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Bekina-Sreenivasan D, Saleeb P, Schmalzle SA. Mycobacterium xenopi native vertebral osteomyelitis and discitis: Case & review of published cases. IDCases 2023; 33:e01835. [PMID: 37502651 PMCID: PMC10368906 DOI: 10.1016/j.idcr.2023.e01835] [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: 05/07/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
Mycobacterium xenopi is a rare cause of spinal osteomyelitis and discitis. Here we report the case of a 68-year-old woman with history of splenectomy for Felty's syndrome who developed M. xenopi lumbar discitis and osteomyelitis following repeated corticosteroid spinal injections for chronic back pain. Review of the 18 cases of M. xenopi spinal osteomyelitis cases described in the literature revealed common threads of immunocompromised hosts and prior spinal manipulation.
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Affiliation(s)
| | - Paul Saleeb
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah A. Schmalzle
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Infectious Disease, University of Maryland School of Medicine, Baltimore, MD, USA
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Mycobacterium xenopi related spine infections: A case report and systematic literature review. One Health 2023; 16:100502. [PMID: 36817979 PMCID: PMC9930194 DOI: 10.1016/j.onehlt.2023.100502] [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: 10/10/2022] [Revised: 02/05/2023] [Accepted: 02/05/2023] [Indexed: 02/13/2023] Open
Abstract
Background and purpose Nontuberculous mycobacteria (NTM) disease is an important infection disease throughout the world. Mycobacterium xenopi (M. xenopi) is a common NTM. Extrapulmonary infections due to M. xenopi, particularly spine infections, are a rare occurrence, but lack of research is cited as a constraint for implementing NTM control in such patients. The purposes of this paper are to describe a case of spondylodiscitis, to review the published literature on cases of M. xenopi spine infections, and to summarize the predisposing factors, diagnosis, and treatment of infection. Methods A case of spondylodiscitis was caused by M. xenopi in a patient with systemic lupus erythematosus (SLE). Research was conducted using the PubMed, ScienceDirect, Embase, Wiley Online Library, and Scopus databases using the following search terms: "Mycobacterium xenopi", "vertebral", "spinal", "spondylodiscitis", "infection", and "osteomyelitis". Results We retrieved 14 cases published before August 2022. The risk factors for infection were iatrogenic infections (3/14, 21.43%), SLE (4/14, 28.57%), AIDS (4/14, 28.57%), and immunocompetence without any comorbidities (3/14, 21.43%). The most common sites of infection were thoracic vertebrae (10/14, 71.43%) and lumbar vertebrae (4/14, 28.57%). A total of 14 cases were isolated and identified as M. xenopi from a toad by mycobacterial culture. The identification time was 55.00 ± 7.55 days (the present report identification time of metagenomic next generation sequencing (mNGS) was only 2 days). All patients were treated with antibiotic therapy, and the duration of treatment was 13.18 ± 2.13 months. Clarithromycin-based therapy showed a higher improvement rate (5/6, 83.33%). Surgical intervention was performed in 5 patients. Only 1 patient did not show any improvement after surgical treatment. Conclusion M. xenopi spine infection in humans presents with atypical clinical symptoms. mNGS identification may be a good choice. M. xenopi may be considered in immunocompromised patients with spinal infection. We recommend a clarithromycin-containing regimen and prolonging the duration of treatment to ensure effectiveness.
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Bachar K, Shulimzon T, Ofek E, Segel MJ. Pleuritis due to Mycobacterium xenopi without pulmonary infection. Access Microbiol 2022; 4:000328. [PMID: 35693475 PMCID: PMC9175977 DOI: 10.1099/acmi.0.000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) may cause pulmonary and extra-pulmonary disease in both immunocompetent and immunocompromised patients. Pleuritis is an uncommon manifestation on NTM disease, and pleuritis caused by Mycobacterium xenopi has only been described once before. Because it is considered to be an environmental contaminant, isolation of M. xenopi from bronchopulmonary secretions or other sites is often dismissed. The disease caused by M. xenopi is usually a pulmonary infection and typically occurs in severely immunocompromised individuals or in immunocompetent patients with an underlying chronic lung disease. We describe an unusual case of pleuritis caused by M. xenopi in a patient without an underlying chronic lung disease and with no evidence of a concurrent M. xenopi pulmonary infection.
