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Hassanzadeh A, Hasannezhad M, Abbasian L, Ghaderkhani S, Ameli F, Allahdadi M. Disseminated mycobacterium genavense infection with central nervous system involvement in an HIV patient: a case report and literature review. BMC Infect Dis 2024; 24:437. [PMID: 38658840 PMCID: PMC11041032 DOI: 10.1186/s12879-024-09316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Immunodeficient patients, particularly HIV patients, are at risk of opportunistic infections. Nontuberculous mycobacteria can cause severe complications in immunodeficient patients. CASE PRESENTATION We describe a 57-year-old HIV patient, primarily presented with coughs and constitutional symptoms, with a unique Mycobacterium genavense abdominal, pulmonary, and central nervous system infection, accompanied by intracranial masses. CONCLUSION The diagnosis of NTM, including M. genavense, must always be considered by clinicians in immunodeficient patients, especially those with HIV, who have a compromised immune system.
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Affiliation(s)
- Ali Hassanzadeh
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, 1419733141, Tehran, Iran
| | - Malihe Hasannezhad
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, 1419733141, Tehran, Iran.
- Iranian Research Center for HIV/AIDS, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ladan Abbasian
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, 1419733141, Tehran, Iran
- Iranian Research Center for HIV/AIDS, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Ghaderkhani
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, 1419733141, Tehran, Iran
- Iranian Research Center for HIV/AIDS, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ameli
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Allahdadi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, 1419733141, Tehran, Iran
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Benchetrit A, Messina F, Matteo M, Vázquez M, Paul R, Gil Zbinden G, Costa N, Santiso G. Microsporum canis pseudomycetoma and disseminated Mycobacterium genavense infection in an HIV/AIDS patient, an unusual combination. Rev Argent Microbiol 2024:S0325-7541(24)00037-3. [PMID: 38644065 DOI: 10.1016/j.ram.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/27/2023] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Pseudomycetomas are rare fungal subcutaneous infections caused by dermatophytes, which are mainly observed in immunocompromised patients. Mycobacterium genavense is considered an opportunistic pathogen in people living with HIV/AIDS (PLWHA), clinically resembling the presentation of Mycobacterium avium complex (MAC). Here, we describe the case of a 26-year-old PLWHA with a 3-month history of a 4cm tumoral, duroelastic and painful lesion located on the back. Histopathology of the tumoral lesion revealed chronic granulomatous inflammation with grains composed of PAS-positive and Grocott-positive septate hyphae, as well as acid-fast bacilli (AFB). Culture on Sabouraud and lactrimel agar developed colonies that were later identified as Microsporum canis. In successive samples, the AFB were identified as M. genavense by restriction analysis of PCR products. Immunocompromised PLWHA not only suffer increased susceptibility to diseases due to unusual pathogens but also atypical clinical presentation of frequently encountered pathogens.
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Affiliation(s)
- Andrés Benchetrit
- Sala 21, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mario Matteo
- Sección de Bacteriología de la Tuberculosis, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariana Vázquez
- Sección de Bacteriología de la Tuberculosis, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Roxana Paul
- Instituto Nacional de Enfermedades Infecciosas-ANLIS Carlos Malbrán, Buenos Aires, Argentina
| | - Germán Gil Zbinden
- Servicio de Anatomía Patológica, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nora Costa
- Sección de Bacteriología de la Tuberculosis, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Infecciosas Francisco Javier Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
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3
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Bes-Berlandier H, Garzaro M, Rouzaud C, Bodard S, Bille E, Ficheux M, Cazals-Hatem D, Veziris N, Lanternier F, Lortholary O. Successful rescue TNF-α blocking for Mycobacterium genavense - Related immune reconstitution inflammatory syndrome: A case report. Heliyon 2024; 10:e29341. [PMID: 38623247 PMCID: PMC11016716 DOI: 10.1016/j.heliyon.2024.e29341] [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: 09/23/2023] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) has been reported in immunocompromised patients with disseminated Mycobacterium genavense. Management relies on high-dose corticosteroids. We describe two cases of late-onset corticosteroid-refractory IRIS related to disseminated infection in a HIV-positive patient and a renal transplant patient who had a favorable outcome with a monoclonal TNF-α blocker.
