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1
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Kramer AJ, Meziara Wilson T, Kimura S, Groover E, DeLeon-Carnes M, Neto RLALT. Mycobacterium genavense granulomatous typhlocolitis in a horse. J Vet Diagn Invest 2024; 36:569-572. [PMID: 38653781 PMCID: PMC11185106 DOI: 10.1177/10406387241247204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
A 23-y-old gelding was presented to a veterinary teaching hospital with a history of chronic, refractory diarrhea. Clinically, the horse was in poor body condition, with a thickened and corrugated large intestine identified by transcutaneous abdominal ultrasonography. At postmortem examination following euthanasia, the large colon and cecum had segmental thickening of the intestinal wall with innumerable mucosal ulcers and prominent polypoid mucosal masses. Many mesenteric and hepatic lymph nodes were enlarged. Histology revealed granulomatous and ulcerative typhlocolitis and granulomatous lymphadenitis with myriad acid-fast, variably gram-positive, intrahistiocytic bacilli that stained by immunohistochemistry for mycobacteria. Molecular testing by PCR and sequencing identified the causative agent as Mycobacterium genavense, which is an unusual presentation of infection in a horse.
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Affiliation(s)
- Alana J. Kramer
- Departments of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Tais Meziara Wilson
- Oak Ridge Institute of Science and Education, Oak Ridge, TN, USA
- Infectious Diseases Pathology Branch (IDPB), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Shune Kimura
- Clinical Sciences, JT Vaughan Large Animal Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Erin Groover
- Clinical Sciences, JT Vaughan Large Animal Teaching Hospital, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Marlene DeLeon-Carnes
- Infectious Diseases Pathology Branch (IDPB), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Rachel L. A. L. T. Neto
- Departments of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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2
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Manshadi SAD, Rezaei M, Moradi M, Hemmatian M. Mycobacterium genavense infections in immunocompromised patients with HIV: A clinical case report. Clin Case Rep 2024; 12:e8993. [PMID: 38831981 PMCID: PMC11144603 DOI: 10.1002/ccr3.8993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Key Clinical Message It is essential to consider non-tuberculosis mycobacterium in HIV-positive patients with fever, abdominal pain, weight loss, and splenomegaly. Abstract Mycobacterium genavense is an opportunistic slow-growing nontuberculous mycobacterium in patients with immunocompromised backgrounds, especially HIV-positive patients. In this study, we present two cases of Mycobacterium genovese infection in HIV-positive patients with a good clinical response to accurate treatment.
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Affiliation(s)
- Seyed Ali Dehghan Manshadi
- Department of Infectious Disease and Tropical Medicine/Iranian Research Center HIV/AIDS (IRCHA)Tehran University of Medical ScienceTehranIran
| | - Mitra Rezaei
- Genomic Research CenterShahid Beheshti University of Medical ScienceTehranIran
| | - Maryam Moradi
- Eye Research Center, The Five Senses Health Institute, Rassoul Akram HospitalIran University of Medical SciencesTehranIran
| | - Marjan Hemmatian
- Department of Infectious Disease and Tropical Medicine/Iranian Research Center HIV/AIDS (IRCHA)Tehran University of Medical ScienceTehranIran
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3
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Ogata R, Kido T, Takeda K, Nemoto K, Heima R, Takao M, Miyashita R, Ozasa M, Tokito T, Okuno D, Ito Y, Yura H, Koga T, Hashimoto K, Takemoto S, Takazono T, Ishimoto H, Sakamoto N, Fukuda K, Sasaki Y, Obase Y, Ishimatsu Y, Yatera K, Izumikawa K, Mukae H. Disseminated Mycobacterium genavense Infection Mimicking Sarcoidosis: A Case Report and Review of Literature on Japanese Patients. Microorganisms 2023; 11:2145. [PMID: 37763989 PMCID: PMC10535052 DOI: 10.3390/microorganisms11092145] [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: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease characterized by noncaseating epithelioid cell granulomas. However, certain infections can exhibit similar histological findings. We present a case of a 69-year-old man who was initially diagnosed with sarcoidosis and later was confirmed, through 16S rRNA sequencing, to have disseminated Mycobacterium genavense infection. Acid-fast bacteria were detected in the bone marrow biopsy using Ziehl-Neelsen staining, but routine clinical tests did not provide a definitive diagnosis. The patient tested negative for HIV, anti-interferon-gamma antibodies, and genetic immunodeficiency disorders. He was treated with multiple drugs, including aminoglycosides and macrolides, but showed no improvement in fever and pancytopenia. However, these clinical signs responded favorably to steroid therapy. We reviewed 17 Japanese cases of M. genavense infection. All cases were in males; 7/17 (41%) were HIV-negative; and 12/17 (71%) had a decreased CD4 count. Genetic analysis confirmed M. genavense isolation, and macrolides were used universally. Mycobacterium genavense infection is challenging to identify and mimics other systemic inflammatory diseases such as sarcoidosis. There are no standard treatment protocols. Our case report and Japanese case review contribute to understanding this rare disease.
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Affiliation(s)
- Ryo Ogata
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Takashi Kido
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Kazuki Nemoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu 807-8556, Japan; (K.N.); (K.Y.)
| | - Riko Heima
- Clinical Genomics Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.H.); (M.T.)
| | - Mami Takao
- Clinical Genomics Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.H.); (M.T.)
| | - Ritsuko Miyashita
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Mutsumi Ozasa
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Takatomo Tokito
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Daisuke Okuno
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Yuya Ito
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Hirokazu Yura
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Kunio Hashimoto
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Shinnosuke Takemoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Kazumasa Fukuda
- Department of Microbiology, University of Occupational and Environmental Health, Japan, Kitakyusyu 807-8556, Japan;
| | - Yuka Sasaki
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo 204-8585, Japan;
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8520, Japan;
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyusyu 807-8556, Japan; (K.N.); (K.Y.)
