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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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Entwistle FM, Coote PJ. Evaluation of greater wax moth larvae, Galleria mellonella, as a novel in vivo model for non-tuberculosis Mycobacteria infections and antibiotic treatments. J Med Microbiol 2018; 67:585-597. [PMID: 29458557 DOI: 10.1099/jmm.0.000696] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the suitability of Galleria mellonella larvae as an in vivo model and drug-screening tool for mycobacteria infections. METHODOLOGY Larvae were infected using a range of inoculum sizes from a variety of rapid-growing mycobacteria, including strains of M. fortuitum, M. marinum and M. aurum. Larval survival, internal bacterial burden and the effects of amikacin, ciprofloxacin, ethambutol, isoniazid and rifampicin treatment on larval survival were measured over 144 h. The effects of these anti-mycobacterial drugs on phagocytosis and circulating haemocyte numbers were also examined using microscopy. RESULTS Larval survival decreased after infection with M. fortuitum and M. marinum in a dose-dependent manner, but remained unaffected by M. aurum. Heat-killed bacteria did not cause larval death. Where antibiotic monotherapy was efficacious, larval survival post-infection increased in a dose-dependent fashion. However, efficacy varied between different antibiotics and species of infecting mycobacteria and, apart from rifampicin, efficacy in vivo correlated poorly with the in vitro minimum inhibitory concentrations (MICs). Combinations of antibiotics led to higher survival of infected larvae than antibiotic monotherapy. Selected antibiotic treatments that enhanced larval survival reduced the overall internal burden of infecting mycobacteria, but did not eradicate the pathogens. Administration of amikacin or ethambutol to uninfected larvae induced an initial transient increase in the numbers of circulating haemocytes and reduced the phagocytic rate of haemocytes in larvae infected with M. marinum. CONCLUSIONS This report demonstrates the potential of employing a wax moth larvae model for studying fast-growing mycobacteria infections, and as a cheap, effective system for initial screening of novel treatments.
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Affiliation(s)
- Frances M Entwistle
- Biomedical Sciences Research Complex, School of Biology, The North Haugh, University of St Andrews, Fife, KY16 9ST, UK
| | - Peter J Coote
- Biomedical Sciences Research Complex, School of Biology, The North Haugh, University of St Andrews, Fife, KY16 9ST, UK
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Mycobacterium fortuitum thoracic empyema: A case report and review of the literature. J Infect Chemother 2015; 21:747-50. [PMID: 26139179 DOI: 10.1016/j.jiac.2015.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/05/2015] [Accepted: 05/30/2015] [Indexed: 11/22/2022]
Abstract
Mycobacterium fortuitum is a rapidly growing nontuberculous mycobacterium. This microorganism is an uncommon etiological agent of lung lesions; among lung lesions caused by M. fortuitum, thoracic empyema is particularly rare. A 61-year-old man who had been treated for chronic hypercapnic respiratory failure with noninvasive ventilation was admitted because of breathing difficulty and was found to have M. fortuitum thoracic empyema. He improved after the administration of amikacin, imipenem/cilastatin, and clarithromycin following sulfamethoxazole/trimethoprim and clarithromycin. This is the first report of M. fortuitum thoracic empyema in a patient without human immunodeficiency virus infection. The thoracic empyema may have developed via a pulmonary fistula in this case. This case highlights the fact that we must be aware of the possibility of M. fortuitum thoracic empyema, especially in patients with M. fortuitum lung infection and treatment with noninvasive ventilation. Multidrug therapy may be effective and important to the resolution of M. fortuitum thoracic empyema.
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Radzniwan MR, Tohid H, Ahmad S, Mohd AF, Md Anshar F. Isolation of Mycobacterium fortuitum in sputum specimens of a patient with chronic cough: Is it clinically significant? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2014; 9:38-41. [PMID: 26425304 PMCID: PMC4568725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Managing chronic cough is diagnostically challenging especially in primary care. This case report highlights the difficulties experienced in approaching a case of chronic cough from a primary care perspective. The discussion also involves the clinical significance and treatment dilemma of M. fortuitum chelonae complex that was isolated from the sputum cultures of an elderly woman who presented with chronic cough for more than a year.