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Affiliation(s)
- Hugo Bes-Berlandier
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
| | - Margaux Garzaro
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
- Université Paris Cité, 15 rue de l’école de Médecine, 75006, Paris, France
| | - Claire Rouzaud
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
| | - Sylvain Bodard
- Université Paris Cité, 15 rue de l’école de Médecine, 75006, Paris, France
- Service de Radiologie adulte, Hôpital-Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
| | - Emmanuelle Bille
- Université Paris Cité, 15 rue de l’école de Médecine, 75006, Paris, France
- Service de Microbiologie, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
| | - Maxence Ficheux
- Service de Néphrologie, Centre Hospitalier universitaire de Caen Normandie, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Dominique Cazals-Hatem
- Université Paris Cité, 15 rue de l’école de Médecine, 75006, Paris, France
- Département de Pathologie, Hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 100, Boulevard Leclerc, 92118, Clichy, France
| | - Nicolas Veziris
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR, 1135, Department of Bacteriology, Saint-Antoine Hospital, APHP. Sorbonne-Université, Centre National de Référence des Mycobactéries, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
- Université Paris Cité, 15 rue de l’école de Médecine, 75006, Paris, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris, 149 rue de Sèvres, 75743, Paris, France
- Université Paris Cité, 15 rue de l’école de Médecine, 75006, Paris, France
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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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5
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Mycobacterium genavense Central Nervous System Infection in a Patient with AIDS. Can J Neurol Sci 2023; 50:305-307. [PMID: 35220993 DOI: 10.1017/cjn.2022.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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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: 2.5] [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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7
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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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8
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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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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: 1.0] [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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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: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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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: 0.3] [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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Abstract
Chinchillas have been used mostly as fur animals and as animal models for human ontological diseases and only recently have been recognized as excellent, long-lived, and robust pet rodents. This review aims to provide updated information on emerging disease conditions in pet chinchillas, such as Streptococcus equi subsp zooepidemicus and Pseudomonas aeruginosa. Furthermore, this review article provides updated information on previously documented disorders, such as urolithiasis and middle ear disease, in chinchillas. This article is intended to serve as a complement to the current veterinary reference literature and to provide valuable and clinically relevant information for veterinarians treating chinchillas.
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Affiliation(s)
- Anna Martel
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Thomas Donnelly
- Exotic Pet Medicine Service, Alfort University Veterinary Teaching Hospital, Ecole Nationale Vétérinaire d'Alfort, 7 Avenue du Géneral de Gaulle, Maisons-Alfort Cedex 94704, France
| | - Christoph Mans
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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Katale BZ, Mbugi EV, Keyyu JD, Fyumagwa RD, Rweyemamu MM, van Helden PD, Dockrell HM, Matee MI. One Health approach in the prevention and control of mycobacterial infections in Tanzania: lessons learnt and future perspectives. ONE HEALTH OUTLOOK 2019; 1:2. [PMID: 33829123 PMCID: PMC7990093 DOI: 10.1186/s42522-019-0002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 09/24/2019] [Indexed: 06/12/2023]
Abstract
BACKGROUND One Health (OH) is an integrated approach, formed inclusive of using multiple disciplines to attain optimal health for humans, animals, and the environment. The increasing proximity between humans, livestock, and wildlife, and its role in the transmission dynamics of mycobacterial infections, necessitates an OH approach in the surveillance of zoonotic diseases. The challenge remains as humans, livestock, and wildlife share resources and interact at various interfaces. Therefore, this review explores the potential of the OH approach to understand the impact of mycobacterial infections in Tanzania in terms of lessons learnt and future perspectives. MATERIALS AND METHODS Available literature on OH and mycobacterial infections in Tanzania was searched in PubMed, Google Scholar, and Web of Science. Articles on mycobacterial infections in Tanzania, published between 1997 to 2017, were retrieved to explore the information on OH and mycobacterial infections. MAIN BODY The studies conducted in Tanzania had have reported a wide diversity of mycobacterial species in humans and animals, which necessitates an OH approach in surveillance of diseases for better control of infectious agents and to safeguard the health of humans and animals. The close proximity between humans and animals increases the chances of inter-specific transmission of infectious pathogens, including drug-resistant mycobacteria. In an era where HIV co-infection is also the case, opportunistic infection by environmental non-tuberculous mycobacteria (NTM), commonly known as mycobacteria other than tuberculosis (MOTT) may further exacerbate the impact of drug resistance. NTM from various sources have greatest potential for diverse strains among which are resistant strains due to continued evolutional changes. CONCLUSION A collaborative interdisciplinary approach among professionals could help in solving the threats posed by mycobacterial infections to public health, particularly by the spread of drug-resistant strains.
