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Chen S, Sun W, Liu R, Yao L, Peng Q. Intracranial infection caused by Mycobacterium rhodesiae with specific imaging findings and good response to medication: a case report and literature review. Front Med (Lausanne) 2024; 11:1414369. [PMID: 38882659 PMCID: PMC11177847 DOI: 10.3389/fmed.2024.1414369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
Nontuberculous mycobacteria (NTM) are exceedingly rare etiological agents of intracranial infections. Among them, Mycobacterium rhodesiae stands out as an even less common pathogen. In this paper, we report the first documented case of a central nervous system (CNS) infection in humans caused by Mycobacterium rhodesiae, which has specific imaging findings and good response to the therapy by using Linezolid, Clarithromycin, and Minocycline. The diagnosis was facilitated by a comprehensive multimodal approach, incorporating multisite imaging, cerebrospinal fluid analysis via next-generation sequencing (NGS), and targeted genetic testing. Furthermore, this paper provides a derivation of the clinical characteristics observed in other documented instances of CNS infections attributable to NTM and based on a review of the current literature. Our experience contributes to the evidence that is needed to understand the full spectrum of NTM-related CNS pathologies and underscores the importance of a multidisciplinary diagnostic process in atypical presentations of intracranial infections.
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Affiliation(s)
- Siwei Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ran Liu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Lanqiu Yao
- Magma Capital Funds, Chicago, IL, United States
| | - Qing Peng
- Department of Neurology, Peking University First Hospital, Beijing, China
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Mina Y, Kline A, Manion M, Hammoud DA, Wu T, Hogan J, Sereti I, Smith BR, Zerbe CS, Holland SM, Nath A. Neurological manifestations of nontuberculous mycobacteria in adults: case series and review of the literature. Front Neurol 2024; 15:1360128. [PMID: 38742044 PMCID: PMC11089811 DOI: 10.3389/fneur.2024.1360128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Nontuberculous mycobacteria (NTM) mediated infections are important to consider in cases with neuroinflammatory presentations. We aimed to characterize cases of NTM with neurological manifestations at the National Institutes of Health (NIH) Clinical Center and review the relevant literature. Materials and methods Between January 1995 and December 2020, six cases were identified. Records were reviewed for demographic, clinical, and radiological characteristics. A MEDLINE search found previously reported cases. Data were extracted, followed by statistical analysis to compare two groups [cases with slow-growing mycobacteria (SGM) vs. those with rapidly growing mycobacteria (RGM)] and evaluate for predictors of survival. NIH cases were evaluated for clinical and radiological characteristics. Cases from the literature were reviewed to determine the differences between SGM and RGM cases and to identify predictors of survival. Results Six cases from NIH were identified (age 41 ± 13, 83% male). Five cases were caused by SGM [Mycobacterium avium complex (MAC) n = 4; Mycobacterium haemophilum n = 1] and one due to RGM (Mycobacterium abscessus). Underlying immune disorders were identified only in the SGM cases [genetic (n = 2), HIV (n = 1), sarcoidosis (n = 1), and anti-interferon-gamma antibodies (n = 1)]. All cases were diagnosed using tissue analysis. A literature review found 81 reports on 125 cases (SGM n = 85, RGM n = 38, non-identified n = 2). No immune disorder was reported in 26 cases (21%). Within SGM cases, the most common underlying disease was HIV infection (n = 55, 65%), and seizures and focal lesions were more common. In RGM cases, the most common underlying condition was neurosurgical intervention or implants (55%), and headaches and meningeal signs were common. Tissue-based diagnosis was used more for SGM than RGM (39% vs. 13%, p = 0.04). Survival rates were similar in both groups (48% SGM and 55% in RGM). Factors associated with better survival were a solitary CNS lesion (OR 5.9, p = 0.01) and a diagnosis made by CSF sampling only (OR 9.9, p = 0.04). Discussion NTM infections cause diverse neurological manifestations, with some distinctions between SGM and RGM infections. Tissue sampling may be necessary to establish the diagnosis, and an effort should be made to identify an underlying immune disorder.
