patient rooms, points in the flow of water to the hospital, and patients' homes. Patient and environmentalM. simiaewere compared by PFGE.Setting:Military treatment facility in San Antonio, Texas.Patients:All patients with cultures positive forM. simiaebetween January 2001 and April 2002. Medical records were reviewed.Results:M. simiaewas recovered from water samples from the hospital, patients' home showers, and a well supplying the hospital. A single PFGE clone was predominant among water isolates (9 of 10) and available patient isolates (14 of 19). There was an association between exposure to hospital water and pulmonary samples positive for the clonalM. simiaestrain (P= .0018). Only 3 of 22 culture-positive patients met criteria forM. simiaepulmonary disease. Of them, two had indistinguishableM. simiaestrains from tap water to which they were routinely exposed.Conclusions:This represents an outbreak ofM. simiaecolonization with one nosocomial infection. It is only the second time thatM. simiaehas been recovered from hospital tap water and its first presentation in municipal water. This study raises issues about the need and feasibility of eliminating or avoiding exposure toM. simiaefrom tap water.
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Affiliation(s)
- Nicholas G Conger
- Department of Infectious Disease, Wilford Hall Medical Center, Lackland AFB, Texas, USA
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Brown-Elliott BA, Philley JV, Benwill JL, Wallace RJ. Current Opinions in the Treatment of Pulmonary Nontuberculous Mycobacteria in Non-Cystic Fibrosis Patients: Mycobacterium abscessus Group, Mycobacterium avium Complex, and Mycobacterium kansasii. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-014-0032-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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García-Martos P, García-Agudo L, González-Moya E, Galán F, Rodríguez-Iglesias M. [Infections due to Mycobacterium simiae]. Enferm Infecc Microbiol Clin 2014; 33:e37-43. [PMID: 25444043 DOI: 10.1016/j.eimc.2014.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/26/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
Abstract
Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed.
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Affiliation(s)
| | | | | | - Fátima Galán
- Servicio de Microbiología, Hospital Puerta del Mar, Cádiz, España
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Hankins D, Kelly M, Vijayan V. Mycobacterium simiae Infection of the Parotid Gland in an Immunocompetent Child. J Pediatric Infect Dis Soc 2013; 2:394-6. [PMID: 26619504 DOI: 10.1093/jpids/pis098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Vini Vijayan
- Division of Immunology, Rheumatology and Infectious Diseases, Department of Pediatrics, University of Florida, Gainesville
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Sassi M, Robert C, Raoult D, Drancourt M. Non-contiguous genome sequence of Mycobacterium simiae strain DSM 44165(T.). Stand Genomic Sci 2013; 8:306-17. [PMID: 23991261 PMCID: PMC3746425 DOI: 10.4056/sigs.3707349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium simiae is a non-tuberculosis mycobacterium causing pulmonary infections in both immunocompetent and imunocompromized patients. We announce the draft genome sequence of M. simiae DSM 44165T. The 5,782,968-bp long genome with 65.15% GC content (one chromosome, no plasmid) contains 5,727 open reading frames (33% with unknown function and 11 ORFs sizing more than 5000 -bp), three rRNA operons, 52 tRNA, one 66-bp tmRNA matching with tmRNA tags from Mycobacterium avium, Mycobacterium tuberculosis, Mycobacterium bovis, Mycobacterium microti, Mycobacterium marinum, and Mycobacterium africanum and 389 DNA repetitive sequences. Comparing ORFs and size distribution between M. simiae and five other Mycobacterium species M. simiae clustered with M. abscessus and M. smegmatis. A 40-kb prophage was predicted in addition to two prophage-like elements, 7-kb and 18-kb in size, but no mycobacteriophage was seen after the observation of 106M. simiae cells. Fifteen putative CRISPRs were found. Three genes were predicted to encode resistance to aminoglycosides, betalactams and macrolide-lincosamide-streptogramin B. A total of 163 CAZYmes were annotated. M. simiae contains ESX-1 to ESX-5 genes encoding for a type-VII secretion system. Availability of the genome sequence may help depict the unique properties of this environmental, opportunistic pathogen.