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Affiliation(s)
- Bugwesa Z. Katale
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Tanzania Wildlife Research Institute (TAWIRI), Arusha, Tanzania
- Southern African Centre for Infectious Diseases Surveillance (SACIDS), Sokoine University of Agriculture (SUA), Chuo Kikuu, Morogoro, Tanzania
| | - Erasto V. Mbugi
- Department of Biochemistry, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Julius D. Keyyu
- Tanzania Wildlife Research Institute (TAWIRI), Arusha, Tanzania
| | | | - Mark M. Rweyemamu
- Southern African Centre for Infectious Diseases Surveillance (SACIDS), Sokoine University of Agriculture (SUA), Chuo Kikuu, Morogoro, Tanzania
| | - Paul D. van Helden
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/ South African Medical Research Council (MRC) Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Hazel M. Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mecky I. Matee
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Southern African Centre for Infectious Diseases Surveillance (SACIDS), Sokoine University of Agriculture (SUA), Chuo Kikuu, Morogoro, Tanzania
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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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Splenic infarction complicated with immune reconstitution inflammatory syndrome due to disseminated Mycobacterium genavense infection in a patient infected with human immunodeficiency virus. J Infect Chemother 2019; 25:1060-1064. [PMID: 31227383 DOI: 10.1016/j.jiac.2019.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/11/2019] [Accepted: 05/24/2019] [Indexed: 11/23/2022]
Abstract
Mycobacterium genavense (M. genavense) is one of the most fastidious, difficult to culture Mycobacterium species. Patients infected with human immunodeficiency virus (HIV) may develop immune reconstitution inflammatory syndrome (IRIS) due to disseminated M. genavense infection as well as disseminated M. avium and intracellulare complex infection. Consensus regarding treatment of IRIS due to disseminated mycobacterium infection has not yet been obtained, although systemic steroid therapy has been recommended in recent guidelines. Here we report the case of a 48-year-old Japanese man diagnosed with HIV and disseminated M. genavense infection. His initial CD4-positive T cell count was 3/μL, and his HIV1-RNA viral load was 13,000 copies/mL. He developed IRIS due to disseminated M. genavense infection after two weeks of receiving antiretroviral agents. The patient's serum alkaline phosphatase level, as a barometer of disseminated M. genavense infection in this case, was difficult to control with several anti-mycobacterial agents, although his fever was improved by non-steroidal anti-inflammatory drugs. About five weeks after the onset of IRIS, the patient developed acute left upper quadrant pain and was diagnosed with splenic infarction by contrast-enhanced computed tomography. After the splenic infarction, the patient's serum alkaline phosphatase level decreased without systemic steroid therapy or anticoagulant agents, and his left upper quadrant pain improved naturally within a few days. This case suggests that IRIS due to disseminated M. genavense infection can complicate splenic infarction in patients with HIV, and splenic infarction could improve the IRIS due to disseminated M. genavense infection.
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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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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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20
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Immune reconstitution inflammatory syndrome due to Mycobacterium genavense in an HIV-infected patient: Impact of rapid species identification by rpoB sequencing on clinical management. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.005007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tribuna C, Ângela C, Eira I, Carvalho A. Pulmonary Kaposi sarcoma and disseminated Mycobacterium genavense infection in an HIV-infected patient. BMJ Case Rep 2015; 2015:bcr-2015-211683. [PMID: 26452414 DOI: 10.1136/bcr-2015-211683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of Kaposi sarcoma (KS) and disseminated infection by Mycobacterium genavense in a 40-year-old HIV-positive man with CD4+ T-cell count 5/µL. He presented with anorexia, diarrhoea, cachexia and multiple firm violaceous nodules distributed over the face, neck and upper and lower extremities. Biopsy of a skin nodule was performed, confirming KS. Immunoperoxidase staining for human herpesvirus 8 was strongly positive. Endoscopic examination revealed erosive duodenopathy. Multiple biopsy samples showed numerous acid-fast bacilli at direct microscopic examination. Real-time PCR (RT-PCR) identified M. genavense. A CT scan showed diffuse pulmonary infiltrates with a 'tree-in-bud' appearance, striking splenomegaly and abdominal lymphadenopathy. A bronchoscopy was performed, revealing typical Kaposi's lesions in the upper respiratory tract. RT-PCR of bronchial aspirate identified M. genavense and Pneumocystis jirovecii. Despite treatment with highly active antiretroviral therapy, antimycobacterial therapy and trimethoprim/sulfamethoxazole, the outcome was fatal.