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Affiliation(s)
- M R Radzniwan
- Radzniwan Mohd Rashid MMed (FamMed) Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | - H Tohid
- Hizlinda Tohid MMed (FamMed) Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre , Jalan Yaacob Latiff, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia
| | - S Ahmad
- Saharuddin Ahmad MMed (FamMed) Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | - Ali F Mohd
- Fairuz Mohd Ali MMed (FamMed) Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur, Malaysia
| | - F Md Anshar
- Fauzi Md Anshar MRCP, FCCP Prince Court Medical Centre, Kuala Lumpur, Malaysia
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Glatstein M, Scolnik D, Bensira L, Domany KA, Shah M, Vala S. Lung abscess due to non-tuberculous, non-Mycobacterium fortuitum in a neonate. Pediatr Pulmonol 2012; 47:1034-7. [PMID: 22451300 DOI: 10.1002/ppul.22558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/04/2011] [Accepted: 01/06/2012] [Indexed: 01/15/2023]
Abstract
Although Mycobacterium fortuitum (MF) is a non-tuberculous mycobacterium that rarely causes disease, there are reported cases of pneumonia, lung abscess, and empyema in subjects with predisposing lung disease. We report a neonate, without predisposing disease or risk factors, who manifested pneumonia and lung abscess. The patient was initially treated with amoxicillin-clavulanic acid and gentamycin, and subsequently with piperazilin, tazobactam, and vancomycin when there was no improvement. Pleural nodules were detected on computed tomography, and microbiology revealed MF in the absence of other pathogens and a week later the organism was identified in culture as MF, confirmed on four separate samples. The MF was sensitive to amikacin and clarithromycin and the patient was continued on oral clarithromycin for two more weeks until full recovery. To our knowledge, this is the first reported case of MF abscess in a neonate. MF should be sought in similar patients, especially when microbiology fails to detect the usual pathogens, and when the clinical picture is unclear.
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Affiliation(s)
- Miguel Glatstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana's Children Hospital, University of Tel-Aviv, Tel-Aviv, Israel.
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Fabbian F, De Giorgi A, Pala M, Fratti D, Contini C. Pleural effusion in an immunocompetent woman caused by Mycobacterium fortuitum. J Med Microbiol 2011; 60:1375-1378. [PMID: 21459911 DOI: 10.1099/jmm.0.024737-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mycobacterium fortuitum is a non-tuberculous mycobacterium that can cause pneumonia, abscess and empyema in subjects with predisposing lung diseases. However, pleurisy with effusion is rare. Herein, we report the case of a 74-year-old immunocompetent female patient without apparent risk factors, who suffered haemorrhagic pleural effusion as the main clinical manifestation. Pleural nodules were detected by computed tomography scan, and microbiological analysis revealed M. fortuitum in the absence of other pathogens. The patient was treated with ceftriaxone and ciprofloxacin, and full recovery ensued in 4 weeks. To our knowledge, this is the first reported case of haemorrhagic pleural effusion in an immunocompetent patient without underlying diseases. Although non-tuberculous mycobacterial infections are rarely accompanied by pleural involvement, M. fortuitum should be considered in such cases, especially when microbiology fails to detect the usual pathogens, and when the clinical picture is unclear.
