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Liu W, Chu J, Xie Z, Yang L, Huang L, Tu S, Cai H, Wu Z, Wei A, Liu C, Cheng Y, Zhang K, Wang N. Mycobacterium abscessus pulmonary disease presenting with spontaneous pneumomediastinum and subcutaneous emphysema in childhood acute lymphoblastic leukemia: a case report and literature review. BMC Pediatr 2023; 23:431. [PMID: 37641081 PMCID: PMC10463631 DOI: 10.1186/s12887-023-04199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Mycobacterium abscessus is a rapidly growing mycobacterium commonly identified in adults with underlying pulmonary diseases but is rarely observed in children. A better understanding of this pathogen in children is essential. CASE PRESENTATION We report the case of a 49-month-old female child without previous underlying pulmonary diseases but with acute lymphoblastic leukemia (ALL). The patient was complicated with pneumonia during chemotherapy, which was primarily characterized by spontaneous pneumomediastinum and subcutaneous emphysema on chest computed tomography (CT). M. abscessus sequences were detected by metagenomic next-generation sequencing in bronchoalveolar lavage fluid. With mechanical ventilation, closed thoracic drainage, and anti-infective therapy for 6 months, the patient's infection was controlled. The patient completed 2.5 years of treatment for ALL, and the drugs were discontinued. The patient currently remains in complete hematologic remission. DISCUSSION We reviewed the literature on 33 children with M. abscessus pulmonary disease. These children mostly had underlying immunodeficiency. Chest CT most often showed nodular shadows, consolidation, and bronchiectasis. Spontaneous pneumomediastinum and subcutaneous emphysema were not reported as major manifestations. CONCLUSION Spontaneous pneumomediastinum and subcutaneous emphysema were our patient's main characteristics on chest CT, and this study enriches the knowledge regarding possible imaging changes in M. abscessus pulmonary disease in children. This case report reflects good clinical experience in maintaining the balance between chemotherapy and anti-infective therapy in childhood ALL.
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Affiliation(s)
- Wenyuan Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Jinhua Chu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Zhiwei Xie
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Linhai Yang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Lingling Huang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Songji Tu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Huaju Cai
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Zhengyu Wu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Anbang Wei
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Chengzhu Liu
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China
| | - Yan Cheng
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China.
| | - Kunlong Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China.
| | - Ningling Wang
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Anhui Province, No. 678 Furong Road, Hefei City, 230601, China.
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Bich Hanh BT, Quang NT, Park Y, Heo BE, Jeon S, Park JW, Jang J. Omadacycline Potentiates Clarithromycin Activity Against Mycobacterium abscessus. Front Pharmacol 2021; 12:790767. [PMID: 34955859 PMCID: PMC8693020 DOI: 10.3389/fphar.2021.790767] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Mycobacterium abscessus is a difficult respiratory pathogen to treat, when compared to other nontuberculus mycobacteria (NTM), due to its drug resistance. In this study, we aimed to find a new clarithromycin partner that potentiated strong, positive, synergy against M. abscessus among current anti-M. abscessus drugs, including omadacycline, amikacin, rifabutin, bedaquiline, and cefoxitine. First, we determined the minimum inhibitory concentrations required of all the drugs tested for M. abscessus subsp. abscessus CIP104536T treatment using a resazurin microplate assay. Next, the best synergistic partner for clarithromycin against M. abscessus was determined using an in vitro checkerboard combination assay. Among the drug combinations evaluated, omadacycline showed the best synergistic effect with clarithromycin, with a fractional inhibitory concentration index of 0.4. This positive effect was also observed against M. abscessus clinical isolates and anti-M. abscessus drug resistant strains. Lastly, this combination was further validated using a M. abscessus infected zebrafish model. In this model, the clarithromycin-omadacyline regimen was found to inhibit the dissemination of M. abscessus, and it significantly extended the lifespan of the M. abscessus infected zebrafish. In summation, the synergy between two anti-M. abscessus compounds, clarithromycin and omadacycline, provides an attractive foundation for a new M. abscessus treatment regimen.
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Affiliation(s)
- Bui Thi Bich Hanh
- Division of Applied Life Science (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, South Korea
| | - Nguyen Thanh Quang
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, South Korea
| | - Yujin Park
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, South Korea
| | - Bo Eun Heo
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, South Korea
| | - Seunghyeon Jeon
- Division of Life Science, Gyeongsang National University, Jinju, South Korea
| | - June-Woo Park
- Department of Environmental Toxicology and Chemistry, Korea Institute of Toxicology, Korea & Human and Environmental Toxicology Program, Korea University of Science and Technology (UST), Daejeon, South Korea
| | - Jichan Jang
- Division of Life Science, Department of Bio & Medical Big Data (BK21 Four Program), Research Institute of Life Science, Gyeongsang National University, Jinju, South Korea.,Division of Life Science, Gyeongsang National University, Jinju, South Korea
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