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (R.O.); (K.T.); (R.M.); (M.O.); (T.T.); (D.O.); (Y.I.); (H.Y.); (S.T.); (T.T.); (H.I.); (N.S.); (Y.O.); (H.M.)
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Vilstrup E, Dahl VN, Fløe A, Degn KB. Disseminated Mycobacterium genavense infection in a patient with a history of sarcoidosis. BMJ Case Rep 2023; 16:e254792. [PMID: 37147106 PMCID: PMC10163504 DOI: 10.1136/bcr-2023-254792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
We present a case of Mycobacterium genavense infection in a man in his 60s with a history of sarcoidosis, treated for 24 years with systemic corticosteroids and later methotrexate as monotherapy. He presented with low grade fever, dyspnoea and right-sided thoracic pain and was admitted due to a treatment-refractory infection. After a prolonged period of symptoms and diagnostics, acid-fast bacilli were demonstrated in pleural fluid and PCR revealed M. genavense The patient was treated with intravenous amikacin, peroral azithromycin, rifampicin and ethambutol for a total of 18 months, with a good clinical and radiological treatment response. Infection with M. genavense is rare in HIV-negative immunocompromised hosts. Diagnosing and treating mycobacterial infections, especially for more rare species, remains a challenge as clinical evidence is sparse. Nonetheless, the disease-causing infection must be considered in symptomatic and immunocompromised patients.
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Affiliation(s)
- Emil Vilstrup
- Department of Internal Medicine Viborg, Viborg Regional Hospital, Viborg, Denmark
| | - Victor Næstholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
| | - Kristine Bruun Degn
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
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Artigues Serra F, García-Gasalla M, Campins A, González de Cabo M, Morales R, Peña RR, Gallegos MC, Riera M. Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report. Medicine (Baltimore) 2022; 101:e30351. [PMID: 36086677 PMCID: PMC10980495 DOI: 10.1097/md.0000000000030351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Since its first identification in the early 1990s, Mycobacterium genavense has been considered and opportunistic pathogen. It mainly causes gastrointestinal symptoms, but also disseminated infections in severely immunosuppressed patients. Sclerosing mesenteritis is a long-term complication with high morbidity and mortality. As it is a rare condition, there are no specific guidelines for its management. We report a challenging case of persistent M. genavense infection, and propose surgery as an alternative treatment strategy. PATIENT CONCERNS A 38-year-old Caucasian man presented to the emergency room with fever, abdominal pain, and night sweats for 3 months. HIV screening revealed a previously unknown HIV-1 infection, with a CD4 cell count of 216 cell/µL and viral load of 361.000 copies/mL at diagnosis. A body CT-scan showed mild splenomegaly as well as mesenteric and retroperitoneal enlarged lymph nodes. Fine needle aspiration revealed the presence of acid-fast bacilli, but mycobacterial cultures were negative. In the second sample, 16S RNA sequencing yielded a diagnosis of M. genavense infection. Despite 2 years of corticosteroids and antimycobacterial treatment excluding rifampicin due to a severe cutaneous reaction, there was no clinical improvement and an increase in the mesenteric lymph node size was observed, with a sclerosing transformation of the mesentery. A surgical approach was proposed to release small bowel loops and to remove fibrin. A second surgery was required due to an acute peritonitis ought to yeyunal segmental isquemia and perforation. Finally, the patient evolved favorably, and antimycobacterial drugs were suspended without relapse. LESSONS Despite a prolonged multidrug strategy, some patients develop persistent M. genavense infection. Once sclerosing mesenteritis is established, clinicians have few treatment options. Surgery should be considered in patients with sclerosing mesenteritis or bowel obstruction. The combination of medical and surgical treatment could be a potential cure for these patients.
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Affiliation(s)
- Francisca Artigues Serra
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | - Mercedes García-Gasalla
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | - Antoni Campins
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | | | - Rafael Morales
- Peritoneal Surface Malignancies Unit, General and Digestive Surgery Department, Hospital Universitari Son Espases-IdISba, Palma, Spain
| | - Rebecca Rowena Peña
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
| | | | - Melchor Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases-IdISBa, Palma, Spain
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Lange C, Böttger EC, Cambau E, Griffith DE, Guglielmetti L, van Ingen J, Knight SL, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, Wagner D, Winthrop K, Daley CL, Lange C, Andrejak C, Böttger E, Cambau E, Griffith D, Guglielmetti L, van Ingen J, Knight S, Leitman P, Marras TK, Olivier KN, Santin M, Stout JE, Tortoli E, Wagner D, Wallace RJ, Winthrop K, Daley C. Consensus management recommendations for less common non-tuberculous mycobacterial pulmonary diseases. THE LANCET INFECTIOUS DISEASES 2022; 22:e178-e190. [DOI: 10.1016/s1473-3099(21)00586-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022]
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Chen J, Nguyen M, Hu H, Cheong E, Sean Riminton D, Reddel S. Refractory Mycobacterium genavense infection secondary to thymoma-associated endogenous IL-12 inhibitor. BMJ Neurol Open 2022; 4:e000285. [PMID: 35663588 PMCID: PMC9119138 DOI: 10.1136/bmjno-2022-000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 12/02/2022] Open
Abstract
Case A 39-year-old man with thymoma-associated acetylcholine receptor antibody myasthenia gravis (MG) presented with fevers, night sweats, abdominal pain and weight loss. Marked splenomegaly and intra-abdominal lymphadenopathy were found. Biopsies confirmed disseminated Mycobacterium genavense infection. Despite antimicrobials and reduced immunosuppressive medications, he worsened. We suspected a thymoma-associated cytokine inhibitory antibody. The addition of subcutaneous interferon-gamma (IFN-γ) induced clinical and radiological improvement. His antimicrobials were able to be ceased. MG remained stable. Subsequent testing demonstrated an endogenous interleukin-12 (IL-12) inhibitor, likely inhibiting the IL-12/IFN-γ axis crucial for defence against mycobacterial infections. Discussion This case illustrates the autoimmune manifestations that can occur with thymoma. It illustrates the benefit of exogenous IFN-γ in overcoming the immune deficit. In this case, its use did not exacerbate existing autoimmune disease or trigger others. We raise awareness of the need to consider cytokine pathway defects as a contributing factor to refractory atypical infections in patients with thymoma-associated MG.