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Affiliation(s)
- Cindy Tribuna
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Cristina Ângela
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Isabel Eira
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
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IDENTIFICATION OF MYCOBACTERIUM GENAVENSE IN A DIANA MONKEY (CERCOPITHECUS DIANA) BY POLYMERASE CHAIN REACTION AND HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY. J Zoo Wildl Med 2015; 46:339-44. [PMID: 26056890 DOI: 10.1638/2013-0246r2.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 25-yr-old Diana monkey (Cercopithecus diana) with a 1.5-yr history of chronic colitis and diarrhea was found to have disseminated granulomatous disease with intralesional acid fast bacilli. Bacilli were identified as Mycobacterium genavense by polymerase chain reaction, sequencing of the 16S-23S ribosomal RNA intergenic spacer (ITS) gene, and mycolic acid analysis by high-performance liquid chromatography. Mycobacterium genavense is a common cause of mycobacteriosis in free-ranging and captive birds. In addition, recognition of opportunistic infection in human immunodeficiency virus-positive patients is increasing. Disease manifestations of M. genavense are similar to Mycobacterium avium complex (MAC) and include fever, wasting, and diarrhea with disseminated disease. Similar clinical signs and lesions were observed in this monkey. Mycobacterium genavense should be considered as a differential for disseminated mycobacterial disease in nonhuman primates as this agent can mimic MAC and related mycobacteria.
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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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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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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: 2.3] [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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Mycobacterium genavense specific mesenteritic syndrome in HIV-infected patients: a new entity of retractile mesenteritis? AIDS 2013; 27:2819-22. [PMID: 24231409 DOI: 10.1097/01.aids.0000433820.25415.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abdominal mesenteritis is a rare and poorly understood gastroenterological disease. Here, we report on two identical cases of Mycobacterium genavense associated retractile mesenteritis in HIV-positive patients. A literature search retrieved only few small retrospective studies, which characterize the clinical course of this seldom infection. We propose a pathogen-specific syndrome of retractile mesenteritis in HIV-positive patients linked to Mycobacterium genavense infection on the basis of our clinical observation and literature meta-analysis with duodenal wall thickening, central mesenterial mass and vascular complications.
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Mycobacterium genavense and Chronic Intermittent Diarrhea in a Kidney and Pancreas Transplant Recipient. Transplantation 2013; 96:e64-6. [DOI: 10.1097/tp.0b013e3182a9026c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brackers de Hugo L, Ffrench M, Broussolle C, Sève P. Granulomatous lesions in bone marrow: clinicopathologic findings and significance in a study of 48 cases. Eur J Intern Med 2013; 24:468-73. [PMID: 23414770 DOI: 10.1016/j.ejim.2012.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Granulomas in bone marrow are an infrequent finding related to various disorders. The aim of this study was to review our clinical experience with granulomatous bone marrow disease and to describe the contributions of recent diagnostic tools, such as (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and molecular biology. METHODS Clinical, laboratory and morphological data on patients with a granuloma based on bone marrow biopsy analysed in the University Hospital Lyon from May 2004 to July 2010 were reviewed. RESULTS We identified 57 cases among 9641 bone marrow biopsies, representing an incidence of 0.59% in the series and an annual incidence of 9.5 cases per year. Nine biopsies performed for staging a known pathology were excluded from further analysis. Among the 48 remaining patients, associated disease was demonstrated in 79%, with infections being the most common (33%), following by sarcoidosis (21%), malignancy (19%) and therapy-induced granulomas (6%). One previously unpublished entity is described: infection with Bartonella henselae diagnosed using molecular biology from node and skin biopsies in two renal transplant patients. (18)F-FDG-PET, performed in 13 cases, showed hypermetabolic foci consistent with sarcoidosis in two cases. Positive PCR result for an infectious pathogen was obtained in three bone marrow samples (Mycobacterium tuberculosis, n=1; Mycobacterium genavense, n=2). CONCLUSION In comparison to previous research, our study reports high proportions of cases caused by sarcoidosis and unknown causes. (18)F-FDG-PET could show signs consistent with sarcoidosis and molecular biology is useful for the detection of fastidious bacteria in immunocompromised patients.
