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A case of mediastinal abscess and infected aortic aneurysm caused by dissemination of Mycobacterium abscessus subsp. massiliense pulmonary disease. J Infect Chemother 2022; 29:82-86. [PMID: 36162647 DOI: 10.1016/j.jiac.2022.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022]
Abstract
An 81-year-old man was admitted to our hospital because of fever and malaise that had persisted for 3 months. The patient had undergone two aortic valve replacements, 10 and 5 years previously, because of aortic valve regurgitation and infectious endocarditis. He also had had asymptomatic Mycobacterium abscessus complex (MABC) pulmonary disease for the two previous years. Contrast-enhanced computed tomography showed a mediastinal abscess and an ascending aortic aneurysm. Mycobacterium abscessus subsp. massiliense was cultured from his blood, suggesting the aortic aneurysm was secondary to infection of an implanted device. After enlargement over only a few days, a leakage of contrast medium to the mediastinal abscess was found on computed tomography. The patient was diagnosed with rupture of an infectious aortic aneurysm, and emergency aortic replacement and drainage of the mediastinal abscess were successful. The patient was treated with several antibiotics, including meropenem, amikacin, and clarithromycin, and his general condition improved. Cultures from both the mediastinal abscess and a pericardial patch that was placed at the time of surgery 5 years previously revealed MABC. In our case, the infected aortic aneurysm most likely resulted from MABC pulmonary disease rather than from previous intraoperative contamination. This route of infection is rare. Physicians should be aware of the possibility of dissemination and subsequent infection of implants related to MABC pulmonary disease.
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2
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Singh M, Heincelman M. Disseminated Nontuberculous Mycobacterium Presenting as Chronic Diarrhea and Wasting. J Investig Med High Impact Case Rep 2022; 10:23247096221101860. [PMID: 35596545 PMCID: PMC9125057 DOI: 10.1177/23247096221101860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Infections due to nontuberculous mycobacterium (NTM) are important in chronically immunosuppressed populations and are a particular threat to solid organ transplant recipients (SOT). However, they are not a common occurrence and have protean manifestations, making it important that clinicians maintain a high degree of suspicion in the correct patient population. Mycobacterium avium complex (MAC) usually presents with pulmonary involvement in immunocompetent population and disseminated disease in SOT patients with fever of unknown origin, lymphadenopathy, and cutaneous lesions being part of the well-known presentation. It is not commonly described as causing severe diarrhea. Here, we present an interesting case of a patient with a kidney and pancreas transplant who presented with debilitating wasting and chronic diarrhea. Biopsies and cultures confirmed MAC. To our knowledge, this is the first case report of MAC causing severe wasting diarrhea in renal transplant patients. The patient was treated with a multidrug regimen. Given the rare presentation of MAC presenting as chronic diarrhea, the treatment regimen is not standardized and infectious disease specialists should be involved early on. Up to 30% of renal transplant patients infected with NTM lose graft function and 20% die. Unfortunately, our patient suffered both these outcomes.
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Affiliation(s)
- Manasi Singh
- Medical University of South Carolina, Charleston, USA
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3
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Malinis MF. Management of Mycobacterium Other than Tuberculosis in Solid Organ Transplantation. Infect Dis Clin North Am 2018; 32:719-732. [PMID: 30146032 DOI: 10.1016/j.idc.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mycobacteria other than tuberculosis are important pathogens to consider in solid organ transplant recipients. Delay in recognition and treatment may incur significant morbidity and mortality. Management of mycobacteria other than tuberculosis requires a knowledge of treatment specific for each species and drug-drug interactions between antimicrobial and immunosuppressive drugs. Therapy in solid organ transplant can be prolonged and may require a reduction in immunosuppression to improve outcomes.
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Affiliation(s)
- Maricar F Malinis
- Section of Infectious Diseases, Yale School of Medicine, PO Box 208022, New Haven, CT 06520-8022, USA.