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Affiliation(s)
- Jessie Chen
- Department of Neurology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - MaiAnh Nguyen
- Department of Immunology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hannah Hu
- Department of Immunology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Elaine Cheong
- Department of Infectious Diseases and Microbiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - D Sean Riminton
- Department of Immunology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Stephen Reddel
- Department of Neurology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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High overall mortality of Mycobacterium genavense infections and impact of antimycobacterial therapy: Systematic review and individual patient data meta-analysis. J Infect 2021; 84:8-16. [PMID: 34788633 DOI: 10.1016/j.jinf.2021.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Mycobacterium genavense is a fastidious slow growing mycobacterium (SGM) that causes disseminated infections in immunocompromised hosts. It has been described in HIV-positive individuals and increasingly in patients without HIV. The infections are difficult to treat and the optimal antimycobacterial regimen is still unknown. METHODS An individual patient data meta-analysis was conducted aiming at including all hitherto published cases of infection with M. genavense. Clinical manifestations, microbiological data, dispositions and immunosuppression were recorded. Antimycobacterial therapies and mortality were analyzed by logistic regression and time-to-event analysis. RESULTS We included 223 patients with infection due to M. genavense published from 1992 to 2021. While the majority was HIV positive (n = 171, 76.7%), 52 patients were non-HIV-patients (23.3%), 36 of whom received immunosuppressive therapy (69%). We could confirm the bacterium's tropism for the gastrointestinal tract with abdominal pain, hepato-/splenomegaly and abdominal lymphadenopathy being major clinical manifestations. More than 90% of patients received antimycobacterial therapy. The regimens consisted mainly of macrolides, rifamycins and ethambutol. Overall mortality was high, but in logistic regression and time-to-event analysis a macrolide containing regimen was associated with better outcomes. CONCLUSION In this first individual patient data meta-analysis of infections with M. genavense we confirm its tropism for the gastrointestinal tract. The high overall mortality underlines the clinical relevance of infection with this bacterium for the individual patient. In addition, our data give a hint that a macrolide containing regimen is associated with better survival.
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9
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Eskandari SK, Jonkers SY, Almesned MAM, Akkerman OW, Verschuuren EAM, Gan CTJ. Recurrent fever 3 years post-lung transplantation: A treacherous case of Mycobacterium genavense. Transpl Infect Dis 2021; 23:e13741. [PMID: 34607392 DOI: 10.1111/tid.13741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Siawosh K Eskandari
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sterre Y Jonkers
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mohammad A M Almesned
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Tuberculosis Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, Netherlands
| | - Erik A M Verschuuren
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Christiaan Tji-Joong Gan
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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10
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Manion M, Lynn N, Pei L, Hammoud DA, Laidlaw E, Roby G, Metzger D, Mejia Y, Lisco A, Zelazny A, Holland S, Vachon ML, Scherer M, Bergin C, Sereti I. To Induce Immune Reconstitution Inflammatory Syndrome or Suppress It: The Spectrum of Mycobacterium genavense in the Antiretroviral Era. Clin Infect Dis 2021; 72:315-318. [PMID: 33501968 DOI: 10.1093/cid/ciaa753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/13/2020] [Indexed: 11/13/2022] Open
Abstract
Mycobacterium genavense is a challenging opportunistic pathogen to diagnose and manage in patients with human immunodeficiency virus (HIV). Persistent immunosuppression or protracted immune reconstitution inflammatory syndrome can lead to complicated clinical courses. We describe 3 cases of M. genavense in patients with HIV representing the spectrum between disease burden and strength of immune response.
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Affiliation(s)
- Maura Manion
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Luxin Pei
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Laidlaw
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Gregg Roby
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Dorinda Metzger
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Andrea Lisco
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Adrian Zelazny
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Steve Holland
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Marie-Louise Vachon
- Centre hospitalier universitaire de Quebec-Université Laval, Quebec City, Quebec, Canada
| | - Matthew Scherer
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Irini Sereti
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
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11
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Murata Y, Mori N, Kagawa N, Okuma K, Yoshida S, Ohkusu K, Honda M. Acid-fast bacilli smear test of a blood culture sample for the diagnosis of disseminated Mycobacterium genavense infection: A case report. Int J STD AIDS 2021; 32:483-485. [PMID: 33570479 DOI: 10.1177/0956462420972224] [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: 11/15/2022]
Abstract
Mycobacterium genavense, a nontuberculous Mycobacterium, is found in immunosuppressed patients, particularly in those with HIV. Mycobacterium genavense incubation under standard culture conditions is difficult, and its identification is challenging using routine culture methods. Herein, we report the case of a 40-year-old Japanese man with HIV presenting with disseminated M. genavense infection. An analysis using an automated blood culture system did not show positive signals during 6 weeks of incubation. However, an acid-fast bacilli smear of his blood sample was positive for the bacterium. Mycobacterium genavense was identified using sequencing analysis, targeting the heat shock protein 65 gene. The patient recovered from the infection, following antibiotic therapy for 18 months. Under suspicion of disseminated M. genavense infection and the absence of bacterial growth in blood culture samples, an acid-fast bacilli smear test of the sample may be useful for timely diagnosis.