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Abstract
The incidence, mortality, and epidemiology of human immunodeficiency virus (HIV)-associated pulmonary infections have changed as a result of effective antiretroviral and prophylaxis antimicrobial therapy. The clinical presentation, radiographic abnormalities, and treatment of pneumonia from various uncommon pathogens in patients with AIDS can be different from those in immunocompetent patients. Advances in invasive and noninvasive testing and molecular biological techniques have improved the diagnosis and prognosis of pulmonary infections in patients infected with HIV. This review focuses on pulmonary infections from nontuberculosis mycobacteria, cytomegalovirus, fungi (aspergillosis, cryptococcosis, endemic fungi), and parasites (toxoplasmosis), and uncommon bacterial pneumonia (nocardiosis, rhodococcosis) in these patients.
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Affiliation(s)
- Jakrapun Pupaibool
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Brown-Elliott BA, Nash KA, Wallace RJ. Antimicrobial susceptibility testing, drug resistance mechanisms, and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev 2012; 25:545-82. [PMID: 22763637 PMCID: PMC3416486 DOI: 10.1128/cmr.05030-11] [Citation(s) in RCA: 335] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Within the past 10 years, treatment and diagnostic guidelines for nontuberculous mycobacteria have been recommended by the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA). Moreover, the Clinical and Laboratory Standards Institute (CLSI) has published and recently (in 2011) updated recommendations including suggested antimicrobial and susceptibility breakpoints. The CLSI has also recommended the broth microdilution method as the gold standard for laboratories performing antimicrobial susceptibility testing of nontuberculous mycobacteria. This article reviews the laboratory, diagnostic, and treatment guidelines together with established and probable drug resistance mechanisms of the nontuberculous mycobacteria.
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Esteban J, García-Pedrazuela M, Muñoz-Egea MC, Alcaide F. Current treatment of nontuberculous mycobacteriosis: an update. Expert Opin Pharmacother 2012; 13:967-86. [DOI: 10.1517/14656566.2012.677824] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hoefsloot W, van Ingen J, Peters EJG, Magis-Escurra C, Dekhuijzen PNR, Boeree MJ, van Soolingen D. Mycobacterium genavense in the Netherlands: an opportunistic pathogen in HIV and non-HIV immunocompromised patients. An observational study in 14 cases. Clin Microbiol Infect 2012; 19:432-7. [PMID: 22439918 DOI: 10.1111/j.1469-0691.2012.03817.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mycobacterium genavense is an opportunistic non-tuberculous mycobacterium previously mostly associated with HIV-infected patients with CD4 counts below 100/μL. In this retrospective observational study of medical charts we studied all Dutch patients in whom M. genavense was detected between January 2002 and January 2010. Of the 14 patients identified, 13 (93%) showed clinically relevant M. genavense disease. All patients with M. genavense disease were severely immunocompromised, including HIV-infected patients, solid organ transplant recipients, those with chronic steroid use in combination with other immune modulating drugs, recipients of chemotherapy for non-Hodgkin lymphoma, and those with immunodeficiency syndromes. Two patients had non-disseminated pulmonary M. genavense disease. Of the 12 patients treated, eight (75%) showed a favourable outcome. Four patients died in this study, three despite treatment for M. genavense disease. We conclude that M. genavense is a clinically relevant pathogen in severely immunocompromised patients that causes predominantly disseminated disease with serious morbidity and mortality. M. genavense is increasingly seen among non-HIV immunocompromised patients.
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Affiliation(s)
- W Hoefsloot
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Rammaert B, Couderc LJ, Rivaud E, Honderlick P, Zucman D, Mamzer MF, Cahen P, Bille E, Lecuit M, Lortholary O, Catherinot E. Mycobacterium genavense as a cause of subacute pneumonia in patients with severe cellular immunodeficiency. BMC Infect Dis 2011; 11:311. [PMID: 22054169 PMCID: PMC3232426 DOI: 10.1186/1471-2334-11-311] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 11/05/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Mycobacterium genavense is a rare nontuberculous mycobacteria (NTM). Human infections are mostly disseminated in the setting of the AIDS epidemic or the use of aggressive immunosuppressive treatments. M. genavense culture is fastidious, requiring supplemented media. Pulmonary involvement rarely occurs as a primary localization. CASES PRESENTATION We report here two patients with pneumonia as the predominant manifestation of M. genavense infection: one kidney transplanted patient and one HIV-infected patient. Both patients were initially treated with anti-tuberculous drugs before the identification of M. genavense on sputum or broncho-alveolar lavage fluid culture. A four-drug regimen including clarithromycin and rifabutin was started. Gamma interferon has been helpful in addition to antimycobacterial treatment for one patient. CONCLUSION Clinicians should be aware that M. genavense could be the etiologic agent of sub-acute pneumonia mimicking tuberculosis in patients with cellular immunodeficiency status.