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Affiliation(s)
- Mohamed Sassi
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de médecine, Marseille, France
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31
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Affiliation(s)
- Evonne T Curran
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
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32
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Williams MM, Armbruster CR, Arduino MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. BIOFOULING 2013; 29:147-62. [PMID: 23327332 PMCID: PMC9326810 DOI: 10.1080/08927014.2012.757308] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Several bacterial species that are natural inhabitants of potable water distribution system biofilms are opportunistic pathogens important to sensitive patients in healthcare facilities. Waterborne healthcare-associated infections (HAI) may occur during the many uses of potable water in the healthcare environment. Prevention of infection is made more challenging by lack of data on infection rate and gaps in understanding of the ecology, virulence, and infectious dose of these opportunistic pathogens. Some healthcare facilities have been successful in reducing infections by following current water safety guidelines. This review describes several infections, and remediation steps that have been implemented to reduce waterborne HAIs.
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Affiliation(s)
- Margaret M Williams
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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33
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Matveychuk A, Fuks L, Priess R, Hahim I, Shitrit D. Clinical and radiological features of Mycobacterium kansasii and other NTM infections. Respir Med 2012; 106:1472-7. [DOI: 10.1016/j.rmed.2012.06.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 06/08/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
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34
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Brown-Elliott BA, Nash KA, Wallace RJ. Antimicrobial susceptibility testing, drug resistance mechanisms, and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev 2012; 25:545-82. [PMID: 22763637 PMCID: PMC3416486 DOI: 10.1128/cmr.05030-11] [Citation(s) in RCA: 335] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Within the past 10 years, treatment and diagnostic guidelines for nontuberculous mycobacteria have been recommended by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). Moreover, the Clinical and Laboratory Standards Institute (CLSI) has published and recently (in 2011) updated recommendations including suggested antimicrobial and susceptibility breakpoints. The CLSI has also recommended the broth microdilution method as the gold standard for laboratories performing antimicrobial susceptibility testing of nontuberculous mycobacteria. This article reviews the laboratory, diagnostic, and treatment guidelines together with established and probable drug resistance mechanisms of the nontuberculous mycobacteria.
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35
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Williams MM, Chen TH, Keane T, Toney N, Toney S, Armbruster CR, Butler WR, Arduino MJ. Point-of-use membrane filtration and hyperchlorination to prevent patient exposure to rapidly growing mycobacteria in the potable water supply of a skilled nursing facility. Infect Control Hosp Epidemiol 2012; 32:837-44. [PMID: 21828963 DOI: 10.1086/661282] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare-associated outbreaks and pseudo-outbreaks of rapidly growing mycobacteria (RGM) are frequently associated with contaminated tap water. A pseudo-outbreak of Mycobacterium chelonae-M. abscessus in patients undergoing bronchoscopy was identified by 2 acute care hospitals. RGM was identified in bronchoscopy specimens of 28 patients, 25 of whom resided in the same skilled nursing facility (SNF). An investigation ruled out bronchoscopy procedures, specimen collection, and scope reprocessing at the hospitals as sources of transmission. OBJECTIVE To identify the reservoir for RGM within the SNF and evaluate 2 water system treatments, hyperchlorination and point-of-use (POU) membrane filters, to reduce RGM. DESIGN A comparative in situ study of 2 water system treatments to prevent RGM transmission. SETTING An SNF specializing in care of patients requiring ventilator support. METHODS RGM and heterotrophic plate count (HPC) bacteria were examined in facility water before and after hyperchlorination and in a subsequent 24-week assessment of filtered water by colony enumeration on Middlebrook and R2A media. RESULTS Mycobacterium chelonae was consistently isolated from the SNF water supply. Hyperchlorination reduced RGM by 1.5 log(10) initially, but the population returned to original levels within 90 days. Concentration of HPC bacteria also decreased temporarily. RGM were reduced below detection level in filtered water, a 3-log(10) reduction. HPC bacteria were not recovered from newly installed filters, although low quantities were found in water from 2-week-old filters. CONCLUSION POU membrane filters may be a feasible prevention measure for healthcare facilities to limit exposure of sensitive individuals to RGM in potable water systems.
