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Nielsen M, Kreiter C, Polsfuß S, Krause A. [Two severe cases of disseminated cutaneous nontuberculous mycobacteriosis due to Mycobacterium haemophilum]. Z Rheumatol 2023; 82:143-150. [PMID: 34825949 DOI: 10.1007/s00393-021-01131-y] [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] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Mycobacterium haemophilum is a rare pathogen belonging to the group of slowly growing nontuberculous mycobacteria (NTM) that can cause infections, especially in immunocompromised patients. Detection by culturing is difficult because M. haemophilum only grows under special cultivation conditions. Therefore, it is believed that the pathogen is too rarely identified as a cause of disease overall. In addition to patients with severe immunodeficiency, e.g. due to acquired immunodeficiency syndrome (AIDS), chemotherapy or immunosuppression after transplantation, patients with underlying rheumatic diseases are increasingly described in the literature, who are at risk due to the immunosuppressive treatment regimen. Clinically, ulcerative skin alterations, lymphadenopathy and arthropathy are in the foreground. In immunosuppressed patients with unclear skin lesions, infections due to M. haemophilum should be considered and specific microbiological diagnostics should be initiated.
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Affiliation(s)
- Martin Nielsen
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Wannsee, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland.
| | - Carolin Kreiter
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Buch, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland
| | - Silke Polsfuß
- Immunologie und Laboratoriumsmedizin, Helios Klinikum Emil von Behring Berlin - Institut für Mikrobiologie, Berlin, Deutschland
| | - Andreas Krause
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Wannsee, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Buch, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland
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Eyer-Silva WDA, Almeida MRD, Martins CJ, Basílio-de-Oliveira RP, Araujo LFD, Basílio-de-Oliveira CA, Azevedo MCVMD, Pinto JFDC, Vasconcellos SEG, Rodrigues-Dos-Santos Í, MagdinierGomes H, Suffys PN. Antiretroviral therapy-induced paradoxical worsening of previously healed Mycobacterium haemophilum cutaneous lesions in advanced HIV infection. Rev Inst Med Trop Sao Paulo 2019; 61:e71. [PMID: 31859848 PMCID: PMC6922018 DOI: 10.1590/s1678-9946201961071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium haemophilum is a nontuberculous mycobacterium that causes localized or disseminated disease, mainly in immunocompromised hosts. We report the case of a 35-year-old HIV-infected woman who presented with several enlarging cutaneous lesions over the arms and legs. Histopathological examination revealed the diagnosis of a cutaneous mycobacterial disease. Mycobacterial analyses unveiled M. haemophilum infection. Six months after completion of a successful antimycobacterial treatment, she developed an immune reconstitution inflammatory syndrome (IRIS). This paradoxical relapse presented as tenderness, redness and swelling at the precise sites of the healed lesions and took place in the setting of significant recovery of the CD4 cell count (from 05 to 318 cells/mm 3 ). Microbiological analyses of these worsening lesions were negative, and they spontaneously remitted without the initiation of a novel antimycobacterial treatment cycle. M. haemophilum infection should always be considered as a cause of skin lesions in immunocompromised subjects. Physicians should be aware of the possibility of IRIS as a complication of successful antiretroviral therapy in HIV-infected patients with M. haemophilum infection.
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Affiliation(s)
- Walter de Araujo Eyer-Silva
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Rodrigues de Almeida
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos José Martins
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo Panno Basílio-de-Oliveira
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana Ferreira de Araujo
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Alberto Basílio-de-Oliveira
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Costa Velho Mendes de Azevedo
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jorge Francisco da Cunha Pinto
- Universidade Federal do Estado do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Centro de Ciências Biológicas e da Saúde, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ícaro Rodrigues-Dos-Santos
- Fundação Oswaldo Cruz, Laboratório de Biologia Molecular Aplicada a Micobactérias, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Harrison MagdinierGomes
- Fundação Oswaldo Cruz, Laboratório de Biologia Molecular Aplicada a Micobactérias, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Philip Noel Suffys
- Fundação Oswaldo Cruz, Laboratório de Biologia Molecular Aplicada a Micobactérias, Rio de Janeiro, Rio de Janeiro, Brazil
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Lerat I, Cambau E, Roth Dit Bettoni R, Gaillard JL, Jarlier V, Truffot C, Veziris N. In vivo evaluation of antibiotic activity against Mycobacterium abscessus. J Infect Dis 2013; 209:905-12. [PMID: 24253289 DOI: 10.1093/infdis/jit614] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prognosis of Mycobacterium abscessus infections is poor due to the lack of effective drug treatment. The objective of this study was to set up an animal model suitable to test antibiotic activity against M. abscessus. METHODS The following mouse strains were evaluated: Swiss, BALB/c, C57BL/6, nude, beige, A/J, and GKO. Antibiotic activity was tested for clarithromycin, amikacin, cefoxitin, tigecycline, and bedaquiline (TMC207). Finally, we evaluated the 3-drug combination clarithromycin, cefoxitin, and amikacin. RESULTS Nude and GKO mice fulfilled criteria for the model but only nude mice offered sufficient availability for large therapeutic experiments. Among the 3 drugs usually combined for treatment of M. abscessus infection, cefoxitin was the most active because it improved survival and reduced bacillary loads in spleen whereas clarithromycin and amikacin prevented death but had little impact on bacillary loads. The triple-drug combination was not more active than cefoxitin alone. Tigecycline displayed bactericidal activity whereas bedaquiline was almost inactive. CONCLUSIONS Nude mice are an adequate model for in vivo chemotherapy studies. Among tested drugs, cefoxitin and tigecycline showed promising in vivo activity against M. abscessus. The best drug combination remains to be determined.