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Affiliation(s)
- Yo Murata
- Department of General Internal Medicine and Infectious Diseases, 38547National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Nobuaki Mori
- Department of General Internal Medicine and Infectious Diseases, 38547National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Narito Kagawa
- Department of Clinical Laboratory, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kentaro Okuma
- Department of General Internal Medicine and Infectious Diseases, 38547National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shinji Yoshida
- Department of General Internal Medicine and Infectious Diseases, 38547National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, 13112Tokyo Medical University, Tokyo, Japan
| | - Miwako Honda
- Department of General Internal Medicine and Infectious Diseases, 38547National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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12
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Improved Prognosis of Infection With Mycobacterium Genavense in Immune-Compromized HIV Patients After Introduction of Combined Antiretroviral Therapy. J Acquir Immune Defic Syndr 2021; 86:e9-e12. [PMID: 32947445 DOI: 10.1097/qai.0000000000002513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Byrne AS, Goudreau A, Bissonnette N, Shamputa IC, Tahlan K. Methods for Detecting Mycobacterial Mixed Strain Infections-A Systematic Review. Front Genet 2020; 11:600692. [PMID: 33408740 PMCID: PMC7779811 DOI: 10.3389/fgene.2020.600692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Mixed strain infection (MSI) refers to the concurrent infection of a susceptible host with multiple strains of a single pathogenic species. Known to occur in humans and animals, MSIs deserve special consideration when studying transmission dynamics, evolution, and treatment of mycobacterial diseases, notably tuberculosis in humans and paratuberculosis (or Johne's disease) in ruminants. Therefore, a systematic review was conducted to examine how MSIs are defined in the literature, how widespread the phenomenon is across the host species spectrum, and to document common methods used to detect such infections. Our search strategy identified 121 articles reporting MSIs in both humans and animals, the majority (78.5%) of which involved members of the Mycobacterium tuberculosis complex, while only a few (21.5%) examined non-tuberculous mycobacteria (NTM). In addition, MSIs exist across various host species, but most reports focused on humans due to the extensive amount of work done on tuberculosis. We reviewed the strain typing methods that allowed for MSI detection and found a few that were commonly employed but were associated with specific challenges. Our review notes the need for standardization, as some highly discriminatory methods are not adapted to distinguish between microevolution of one strain and concurrent infection with multiple strains. Further research is also warranted to examine the prevalence of NTM MSIs in both humans and animals. In addition, it is envisioned that the accurate identification and a better understanding of the distribution of MSIs in the future will lead to important information on the epidemiology and pathophysiology of mycobacterial diseases.
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Affiliation(s)
| | - Alex Goudreau
- Science & Health Sciences Librarian, University of New Brunswick, Saint John, NB, Canada
| | - Nathalie Bissonnette
- Sherbrooke Research and Development Center, Agriculture and Agri-Food Canada, Sherbrooke, QC, Canada
| | - Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Kapil Tahlan
- Department of Biology, Memorial University of Newfoundland, St. John's, NL, Canada
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14
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Hosoda C, Ishiguro T, Shimizu Y, Kanegane H, Takayanagi N. Mycobacterium genavense Infection Presenting as an Endobronchial Polyp and Upper Lobe Atelectasis. Am J Respir Crit Care Med 2020; 202:e144-e145. [PMID: 33007161 DOI: 10.1164/rccm.202005-1652im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chiaki Hosoda
- Department of Respiratory Medicine and.,Department of Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | | | - Yoshihiko Shimizu
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan; and
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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15
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Robalo Nunes T, Calderón A, Barroso C, Marques N. Disseminated infection by Mycobacterium genavense in an HIV-1 infected patient. IDCases 2020; 21:e00926. [PMID: 32775210 PMCID: PMC7399251 DOI: 10.1016/j.idcr.2020.e00926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022] Open
Abstract
Mycobacterium genavenseinfection, a non-tuberculous mycobacteria, should be considered in immunosuppressed patients. Disseminated infection by Mycobacterium genavense is a clinical and microbiological diagnostic challenge. There are no standardized treatment guidelines for Mycobacterium genavense, but schemes with clarithromycin are favoured.
Opportunistic infections are an important cause of death and morbidity among HIV infected patients. Disseminated infections by nontuberculous mycobacteria are a diagnostic to consider among these patients with a high level of immunosuppression. A 64 year old Caucasian man, born in Angola, living in Portugal since 1975, presented in the emergency room with generalized malaise, weight loss, vesperal temperatures of around 37.5 °C with night sweats for two months, and epigastric abdominal pain with liquid stools in the 2 previous weeks. Laboratory study revealed a previously undiagnosed HIV-1 infection with 42 Lymphocytes CD4+/uL and viremia of 61,249 copies/mL. The abdominal-pelvic CT scan showed multiple necrotic ganglia in the mesenterium and mesenteric vases, which were biopsied revealing positive PCR for a nontuberculous mycobacteria; duodenal biopsies showed similar results. The bone marrow blood culture yeald the growth of Mycobacterium genavense. Antimicobacterial treatment was started and after six months he showed imagiological deterioration and the antibiogram revealed resistance to all antimycobacterial agents. The therapeutic scheme was empirically changed and the patient kept under vigilance with chronic therapy. This rare clinical case is both a diagnostic and therapeutic challenge.