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Affiliation(s)
- Margaret M Williams
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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36
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Camarena Miñana JJ, González Pellicer R. Micobacterias atípicas y su implicación en patología infecciosa pulmonar. Enferm Infecc Microbiol Clin 2011; 29 Suppl 5:66-75. [DOI: 10.1016/s0213-005x(11)70046-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Five-year outbreak of community- and hospital-acquired Mycobacterium porcinum infections related to public water supplies. J Clin Microbiol 2011; 49:4231-8. [PMID: 21998415 DOI: 10.1128/jcm.05122-11] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium porcinum is a rarely encountered rapidly growing Mycobacterium (RGM). We identified M. porcinum from 24 patients at a Galveston university hospital (University of Texas Medical Branch) over a 5-year period. M. porcinum was considered a pathogen in 11 (46%) of 24 infected patients, including 4 patients with community-acquired disease. Retrospective patient data were collected, and water samples were cultured. Molecular analysis of water isolates, clustered clinical isolates, and 15 unrelated control strains of M. porcinum was performed. Among samples of hospital ice and tap water, 63% were positive for RGM, 50% of which were M. porcinum. Among samples of water from the city of Galveston, four of five households (80%) were positive for M. porcinum. By pulsed-field gel electrophoresis (PFGE), 8 of 10 environmental M. porcinum were determined to belong to two closely related clones. A total of 26 of 29 clinical isolates subjected to PFGE (including isolates from all positive patients) were clonal with the water patterns, including patients with community-acquired disease. Fifteen control strains of M. porcinum had unique profiles. Sequencing of hsp65, recA, and rpoB revealed the PFGE outbreak clones to have identical sequences, while unrelated strains exhibited multiple sequence variants. M. porcinum from 22 (92%) of 24 patients were clonal, matched hospital- and household water-acquired isolates, and differed from epidemiologically unrelated strains. M. porcinum can be a drinking water contaminant, serve as a long-term reservoir (years) for patient contamination (especially sputum), and be a source of clinical disease. This study expands concern about public health issues regarding nontuberculous mycobacteria. Multilocus gene sequencing helped define clonal populations.
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38
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Nontuberculous Mycobacteria and the Lung: From Suspicion to Treatment. Lung 2010; 188:269-82. [DOI: 10.1007/s00408-010-9240-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/19/2010] [Indexed: 10/19/2022]
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39
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Abstract
Despite using modern microbiological diagnostic approaches, the aetiological agents of pneumonia remain unidentified in about 50% of cases. Some bacteria that grow poorly or not at all in axenic media used in routine clinical bacteriology laboratory but which can develop inside amoebae may be the agents of these lower respiratory tract infections (RTIs) of unexplained aetiology. Such amoebae-resisting bacteria, which coevolved with amoebae to resist their microbicidal machinery, may have developed virulence traits that help them survive within human macrophages, i.e. the first line of innate immune defence in the lung. We review here the current evidence for the emerging pathogenic role of various amoebae-resisting microorganisms as agents of RTIs in humans. Specifically, we discuss the emerging pathogenic roles of Legionella-like amoebal pathogens, novel Chlamydiae (Parachlamydia acanthamoebae, Simkania negevensis), waterborne mycobacteria and Bradyrhizobiaceae (Bosea and Afipia spp.).