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Affiliation(s)
- Blandine Rammaert
- Université Paris-Descartes, Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France
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Piersimoni C. Nontuberculous mycobacteria infection in solid organ transplant recipients. Eur J Clin Microbiol Infect Dis 2011; 31:397-403. [DOI: 10.1007/s10096-011-1329-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 06/20/2011] [Indexed: 11/29/2022]
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Charles P, Lortholary O, Dechartres A, Doustdar F, Viard JP, Lecuit M, Gutierrez MC. Mycobacterium genavense infections: a retrospective multicenter study in France, 1996-2007. Medicine (Baltimore) 2011; 90:223-230. [PMID: 21694645 DOI: 10.1097/md.0b013e318225ab89] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mycobacterium genavense, a nontuberculous mycobacterium, led to devastating infections in patients with acquired immunodeficiency syndrome (AIDS) before highly active antiretroviral therapy (HAART) was available, as well as in other immunocompromised patients. We conducted the current study to describe the features of this infection in patients infected with human immunodeficiency virus (HIV) in the HAART era and in non HIV-infected patients.We conducted a retrospective cohort survey in France. All patients with M. genavense infection diagnosed from 1996 to 2007 at the National Reference Center, Institut Pasteur, Paris, were identified and their clinical, laboratory, and microbiologic data were centralized in a single database. Twenty-five cases of M. genavense infection originating from 19 centers were identified. Twenty patients had AIDS, 3 had solid organ transplantation, and 2 had sarcoidosis. Sixty-four percent (n = 16) were male, mean age was 42 years, and median CD4 count was 13/mm (range, 0-148/mm) in patients with AIDS. Twenty-four patients had disseminated infection with fever (75%, n = 18), weight loss (79%, n = 19), abdominal pain (71%, n = 17), diarrhea (62.5%, n = 15), splenomegaly (71%, n = 17), hepatomegaly (62.5%, n = 15), or abdominal adenopathy (62.5%, n = 15). M. genavense was isolated from the lymph node (n = 13), intestinal biopsy (n = 9), blood (n = 6), sputum (n = 3), stool (n = 3), and bone marrow (n = 5). Eleven patients (44%) died, 8 (32%) were considered cured with no residual symptoms, and 6 (24%) had chronic symptoms. The 1-year survival rate was 72%.The prognosis of M. genavense infection in HIV-infected patients has dramatically improved with HAART. Clinical presentations in HIV and non-HIV immunocompromised patients were similar.
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Affiliation(s)
- Pierre Charles
- From Université Paris Descartes, Hôpital Necker-Enfants Malades (APHP), Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur (PC, OL, JPV, ML), Paris; Hôpital Foch, Service de Médecine Interne (PC), Suresnes; Institut Pasteur, Département Infection et Epidémiologie (OL, FD, ML, MCG), Paris; INSERM U 738, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique (APHP), Université Paris V (AD), Paris; Inserm (ML), Avenir U 604
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38
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Miyoshi H, Tamura G, Satoh T, Homma R, Omoto E, Nakano N, Wada R. Disseminated Mycobacterium genavense infection in a healthy boy. Hum Pathol 2010; 41:1646-9. [DOI: 10.1016/j.humpath.2010.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
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39
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Infection with Mycobacterium genavense in a patient with systemic lupus erythematosus. Clin Rheumatol 2009; 28 Suppl 1:S39-41. [PMID: 19252819 DOI: 10.1007/s10067-009-1120-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
Abstract
A 55-year-old woman with systemic lupus erythematosus was admitted with fever of unknown origin. She had been on an immunosuppressive regimen for the past 8 years including steroids and Azathioprine. Laboratory parameters revealed a markedly elevated C-reactive protein of 189 mg/l, antinuclear antibodies of 1:2,560, a hemoglobin level of 9.0 g/dl, and a severe lymphopenia (total lymphocytes 49.4/microl, CD4(+) cells 2/microl, CD8(+) cells 7/microl). Neither blood culture samples nor computed tomography and magnetic resonance imaging of the chest and abdomen nor a trans-esophageal echocardiography revealed positive results. A bone marrow biopsy did not show signs of hematologic disease, but revealed a small granuloma rife with acid-fast bacilli, which were later confirmed to be Mycobacterium genavense by gene sequencing. To our knowledge, this is the first case involving M. genavense infection in a patient with systemic lupus erythematosus. In contrast to other reports regarding disseminated M. genavense infection, the patient is still alive and well.