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Affiliation(s)
- Keren Bachar
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Tiberiu Shulimzon
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Efrat Ofek
- Department of Pathology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Michael J. Segel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
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Rodari P, Marocco S, Buonfrate D, Beltrame A, Piubelli C, Orza P, Fittipaldo VA, Bisoffi Z. Prosthetic joint infection due to Mycobacterium xenopi: a review of the literature with a new case report. Infection 2019; 48:165-171. [PMID: 31098926 DOI: 10.1007/s15010-019-01318-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/07/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Extrapulmonary infections due to M. xenopi, particularly osteoarticular localizations, are rare. The purpose of this paper is to describe a case of prosthetic hip infection and to review the published literature on cases of M. xenopi osteoarticular infections. METHODS Literature search was performed in the following databases: MEDLINE (PubMed), Embase, Central (the Cochrane Library 2019, Issue 1), LILACS (BIREME) (Latin American and Caribbean Health Science Information database) and Clinical Trials databases (14th August 2018). We included all case reports and case series on adult patients diagnosed with bone or joint infection by M. xenopi for whom the treatment and outcome were specified. RESULTS We retrieved 30 cases published between 1982 and 2012, among which 25 (83.3%) were reported from Europe. The two most common infection sites were spine (12/30, 40%) and knee (9/30, 30%). Risk factors for infection were previous invasive procedures (11/30, 36.7%), autoimmune disease (8/30, 26.7%), AIDS (4/30, 13.3%) and other comorbidities (2/30, 6.7%); five patients had no past medical history. All patients were treated with antibiotic combinations, but composition and duration of regimens hugely varied. Surgical intervention was performed in 16 patients (53.3%). Only 11 patients obtained full recovery of articular mobility after treatment. CONCLUSION This work highlights the difficulties in diagnosing and treating M. xenopi osteoarticular infections. Globally, evidence supporting the best practice for diagnosis and treatment of this infection is scanty.
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Affiliation(s)
- Paola Rodari
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Stefania Marocco
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Dora Buonfrate
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Anna Beltrame
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Chiara Piubelli
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Pierantonio Orza
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Veronica Andrea Fittipaldo
- Unità di Revisioni Sistematiche e Linee Guida, Dipartimento di Oncologia, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Zeno Bisoffi
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
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Kim CJ, Kim UJ, Kim HB, Park SW, Oh MD, Park KH, Kim NJ. Vertebral osteomyelitis caused by non-tuberculous mycobacteria: Predisposing conditions and clinical characteristics of six cases and a review of 63 cases in the literature. Infect Dis (Lond) 2016; 48:509-16. [PMID: 27002256 DOI: 10.3109/23744235.2016.1158418] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Several case series have reported on clinical and radiographic characteristics of patients with vertebral osteomyelitis (VO) caused by non-tuberculous mycobacteria (NTM). However, only a few patients were included, and systematic reviews are still lacking. The aim of this study was to update and summarise the pre-disposing conditions, clinical and radiographic characteristics of such cases due to NTM. Methods In this study, a systematic review was conducted of the English-language literature from 1961-2014 to investigate the pre-disposing conditions and characteristics of cases of VO due to NTM. Also, six additional cases diagnosed in the study hospitals were described; these cases are included in an analysis of a total of 69 cases of NTM VO. Results The most common species, regardless of the presence of HIV co-infection, was M. avium Complex followed by M. xenopi. Ten cases with HIV infection had a median CD4 lymphocyte count of 320/mm(3) (range = 41-465/mm(3)) at the time of diagnosis of NTM VO. The VO in the cases with HIV infections occurred at an earlier age and more often involved the thoracic spine than in the cases without HIV infection. Pre-disposing trauma or surgery was reported in 14.5% (10/69) of the cases. A variety of immunosuppressive diseases were observed in 49.3% of the patients, including the 10 with HIV infections and corticosteroids were used in 27.5% of the cases. Surgery was performed in 67.6% and improvement was reported in 80.6%. Conclusion NTM should be considered in immunocompromised patients with indolent VO without confirmation of tuberculosis.