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Affiliation(s)
- Frédéric Lamoth
- Infectious Diseases Service, University of Lausanne, Lausanne, Switzerland
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40
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Wang SH, Pancholi P, Stevenson K, Yakrus MA, Butler WR, Schlesinger LS, Mangino JE. Pseudo-outbreak of "Mycobacterium paraffinicum" infection and/or colonization in a tertiary care medical center. Infect Control Hosp Epidemiol 2009; 30:848-53. [PMID: 19653819 DOI: 10.1086/599071] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate a pseudo-outbreak of "Mycobacterium paraffinicum" (unofficial taxon) infection and/or colonization, using isolates recovered from clinical and environmental specimens. DESIGN Outbreak investigation. SETTING University-affiliated, tertiary-care hospital. METHODS M. paraffinicum, a slow-growing, nontuberculous species of mycobacteria, was recovered from 21 patients and an ice machine on a single patient care unit over a 2.5-year period. The clinical, epidemiological, and environmental investigation of this pseudo-outbreak is described. RESULTS Twenty-one patients with pulmonary symptoms and possible risk factors for tuberculosis were admitted to inpatient rooms that provided airborne isolation conditions in 2 adjacent hospital buildings. In addition, 1 outpatient had induced sputum cultured for mycobacteria in the pulmonary function laboratory. Of the samples obtained from these 21 patients, 26 isolates from respiratory samples and 1 isolate from a stool sample were identified as M. paraffinicum. Environmental isolates obtained from an ice machine in the patient care unit where the majority of the patients were admitted were also identified as M. paraffinicum. CONCLUSIONS An epidemiological investigation that used molecular tools confirmed the suspicion of a pseudo-outbreak of M. paraffinicum infection and/or colonization. The hospital water system was identified as the source of contamination.
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Affiliation(s)
- Shu-Hua Wang
- Center for Microbial Interface Biology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, USA.
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41
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Clinical and radiological features of Mycobacterium kansasii infection and Mycobacterium simiae infection. Respir Med 2008; 102:1598-603. [DOI: 10.1016/j.rmed.2008.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 04/13/2008] [Accepted: 05/25/2008] [Indexed: 11/21/2022]
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Maoz C, Shitrit D, Samra Z, Peled N, Kaufman L, Kramer MR, Bishara J. Pulmonary Mycobacterium simiae infection: comparison with pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis 2008; 27:945-50. [PMID: 18488259 DOI: 10.1007/s10096-008-0522-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 04/01/2008] [Indexed: 10/22/2022]
Abstract
To identify the clinical and radiological features distinguishing Mycobacterium simiae respiratory infection from pulmonary tuberculosis, the demographics, underlying conditions, and clinical and radiological findings of 121 consecutive patients with pulmonary tuberculosis and 102 with M. simiae respiratory infection were compared retrospectively. In the M. simiae group, the patients were older (mean age 69 +/- 16 years vs. 47 +/- 21 years, p = 0.0001), with a female predominance (62% vs. 45%, p = 0.008). Only 4% were of Ethiopian origin compared to 25% of the tuberculosis group (p = 0.0001). M. simiae infection was associated with significantly higher rates of smoking history, underlying chronic obstructive pulmonary disease, zero human immunodeficiency virus (HIV) infection compared to 10% in the tuberculosis group (p = 0.001), blunted symptoms, and noncavitary infiltrates in the lower/middle lobes on chest X-ray. HIV-negative patients with M. simiae respiratory infection are distinguishable from patients with pulmonary tuberculosis by several demographic, clinical, and radiological features. These findings have important diagnostic and therapeutic implications.
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Affiliation(s)
- C Maoz
- Recanati Center for Medicine and Research, Rabin Medical Center, Beilinson Hospital, Petah Tiqwa, Israel
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43
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Cruz AT, Goytia VK, Starke JR. Mycobacterium simiae complex infection in an immunocompetent child. J Clin Microbiol 2007; 45:2745-6. [PMID: 17537950 PMCID: PMC1951226 DOI: 10.1128/jcm.00359-07] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nontuberculous mycobacteria are ubiquitous in the environment but rarely infect immunocompetent patients. We describe a pediatric case of Mycobacterium simiae complex lymphadenitis in an immunocompetent child and review the natural history, clinical manifestations, diagnosis, and current management of the disease.
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Affiliation(s)
- Andrea T Cruz
- Department of Pediatrics, Section of Infectious Disease, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030-2399, USA.