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Affiliation(s)
- Yair Mina
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ahnika Kline
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Maura Manion
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Dima A. Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Tianxia Wu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Julie Hogan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Irini Sereti
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Bryan R. Smith
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Christa S. Zerbe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Steven M. Holland
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
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Martinez-Poles J, Saldaña-Díaz AI, Esteban J, Lara-Almunia M, Vizarreta Figueroa AT, Martín-Gil L, Cebrián-Escudero J, Fernández-Ferro J. Meningoencephalitis due to Mycobacterium lentiflavum in an immunocompromised patient: Case report. Eur J Neurol 2023; 30:1152-1154. [PMID: 36478338 DOI: 10.1111/ene.15659] [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: 09/19/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
The first case of meningoencephalitis due to Mycobacterium lentiflavum in an immunocompromised patient is reported. Clinical and radiological characteristics are described, as well as the treatment and prognosis of the patient.
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Affiliation(s)
- Javier Martinez-Poles
- Servicio Integrado de Neurología, Hospital Universitario Infanta Elena, Hospital Universitario Rey Juan Carlos, Hospital Universitario General de Villalba, Madrid, Spain
| | - Ana Isabel Saldaña-Díaz
- Servicio Integrado de Neurología, Hospital Universitario Infanta Elena, Hospital Universitario Rey Juan Carlos, Hospital Universitario General de Villalba, Madrid, Spain
| | - Jaime Esteban
- Servicio de Microbiología Clínica, IIS-Fundación Jiménez Díaz, UAM, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Mónica Lara-Almunia
- Servicio de Neurocirugía, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | | | - Leticia Martín-Gil
- Servicio Integrado de Neurología, Hospital Universitario Infanta Elena, Hospital Universitario Rey Juan Carlos, Hospital Universitario General de Villalba, Madrid, Spain
| | - José Cebrián-Escudero
- Servicio Integrado de Neurología, Hospital Universitario Infanta Elena, Hospital Universitario Rey Juan Carlos, Hospital Universitario General de Villalba, Madrid, Spain
| | - José Fernández-Ferro
- Servicio Integrado de Neurología, Hospital Universitario Infanta Elena, Hospital Universitario Rey Juan Carlos, Hospital Universitario General de Villalba, Madrid, Spain
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Okolie CE, Essien UC. Optimizing Laboratory Diagnostic Services for Infectious Meningitis in the Meningitis Belt of sub-Saharan Africa. ACS Infect Dis 2019; 5:1980-1986. [PMID: 31738509 DOI: 10.1021/acsinfecdis.9b00340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For longer than a century, the "meningitis belt" of sub-Saharan Africa has experienced the largest-ever global meningitis epidemic. Whereas HIV-associated immunosuppression drives higher susceptibility to environmental infectious organisms with tropism for the central nervous system (CNS), most diagnostic laboratories in the belt stick to N. meningitidis, H. influenzae, and S. pneumoniae. Cryptococcus neoformans has been the leading cause of death (incidence, 89%; death, 75%). To establish whether diagnostic services target geographically important pathogens, there is a need to know the current spectrum of etiology. Given Africa's agro-silvo-pastoralism, the One Health diagnostic approach is recommended. Considering multipathogen detection capacity, needed speed for corticosteroid therapy decision, and susceptibility/resistance to antimicrobials with improved CNS penetration, proposed laboratory categorization will help neurologists to choose suitable services.
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Affiliation(s)
- Charles E. Okolie
- Diagnostics for One Health, Department of Microbiology, College of Pure
and Applied Sciences, Landmark University, Km 4 Ipetu Road, Omu-Aran, Kwara State, Nigeria 251101
| | - Unyime C. Essien
- Department of Medical Laboratory Science, Faculty of Allied Sciences, College of Medical and Health Sciences, University of Jos, Jos, Plateau State, Nigeria 930222
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