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Kilinç G, Saris A, Ottenhoff THM, Haks MC. Host-directed therapy to combat mycobacterial infections. Immunol Rev 2021; 301:62-83. [PMID: 33565103 PMCID: PMC8248113 DOI: 10.1111/imr.12951] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 12/27/2022]
Abstract
Upon infection, mycobacteria, such as Mycobacterium tuberculosis (Mtb) and nontuberculous mycobacteria (NTM), are recognized by host innate immune cells, triggering a series of intracellular processes that promote mycobacterial killing. Mycobacteria, however, have developed multiple counter‐strategies to persist and survive inside host cells. By manipulating host effector mechanisms, including phagosome maturation, vacuolar escape, autophagy, antigen presentation, and metabolic pathways, pathogenic mycobacteria are able to establish long‐lasting infection. Counteracting these mycobacteria‐induced host modifying mechanisms can be accomplished by host‐directed therapeutic (HDT) strategies. HDTs offer several major advantages compared to conventional antibiotics: (a) HDTs can be effective against both drug‐resistant and drug‐susceptible bacteria, as well as potentially dormant mycobacteria; (b) HDTs are less likely to induce bacterial drug resistance; and (c) HDTs could synergize with, or shorten antibiotic treatment by targeting different pathways. In this review, we will explore host‐pathogen interactions that have been identified for Mtb for which potential HDTs impacting both innate and adaptive immunity are available, and outline those worthy of future research. We will also discuss possibilities to target NTM infection by HDT, although current knowledge regarding host‐pathogen interactions for NTM is limited compared to Mtb. Finally, we speculate that combinatorial HDT strategies can potentially synergize to achieve optimal mycobacterial host immune control.
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Affiliation(s)
- Gül Kilinç
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Anno Saris
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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2
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Diffuse Skin Nodules in an Oyster Farmer: Disseminated Mycobacterium marinum. Am J Med 2021; 134:e57-e59. [PMID: 32710828 DOI: 10.1016/j.amjmed.2020.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/20/2022]
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3
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Berman HS, Thomas L, Beynet D, Gates G, Shi V, Hsiao J. Fish tank granuloma during tumor necrosis factor-alpha inhibitor treatment: A case report and literature review. Dermatol Ther 2020; 33:e14058. [PMID: 32705736 DOI: 10.1111/dth.14058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Hannah S Berman
- David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Logan Thomas
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David Beynet
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gregory Gates
- Division of Dermatopathology, Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vivian Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Jennifer Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Schubert N, Schill T, Plüß M, Korsten P. Flare or foe? - Mycobacterium marinum infection mimicking rheumatoid arthritis tenosynovitis: case report and literature review. BMC Rheumatol 2020; 4:11. [PMID: 32190818 PMCID: PMC7074991 DOI: 10.1186/s41927-020-0114-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Rheumatoid arthritis is the most common type of inflammatory arthritis affecting about 1% of the population. With the advent of disease-modifying anti-rheumatic drugs the disease can be well controlled in many cases. Patients, however, are prone to developing infectious complications. In rare cases, these can mimic a flare of the underlying itself. Case presentation We report the case of a 45-year-old female patient with a history of seronegative rheumatoid arthritis (RA) who presented with swelling and tenderness of the third metacarpophalangeal joint of the right hand. A flare of her RA was suspected based on clinical and ultrasound findings which showed a tenosynovitis with intense power doppler activity. Her steroid dose was increased but the clinical response to glucocorticoid therapy was very limited. Subsequently, she developed skin manifestations of ‘swimmer’s granuloma’ over the next 2 weeks after first presentation. Finally, a diagnosis of a Mycobacterium marinum infection was established with the help of tissue biopsy and culture, and the patient received appropriate antibiotic treatment with the desired effect. Conclusions This case highlights the difficulty of distinction between infection and inflammation in patients with joint swelling and pain, especially in the age of disease-modifying drugs (DMARDs) and the concomitant risk of atypical infections. A review of the literature identified eight additional published cases, which suggests that Mycobacterium marinum infection is a rare but recognized complication of DMARD therapy. It can mimic a flare of the underlying arthritis potentially leading to diagnostic delays, and requires differential diagnostic methods to identify the pathogen and pave the way for appropriate treatment.