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Affiliation(s)
- Chung-Jong Kim
- a Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Uh-Jin Kim
- b Department of Infectious Diseases , Chonnam National University Medical School , Gwang-ju , Republic of Korea
| | - Hong Bin Kim
- a Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Sang Won Park
- a Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Myoung-Don Oh
- a Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Kyung-Hwa Park
- b Department of Infectious Diseases , Chonnam National University Medical School , Gwang-ju , Republic of Korea
| | - Nam Joong Kim
- a Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Republic of Korea
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Salmon JH, Direz G, Ziza JM, Desplaces N, Brochot P, Eschard JP. Discitis and sacroiliitis diagnosed 15years after iatrogenic Mycobacterium xenopi inoculation. Joint Bone Spine 2012; 79:409-11. [DOI: 10.1016/j.jbspin.2012.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
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Peripheral arthritis caused by Mycobacterium avium-intracellulare in a patient with ankylosing spondylitis. J Clin Rheumatol 2009; 15:323-4. [PMID: 19734747 DOI: 10.1097/rhu.0b013e3181bbbcfb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yim K, Nazeer SH, Kiska D, Rose FB, Brown D, Cynamon MH. Recurrent Mycobacterium xenopi infection in a patient with rheumatoid arthritis receiving etanercept. ACTA ACUST UNITED AC 2009; 36:150-4. [PMID: 15061673 DOI: 10.1080/00365540310017474] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A case of recurrent Mycobacterium xenopi infection presenting as Pott's disease in a patient receiving etanercept for severe rheumatoid arthritis is described. A 49-y-old Caucasian male had received a total of 11 months of anti-mycobacterial therapy for hip infection acquired 15 months earlier; he presented with progressive back pain, which was diagnosed as Pott's disease. He had been treated with etanercept in addition to his prior immunosuppressive agents after the diagnosis of hip infection.
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Affiliation(s)
- Kyongwook Yim
- Division of Infectious Diseases, Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
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Sobottke R, Zarghooni K, Seifert H, Faetkenheuer G, Koriller M, Michael JWP, Delank KS, Eysel P. Spondylodiscitis caused by Mycobacterium xenopi. Arch Orthop Trauma Surg 2008; 128:1047-53. [PMID: 18193243 DOI: 10.1007/s00402-007-0553-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Indexed: 02/09/2023]
Abstract
The infection with non-tuberculous mycobacterium correlates highly with immunodeficiency. Mycobacterium xenopi (M. xenopi) is most commonly isolated in the respiratory tract, as a cause of endogenous spondylodiscitis it occurs but rarely. Only seven such cases have been reported in literature. In this paper, we present the case of an about 28-year-old HIV-positive patient with a long history of back pain. MRI of the spinal column and Positron Emission Tomography with (18)F-fluorodeoxyglucose as a tracer (F18-FDG-PET) confirmed the suspected spondylodiscitis. After performing a CT-controlled abscess drainage the patient's condition improved. Because of the severe destruction of the spinal segment concerned and because of the epidural abscess formation a vertebrectomy of T10 and surgical debridement of the paravertebral soft tissue via thoracotomy became urgently necessary. The spine was stabilized by interposing a cage and an anterolateral monobar system. M. xenopi could be proven by PCR out of the intraoperative specimen. After operation and antituberculotic therapy there was a fast convalescence. Diagnostics, therapy, and clinical outcome are discussed.