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4
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Ingilizova M, Epstein S, Heun Lee D, Patel N, Patel Babariya S, Morgenstern R, Popnikolov N, Coppock D. A rare case of disseminated Mycobacterium avium complex with colitis in a renal transplant recipient. Transpl Infect Dis 2018; 21:e13011. [PMID: 30298542 DOI: 10.1111/tid.13011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 01/15/2023]
Abstract
Mycobacterium avium complex (MAC) colitis is a rare complication of immunosuppression in solid organ transplant (SOT) recipients. Here, we describe a case of disseminated MAC infection with colitis following renal transplantation. Despite common pathways of immunosuppression, SOT recipients and human immunodeficiency virus (HIV)-infected patients differ in their typical presentations of MAC infection. Intestinal infections have been more commonly reported in HIV-infected patients than in SOT recipients. The explanation for this difference may be related to HIV's targeted effects on the CD4+ T-cell reservoir in gut-associated lymphoid tissue.
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Affiliation(s)
- Marinela Ingilizova
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Shara Epstein
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Dong Heun Lee
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Neal Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Shraddha Patel Babariya
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ricardo Morgenstern
- Division of Gastroenterology and Hepatology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nikolay Popnikolov
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Dagan Coppock
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
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5
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Parr JB, Lachiewicz AM, van Duin D, Chong PP. Successful Diagnosis of Intestinal Mycobacterium avium Complex Infection in a Kidney Transplant Recipient Using Nasogastric Aspirate Culture: A Case Report. Transplant Proc 2018; 49:2362-2364. [PMID: 29198678 DOI: 10.1016/j.transproceed.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022]
Abstract
Intestinal Mycobacterium avium complex (MAC) infections are rare and can be challenging to diagnose. We describe a case of intestinal MAC infection in a kidney transplant recipient with 5 months of unexplained weight loss and abdominal pain who developed intestinal obstruction. Esophagoduodenoscopy with biopsies was performed but was nondiagnostic. Intestinal MAC was diagnosed via nasogastric aspirate culture results. The patient's symptoms rapidly improved after initiation of appropriate treatment, but he later died of aspiration pneumonia and candidemia.
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Affiliation(s)
- J B Parr
- Division of Infectious Diseases, Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - A M Lachiewicz
- Division of Infectious Diseases, Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - D van Duin
- Division of Infectious Diseases, Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - P P Chong
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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6
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Song Y, Zhang L, Yang H, Liu G, Huang H, Wu J, Chen J. Nontuberculous mycobacteriuminfection in renal transplant recipients: a systematic review. Infect Dis (Lond) 2018; 50:409-416. [PMID: 29400108 DOI: 10.1080/23744235.2017.1411604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yan Song
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Li Zhang
- Kidney Disease Department, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, PR China
| | - Hao Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Guangjun Liu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Hongfeng Huang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Jianyong Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
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7
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Abad CL, Razonable RR. Non-tuberculous mycobacterial infections in solid organ transplant recipients: An update. J Clin Tuberc Other Mycobact Dis 2016; 4:1-8. [PMID: 31723683 PMCID: PMC6850244 DOI: 10.1016/j.jctube.2016.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/05/2016] [Accepted: 04/08/2016] [Indexed: 11/21/2022] Open
Abstract
Non-tuberculous mycobacteria are ubiquitous environmental organisms that are now increasingly recognized as important causes of clinical disease in solid organ transplant recipients. Risk factors of non-tuberculous mycobacteria infection are severe immunologic defects and structural abnormalities. Lung transplant recipients are at higher risk for non-tuberculous mycobacterial disease compared to recipients of other solid organs. The clinical presentation could be skin and soft tissue infection, osteoarticular disease, pleuropulmonary infection, bloodstream (including catheter-associated) infection, lymphadenitis, and disseminated or multi-organ disease. Management of non-tuberculous mycobacteria infection is complex due to the prolonged treatment course with multi-drug regimens that are anticipated to interact with immunosuppressive medications. This review article provides an update on infections due to non-tuberculous mycobacteria after solid organ transplantation, and discusses the epidemiology, risk factors, clinical presentation, and management.