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Affiliation(s)
- Nils Schubert
- 1Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| | - Tillmann Schill
- 2Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Marlene Plüß
- 1Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| | - Peter Korsten
- 1Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
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Rida MA, Bardawil T, Ibrahim D. First Reported Mycobacterium Marinum Infection Case in a Patient With Psoriatic Arthritis Maintained on Golimumab. Arch Rheumatol 2020; 35:454-455. [PMID: 33458672 PMCID: PMC7788640 DOI: 10.46497/archrheumatol.2020.7714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Tara Bardawil
- Department of Dermatology, American Univerisity of Beirut Medical Center, Beirut, Lebanon
| | - Dima Ibrahim
- Department of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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Clinical, Dermatoscopical and Laboratory Essentials of Fish Tank Granuloma. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
In immunocompetent individuals Mycobacterium marinum (M. marinum) infection usually presents with localized skin lesions, better known as “swimming pool granuloma” or “fish tank granuloma” (FTG). When establishing the diagnosis of FTG, doctors encounter several problems in the clinical practice: granulomas are detected in less than two thirds of biopsies and acid-fast bacilli are identified only in a minority of cases. Majority of disseminated and aggressive FTG forms are unrecognized at the beginning, and occur in immunosuppressed patients, including organ transplant patients. Functional impairment or even amputation of the extremity, visceral involvement and lethal outcome have been reported. Although more than one thousand cases of FTG have been reported worldwide, dermatoscopy of FTG, as a diagnostic aid, has not been reported yet. Presenting the case of FTG of recent onset where, guided by dermatoscopy, microorganisms were isolated and identified from the biopsy material, we summarize the essentials of clinical and laboratory diagnostics of M. marinum infection.
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Denouement. Pediatr Infect Dis J 2019; 38:1160-1161. [PMID: 31626052 DOI: 10.1097/01.inf.0000605108.81974.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oh TH, Kim UJ, Kang SJ, Jang HC, Park KH, Jung SI, Ahn JH. Disseminated Invasive Mycobacterium marinum Infection Involving the Lung of a Patient with Diabetes Mellitus. Infect Chemother 2018; 50:59-64. [PMID: 29637757 PMCID: PMC5895835 DOI: 10.3947/ic.2018.50.1.59] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022] Open
Abstract
Mycobacterium marinum infection in humans occurs mainly as a granulomatous infection after exposure of traumatized skin to contaminated water. It is usually confined to the skin and soft tissue. Disseminated disease involving other organs rarely occurs in immunocompetent patients. Here, we report a case of disseminated M. marinum infection involving not only the cutaneous tissue, but also the lung of a male patient with uncontrolled diabetes and a previous history of steroid injection who was employed by a deep-water fishery.
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Affiliation(s)
- Tae Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Uh Jin Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Joon Hwan Ahn
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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Abstract
ABSTRACT
Mycobacterium marinum
is a well-known pathogenic mycobacterium for skin and soft tissue infections and is associated with fishes and water. Among nontuberculous mycobacteria (NTM), it is the leading cause of extrarespiratory human infections worldwide. In addition, there is a specific scientific interest in
M. marinum
because of its genetic relatedness to
Mycobacterium tuberculosis
and because experimental infection of
M. marinum
in fishes mimics tuberculosis pathogenesis. Microbiological characteristics include the fact that it grows in 7 to 14 days with photochromogenic colonies and is difficult to differentiate from
Mycobacterium ulcerans
and other mycolactone-producing NTM on a molecular basis. The diagnosis is highly suspected by the mode of infection, which is related to the hobby of fishkeeping, professional handling of marine shells, or swimming in nonchlorinated pools. Clinics distinguished skin and soft tissue lesions (typically sporotrichoid or subacute hand nodules) and lesions disseminated to joint and bone, often related with the local use of corticosteroids. In clinical microbiology, microscopy and culture are often negative because growth requires low temperature (30°C) and several weeks to succeed in primary cultivation. The treatment is not standardized, and no randomized control trials have been done. Therapy is a combination of surgery and antimicrobial agents such as cyclines and rifampin, with successful outcome in most of the skin diseases but less frequently in deep tissue infections. Prevention can be useful with hand protection recommendations for professionals and all persons manipulating fishes or fish tank water and use of alcohol disinfection after contact.
