Pacemaker infection at generator site by Mycobacterium mageritense: A case report and review of the literature

We herein report an unusual case of Mycobacterium mageritense pacemaker infection at generator site in a 62-year old female with no pertinent past medical history. Pacemaker-related infections caused by nontuberculous mycobacteria are rare but can lead to significant morbidity and mortality. Mycobacterium mageritense is rarely reported in pacemaker infections and is challenging to treat due to resistance to many antimicrobial agents. In our case, the patient's pacemaker infection did not respond to standard treatment, leading to complete device removal. Our case highlights the challenges in treating Mycobacterium Mageritense, especially that our patient had a more resistant organism than those reported previously in literature. To our knowledge, such cases are infrequently reported in the literature.

The Mycobacterium avium complex - an underestimated threat to humans and animals

INTRODUCTION AND OBJECTIVE

The Mycobacterium avium complex (MAC) is a group of acid-resistant bacteria within the Mycobacteriaceae. Their cell walls have a specific structure impervious to many disinfectants. Mycobacteria are widespread in the environment and can also be found in food. This aim of the article is to review the current state of knowledge about the sources of infection, symptoms and treatment of MAC diseases in humans and animals, and summarizes the available methods for identifying the bacteria. It pays a special attention to the zoonotic potential of MAC bacteria and possible routes of transmission between humans and animals, including possible food-borne routes.

BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE.

MAC bacterial infections occur both in immunocompetent people and those with functional predispositions and compromised immunity, particularly during HIV infection or immunosuppressive treatment. The incidence of MAC infections in humans is growing, with the most common form of infection being pulmonary disease (MTC-PD); however, there are conflicting reports on the role of Mycobacterium avium paratuberculosis (MAP) in the development of Crohn's disease. MAC bacteria can also attack livestock, household pets, and wild animals. Unfortunately, treatment is lengthy and often fails due to microbiological relapse; there is also increasing evidence of MAC bacteria are developing multi-drug resistance.

CONCLUSIONS

Although new antibiotics are being created to inhibit the growth and division of Mycobacterium avium, there is clearly a need for further research into the virulence factors associated with MAC bacteria. Further studies should also examine the role of MAP in the etiopathogenesis of Crohn's disease.

A rare case of Mycobacterium fortuitum infection causing chyluria

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Retroperitoneal lymphatics obstruction is a rare presentation of M. fortuitum infection.

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Successful treatment was achieved by 6 months of combination anti-mycobacterials.

We report a case of chyluria caused by Mycobacterium fortuitum infection in a sixty-four year old male, who was successfully treated with two weeks of amikacin, trimethoprim-sulfamethoxazole and levofloxacin followed by twenty four weeks of levofloxacin and doxycycline.

Detection of clinically important non tuberculous mycobacteria (NTM) from pulmonary samples through one-step multiplex PCR assay

Background

The burden of non-tuberculous mycobacterial (NTM) disease is increasing worldwide but still its diagnosis is delayed and it is mistaken as multidrug-resistant tuberculosis (MDR-TB).The present study was performed to develop a multiplex PCR assay for detection and identification of clinically most common NTM to the species level from pulmonary samples.

Results

Out of 50 isolates, 26 were identified as Mycobacterium kansasii (MK), 20 were identified as Mycobacterium abscessus (MA) and 4 were identified as Mycobacterium avium complex (MAC) through multiplex PCR and further confirmed by sequencing.

Conclusion

Our study showed that multiplex PCR assay is a simple, convenient, and reliable technique for detection and differential identification of major NTM species.

Mutation in MPT64 gene influencing diagnostic accuracy of SD Bioline assay (capilia)

Background

Success of India’s TB control program relies on rapid case detection, monitoring, care and treatment of drug resistance. Patients on multidrug resistance (MDR) treatment are monitored by follow up cultures. Discordant results (culture and smear positive while capilia negative) are usually declared negative Mycobacterium tuberculosis complex (MTBC). This study was designed to understand the possible causes of discordant results.

Methods

The capilia kit was evaluated to test its utility among 4737 follow up MDR patients enrolled during a period of 1 year. A total of 889 were liquid culture positive, 3375 were negative and 473 were contaminated. Of the 889 cultures positive, 829 were found positive by ZN smear, capilia test and MTBDR plus assay. The cultures which gave a positive result on Mycobacterium Growth Indicator Tube 960 (MGIT 960) and ZN smear but were negative on capilia test with no growth on Brain Heart Infusion agar (BHI) were included in this study. The conflicting results of capilia were compared with other molecular techniques; MTBDR plus assay and DNA sequence analysis of MPT64 gene.

Results

Out of 889 culture positive, 60 (6.7%) were found positive on liquid culture and ZN smear but were negative on capilia. Of these 60 cultures, 10 (16.7%) were found positive by both MTBDR plus assay and PCR. The sequencing analysis revealed that all of the capilia negative isolates had mutations within the MPT64 gene.

Conclusion

Re-evaluation of culture positive but capilia negative isolates should be done before declaring them as Mycobacterium other than tuberculosis (MOTT) because such cases can act as chronic carriers of TB in the population which can lead to the rise of this lethal disease.

Nontuberculous mycobacterial skin disease in cat; diagnosis and treatment - Case report

INTRODUCTION

Mycobacterial diseases of humans and animals can be caused by mycobacteria other than tuberculosis (MOTT). The transmission of the infection primarily occurs via the respiratory or oral routes, but also via a damaged skin barrier. MOTT have high resistance to external factors; therefore, infected, undiagnosed animals can pose a risk for public health.

CASE REPORT

The case study describes mycobacterial skin infection in a domestic cat. The correct diagnosis was reached four months after the appearance of the first clinical signs. Those were purulent, granulomatous lesions and fistulas, which could potentially act as a source of the infection for the owners and the veterinarian who cared for the animal.

CONCLUSION

Despite using advanced diagnostic techniques, establishing the final cause of the cat's illness was a lengthy process. The skin lesions could contribute to the transmission of the bacteria in the environment. Non-targeted treatments could also cause antimicrobial resistance.

Multiple abdominal abscesses - A not so common presentation of NTM

Non-tuberculous Mycobacteria/Mycobacterium other than tuberculosis (MOTT) are ubiquitous organisms. They are acid fast bacilli often giving trouble to the physician to distinguish it from Mycobacterium tuberculosis. These organisms are a menace for the treating physician as when to treat and when not to treat. They are often difficult to diagnose and may present in a variety of forms with propensity to cause number of infections of different body parts and organs. They are more common in immunocompromised individuals e.g. HIV infection. Here we are reporting a not so common manifestation of NTM which presented as multiple abdominal abscesses in a middle aged female probably secondary to surgical site infection, however she responded dramatically to the designed treatment.

Co(II) and Cu(II) pyrophosphate complexes have selectivity and potency against Mycobacteria including Mycobacterium tuberculosis

Tuberculosis (TB) causes up to 10 million incident cases worldwide per annum. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains are leading factors in the resurgence of TB cases and the need to produce new agents to combat such infection. Herein, we describe Co(II) and Cu(II) metal based complexes that feature the pyrophosphate ligand with notable selectivity and marked potency against Mycobacterium tuberculosis, including MDR strains. Such complexes are confirmed to be bacteriocidal and not affected by efflux inhibitors. Finally, while susceptibility to copper has recently been established for M. tuberculosis, the greater efficacy of cobalt observed herein is of considerable note and in line with the discovery of a copper metallothionein in M. tuberculosis.