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Affiliation(s)
- Cybele L Abad
- Division of Infectious Diseases and the William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, 55905 MN, United States
| | - Raymund R Razonable
- Division of Infectious Diseases and the William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, 55905 MN, United States
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Meinerz G, da Silva C, Goldani J, Garcia V, Keitel E. Epidemiology of tuberculosis after kidney transplantation in a developing country. Transpl Infect Dis 2016; 18:176-82. [DOI: 10.1111/tid.12501] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/24/2015] [Accepted: 11/22/2015] [Indexed: 01/30/2023]
Affiliation(s)
- G. Meinerz
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - C.K. da Silva
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - J.C. Goldani
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
| | - V.D. Garcia
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
| | - E. Keitel
- Department of Nephrology and Kidney Transplantation; Santa Casa de Misericórdia de Porto Alegre; Porto Alegre Brazil
- Post Graduation Program in Pathology; Universidade Federal de Ciências da Saúde de Porto Alegre; Porto Alegre Brazil
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9
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Fadlallah J, Rammaert B, Laurent S, Lanternier F, Pol S, Franck N, Mamzer M, Dupin N, Lortholary O. Mycobacterium aviumcomplex disseminated infection in a kidney transplant recipient. Transpl Infect Dis 2016; 18:105-11. [DOI: 10.1111/tid.12478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/28/2015] [Accepted: 09/20/2015] [Indexed: 01/20/2023]
Affiliation(s)
- J. Fadlallah
- Université Paris Descartes; Centre d'Infectiologie Necker Pasteur; IHU Imagine; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
| | - B. Rammaert
- Université Paris Descartes; Centre d'Infectiologie Necker Pasteur; IHU Imagine; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
| | - S. Laurent
- Service d'anatomopathologie; Hôpital Cochin; Université Paris Descartes; APHP; Paris France
| | - F. Lanternier
- Université Paris Descartes; Centre d'Infectiologie Necker Pasteur; IHU Imagine; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
| | - S. Pol
- Service d'hépatologie; Hôpital Cochin; Université Paris Descartes; APHP; Paris France
| | - N. Franck
- Service de dermatologie; Hôpital Cochin; Pavillon Tarnier; Université Paris Descartes; APHP; Paris France
| | - M.F. Mamzer
- Service de transplantation rénale; Hôpital Necker Enfants Malades; Université Paris Descartes; APHP; Paris France
| | - N. Dupin
- Service de dermatologie; Hôpital Cochin; Pavillon Tarnier; Université Paris Descartes; APHP; Paris France
| | - O. Lortholary
- Université Paris Descartes; Centre d'Infectiologie Necker Pasteur; IHU Imagine; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
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10
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Mycobacterium avium Complex Infection in a Patient with Sickle Cell Disease and Severe Iron Overload. Case Rep Infect Dis 2014; 2014:405323. [PMID: 25544913 PMCID: PMC4269307 DOI: 10.1155/2014/405323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/28/2014] [Accepted: 11/06/2014] [Indexed: 12/03/2022] Open
Abstract
A 34-year-old female with sickle cell anemia (hemoglobin SS disease) and severe iron overload presented to our institution with the subacute presentation of recurrent pain crisis, fever of unknown origin, pancytopenia, and weight loss. A CT scan demonstrated both lung and liver nodules concerning for granulomatous disease. Subsequent biopsies of the liver and bone marrow confirmed the presence of noncaseating granulomas and blood cultures isolated Mycobacterium avium complex MAC. Disseminated MAC is considered an opportunistic infection typically diagnosed in the immunocompromised and rarely in immunocompetent patients. An appreciable number of mycobacterial infection cases have been reported in sickle cell disease patients without immune dysfunction. It has been reported that iron overload is known to increase the risk for mycobacterial infection in vitro and in vivo studies. While iron overload is primarily known to cause end organ dysfunction, the clinical relationship with sickle cell disease and disseminated MAC infection has not been reported. Clinical iron overload is a common condition diagnosed in the sub-Saharan African population. High dietary iron, genetic defects in iron trafficking, as well as hemoglobinopathy are believed to be the etiologies for iron overload in this region. Patients with iron overload in this region were 17-fold more likely to die from Mycobacterium tuberculosis. Both experimental and clinical evidence suggest a possible link to iron overload and mycobacterial infections; however larger observational studies are necessary to determine true causality.