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11
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Downey C. Serious infection during etanercept, infliximab and adalimumab therapy for rheumatoid arthritis: A literature review. Int J Rheum Dis 2015. [DOI: 10.1111/1756-185x.12659] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Colum Downey
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
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12
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Wipasa J, Wongkulab P, Chawansuntati K, Chaiwarit R, Supparatpinyo K. Cellular immune responses in HIV-negative immunodeficiency with anti-interferon-γ antibodies and opportunistic intracellular microorganisms. PLoS One 2014; 9:e110276. [PMID: 25329064 PMCID: PMC4203775 DOI: 10.1371/journal.pone.0110276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 09/15/2014] [Indexed: 01/15/2023] Open
Abstract
Background Cell-mediated immunity plays a crucial role in resistance to intracellular infection. We previously reported antibodies against interferon-gamma (IFN-γ) in HIV− negative (HIV−) patients with acquired immunodeficiency presenting with repeated episodes of disseminated infection caused by uncommon opportunistic intracellular fungal, bacterial, and viral pathogens. This follow-up study aimed to investigate cellular immune responses in these unusual patients. Methods Twenty HIV− patients presenting with ≥2 episodes of culture- or histopathologic-proven opportunistic infections were enrolled along with age- and sex-matched controls comprised of 20 HIV+ patients plus 20 healthy adults. Monocyte phenotyping and intracellular cytokine production were determined by staining with specific antibodies followed by flow cytometry. Anti-interferon-γ antibodies were measured by enzyme-linked immunosorbent assay, and inducible nitric oxide synthase by reverse-transcription polymerase chain reaction. Results There were no differences among cases, HIV+, and healthy controls in the percentage of monocytes, or CD68 and HLA-DR expression on their surfaces. FcR1 (CD119) expression on monocytes was significantly higher in cases than in HIV+ (p<0.05) and healthy controls (p<0.01), suggesting the presence of activated monocytes in the circulation. Interleukin (IL)-2 and tumor necrosis factor (TNF)-α production in CD4 cells were significantly lower in cases than in healthy controls (p<0.01 and p<0.001, respectively). CD8 production of TNF-α among cases was significantly lower than that of healthy controls (p<0.05). Conclusion Immunodeficiency in HIV− individuals with repeated infections with intracellular pathogens may be associated with one or more of the abnormal immune responses reflected by the reduced production of both IL-2 by CD4 T cells and TNF-α by CD4 T cells and CD8 T cells, as well as presence of anti-IFN-γ antibody, as previously reported.
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Affiliation(s)
- Jiraprapa Wipasa
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Khuanchai Supparatpinyo
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
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Mori S, Tokuda H, Sakai F, Johkoh T, Mimori A, Nishimoto N, Tasaka S, Hatta K, Matsushima H, Kaise S, Kaneko A, Makino S, Minota S, Yamada T, Akagawa S, Kurashima A. Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents: a retrospective multicenter study in Japan. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0577-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Immunocompromised patients and their pets: Still best friends? Vet J 2013; 197:662-9. [DOI: 10.1016/j.tvjl.2013.05.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 04/16/2013] [Accepted: 05/27/2013] [Indexed: 11/22/2022]
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15
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Ferreira J, Grochowsky J, Krakower D, Zuromskis P, Baden R, Cheifetz AS. Mycobacterium marinum: an increasingly common opportunistic infection in patients on infliximab. Am J Gastroenterol 2012; 107:1268-9. [PMID: 22859009 PMCID: PMC4784477 DOI: 10.1038/ajg.2012.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jason Ferreira
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jared Grochowsky
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Douglas Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Peter Zuromskis
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rachel Baden
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Adam S. Cheifetz
- Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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17
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Mori S, Tokuda H, Sakai F, Johkoh T, Mimori A, Nishimoto N, Tasaka S, Hatta K, Matsushima H, Kaise S, Kaneko A, Makino S, Minota S, Yamada T, Akagawa S, Kurashima A. Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents: a retrospective multicenter study in Japan. Mod Rheumatol 2011; 22:727-37. [PMID: 22207481 PMCID: PMC3440561 DOI: 10.1007/s10165-011-0577-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/08/2011] [Indexed: 11/30/2022]
Abstract
Objective This study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA). Methods We conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab. Results Most cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients. Conclusion CT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.