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Affiliation(s)
- R Sobottke
- Department of Orthopaedic Surgery, University of Cologne, Cologne, Germany.
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10
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Les infections à mycobactéries non tuberculeuses. Rev Med Interne 2008; 29:370-9. [DOI: 10.1016/j.revmed.2007.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Accepted: 09/14/2007] [Indexed: 01/15/2023]
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Salliot C, Desplaces N, Boisrenoult P, Koeger AC, Beaufils P, Vincent V, Mamoudy P, Ziza JM. Arthritis Due toMycobacterium xenopi:A Retrospective Study of 7 Cases in France. Clin Infect Dis 2006; 43:987-93. [PMID: 16983609 DOI: 10.1086/507631] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 07/05/2006] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Mycobacterium xenopi is a nontuberculous mycobacterium responsible for opportunistic and nosocomial infections, chiefly of the lung; few cases of bone and joint infection have been reported. From July 1989 through May 1993, an outbreak of 58 cases of nosocomial discitis due to M. xenopi infection following percutaneous nucleotomy occurred in a French hospital. Peripheral M. xenopi arthritis seems exceedingly rare. We conducted a study to assess the epidemiological and clinical patterns of M. xenopi arthritis. METHODS We retrospectively reviewed cases of M. xenopi arthritis reported from May 1993 through October 2004. RESULTS We identified 7 cases, all of which occurred after invasive surgical procedures were performed on the affected joint, suggesting a nosocomial pattern of infection. Two patients may have been contaminated at the hospital where the M. xenopi discitis outbreak occurred. No source was identified in the other 5 patients. Despite the probable nosocomial nature of the infections, the diagnosis was delayed (mean time until diagnosis, 50 months). Repeated collection of deep tissue specimens for bacteriological analysis seemed crucial to the diagnosis. The treatment relied on combination antimicrobial therapy and surgery. Among 11 cases of M. xenopi osteoarticular infection reported in the literature from 1975 to 2005, (arthritis in 9 cases and osteitis in 2), none were nosocomial. CONCLUSION A high index of suspicion should be maintained to ensure the diagnosis of M. xenopi arthritis before chronic monoarthritis and before the development of irreversible joint damage.
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Affiliation(s)
- Carine Salliot
- Department of Internal Medicine and Rheumatology, Diaconesses-Croix-Saint-Simon Hospital, Paris, 75020, France.
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Marie I, Hachulla E, Chérin P, Hellot MF, Herson S, Levesque H, Hatron PY. Opportunistic infections in polymyositis and dermatomyositis. Arthritis Care Res (Hoboken) 2005; 53:155-65. [PMID: 15818648 DOI: 10.1002/art.21083] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess prevalence and characteristics of opportunistic infections in patients with polymyositis/dermatomyositis (PM/DM). To determine the predictive values for opportunistic infections on clinical presentation, biochemical findings, and paraclinical features of PM/DM to detect patients at risk of opportunistic infections. METHODS The medical records of 156 consecutive PM/DM patients in 3 medical centers were reviewed. RESULTS Eighteen PM/DM patients (11.5%) developed opportunistic infections. The majority of patients exhibited an opportunistic infection after the onset of PM/DM (89% of cases). Opportunistic infections occurred most frequently during the first year following PM/DM diagnosis (62.5%). The pathogen microorganisms responsible for opportunistic infections were various, i.e., Candida albicans, Pneumocystis carinii, Aspergillus fumigatus, Geotrichum capitatum, Mycobacterium avium-intracellulare complex, M. xenopi, M. marinum, M. tuberculosis, Helicobacter heilmanii, cytomegalovirus, and herpes simplex virus. Mortality rates were as high as 27.7% in these PM/DM patients. Higher mean daily doses of steroids, lymphopenia, and lower serum total protein levels were significantly more frequent in the group of PM/DM patients with opportunistic infections. CONCLUSION Our study underscores the high frequency of opportunistic infections in PM/DM, resulting in an increased mortality rate. It also indicates that a great variety of microorganisms are responsible for opportunistic infections, although they were more often due to fungi (>50% of cases). Our series highlights a predominance of both lung and digestive opportunistic infections (89% of cases). In addition, our results suggest that PM/DM patients presenting with factors predictive of opportunistic infection may require closer monitoring.