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Affiliation(s)
- Isabelle Lerat
- Laboratoire de Bactériologie-Hygiène, Faculté de Médecine, Université Pierre et Marie Curie
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Kay MK, Perti TR, Duchin JS. Tattoo-associated Mycobacterium haemophilum skin infection in immunocompetent adult, 2009. Emerg Infect Dis 2012; 17:1734-6. [PMID: 21888807 PMCID: PMC3322073 DOI: 10.3201/eid1709.102011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
After a laboratory-confirmed case of Mycobacterium haemophilum skin infection in a recently tattooed immunocompetent adult was reported, we investigated to identify the infection source and additional cases. We found 1 laboratory-confirmed and 1 suspected case among immunocompetent adults who had been tattooed at the same parlor.
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Affiliation(s)
- Meagan K Kay
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ, Winthrop K. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367-416. [PMID: 17277290 DOI: 10.1164/rccm.200604-571st] [Citation(s) in RCA: 4002] [Impact Index Per Article: 235.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Mycobacterium haemophilum is an emerging cutaneous and systemic pathogen in immunosuppressed adults. Reports in the pediatric literature prior to 2004, limited to immunocompetent children with lymphadenitis, offer a different clinical presentation from that of the immunosuppressed adult. We report an instance of this atypical mycobacterial infection occurring in an immunosuppressed boy with clinical findings similar to those described in immunosuppressed adults.
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Affiliation(s)
- Lisa B Campbell
- Department of Dermatology, Geisinger Medical Centre, Danville, Pennsylvania 17822, USA
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Brown-Elliott BA, Griffith DE, Wallace RJ. Newly described or emerging human species of nontuberculous mycobacteria. Infect Dis Clin North Am 2002; 16:187-220. [PMID: 11917813 DOI: 10.1016/s0891-5520(03)00052-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The advent of molecular testing in the laboratory has brought about the recognition of multiple newly characterized mycobacterial species not previously recognizable with most standard techniques. Some of the species are nonpathogenic, but the majority may cause clinical disease. Each is likely to have its own biology, drug susceptibility pattern, and response to drug/surgical therapy. Thus, it is important to try to recognize these new species in the laboratory. A study of the phenotypic and genotypic characteristics of these new species also may help to elucidate the epidemiology and pathogenesis of these organisms. In addition, there are multiple emerging species of nontuberculous mycobacteria including M. ulcerans, M. haemophilum, M. xenopi, and M. malmoense. [table: see text] These species are being recognized increasingly as a cause of human disease and recovered within the laboratory. The clinician must learn about these new pathogens to recognize them clinically and assist the laboratory in their recovery.
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Affiliation(s)
- Barbara A Brown-Elliott
- Mycobacteria/Nocardia Laboratory, Department of Microbiology, University of Texas Health Center, Tyler, Texas, USA.
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Kuijper EJ, Wit FWNM, Veenstra J, Böttger EC. Recovery of Mycobacterium haemophilum skin infection in an HIV-1-infected patient after the start of antiretroviral triple therapy. Clin Microbiol Infect 2002; 3:584-585. [PMID: 11864191 DOI: 10.1111/j.1469-0691.1997.tb00317.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. J. Kuijper
- Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands
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Shah MK, Sebti A, Kiehn TE, Massarella SA, Sepkowitz KA. Mycobacterium haemophilum in immunocompromised patients. Clin Infect Dis 2001; 33:330-7. [PMID: 11438898 DOI: 10.1086/321894] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2000] [Revised: 12/15/2000] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium haemophilum, a recently described pathogen, can cause an array of symptoms in immunocompromised patients. To date, 90 patients with this infection have been described worldwide. We report our institution's experience with 23 patients who were treated from 1990 through 2000. Fourteen patients had undergone bone marrow transplantation, 5 were infected with human immunodeficiency virus, 3 had hematologic malignancies, and 1 had no known underlying immunosuppression. Clinical syndromes on presentation included skin lesions alone in 13 patients, arthritis or osteomyelitis in 4 patients, and lung disease in 6 patients. Although patients with skin or joint involvement had favorable outcomes, 5 of 7 patients with lung infection died. Prolonged courses of multidrug therapy are required for treatment. A diagnosis of M. haemophilum infection must be considered for any immunocompromised patient for whom acid-fast bacilli are identified in a cutaneous, synovial fluid or respiratory sample or for whom granulomas are identified in any pathological specimen.
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Affiliation(s)
- M K Shah
- Infectious Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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