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MESH Headings
- Adalimumab
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized/adverse effects
- Antirheumatic Agents/adverse effects
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnostic imaging
- Arthritis, Rheumatoid/drug therapy
- Etanercept
- Female
- Humans
- Immunoglobulin G/adverse effects
- Infliximab
- Male
- Middle Aged
- Mycobacterium Infections, Nontuberculous/chemically induced
- Mycobacterium Infections, Nontuberculous/complications
- Mycobacterium Infections, Nontuberculous/diagnostic imaging
- Radiography, Thoracic
- Receptors, Tumor Necrosis Factor
- Retrospective Studies
- Tomography, X-Ray Computed
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan.
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Is continuation of anti-tumor necrosis factor-α therapy a safe option for patients who have developed pulmonary mycobacterial infection? : Case presentation and literature review. Clin Rheumatol 2011; 31:203-10. [PMID: 22170032 DOI: 10.1007/s10067-011-1902-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
Abstract
Continuation of anti-tumor necrosis factor-α (TNFα) therapy generally has not been recommended for patients who have developed nontuberculous mycobacterial (NTM) diseases; in daily practice, however, we often encounter patients with refractory rheumatoid arthritis (RA) who experience uncontrollable flares following withdrawal of anti-TNFα agents. Here, we report a case of pulmonary NTM disease caused by Mycobacterium intracellulare occurring in a patient with refractory RA undergoing etanercept therapy. Since there was the concern of an exacerbation of RA symptoms, etanercept was continued during anti-NTM therapy. The patient's pulmonary symptoms and radiological abnormalities were found to have markedly improved in a relatively short time period after beginning the anti-NTM therapy. Additionally, her RA symptoms were adequately controlled without the occurrence of any unexpected adverse events. The continuation of etanercept therapy may be a safe option during anti-NTM therapy if patients' underlying diseases would otherwise be difficult to control. Strictly supervised anti-NTM therapy and patients' informed consent are mandatory. We review the medical literature on NTM disease associated with anti-TNFα therapy for rheumatic diseases and discuss the safety of simultaneous use of anti-TNFα agents in patients during anti-NTM therapy.
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Finkelstein R, Oren I. Soft tissue infections caused by marine bacterial pathogens: epidemiology, diagnosis, and management. Curr Infect Dis Rep 2011; 13:470-7. [PMID: 21785929 DOI: 10.1007/s11908-011-0199-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Skin and soft tissue infections (SSTIs) are one of the most common infection syndromes and may be caused by a large number of microorganisms. Some principles of aquatic injuries are different than those of land-based trauma. Wounds sustained in marine environment are exposed to a milieu of bacteria rarely encountered in different settings. These include Vibrio spp., Aeromonas spp., Shewanella spp., Erysipelothrix rhusiopathiae, Mycobacterium marinum, Streptococcus iniae, and other microbes. Failure to recognize and treat these uncommon pathogens in a timely manner may result in significant morbidity or death. These infections are frequently contracted as a result of recreational swimming, fishing injuries, or seafood handling. The spectrum of manifestations is wide, varying from cases of mild cellulitis, to severe life-threatening necrotizing fasciitis requiring radical surgery, to sepsis and death. This review will focus on the epidemiology, clinical manifestations, and treatment of SSTIs caused by the most important marine pathogens.