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Affiliation(s)
- Isabelle Marie
- Centre Hospitalier Universitaire de Rouen-Boisguillaume and Inserm Unit 644, Rouen, France.
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Petitjean G, Fluckiger U, Schären S, Laifer G. Vertebral osteomyelitis caused by non-tuberculous mycobacteria. Clin Microbiol Infect 2004; 10:951-3. [PMID: 15521995 DOI: 10.1111/j.1469-0691.2004.00949.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vertebral osteomyelitis caused by non-tuberculous mycobacteria is a rare disease, with only 31 cases and one nosocomial outbreak reported in the literature (MedLine review between 1965 and December 2003). The clinical features are often indistinguishable from those of pyogenic osteomyelitis. Early diagnosis of such infections is a major challenge because of the slow growth of these microorganisms. No consensus guidelines for the treatment of these infections exist. Prolonged anti-mycobacterial therapy in combination with surgical debridement is recommended.
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Teh CL, Kong KO, Chong APY, Badsha H. Mycobacterium haemophilum infection in an SLE patient on mycophenolate mofetil. Lupus 2003; 11:249-52. [PMID: 12043889 DOI: 10.1191/0961203302lu175cr] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We describe a case of Mycobacterium haemophilum in an immunocompromised patient with systemic lupus erythematosus (SLE). Mycobacterium haemophilum is a recently described pathogen which has not been previously described either in SLE patients or patients on Mycophenolate Mofetil. Mycobacterium haemophilum can be difficult to diagnose, as it may not have the granulomas characteristic of atypical mycobacterial infections. Combination therapy with at least two drugs for several months is required and the outcome depends on the patient's underlying immunocompromised state. Our report highlights the need for early diagnosis and treatment of Mycobacterium haemophilum in immunocompromised patients with SLE.
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Affiliation(s)
- C L Teh
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
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Astagneau P, Desplaces N, Vincent V, Chicheportiche V, Botherel A, Maugat S, Lebascle K, Léonard P, Desenclos J, Grosset J, Ziza J, Brücker G. Mycobacterium xenopi spinal infections after discovertebral surgery: investigation and screening of a large outbreak. Lancet 2001; 358:747-51. [PMID: 11551599 DOI: 10.1016/s0140-6736(01)05843-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycobacterium xenopi spinal infections were diagnosed in 1993 in patients who had undergone surgical microdiscectomy for disc hernia, by nucleotomy or microsurgery, in a private hospital. Contaminated tap water, used for rinsing surgical devices after disinfection, was identified as the source of the outbreak. Several cases were recorded in the 4 years after implementation of effective control measures because of the long time between discectomy and case detection. The national health authorities decided to launch a retrospective investigation in patients who were exposed to M xenopi contamination in that hospital. METHODS Mailing and media campaigns were undertaken concurrently to trace exposed patients for spinal infections. Patients were screened by magnetic resonance imaging (MRI), and the scans were reviewed by a radiologist who was unaware of the diagnosis. Suspected cases had discovertebral biopsy for histopathological and bacteriological examination. FINDINGS Of 3244 exposed patients, 2971 (92%) were informed about the risk of infection and 2454 (76%) had MRI. Overall, 58 cases of M xenopi spinal infection were identified (overall cumulative frequency 1.8%), including 26 by the campaign (mean delay in detection 5.2 years, SD 2.4, range 1-10 years). Multivariate analysis showed that the risk of M xenopi spinal infection was related to nucleotomy and high number of patients per operating session. INTERPRETATION Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly and receive effective information.
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