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11
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Ghrew MH, Lavery K, Gornasa M, Wilding T, Walsham A, O'Riordan E. Successful renal transplant in patient with controlled pulmonary non-tuberculous mycobacterium infection. Libyan J Med 2014; 9:25766. [PMID: 25249307 PMCID: PMC4172695 DOI: 10.3402/ljm.v9.25766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Murad H Ghrew
- Mycobacterial Infections Clinic, Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Kay Lavery
- Mycobacterial Infections Clinic, Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Magde Gornasa
- Mycobacterial Infections Clinic, Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Tina Wilding
- Mycobacterial Infections Clinic, Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Edmond O'Riordan
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
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12
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Update on Nontuberculous Mycobacterial Infections in Solid Organ and Hematopoietic Stem Cell Transplant Recipients. Curr Infect Dis Rep 2014; 16:421. [DOI: 10.1007/s11908-014-0421-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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13
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Singh S, Yosypiv IV, Iorember FM. Disseminated mycobacterium avium complex infection in a pediatric renal transplant recipient. Clin Pediatr (Phila) 2012; 51:892-5. [PMID: 21669902 DOI: 10.1177/0009922811411476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Shipra Singh
- Tulane University Health Sciences Center, New Orleans, LA 70118, USA
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14
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The antibiotic resistance arrow of time: efflux pump induction is a general first step in the evolution of mycobacterial drug resistance. Antimicrob Agents Chemother 2012; 56:4806-15. [PMID: 22751536 DOI: 10.1128/aac.05546-11] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We hypothesize that low-level efflux pump expression is the first step in the development of high-level drug resistance in mycobacteria. We performed 28-day azithromycin dose-effect and dose-scheduling studies in our hollow-fiber model of disseminated Mycobacterium avium-M. intracellulare complex. Both microbial kill and resistance emergence were most closely linked to the within-macrophage area under the concentration-time curve (AUC)/MIC ratio. Quantitative PCR revealed that subtherapeutic azithromycin exposures over 3 days led to a 56-fold increase in expression of MAV_3306, which encodes a putative ABC transporter, and MAV_1406, which encodes a putative major facilitator superfamily pump, in M. avium. By day 7, a subpopulation of M. avium with low-level resistance was encountered and exhibited the classic inverted U curve versus AUC/MIC ratios. The resistance was abolished by an efflux pump inhibitor. While the maximal microbial kill started to decrease after day 7, a population with high-level azithromycin resistance appeared at day 28. This resistance could not be reversed by efflux pump inhibitors. Orthologs of pumps encoded by MAV_3306 and MAV_1406 were identified in Mycobacterium tuberculosis, Mycobacterium leprae, Mycobacterium marinum, Mycobacterium abscessus, and Mycobacterium ulcerans. All had highly conserved protein secondary structures. We propose that induction of several efflux pumps is the first step in a general pathway to drug resistance that eventually leads to high-level chromosomal-mutation-related resistance in mycobacteria as ordered events in an "antibiotic resistance arrow of time."
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Piersimoni C. Nontuberculous mycobacteria infection in solid organ transplant recipients. Eur J Clin Microbiol Infect Dis 2011; 31:397-403. [DOI: 10.1007/s10096-011-1329-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/20/2011] [Indexed: 11/29/2022]
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16
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Fan MH, Hadjiliadis D. Incidence and management of mycobacterial infection in solid organ transplant recipients. Curr Infect Dis Rep 2010; 11:216-22. [PMID: 19366564 DOI: 10.1007/s11908-009-0032-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although advances in surgical technique, immunosuppressive regimens, and medical management have led to improved survival and quality of life after solid organ transplantation, infection continues to represent a major cause of morbidity and mortality in transplant recipients. Immunosuppressive therapy after transplantation compromises cell-mediated immunity in particular, leaving the patient at risk for opportunistic as well as routine community-acquired infections. Mycobacterial infection is a rare but important complication of solid organ transplantation, presenting significant risk to the patient and challenges in terms of treatment. The available literature consists predominantly of case reports and institutional experiences. This article examines both Mycobacterium tuberculosis and nontuberculous mycobacterial infection in the transplant setting.
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Affiliation(s)
- Ming-Hui Fan
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, 835 West Gates Building, 3600 Spruce Street, Philadelphia, PA 19104, USA.