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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: 3927] [Impact Index Per Article: 231.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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41
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Nurmohamed S, Weenink A, Moeniralam H, Visser C, Bemelman F. Hyperammonemia in generalized Mycobacterium genavense infection after renal transplantation. Am J Transplant 2007; 7:722-3. [PMID: 17250553 DOI: 10.1111/j.1600-6143.2006.01680.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
After solid organ transplantation, patients are susceptible to infection caused by uncommon pathogens due the immunosuppressive drug therapy. Here, we report the first case of disseminated Mycobacterium genavense infection in a HIV seronegative renal transplant patient. The most striking clinical feature was a decreased consciousness. Blood results revealed hyperammonemia with otherwise normal liver function. Occurrence of hyperammonemia and massive M. genavense infection has not been reported before.
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Affiliation(s)
- S Nurmohamed
- Renal Transplant Unit, Department of Internal Medicine, Academic Medical Center University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam
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42
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Hilborn ED, Covert TC, Yakrus MA, Harris SI, Donnelly SF, Rice EW, Toney S, Bailey SA, Stelma GN. Persistence of nontuberculous mycobacteria in a drinking water system after addition of filtration treatment. Appl Environ Microbiol 2006; 72:5864-9. [PMID: 16957205 PMCID: PMC1563680 DOI: 10.1128/aem.00759-06] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is evidence that drinking water may be a source of infections with pathogenic nontuberculous mycobacteria (NTM) in humans. One method by which NTM are believed to enter drinking water distribution systems is by their intracellular colonization of protozoa. Our goal was to determine whether we could detect a reduction in the prevalence of NTM recovered from an unfiltered surface drinking water system after the addition of ozonation and filtration treatment and to characterize NTM isolates by using molecular methods. We sampled water from two initially unfiltered surface drinking water treatment plants over a 29-month period. One plant received the addition of filtration and ozonation after 6 months of sampling. Sample sites included those at treatment plant effluents, distributed water, and cold water taps (point-of-use [POU] sites) in public or commercial buildings located within each distribution system. NTM were recovered from 27% of the sites. POU sites yielded the majority of NTM, with >50% recovery despite the addition of ozonation and filtration. Closely related electrophoretic groups of Mycobacterium avium were found to persist at POU sites for up to 26 months. Water collected from POU cold water outlets was persistently colonized with NTM despite the addition of ozonation and filtration to a drinking water system. This suggests that cold water POU outlets need to be considered as a potential source of chronic human exposure to NTM.
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Affiliation(s)
- Elizabeth D Hilborn
- U.S. Environmental Protection Agency, MD-58A, Research Triangle Park, NC 27711, USA.
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43
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Trueba F, Saint-Blancard P, Fabre M, Andriamanantena D, Rault A, Hervé V. Infections à Mycobacterium genavense diagnostiquées par le test INNO-LiPA MYCOBACTERIA Amplification v2. Presse Med 2006; 35:985-6. [PMID: 16783260 DOI: 10.1016/s0755-4982(06)74734-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Diagnosis of atypical mycobacterial infections can be facilitated by molecular biology techniques. CASES Two severely immunodepressed patients were admitted for deterioration of their general health status. Bacteriological analysis of histopathologic fragments showed the presence of acid- and alcohol-resistant bacilli. INNO-LiPA MYCOBACTERIA Amplification v2 made it possible to diagnose Mycobacterium genavense infection. COMMENTS M. genavense is a slow-growing atypical mycobacterium. The molecular biology techniques used by INNO-LiPA MYCOBACTERIA V2 permit its swift identification.
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Affiliation(s)
- François Trueba
- Service de biologie clinique, Hôpital d'Instruction de Armées Percy, Clamart (92).