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Affiliation(s)
- Tomás Robalo Nunes
- Infectious Diseases Resident, Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Calderón
- Pathology Resident, Histopathology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Clara Barroso
- Consultant in Pneumology, Centro de Diagnóstico Pneumológico, Almada, Portugal
| | - Nuno Marques
- Head of Department of Infectious Diseases, Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
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16
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The First Case of Concomitant Mycobacterium Genavense Lymphadenitis and EBV-Positive Lymphoproliferative Disorder. Mediterr J Hematol Infect Dis 2020; 12:e2020035. [PMID: 32670513 PMCID: PMC7340235 DOI: 10.4084/mjhid.2020.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/02/2020] [Indexed: 11/08/2022] Open
Abstract
This is the first case of concurrent Mycobacterium genavense lymphadenitis and Epstein-Barr virus (EBV)-positive lymphoproliferative disorder (LPD) in the same lymph node with no immunocompromised history. M. genavense infection is a rare opportunistic infection mainly for human immunodeficiency virus (HIV)-infected patients. Although no immunodeficiency was detected in our patient, our case indicates that the immunodeficiency in the background of EBV latency type III and the immunosuppression by malignant lymphoma itself might induce the M. genavense lymphadenitis. This case highly alerts clinicians to the immunosuppressive state of EBV-positive LPD with latency type III even if any immunodeficient serological factors are not detected.
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17
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18
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Ekermans P, de Gama R, Kock C, Hoosien E, Slavik T, Marshall T, Corcoran C, van Ingen J. An unusual case of abdominal mycobacterial infection: Case report and literature review. South Afr J HIV Med 2019; 20:993. [PMID: 31534791 PMCID: PMC6739527 DOI: 10.4102/sajhivmed.v20i1.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/13/2019] [Indexed: 11/30/2022] Open
Abstract
This article presents a case of an HIV-infected paediatric patient with an unusual Mycobacterium genavense infection with predominantly abdominal organ involvement.
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Affiliation(s)
- Pieter Ekermans
- Department of Microbiology, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Rene de Gama
- Department of Paediatrics, Netcare Unitas Hospital, Centurion, South Africa
| | - Celeste Kock
- Department of Paediatrics, Mediclinic Midstream Hospital, Midstream, South Africa
| | - Ebrahim Hoosien
- Department of Microbiology, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Tomas Slavik
- Department of Histology, AMPATH Laboratories, Pretoria, South Africa
| | - Terry Marshall
- Department of Molecular Medicine, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Craig Corcoran
- Department of Molecular Medicine, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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19
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Gonzalez-Granado LI, Ruiz-García R, Blas-Espada J, Moreno-Villares JM, Germán-Diaz M, López-Nevado M, Paz-Artal E, Toldos O, Rodriguez-Gil Y, de Inocencio J, Domínguez-Pinilla N, Allende LM. Acquired and Innate Immunity Impairment and Severe Disseminated Mycobacterium genavense Infection in a Patient With a NF-κB1 Deficiency. Front Immunol 2019; 9:3148. [PMID: 30761159 PMCID: PMC6362422 DOI: 10.3389/fimmu.2018.03148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022] Open
Abstract
Background: NF-κB1 is a master regulator of both acquired and innate responses. NFKB1 loss-of-function mutations elicit a wide clinical phenotype with asymptomatic individuals at one end of the spectrum and patients with common variable immunodeficiency, combined immunodeficiency or autoinflammation at the other. Impairment of acquired and innate immunity and disseminated Mycobacterium genavense infection expands the clinical and immunological phenotype of NF-κB1 deficiency. Objective: Functional and molecular characterization of a patient with a novel phenotype of NF-κB1 deficiency. Methods: Circulating T, B, dendritic cell subsets and innate or unconventional T-cells were quantified. The cytokine production in stimulated whole blood samples was assessed and molecular characterization by next generation sequencing and gene expression assays were also performed. Results: We report a patient presenting with features of combined immunodeficiency (CID) and disseminated Mycobacterium genavense infection. Sequencing of genomic DNA identified a novel synonymous mutation (c.705G > A) in NFKB1 gene which resulted in exon 8 skipping and haploinsufficiency of the NF-κB1 subunit p50. The susceptibility to atypical mycobacterial infection has not been previously reported and may be the result of a dendritic cell deficiency. A selective deficiency of circulating follicular helper T (cTFH) cells responsible for mediating the differentiation of naive B cells into memory and plasma cells was also present in the patient. It could affect the maturation of innate or unconventional T cells where NF-κB1 could also be involved. Conclusion: These findings showed that the role of NF-κB1 in humans could be critical for the development of acquired and innate immunity and further highlights the role of human T cells in anti-mycobacterial immunity.
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Affiliation(s)
- Luis Ignacio Gonzalez-Granado
- Primary Immunodeficiencies Unit, Department of Pediatrics, School of Medicine, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain.,Research Institute Hospital 12 Octubre (I+12), Madrid, Spain
| | - Raquel Ruiz-García
- Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.,Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Javier Blas-Espada
- Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.,Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - José Manuel Moreno-Villares
- Pediatric Nutrition, Pediatrics, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Marta Germán-Diaz
- Pediatric Nutrition, Pediatrics, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Marta López-Nevado
- Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.,Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Estela Paz-Artal
- Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.,Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Immunology Department, University San Pablo CEU, Madrid, Spain
| | - Oscar Toldos
- Pathology Department, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Jaime de Inocencio
- Pediatric Rheumatology Unit, Department of Pediatrics, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Nerea Domínguez-Pinilla
- Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.,Pediatric Hematology and Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - Luis M Allende
- Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.,Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
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20
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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: 0.1] [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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21
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De Lorenzi G, Kamphuisen K, Biscontini G, Pacciarini M, Zanoni M, Luppi A. Mycobacterium genavense Infection in a Domestic Ferret (Mustela putorius furo). Top Companion Anim Med 2018; 33:119-121. [DOI: 10.1053/j.tcam.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 11/11/2022]
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22
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Asakura T, Namkoong H, Sakagami T, Hasegawa N, Ohkusu K, Nakamura A. Disseminated Mycobacterium genavense Infection in Patient with Adult-Onset Immunodeficiency. Emerg Infect Dis 2018. [PMID: 28628454 PMCID: PMC5512497 DOI: 10.3201/eid2307.161677] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of disseminated Mycobacterium genavense infection resulting from neutralizing anti–interferon-γ autoantibodies in the patient. We identified M. genavense targeting the hsp65 gene in an aspiration specimen of the lymph node. Adult-onset immunodeficiency caused by neutralizing anti–interferon-γ autoantibodies, in addition to HIV infection, can lead to disseminated nontuberculous mycobacterial infection.