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17
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Moxifloxacin pharmacokinetics/pharmacodynamics and optimal dose and susceptibility breakpoint identification for treatment of disseminated Mycobacterium avium infection. Antimicrob Agents Chemother 2010; 54:2534-9. [PMID: 20385862 DOI: 10.1128/aac.01761-09] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Organisms of the Mycobacterium avium-intracellulare complex (MAC) have been demonstrated to be susceptible to moxifloxacin. However, clinical data on how to utilize moxifloxacin to treat disseminated MAC are scanty. In addition, there have been no moxifloxacin pharmacokinetic-pharmacodynamic (PK/PD) studies performed for MAC infection. We utilized an in vitro PK/PD model of intracellular MAC to study moxifloxacin PK/PD for disseminated disease. Moxifloxacin doses, based on a serum half-life of 12 h, were administered, and the 0- to 24-h area under the concentration-time curve (AUC(0-24)) to MIC ratios associated with 1.0 log(10) CFU/ml per week kill and 90% of maximal kill (EC(90)) were identified. The AUC(0-24)/MIC ratio associated with 1.0 log(10) CFU/ml kill was 17.12, and that with EC(90) was 391.56 (r(2) = 0.97). Next, the moxifloxacin MIC distribution in 102 clinical isolates of MAC was identified. The median MIC was 1 to 2 mg/liter. Monte Carlo simulations of 10,000 patients with disseminated MAC were performed to determine the probability that daily moxifloxacin doses of 400 and 800 mg/day would achieve or exceed 1.0 log(10) CFU/ml per week kill or EC(90). Doses of 400 and 800 mg/day achieved the AUC(0-24)/MIC ratio of 17.12 in 64% and 92% of patients, respectively. The critical concentration of moxifloxacin against MAC was identified as 0.25 mg/liter in Middlebrook media. The proposed susceptibility breakpoint means that a larger proportion of clinical isolates is resistant to moxifloxacin prior to therapy. For patients infected with susceptible isolates, however, 800 mg a day should be examined for safety and efficacy for disseminated M. avium disease.
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Ho T, Rommelaere M, Coche E, Yombi JC, Kanaan N. Nontuberculous mycobacterial pulmonary infection in renal transplant recipients. Transpl Infect Dis 2010; 12:138-42. [DOI: 10.1111/j.1399-3062.2009.00473.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Unusual Cause of Fever in an Immunocompromised Patient With No Human Immunodeficiency Virus Infection Who Received a Renal Transplant. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181b28907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Rawla M, Kozak A, Hadley S, LeCates W. Mycobacterium avium-intracellulare-associated acute interstitial nephritis: a rare cause of renal allograft dysfunction. Transpl Infect Dis 2009; 11:529-33. [DOI: 10.1111/j.1399-3062.2009.00432.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Razonable RR. Nontuberculous mycobacterial infections after transplantation: a diversity of pathogens and clinical syndromes. Transpl Infect Dis 2009; 11:191-4. [PMID: 19392731 DOI: 10.1111/j.1399-3062.2009.00392.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Valerga M, Cugliari M, Cefalo E, Martín M. Infección por Mycobacterium avium en un paciente trasplantado renal. Enferm Infecc Microbiol Clin 2007; 25:294-5. [PMID: 17386231 DOI: 10.1016/s0213-005x(07)74288-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Nurmohamed S, Weenink A, Moeniralam H, Visser C, Bemelman F. Hyperammonemia in generalized Mycobacterium genavense infection after renal transplantation. Am J Transplant 2007; 7:722-3. [PMID: 17250553 DOI: 10.1111/j.1600-6143.2006.01680.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
After solid organ transplantation, patients are susceptible to infection caused by uncommon pathogens due the immunosuppressive drug therapy. Here, we report the first case of disseminated Mycobacterium genavense infection in a HIV seronegative renal transplant patient. The most striking clinical feature was a decreased consciousness. Blood results revealed hyperammonemia with otherwise normal liver function. Occurrence of hyperammonemia and massive M. genavense infection has not been reported before.
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Affiliation(s)
- S Nurmohamed
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam
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Bal AM. Isoniazid prophylaxis in end-stage renal disease. Transpl Infect Dis 2006; 8:242-3; author reply 243. [PMID: 17116141 DOI: 10.1111/j.1399-3062.2006.00146.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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