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44
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Travis EK, Junge RE, Terrell SP. Infection withMycobacterium simiaecomplex in four captive Micronesian kingfishers. J Am Vet Med Assoc 2007; 230:1524-9. [PMID: 17504049 DOI: 10.2460/javma.230.10.1524] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 4 captive adult Micronesian kingfishers (Halcyon cinnamomina cinnamomina) at 3 zoologic institutions were examined routinely or because of dyspnea or lethargy. CLINICAL FINDINGS All birds had marked hepatomegaly. Two birds had dyspnea caused by compression of air sacs by the enlarged liver, and 1 bird had generalized weakness and lethargy. Three birds had distended coelomic cavities, and 3 birds were thin or had lost weight. There were no consistent abnormalities in blood analytes. Results of most ancillary diagnostic tests such as acid-fast staining of cloacal or fecal swab specimens and culture of feces for acid-fast bacteria were negative. Results of examination of hepatic biopsy specimens in 2 of 4 birds were suggestive of mycobacteriosis. TREATMENT AND OUTCOME 3 birds died or were euthanized soon after diagnosis. One kingfisher was isolated and monitored for 4 months without treatment and died during anesthesia for disease monitoring. Postmortem histologic examination revealed histiocytic hepatitis and acid-fast bacteria in all 4 birds. Bacteriologic culture of liver specimens yielded Mycobacterium simiae complex in all 4 birds. CLINICAL RELEVANCE Infection with M simiae complex should be considered in ill Micronesian kingfishers, and further monitoring is warranted to determine whether this is an emerging pathogen in this species.
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Affiliation(s)
- Erika K Travis
- Saint Louis Zoo, 1 Government Dr, St Louis, MO 63110, USA
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45
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Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ, Winthrop K. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367-416. [PMID: 17277290 DOI: 10.1164/rccm.200604-571st] [Citation(s) in RCA: 3917] [Impact Index Per Article: 230.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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46
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Abstract
Mycobacterium simiae, a multidrug-resistant, opportunistic acid-fast bacillus, usually causes infection in immunocompromised hosts. We describe a previously healthy child with M. simiae necrotizing granulomatous cervical lymphadenitis. Cure was achieved with excision of the affected nodes and adjunctive antimicrobial therapy.
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Affiliation(s)
- Niraj C Patel
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas 77030, USA.
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47
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Bettiker RL, Axelrod PI, Fekete T, St John K, Truant A, Toney S, Yakrus MA. Delayed recognition of a pseudo-outbreak of Mycobacterium terrae. Am J Infect Control 2006; 34:343-7. [PMID: 16877101 DOI: 10.1016/j.ajic.2005.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 12/14/2005] [Accepted: 12/14/2005] [Indexed: 11/28/2022]
Abstract
Pseudo-outbreaks of mycobacteria are difficult to recognize because of long incubation periods for growth and species identification. We report our experience with one clinical microbiology laboratory that isolated a species of nontuberculous mycobacteria from 14 patient specimens. These specimens came from 12 patients at 2 hospitals over a 6-day period and included 6 different fluids or tissues. Because of the delay between mycobacterial specimen submission and growth in culture, the outbreak was not noted until more than a month later. Initial species determination by a reference laboratory indicated that these isolates were Mycobacterium fortuitum. One patient received treatment for presumed M fortuitum brain infection, and it was not effective in changing her clinical course. The isolates were sent to the Centers for Disease Control and Prevention (CDC) for identification and typing by pulsed-field gel electrophoresis. The CDC determined that the isolates were an identical strain of M terrae, thus confirming a pseudo-outbreak. Combining pseudo-outbreak isolates with those correctly identified initially as M terrae during the 6-day period in question, there were 22 samples from 20 patients with M terrae. Since the pseudo-outbreak, the number of cultures of M terrae in the clinical laboratory has returned to baseline levels without any specific intervention.