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Affiliation(s)
- Fabio Fabbian
- Section of Clinical Medicine, Department of Clinical and Experimental Medicine, University Hospital St Anna, University of Ferrara, 44100 Ferrara, Italy
| | - Alfredo De Giorgi
- Section of Clinical Medicine, Department of Clinical and Experimental Medicine, University Hospital St Anna, University of Ferrara, 44100 Ferrara, Italy
| | - M Pala
- Section of Clinical Medicine, Department of Clinical and Experimental Medicine, University Hospital St Anna, University of Ferrara, 44100 Ferrara, Italy
| | - Daniela Fratti
- Section of Clinical Medicine, Department of Clinical and Experimental Medicine, University Hospital St Anna, University of Ferrara, 44100 Ferrara, Italy
| | - Carlo Contini
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University Hospital St Anna, University of Ferrara, 44100 Ferrara, Italy
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Park S, Suh GY, Chung MP, Kim H, Kwon OJ, Koh WJ. Successful Treatment of Mycobacterium fortuitum Lung Disease with Oral Antibiotic Therapy: a Case Report. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.4.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sunghoon Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Jung Koh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Clinical significance of Mycobacterium fortuitum isolated from respiratory specimens. Respir Med 2007; 102:437-42. [PMID: 17997087 DOI: 10.1016/j.rmed.2007.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 08/18/2007] [Accepted: 10/05/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although Mycobacterium fortuitum is not an uncommon organism among the non-tuberculous mycobacteria isolated from respiratory specimens, its clinical significance had not been well studied. METHODS We identified all patients whose respiratory specimens were positive for M. fortuitum between January 2003 and December 2005. Among 182 patients whose specimens were positive for M. fortuitum, 26 were positive at least twice. We retrospectively reviewed their characteristics, and clinical courses. RESULTS Of the 26 patients, 15 had two positive culture results for M. fortuitum; the other 11 had three or more. Sixteen patients were male and the median age was 61.5 years. Major presenting symptoms were cough (65%) and sputum (58%). Most patients had known underlying lung diseases, including prior tuberculosis (54%), lung cancer (15%), idiopathic pulmonary fibrosis (15%), and other mycobacterial lung disease (15%). The most common CT findings were bronchiectasis (80%). Only one patient received specific prolonged antibiotic therapy against M. fortuitum infection; the other 25 did not. No patients showed clinical aggravation during the follow-up period, although in five patients their underlying lung diseases continued to progress. The median follow-up duration was 12.5 months and none of the patients whose sputum specimens were available had persistent positive cultures for M. fortuitum. CONCLUSION M. fortuitum usually causes colonization or transient infection in patients with underlying lung disease, such as prior tuberculosis or bronchiectasis. The majority of patients may not need to receive prolonged antibiotic therapy for M. fortuitum isolates.
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Brown-Elliott BA, Wallace RJ. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev 2002; 15:716-46. [PMID: 12364376 PMCID: PMC126856 DOI: 10.1128/cmr.15.4.716-746.2002] [Citation(s) in RCA: 600] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The history, taxonomy, geographic distribution, clinical disease, and therapy of the pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria (RGM) are reviewed. Community-acquired disease and health care-associated disease are highlighted for each species. The latter grouping includes health care-associated outbreaks and pseudo-outbreaks as well as sporadic disease cases. Treatment recommendations for each species and type of disease are also described. Special emphasis is on the Mycobacterium fortuitum group, including M. fortuitum, M. peregrinum, and the unnamed third biovariant complex with its recent taxonomic changes and newly recognized species (including M. septicum, M. mageritense, and proposed species M. houstonense and M. bonickei). The clinical and taxonomic status of M. chelonae, M. abscessus, and M. mucogenicum is also detailed, along with that of the closely related new species, M. immunogenum. Additionally, newly recognized species, M. wolinskyi and M. goodii, as well as M. smegmatis sensu stricto, are included in a discussion of the M. smegmatis group. Laboratory diagnosis of RGM using phenotypic methods such as biochemical testing and high-performance liquid chromatography and molecular methods of diagnosis are also discussed. The latter includes PCR-restriction fragment length polymorphism analysis, hybridization, ribotyping, and sequence analysis. Susceptibility testing and antibiotic susceptibility patterns of the RGM are also annotated, along with the current recommendations from the National Committee for Clinical Laboratory Standards (NCCLS) for mycobacterial susceptibility testing.
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Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev 2002. [PMID: 12364376 DOI: 10.1128/crm.15.4.716-746.2002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The history, taxonomy, geographic distribution, clinical disease, and therapy of the pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria (RGM) are reviewed. Community-acquired disease and health care-associated disease are highlighted for each species. The latter grouping includes health care-associated outbreaks and pseudo-outbreaks as well as sporadic disease cases. Treatment recommendations for each species and type of disease are also described. Special emphasis is on the Mycobacterium fortuitum group, including M. fortuitum, M. peregrinum, and the unnamed third biovariant complex with its recent taxonomic changes and newly recognized species (including M. septicum, M. mageritense, and proposed species M. houstonense and M. bonickei). The clinical and taxonomic status of M. chelonae, M. abscessus, and M. mucogenicum is also detailed, along with that of the closely related new species, M. immunogenum. Additionally, newly recognized species, M. wolinskyi and M. goodii, as well as M. smegmatis sensu stricto, are included in a discussion of the M. smegmatis group. Laboratory diagnosis of RGM using phenotypic methods such as biochemical testing and high-performance liquid chromatography and molecular methods of diagnosis are also discussed. The latter includes PCR-restriction fragment length polymorphism analysis, hybridization, ribotyping, and sequence analysis. Susceptibility testing and antibiotic susceptibility patterns of the RGM are also annotated, along with the current recommendations from the National Committee for Clinical Laboratory Standards (NCCLS) for mycobacterial susceptibility testing.
