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Gaudêncio M, Carvalho A, Bertão MI, Barreiro I, Bessa MI, Gonçalves A. Mycobacterium chelonae Cutaneous Infection: A Challenge for an Internist. Eur J Case Rep Intern Med 2021; 8:003013. [PMID: 34912746 PMCID: PMC8668006 DOI: 10.12890/2021_003013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 11/17/2022] Open
Abstract
Cutaneous infections caused by the Mycobacterium chelonae complex show a heterogeneous clinical presentation, which varies according to the patient’s immune status. Most standard antimycobacterials have no effect against these species. Clarithromycin alone was shown to provide adequate treatment, although resistance has been reported. Consequently, the literature supports multi-drug therapy to combat resistant strains. Here, we describe the case of a 59-year-old man under systemic immunosuppressive therapy who developed cutaneous lesions whose evolution was highly suggestive of atypical infection.
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Affiliation(s)
- Margarida Gaudêncio
- Department of Internal Medicine, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - André Carvalho
- Department of Internal Medicine, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - Maria Inês Bertão
- Department of Internal Medicine, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - Ivo Barreiro
- Department of Internal Medicine, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - Maria Isabel Bessa
- Department of Internal Medicine, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
| | - Abílio Gonçalves
- Department of Internal Medicine, Hospital Distrital da Figueira da Foz, EPE, Figueira da Foz, Portugal
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Park MA, Gaghan LJ, Googe PB, Klein KR, Mervak JE. Disseminated cutaneous Mycobacterium chelonae infection as a presenting sign of ectopic adrenocorticotropic hormone syndrome. JAAD Case Rep 2021; 18:79-81. [PMID: 34869812 PMCID: PMC8626626 DOI: 10.1016/j.jdcr.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Meredith A Park
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey J Gaghan
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul B Googe
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Klara R Klein
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Julie E Mervak
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Navarro-Bielsa A, Bielsa A, Gomez-Mateo M, Abadías-Granado I. Nódulos de distribución esporotricoide en una paciente con sarcoidosis. ACTAS DERMO-SIFILIOGRAFICAS 2021; 114:349-352. [PMID: 36180283 DOI: 10.1016/j.ad.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
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DuBow A, Morand M, Désy D, Krasny M. Recurrence of cutaneous Mycobacterium chelonae infection: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19845231. [PMID: 31065356 PMCID: PMC6487756 DOI: 10.1177/2050313x19845231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mycobacterium chelonae is a species of mycobacteria that can be found ubiquitously in the environment. It can be found in soil, water, and in aquatic animals. Infections with this pathogen usually involve the soft tissues, eyes, bones, and skin. We present the case of a recurrence of a sporotrichoid cutaneous infection by M. chelonae in an immunocompromised 31-year-old woman with systemic lupus erythematosus. The patient originally developed a swelling of her right foot followed by a sporotrichoid pattern of infection on her right lower leg. A susceptibility profile was established, and treatment with linezolid and clarithromycin was administered for 8 months, in accordance with guidelines from the American Thoracic Society. The patient was clear of new lesions for approximately 1 month before noting a re-emergence. Treatment with linezolid and clarithromycin was re-initiated with subsequent improvement. This case underlines the need for prolonged treatment of this infection in patients with an immunocompromised status.
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Affiliation(s)
- Anaïs DuBow
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Meggie Morand
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Delphine Désy
- Department of Pathology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
| | - Mark Krasny
- Department of Dermatology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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Bhalla GS, Sarao MS, Kalra D, Bandyopadhyay K, John AR. Methods of phenotypic identification of non-tuberculous mycobacteria. Pract Lab Med 2018; 12:e00107. [PMID: 30094310 PMCID: PMC6074605 DOI: 10.1016/j.plabm.2018.e00107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/10/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are composed of mycobacterial species other than the Mycobacterium tuberculosis complex. Initially thought to be mere contaminants when isolated from clinical specimens, literature is increasing by the day showing NTM as proven pathogens. Due to the difference in antimicrobial susceptibility of different species, it becomes imperative for the microbiology laboratory to identify them to the species level. Molecular methods are available for rapid and accurate identification, but in a resource limited nation, phenotypic methods, albeit time consuming, are of paramount importance. By means of this article, the authors intend provide a concise summary of the basic biochemical reactions which can be done to identify most commonly isolated NTM.
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Affiliation(s)
- Gurpreet S. Bhalla
- Department of Lab Sciences, Army Hospital (R&R), New Delhi 110010, India
- Corresponding author.
| | - Manbeer S. Sarao
- Div of Infectious Diseases, Detroit Medical Centre, Michigan, United States
| | - Dinesh Kalra
- Department of Microbiology, Command Hospital (WC), Chandimandir, India
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Mannelli VK, Rai MP, Nemakayala DR, Kadiri NP. Mycobacterium ChelonaeDeveloping Multidrug Resistance. BMJ Case Rep 2018; 2018:bcr-2017-222569. [PMID: 29472421 DOI: 10.1136/bcr-2017-222569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Mycobacterium chelonae is a rapidly growing mycobacterium which is known to respond well to standard antibiotic treatment regimen. There are no specific guidelines for treatment. Antibiotics are chosen based on the bacterial sensitivity. Here we present a 47-year-old man with hip replacement who developed bright red papular generalised skin lesions and bilateral hip abscess. On workup, it was confirmed that M. chelonae was the causative organism. He was given 8 weeks of antibiotics; however, there was worsening of the hip abscess on interval imaging. The progression was most likely due to M. chelonae developing antibiotic resistance. Physicians should be aware of the rising resistance of this organism, and guide antibiotic therapy based on bacterial sensitivity to yield better outcomes.