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23
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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: 17] [Impact Index Per Article: 2.4] [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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24
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Mahmood M, Ajmal S, Abu Saleh OM, Bryson A, Marcelin JR, Wilson JW. Mycobacterium genavense infections in non-HIV immunocompromised hosts: a systematic review. Infect Dis (Lond) 2017; 50:329-339. [PMID: 29157060 DOI: 10.1080/23744235.2017.1404630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Mycobacterium genavense is a non-tuberculous mycobacterium which can rarely cause disease in non-HIV immunocompromised hosts. We describe our experience with this unusual infection and perform a systematic review of the literature to describe the features of M. genavense infection in non-HIV immunocompromised hosts. METHODS All cases of Mycobacterium genavense infection in non-HIV patients at our institution were reviewed. In addition, we conducted a systematic review of the literature to identify previously published cases of M. genavense infections in non-HIV hosts. FINDINGS Two cases of M. genavense were identified at our center; a 51-year-old renal transplant recipient with a prosthetic knee joint infection and a 66-year-old woman with idiopathic CD4 lymphocytopenia with gastrointestinal tract disease. The systematic review identified 44 cases of M. genavense infection in non-HIV hosts. The most common underlying conditions were solid organ transplantation (40%), sarcoidosis (14%) and hematopoietic stem cell transplantation (7%). Disease most commonly involved the gastrointestinal tract, spleen, liver or bone marrow. Diagnosis was challenging with PCR required for identification in nearly all cases. Over one-third of patients died, which may reflect the combination of infection and underlying comorbidities. Overall cure was achieved in 61% with a mean duration of antimycobacterial therapy of 15.5 months (range 10-24). CONCLUSION M. genavense infection is a rare mycobacterial infection in non-HIV immunocompromised hosts. It should be suspected in immunocompromised patients presenting with disseminated mycobacterial infection, acid fast bacilli on smear or histopathologic examination, with poor or no growth in mycobacterial cultures.
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Affiliation(s)
- Maryam Mahmood
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Saira Ajmal
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Omar M Abu Saleh
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
| | - Alexandra Bryson
- b Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | - Jasmine R Marcelin
- c Divison of Infectious Disease, Department of Medicine , University of Nebraska Medical Center , Omaha , NE , USA
| | - John W Wilson
- a Division of Infectious Disease, Department of Medicine , Mayo Clinic , Rochester , MN , USA
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25
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Holland SM, Pierce VM, Shailam R, Glomski K, Farmer JR. Case 28-2017. A 13-Month-Old Girl with Pneumonia and a 33-Year-Old Woman with Hip Pain. N Engl J Med 2017; 377:1077-1091. [PMID: 28902581 DOI: 10.1056/nejmcpc1706097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Steven M Holland
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Virginia M Pierce
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Randheer Shailam
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Krzysztof Glomski
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Jocelyn R Farmer
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
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26
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Toussi A, Goodarzi A, Kulubya E, Lee DJ, Waldau B. Mycobacterium Genavense Granuloma Mimicking a Brain Tumor: A Case Report. Cureus 2017; 9:e1547. [PMID: 29018644 PMCID: PMC5630459 DOI: 10.7759/cureus.1547] [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: 11/10/2022] Open
Abstract
Mycobacterium genavense (M. genavense) is a rare, non-tuberculous organism that commonly leads to gastrointestinal infections in immunocompromised patients. Only two cases of intracranial M. genavense infection have been reported to date. We describe a third case of M. genavense granuloma mimicking a right parietal intracranial mass, and review the literature on this exceedingly rare pathology.
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Affiliation(s)
- Atrin Toussi
- Neurological Surgery, University of California, Davis Medical Center
| | - Amir Goodarzi
- Neurological Surgery, University of California, Davis Medical Center
| | - Edwin Kulubya
- Neurological Surgery, University of California, Davis Medical Center
| | - Darrin J Lee
- Neurological Surgery, University of California, Davis Medical Center
| | - Ben Waldau
- Neurological Surgery, University of California, Davis Medical Center
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27
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Bourlon C, Vargas-Serafín C, López-Karpovitch X. Mycobacterium genavenseinvading the bone marrow in a HIV-positive patient. Clin Case Rep 2017; 5:1043-1045. [PMID: 28588869 PMCID: PMC5458027 DOI: 10.1002/ccr3.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/26/2016] [Accepted: 03/15/2017] [Indexed: 11/13/2022] Open
Abstract
Nontuberculous mycobacteria infrequently cause disseminated infections in immunocompetent hosts. However, they are increasingly being recognized in immunocompromised patients. We present the case of a 40‐year‐old HIV‐positive male presenting with lymphadenopathies and pancytopenia in whom disseminated infection, with bone marrow involvement by Mycobacterium genavense (M. genavense) was diagnosed.
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Affiliation(s)
- Christianne Bourlon
- Department of Hematology and Oncology; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Cesar Vargas-Serafín
- Department of Internal Medicine; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
| | - Xavier López-Karpovitch
- Department of Hematology and Oncology; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Mexico City Mexico
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28
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Abstract
The importance of mycobacteria as opportunistic pathogens, particularly members of the M. avium complex (MAC), in patients with progressive HIV infection was recognized early in the AIDS epidemic. It took longer to appreciate the global impact and devastation that would result from the deadly synergy that exists between HIV and M. tuberculosis. This HIV/M. tuberculosis co-pandemic is ongoing and claiming millions of lives every year. In addition to MAC, a number of other non-tuberculous mycobacteria have been recognized as opportunistic pathogens in HIV-infected individuals; some of these are more commonly encountered (e.g., M. kansasii) than others (M. haemophilum and M. genevense). Finally, there are challenges to concomitantly treating the HIV and the infecting Mycobacterium species, because of antimicrobial resistance, therapeutic side-effects and the complex pharmacologic interactions of the antiretroviral and antimycobacterial multidrug therapy.