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Martín Serrano C, Soler Sempere MJ, Hernández Blasco L, Romero Candeira S. [Solitary pulmonary nodule due to Mycobacterium fortuitum]. Arch Bronconeumol 2002; 38:194-6. [PMID: 11953274 DOI: 10.1016/s0300-2896(02)75189-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report the case of an asthmatic man in whom a solitary pulmonary nodule was discovered after an episode of self-limited hemoptysis. Infection was suspected after initial response to empirical antibiotic therapy, and the pathogen was later identified to be a rare mycobacterium. The pulmonary nodule resolved without surgery after oral quinolone therapy. Mycobacterium fortuitum should be added to the list of possible causes of solitary pulmonary nodule in Spain.
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Affiliation(s)
- C Martín Serrano
- Servicio de Neumología, Hospital General Universitario de Alicante, Spain
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Patz EF, Swensen SJ, Erasmus J. PULMONARY MANIFESTATIONS OF NONTUBERCULOUS MYCOBACTERIUM. Radiol Clin North Am 1995. [DOI: 10.1016/s0033-8389(22)00615-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lin R, Holland GN, Helm CJ, Elias SJ, Berlin OG, Bruckner DA. Comparative efficacy of topical ciprofloxacin for treating Mycobacterium fortuitum and Mycobacterium chelonae keratitis in an animal model. Am J Ophthalmol 1994; 117:657-62. [PMID: 8172274 DOI: 10.1016/s0002-9394(14)70074-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mycobacterium fortuitum and M. chelonae are the two most common causes of nontuberculous mycobacterial keratitis, and they may be difficult to differentiate at diagnosis. Mycobacterium fortuitum is generally more sensitive to ciprofloxacin in vitro than is M. chelonae. Using a rabbit model, we compared the efficacy of topical ciprofloxacin (3 mg/ml) against M. chelonae keratitis to its efficacy against M. fortuitum keratitis. After four days of therapy, ciprofloxacin significantly reduced the number of both organisms in treated eyes compared to untreated control eyes (both P values < .001). Mean culture ratios (colony-forming units in treated eye divided by colony-forming units in untreated eye for each rabbit) were used to compare efficacy between groups. When all treated animals were considered, no significant difference was found between groups (P = .13). When outlier values were excluded, ciprofloxacin was more effective against M. fortuitum than M. chelonae (P = .01). When treated and untreated eyes were compared after therapy in the M. fortuitum group, ciprofloxacin treatment was associated with a reduction in mean stromal infiltrate area (P = .03) and in the tendency to form satellite lesions (P = .07). A clinical effect was not observed in the M. chelonae group. Although ciprofloxacin is effective against both organisms, it appears to be less effective against M. chelonae than M. fortuitum in vivo.
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Affiliation(s)
- R Lin
- University of California Los Angeles Ocular Inflammation Disease Center, Jules Stein Eye Institute, Department of Ophthalmology 90024-7003
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Affiliation(s)
- W T Miller
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104
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Abstract
Environmental (atypical, opportunist, other) mycobacteria were first isolated nearly a century ago. The classification of these "other than Mycobacterium tuberculosis" organisms was initially chaotic until Runyon proposed a scheme of four groups in 1959. Mycobacterium fortuitum is a member of group IV: Rapid growers. These ubiquitous terrestrial and aquatic forms contaminate water supplies, reagents, and clinical samples. They may colonise the respiratory systems of patients whose local defence mechanisms have been impaired or those with congenital and acquired immune defects. They can also cause disease in immunocompetent individuals. There have been fewer than 20 published cases of pulmonary infection caused by M fortuitum. A further case is reported of fatal pulmonary infection in an elderly patient with long standing chronic obstructive airways disease (COAD). He had left upper zone shadowing on chest radiography and lung abscesses at post mortem examination yielded only M fortuitum.
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Affiliation(s)
- M P Lessing
- Department of Medical Microbiology, St Mary's Hospital, London
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