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Affiliation(s)
- Vinod Kumar Mannelli
- Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA
| | - Manoj P Rai
- Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA
| | | | - Naga Preethi Kadiri
- Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA
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Pinto-Gouveia M, Gameiro A, Ramos L, Cardoso JC, Brites MM, Tellechea Ó, Figueiredo A. Mycobacterium chelonae Is an Ubiquitous Atypical Mycobacterium. Case Rep Dermatol 2015; 7:207-11. [PMID: 26351432 PMCID: PMC4560325 DOI: 10.1159/000438898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The type of cutaneous infection varies mainly according to the patient's immune status, and the disseminated form is mostly found in the context of immunosuppression. We report the case of a 62-year-old male who was under long-term systemic corticosteroid therapy and presented with a 7-month history of multiple painless cutaneous lesions at various stages of development: papules, nodules, pustules and hemorrhagic crusts, as well as small erosions and ulcers distributed over the limbs and scalp. Cutaneous biopsy showed a suppurative granulomatous infiltrate with abscess formation. Fite stain revealed numerous extracellular bacilli, suggesting mycobacterial infection, particularly by atypical mycobacteria. Culture of a skin sample revealed Mycobacterium chelonae. The patient started multidrug therapy and showed clinical improvement despite of resistance to one of the antibiotics. This striking presentation underlines the role of immunosuppression with corticotherapy as a major risk factor for these infections. Multidrug therapy is advised and antibiogram is essential in directing treatment.
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Kothavade RJ, Dhurat RS, Mishra SN, Kothavade UR. Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis 2012; 32:161-88. [PMID: 23139042 DOI: 10.1007/s10096-012-1766-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Rapidly growing mycobacteria (RGM) are known to cause pulmonary, extra-pulmonary, systemic/disseminated, and cutaneous and subcutaneous infections. The erroneous detection of RGM that is based solely on microscopy, solid and liquid cultures, Bactec systems, and species-specific polymerase chain reaction (PCR) may produce misleading results. Thus, inappropriate therapeutic measures may be used in dermatologic settings, leading to increased numbers of skin deformity cases or recurrent infections. Molecular tools such as the sequence analyses of 16S rRNA, rpoB and hsp65 or PCR restriction enzyme analyses, and the alternate gene sequencing of the superoxide dismutase (SOD) gene, dnaJ, the 16S-23S rRNA internal transcribed spacers (ITS), secA, recA1, dnaK, and the 32-kDa protein gene have shown promising results in the detection of RGM species. PCR restriction enzyme analyses (PRA) work better than conventional methods at identifying species that are closely related. Recently introduced molecular tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), pyrosequencing, DNA chip technology, and Beacon probes-combined PCR probes have shown comparable results in the detection of various species of RGM. Closely related RGM species (e.g., Mycobacterium fortuitum, M. chelonae, and M. abscessus) must be clearly differentiated using accurate molecular techniques because their therapeutic responses are species-specific. Hence, this paper reviews the following aspects of RGM: (i) its sources, predisposing factors, clinical manifestations, and concomitant fungal infections; (ii) the risks of misdiagnoses in the management of RGM infections in dermatological settings; (iii) the diagnoses and outcomes of treatment responses in common and uncommon infections in immunocompromised and immunocompetent patients; (iv) conventional versus current molecular methods for the detection of RGM; (v) the basic principles of a promising MALDI-TOF MS, sampling protocol for cutaneous or subcutaneous lesions and its potential for the precise differentiation of M. fortuitum, M. chelonae, and M. abscessus; and (vi) improvements in RGM infection management as described in the recent 2011 Clinical and Laboratory Standards Institute (CLSI) guidelines, including interpretation criteria of molecular methods and antimicrobial drug panels and their break points [minimum inhibitory concentrations (MICs)], which have been highlighted for the initiation of antimicrobial therapy.
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Affiliation(s)
- R J Kothavade
- Microbiology Lab, Epcor, 10065 Jasper Ave NW, Edmonton, AB, T5J 3B1, Canada.
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Paolo WF, Nosanchuk JD. Adrenal infections. Int J Infect Dis 2006; 10:343-53. [PMID: 16483815 PMCID: PMC7110804 DOI: 10.1016/j.ijid.2005.08.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 08/01/2005] [Accepted: 08/08/2005] [Indexed: 11/18/2022] Open
Abstract
Adrenal infections are an important but under-recognized clinical entity. The adrenal gland can be infected by a myriad of pathogens including fungi, viruses, parasites, and bacteria. Infection can directly or indirectly cause tissue damage and alteration in endocrine function. Direct damage occurs via microbial replication and local production of toxic compounds, such as endotoxins. Indirect damage results from alterations in the regulation of a host's immunologic and endocrine mediators in response to damage by a microbe at a distant site. Variations in pathogen tropism, adrenal anatomy, and host immune integrity contribute to the progression of active disease and discernable adrenal dysfunction. Early recognition and intervention in the case of adrenal infection can significantly improve outcome, demonstrating the need for increased clinical suspicion in the appropriate clinical setting.
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