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Affiliation(s)
- Gary W Procop
- Staff, Pathology and Clinical Microbiology, Cleveland Clinic, 9500 Euclid Avenue/LL2-2, Cleveland, OH 44195, United States.
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29
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Ullmann LS, das Neves Dias-Neto R, Cagnini DQ, Yamatogi RS, Oliveira-Filho JP, Nemer V, Teixeira RHF, Biondo AW, Araújo JP. Mycobacterium genavense infection in two species of captive snakes. J Venom Anim Toxins Incl Trop Dis 2016; 22:27. [PMID: 27777582 PMCID: PMC5070184 DOI: 10.1186/s40409-016-0082-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/10/2016] [Indexed: 11/11/2022] Open
Abstract
Background Mycobacterium is an important zoonotic agent with companion, livestock and wildlife animals reportedly playing a role as reservoirs. Although its association with reptiles has been described, the disease cycle remains to be fully established, particularly in snakes. Accordingly, this study aimed to report the occurrence of mycobacteriosis with clinical pneumonia in one exotic python snake (Python molurus) and one native green snake (Philodryas olfersii) from the Sorocaba Zoo, São Paulo state, Brazil. Methods Diagnosis was based on necropsy, histopathological examination, Ziehl-Neelsen stain and immunohistochemistry. Results Using a nested PCR followed by DNA sequencing and bioinformatics analysis, the causative Mycobacterium species was identified as Mycobacterium genavense. Conclusion Mycobacterium genavense is an infectious zoonotic agent of animal and public health concerns.
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Affiliation(s)
- Leila Sabrina Ullmann
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, São Paulo State University (UNESP - Univ Estadual Paulista), Distrito de Rubião Junior, s/n, Botucatu, SP 80035-050 Brazil
| | | | - Didier Quevedo Cagnini
- Department of Clinical Veterinary Medicine, School of Veterinary Medicine and Animal Husbandry, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, SP Brazil
| | | | - Jose Paes Oliveira-Filho
- Department of Clinical Veterinary Medicine, School of Veterinary Medicine and Animal Husbandry, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, SP Brazil
| | - Viviane Nemer
- Department of Veterinary Medicine, Federal University of Paraná, Curitiba, Brazil
| | | | - Alexander Welker Biondo
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, São Paulo State University (UNESP - Univ Estadual Paulista), Distrito de Rubião Junior, s/n, Botucatu, SP 80035-050 Brazil
| | - João Pessoa Araújo
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, São Paulo State University (UNESP - Univ Estadual Paulista), Distrito de Rubião Junior, s/n, Botucatu, SP 80035-050 Brazil
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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: 26] [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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Ombelet S, Van Wijngaerden E, Lagrou K, Tousseyn T, Gheysens O, Droogne W, Doubel P, Kuypers D, Claes K. Mycobacterium genavenseinfection in a solid organ recipient: a diagnostic and therapeutic challenge. Transpl Infect Dis 2016; 18:125-31. [DOI: 10.1111/tid.12493] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- S. Ombelet
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - E. Van Wijngaerden
- Department of General Internal Medicine; University Hospitals Leuven; Leuven Belgium
| | - K. Lagrou
- Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - T. Tousseyn
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - O. Gheysens
- Department of Nuclear Medicine; University Hospitals Leuven; Leuven Belgium
| | - W. Droogne
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - P. Doubel
- Department of Nephrology; AZ Groeninge; Kortrijk Belgium
| | - D. Kuypers
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - K.J. Claes
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
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Costa RS, Gonçalves B, Ferreira A. An Uncommon Etiology for a Common Problem in an HIV-Positive Patient. Gastroenterology 2015; 149:e1-2. [PMID: 26307749 DOI: 10.1053/j.gastro.2015.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/20/2015] [Indexed: 12/02/2022]
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Wassilew N, Ciaffi L, Calmy A. Mesenterial involvement of Mycobacterium genavense infection: hard to find, hard to treat. BMJ Case Rep 2015; 2015:bcr-2014-208241. [PMID: 25976189 DOI: 10.1136/bcr-2014-208241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium genavense is a rare pathogen affecting severely immunosuppressed patients. We report the case of persistent relapsing M. genavense infection in a 48-year-old African man with a positive diagnosis of HIV infection. Despite being under effective antiretroviral therapy with partial immune reconstitution, he developed irreversible long-term abdominal complications, possibly due to persistent M. genavense infection and sustained inflammation. Case management consists of individual risk assessment, close follow-up and personalised treatment strategies concerning the duration of antimycobacterial therapy and early application of steroids. Patients with profound immunosuppression, a high viral load at HIV diagnosis and a high burden of M. genavense, appear to be at higher risk. The pathogenicity of this complication is not well known and its optimal management has still to be determined.