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Affiliation(s)
- Renato Finkelstein
- Infectious Diseases Unit, Rambam Healthcare Campus, 31096, Haifa, Israel,
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Jacobs S, George A, Papanicolaou GA, Lacouture ME, Tan BH, Jakubowski AA, Kaltsas A. Disseminated Mycobacterium marinum infection in a hematopoietic stem cell transplant recipient. Transpl Infect Dis 2011; 14:410-4. [PMID: 22093773 DOI: 10.1111/j.1399-3062.2011.00681.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 05/18/2011] [Accepted: 08/08/2011] [Indexed: 11/30/2022]
Abstract
Mycobacterium marinum is a photochromogenic mycobacterium that is ubiquitous in the aquatic environment. In the general population, exposure to aquaria is the most common cause of M. marinum infection. Known as "swimmer's granuloma" or "fish tank granuloma," M. marinum is an occupational hazard for aquarium cleaners and fishermen. There are several reports in the literature of M. marinum infection in immunocompromised hosts, including those with solid organ transplants, but none in patients who have received stem cell transplants (SCTs). To our knowledge, this is a first report of disseminated M. marinum infection in an SCT recipient who continued to develop new skin lesions even after months of targeted therapy. The implications are that elderly patients who receive T-cell-depleted SCTs may be at prolonged risk for pathogens dependent on cellular immunity, and the presentation of illness with such pathogens may be more severe and widely disseminated than might otherwise be expected.
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Affiliation(s)
- S Jacobs
- Division of Infectious Diseases, New York Presbyterian Hospital - Weill Cornell, New York, New York, USA
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21
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Thanou-Stavraki A, Sawalha AH, Crowson AN, Harley JB. Noodling andMycobacterium marinuminfection mimicking seronegative rheumatoid arthritis complicated by anti-tumor necrosis factor α therapy. Arthritis Care Res (Hoboken) 2010; 63:160-4. [DOI: 10.1002/acr.20303] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ramos JM, García-Sepulcre MF, Rodríguez JC, Padilla S, Gutiérrez F. Mycobacterium marinum infection complicated by anti-tumour necrosis factor therapy. J Med Microbiol 2010; 59:617-621. [DOI: 10.1099/jmm.0.017277-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Mycobacteria other than tuberculosis infections in patients taking various tumour necrosis factor (TNF)-α inhibitors have been reported in the literature. We describe sporotrichoid spread of Mycobacterium marinum in a man with Crohn's disease treated with infliximab. After starting ethambutol and rifampicin and discontinuing infliximab, a worsening appeared. M. marinum infection may have a potential local spread and systemic dissemination in patients treated with TNF-α inhibitors.
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Affiliation(s)
- José M. Ramos
- Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Juan C. Rodríguez
- Microbiology Section, Hospital General Universitario de Elche, Alicante, Spain
| | - Sergio Padilla
- Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain
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Guyot A, Begon E, Abramowitz L, Landry J, Marinho E, Descamps V, Crickx B. Infection cutanée aiguë et nécrosante à Mycobacterium marinum chez un patient traité par infliximab pour une maladie de Crohn. Ann Dermatol Venereol 2009; 136:806-10. [DOI: 10.1016/j.annder.2009.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
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Adenis-Lamarre E, Kostrzewa E, Texier-Maugein J, Doutre MS. [Cutaneous infection due to Mycobacterium chelonae during anti-TNF therapy]. Ann Dermatol Venereol 2009; 136:811-4. [PMID: 19917435 DOI: 10.1016/j.annder.2009.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mycobacterium chelonae is a ubiquitous, rapidly growing, opportunistic, non-tuberculous mycobacterium that can cause skin and bone tissue infections. We report a case of cutaneous infection due to M. chelonae following anti-TNF therapy. CASE REPORT A 70-year-old woman with a medical history of rheumatoid arthritis was admitted for several purple nodular cutaneous lesions on her right leg evolving for 2 months. At admission, she was on prednisone, methotrexate and adalimumab for her rheumatoid arthritis. Skin lesions appeared 5 days before etanercept, which was taken for 5 months before being discontinued for adalimumab. Both the histopathological examination and bacterial culture of involved skin showed the presence of M. chelonae. Adalimumab was immediately discontinued and a combination of amoxicillin-clavulanic acid and tigecyclin was started. DISCUSSION TNF-alpha plays a pivotal role in immune reaction to intracellular pathogens. Very few cases of cutaneous infection involving M. chelonae in association with an anti-TNF-alpha therapy have been reported in the literature. To our knowledge, this is the first case occurring during treatment with etanercept and symptoms worsened with the introduction of adalimumab. In addition, this case underlines the difficulties of effectively treating this mycobacterium.
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Affiliation(s)
- E Adenis-Lamarre
- Service de dermatologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France.
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