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48
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Esteban J, Fernández Roblas R, García Cía JI, Zamora N, Ortiz A. Clinical significance and epidemiology of non-pigmented rapidly growing mycobacteria in a university hospital. J Infect 2006; 54:135-45. [PMID: 16616783 DOI: 10.1016/j.jinf.2006.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 02/21/2006] [Accepted: 02/23/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To study the clinical significance and epidemiology of Non-pigmented rapidly growing mycobacteria (NPRGM) during a 13-year period. METHODS We performed a retrospective study of patients with isolates of NPRGM to evaluate their clinical significance. We also analyzed the strains using Randomly Amplified Polymorphic DNA (RAPD) analysis to evaluate the relationship between strains. RESULTS Between 1990 and 2003, 65 patients had an isolate of NPRGM. Twenty of them were considered significant (19 cases) or doubtful (1 case). Many cases were skin and soft tissue infections. Six cases were foreign-body related. All the patients recovered with antibiotic therapy and removal of the foreign body. All the patients were apparently unrelated, despite 56.9% of the isolates were detected between 1995 and 1997. RAPD analysis was performed on 43 strains, and showed only a cluster of two Mycobacterium chelonae isolates. Both of them were related with contamination of a laboratory reactive, and were considered non-significant. CONCLUSION In our hospital, almost one-third of the isolates of NPRGM were significant, being this percentage higher for skin and soft tissue isolates. Patients were cured with antibiotic therapy, but the removal of foreign bodies appeared to be necessary for a good outcome. A minor pseudo-outbreak was detected. No predominant strain was detected.
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Affiliation(s)
- J Esteban
- Department of Clinical Microbiology, Fundación Jiménez Díaz, Av. Reyes Católicos 2, 28040-Madrid, Spain.
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49
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Samra Z, Kaufman L, Pitlik S, Shalit I, Bishara J. Emergence of Mycobacterium simiae in respiratory specimens. ACTA ACUST UNITED AC 2006; 37:838-41. [PMID: 16308217 DOI: 10.1080/00365540500264712] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Temporal changes in epidemiology of non-tuberculous mycobacteria (NTM) infections have hardly been explored. Frequency of isolation of different NTM species varies geographically. We aimed to determine whether the distribution of Mycobacteria species isolated from respiratory specimens had changed from 1996 to 2003. We analysed data on 484 patient mycobacterial isolates from 23,483 respiratory specimens submitted to the Laboratory of Microbiology in a tertiary medical centre. The proportion of patients with Mycobacterium tuberculosis isolates decreased from 44.6% in period I (1996-1999) to 20.6% in period II (2000-2003). Among the NTM, the proportion of some species increased significantly (Mycobacterium simiae: 8.4% to 31.6%; Mycobacterium fortuitum 12% to 20%; and Mycobacterium chelonae 4.8% to 11.3%), while others decreased (Mycobacterium avium complex 31.3% to 17.3%; Mycobacterium kansasii 28.9% to 7.5%; and Mycobacterium haemophilum 1.2% to 0%). These findings disclose major temporal changes in the distribution of mycobacterial species in respiratory specimens with an impressive emergence and takeover of M. simiae.
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Affiliation(s)
- Zmira Samra
- Departmnent of Clinical Microbiology, Rabin Medical Centre, Beilinson Campus, Sackler Faculty of Medicine, Israel
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Carrière C, Godreuil S, Gouby A, Vincent V, Marchandin H, Terru D, Delaporte E, Sorokaty JM, Jumas-Bilak E, Van de Perre P. [Mycobacterium simiae infections: about two cases]. ACTA ACUST UNITED AC 2005; 53:324-7. [PMID: 16004943 DOI: 10.1016/j.patbio.2004.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Accepted: 07/28/2004] [Indexed: 11/18/2022]
Abstract
We report two cases of Mycobacterium simiae infections differing by the site of infection, the immunological status of the patients and the diagnostic methods used. The first case is a disseminated infection in an advanced immunosuppressed patient who died quickly confirming the severity of this infection in the context of HIV infection. The second case presented is a respiratory disease in a women with a past history of tuberculosis and an uneventful evolution of the M. simiae infection under treatment. These two cases demontrate the importance of molecular methods to correctly identify M. simiae.
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Affiliation(s)
- C Carrière
- Laboratoire de bactériologie, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Giraud, 34295 Montpellier, France.
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