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Affiliation(s)
- Nasstasja Wassilew
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Laura Ciaffi
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
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Hernández-Toloza JE, Rincón-Serrano MDP, Celis-Bustos YA, Aguillón CI. [Identification of mycobacteria to the species level by molecular methods in the Public Health Laboratory of Bogotá, Colombia]. Enferm Infecc Microbiol Clin 2015; 34:17-22. [PMID: 25888362 DOI: 10.1016/j.eimc.2015.03.003] [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: 10/22/2014] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Global epidemiology of non-tuberculous mycobacteria (NTM) is unknown due to the fact that notification is not required in many countries, however the number of infection reports and outbreaks caused by NTM suggest a significant increase in the last years. Traditionally, mycobacteria identification is made through biochemical profiles which allow to differentiate M. tuberculosis from NTM, and in some cases the mycobacteria species. Nevertheless, these methods are technically cumbersome and time consuming. On the other hand, the introduction of methods based on molecular biology has improved the laboratory diagnosis of NTM. OBJECTIVE To establish the NTM frequency in positive cultures for acid-fast bacilli (AAFB) which were sent to Laboratorio de Salud Pública de Bogotá over a 12 month period. MATERIALS AND METHODS A total of 100 positive cultures for acid-fast bacilli from public and private hospitals from Bogotá were identified by both biochemical methods and the molecular methods PRA (PCR-restriction enzyme analysis) and multiplex-PCR. Furthermore, low prevalence mycobacteria species and non-interpretable results were confirmed by 16SrDNA sequentiation analysis. RESULTS Identification using the PRA method showed NMT occurrence in 11% of cultures. In addition, this molecular methodology allowed to detect the occurrence of more than one mycobacteria in 4% of the cultures. Interestingly, a new M. kubicae pattern of PCR-restriction analysis is reported in our study. CONCLUSION Using a mycobacteria identification algorithm, which includes the molecular method PRA, improves the diagnostic power of conventional methods and could help to advance both NTM epidemiology knowledge and mycobacteriosis control.
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Abstract
Pulmonary disease is by far the most frequent disease caused by nontuberculous mycobacteria (NTM). To diagnose NTM pulmonary disease (NTM-PD), patients should have symptoms and radiologic signs suggestive of NTM-PD, and cultures of multiple respiratory tract samples must grow the same NTM species. Thus, the microbiological laboratory has a central role in the diagnosis of NTM-PD. This review summarizes currently available data on techniques involved in the microbiological diagnosis of NTM-PD, and aims to provide a framework for optimal microbiological diagnosis.
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Ramanan P, Khare R, Tosh PK, Wilson JW, Wengenack NL. A 36‐year‐old female from Kuwait with AIDS presenting with fever and abdominal pain. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Poornima Ramanan
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Reeti Khare
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Pritish K. Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - John W. Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Nancy L. Wengenack
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, USA
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Different penetrance of disseminated infections caused by nontuberculous Mycobacteria in Mendelian susceptibility to mycobacterial disease associated with a novel mutation. Pediatr Infect Dis J 2014; 33:328-30. [PMID: 24064560 DOI: 10.1097/inf.0000000000000099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Deficiency in the interleukin12/INFgamma pathway is a genetic condition that predisposes to some infections, including nontuberculous mycobacteria infection and extraintestinal salmonellosis. We report 2 cases in sisters who were diagnosed with a genetic defect caused by a new mutation in Interleukin-12 receptor β1 chain (IL12Rβ1) leading to different clinical presentations and responses to therapy.
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Mycobacterium genavense Infections in a Tertiary Hospital and Reviewed Cases in Non-HIV Patients. PATHOLOGY RESEARCH INTERNATIONAL 2014; 2014:371370. [PMID: 24693456 PMCID: PMC3945967 DOI: 10.1155/2014/371370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/10/2014] [Indexed: 11/18/2022]
Abstract
Mycobacterium genavense is a relatively new species of nontuberculous mycobacterium reported to cause disseminated infections in patients with AIDS and later on in non-HIV immunosuppressed patients. We describe clinical and laboratory features and response to therapy in 7 patients, three of them with HIV infection and four non-HIV-three organ transplant recipients and one with hyper-IgE syndrome-in Valencia, Spain, in a ten years period. We then summarize the published cases of M. avium complex infection, with invasion of peripheral blood, liver, spleen, bone marrow, lymph nodes, and lungs. In clinical samples a large number of acid-fast bacilli were observed. M. genavense grew only from liquid media and after a prolonged incubation period. Its identification was accomplished through molecular methods. Patients were treated with prolonged combinations of antimicrobial agents. There was clinical favourable outcome in 4 patients.
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van der Werf MJ, Ködmön C, Katalinić-Janković V, Kummik T, Soini H, Richter E, Papaventsis D, Tortoli E, Perrin M, van Soolingen D, Zolnir-Dovč M, Ostergaard Thomsen V. Inventory study of non-tuberculous mycobacteria in the European Union. BMC Infect Dis 2014; 14:62. [PMID: 24502462 PMCID: PMC3922012 DOI: 10.1186/1471-2334-14-62] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/22/2013] [Indexed: 11/16/2022] Open
Abstract
Background Since non-tuberculous mycobacteria (NTM) disease is not notifiable in most European Union (EU) and European Economic Area (EEA) countries, the epidemiological situation of the >150 NTM species is largely unknown. We aimed to collect data on the frequency of NTM detection and NTM species types in EU/EEA countries. Methods Officially nominated national tuberculosis reference laboratories of all EU/EEA countries were asked to provide information on: laboratory routines for detection and identification of NTM, including drug sensitivity testing (DST) methods; data on the number and type of NTM species identified; coverage and completeness of the provided data on NTM; type and number of human specimens tested for NTM; and number of specimens tested for Mycobacterium tuberculosis complex and NTM. This information was summarized and the main results are described. Results In total, 99 different NTM species were identified with M. avium, M. gordonae, M. xenopi , M. intracellulare, and M. fortuitum identified most frequently. Seven percent of the NTM species could not be identified. NTM was cultured from between 0.4-2.0% of the specimens (data from four countries). The laboratories use culturing methods optimised for M. tuberculosis complex. Identification is mainly carried out by a commercial line probe assay supplemented with sequencing. Most laboratories carried out DST for rapid growers and only at the explicit clinical request for slow growers. Conclusion It is likely that the prevalence of NTM is underestimated because diagnostic procedures are not optimized specifically for NTM and isolates may not be referred to the national reference laboratory for identification. Due to the diagnostic challenges and the need to establish the clinical relevance of NTM, we recommend that countries should concentrate detection and identification in only few laboratories.
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