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Trueba F, Fabre M, Saint-Blancard P. Rapid identification of Mycobacterium genavense with a new commercially available molecular test, INNO-LiPA MYCOBACTERIA v2. J Clin Microbiol 2004; 42:4403-4. [PMID: 15365056 PMCID: PMC516359 DOI: 10.1128/jcm.42.9.4403-4404.2004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a rare mesenteric localized Mycobacterium genavense infection in a severely immunocompromised human immunodeficiency virus-infected patient. An INNO-LiPA MYCOBACTERIA v2 test was performed directly on biopsy samples. This new molecular tool could be used for simultaneous identification of mycobacterium species from human specimens, but other studies are needed to validate our first results.
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Affiliation(s)
- François Trueba
- Department of Clinical Microbiology, Percy Hospital, 101 avenue Henri Barbusse, 92141 Clamart cedex, France.
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45
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Somoskovi A, Mester J, Hale YM, Parsons LM, Salfinger M. Laboratory diagnosis of nontuberculous mycobacteria. Clin Chest Med 2002; 23:585-97. [PMID: 12370994 DOI: 10.1016/s0272-5231(02)00018-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In conclusion, it is important to realize that there is no "stand alone" assay for the identification of NTM. Many new species may not be recognized in all assays. Newer molecular tests are more accurate for identification than phenotypic tests and have significantly improved turnaround time. Clinical significance of an isolate should be determined, however, before committing resources for the identification of a mycobacterial isolate to the species level. In addition, there are significant differences in the range and quality of services provided by different laboratories. Today, techniques and equipment are increasingly complex and costly, making it more difficult to upgrade every local laboratory to perform these assays. But because specimen delivery and communication of results can be rapidly and easily achieved, utilization of reference laboratories for rarely performed sophisticated tests is a more practical approach.
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Affiliation(s)
- Akos Somoskovi
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Stormon M, Friedman J, King S, Cutz E, Furuya KN. An unusual case of diarrhea in schimke immuno-osseous dysplasia. J Pediatr Gastroenterol Nutr 2002; 35:369-71. [PMID: 12352531 DOI: 10.1097/00005176-200209000-00027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Michael Stormon
- Division GI Nutrition, Department of Pediatric Medicine, The Hospital for Sick Children, Toronto Canada
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47
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Hilborn ED, Royster MO, Drabkowski DJ. Survey of US Public Health Laboratories: Microbial Pathogens on the CCL. ACTA ACUST UNITED AC 2002. [DOI: 10.1002/j.1551-8833.2002.tb09492.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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: 69] [Impact Index Per Article: 3.1] [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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Krebs T, Zimmerli S, Bodmer T, Lämmle B. Mycobacterium genavense infection in a patient with long-standing chronic lymphocytic leukaemia. J Intern Med 2000; 248:343-8. [PMID: 11086646 DOI: 10.1046/j.1365-2796.2000.00730.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the first case of disseminated infection with Mycobacterium genavense in an HIV-seronegative patient with a chronic haematological disorder. Our patient, an 80-year-old woman, had been under long-term treatment with chlorambucil (partially in combination with prednisone) for B-cell chronic lymphocytic leukaemia (B-CLL). When she developed general fatigue and progressive anaemia, as well as progressive lymphadenopathy and splenomegaly, bone marrow biopsy revealed granulomas with acid-fast bacilli, and cultures of both bone marrow and blood grew M. genavense. The patient's CD4+ cell count was approximately 100 microL(-1). Treatment with clarithromycin, ethambutol and rifabutin resulted in improvement of anaemia and general health as well as in regression of lymphadenopathy and splenomegaly.
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MESH Headings
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Anti-Inflammatory Agents/adverse effects
- Antibiotics, Antitubercular/therapeutic use
- Antineoplastic Agents, Alkylating/adverse effects
- Antitubercular Agents/therapeutic use
- Bone Marrow Examination
- Chlorambucil/adverse effects
- Clarithromycin/therapeutic use
- Drug Therapy, Combination
- Ethambutol/therapeutic use
- Fatigue/microbiology
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Lymphatic Diseases/microbiology
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium Infections, Nontuberculous/etiology
- Nontuberculous Mycobacteria/classification
- Prednisone/adverse effects
- Rifabutin/therapeutic use
- Splenomegaly/microbiology
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Affiliation(s)
- T Krebs
- Central Hematology Laboratory, Inselspital, University Hospital of Bern, Switzerland
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