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Disseminated Mycobacterium szulgai infection in a patient with anti-interferon-gamma autoantibodies. IDCases 2020; 21:e00848. [PMID: 32518754 PMCID: PMC7272508 DOI: 10.1016/j.idcr.2020.e00848] [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: 03/18/2020] [Revised: 05/23/2020] [Accepted: 05/24/2020] [Indexed: 11/23/2022] Open
Abstract
Incidence of nontuberculous mycobacterial infections has increased during the past decades. Disseminated infections are relatively rare and associated with immunocompromised status. We report a case of disseminated Mycobacterium szulgai infection of cervical lymphadenitis and pulmonary involvement with positive anti-interferon-gamma autoantibodies. The patient was successfully treated with rifampin, ethambutol, and clarithromycin. The case reports and series through search engines of Pubmed and Google with the keyword of disseminated infection of M. szulgai were reviewed. Fifteen patients of disseminated M. szulgai infection were reviewed and included. DisseminatedM. szulgaiinfection involves bone, skin and lymph node more common instead of pulmonary involvement, and most are associated with immunocompromised status with neoplastic hematologic disorders. In patients with disseminated M. szulgai infection, long term anti-mycobacterial agents are necessary. Most patients will respond to rifampin and ethambutol combination regimens.
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Lee EJ, Park JY, Kim EY, Choi J, Kim HS, Chung SW, Yoo JH, Choi CW, Kim GY, Lee JH, Kim YH. A Case of Mycobacterium szulgaiLung Disease in Patient with Healed Tuberculosis. Tuberc Respir Dis (Seoul) 2012. [DOI: 10.4046/trd.2012.72.1.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun Jung Lee
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jaeho Choi
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Soo Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Wan Chung
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jee-Hong Yoo
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Cheon Woong Choi
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Gou Young Kim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Hoo Lee
- Department of Pulmonary and Critical Care Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yee Hyung Kim
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Andréjak C, Lescure FX, Schmit JL, Jounieaux V. [Diagnosis and treatment of atypical mycobacterial infections of the respiratory tract]. Rev Mal Respir 2011; 28:1293-309. [PMID: 22152937 DOI: 10.1016/j.rmr.2011.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/28/2011] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Non tuberculous mycobacteria (NTM), unlike tuberculous mycobacteria, are not strictly human pathogens. The diagnosis of infection and the choice of treatment remain difficult. BACKGROUND Evidence of a NTM in a pulmonary sample is not synonymous with infection. The diagnosis depends on the association of clinical, radiological and microbiological factors. If a NTM is isolated from a respiratory sample, the probability of infection depends on the species. The main NTMs responsible for pulmonary infection in France are Mycobacterium avium intracellulare, Mycobacterium xenopi, Mycobacterium kansasi and Mycobacterium abscessus. Their management is difficult and poorly understood. Treatment is well established for M. avium intracellulare and M. kansasii, with combinations of clarithromycin-rifampicin-ethambutol and isoniazid-rifampicin-ethambutol respectively. For M. xenopi, the optimal treatment is not known and a combination of clarithromycin-rifampicin-ethambutol, with moxifloxacin as an alternative, is currently recommended. In general, treatment is prolonged and often associated with problems of tolerance. VIEWPOINT AND CONCLUSION The management of NTM infection, taking into account of the increase in patients "at risk", is an important issue. Further studies are needed to improve the criteria for infection and to find the optimal therapeutic combinations.
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Affiliation(s)
- C Andréjak
- Service de pneumologie et réanimation respiratoire, CHU d'Amiens, avenue Laënnec, Amiens cedex 1, France.
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Mycobacterium szulgai: an unusual cause of disseminated mycobacterial infections. Infection 2011; 40:463-8. [DOI: 10.1007/s15010-011-0213-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 10/03/2011] [Indexed: 11/27/2022]
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Abstract
A 58-year-old man was seen with complaints of fevers, night sweats, weight loss, and multiple bilateral cavitary lung lesions. Mycobacterium szulgai with nearly identical antibiograms grew from separate sputum specimens 9 years apart. He was treated with a combination of clarithromycin and ethambutol with clinical, microbiologic, and radiographic resolution of disease. This is the longest untreated case of documented Mycobacterium szulgai infection reported, and offers a glimpse of its natural history when left untreated. Despite an infrequent isolation (<0.5% of cases), it is a pathogenic organism which warrants treatment.
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van Ingen J, Boeree M, de Lange W, de Haas P, Dekhuijzen P, van Soolingen D. Clinical Relevance ofMycobacterium szulgaiin The Netherlands. Clin Infect Dis 2008; 46:1200-5. [DOI: 10.1086/529443] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ, Winthrop K. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367-416. [PMID: 17277290 DOI: 10.1164/rccm.200604-571st] [Citation(s) in RCA: 3908] [Impact Index Per Article: 229.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Kang-Birken SL, Prichard JG. Mycobacterium szulgaiin a Patient with Advanced Acquired Immunodeficiency Syndrome: An Unusual Pathogen with Unusual Multidrug Resistance. Pharmacotherapy 2006; 26:1646-9. [PMID: 17064210 DOI: 10.1592/phco.26.11.1646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 37-year-old Hispanic man with advanced acquired immunodeficiency syndrome developed extensive pulmonary disease with persistent cough, fever, night sweats, worsening dyspnea, and weight loss. Sputum samples showed scant growth of acid-fast bacilli. He failed to respond to the standard tuberculosis regimen of isoniazid, rifampin, ethambutol, and pyrazinamide. Subsequently, Mycobacterium szulgai was identified, and susceptibility tests showed it to be resistant to all four of those agents. Therapy was changed to clarithromycin, doxycycline, ciprofloxacin, and amikacin. Within 2 weeks, the patient's condition improved significantly, and 6 months after treatment, extensive pulmonary infiltrates had nearly resolved. Fewer than 1% of all human isolates of mycobacteria consist of M. szulgai, which is relatively susceptible to standard antimycobacterial agents. To our knowledge, this is the first reported case of M. szulgai with resistance to all primary antituberculosis drugs.
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Affiliation(s)
- S Lena Kang-Birken
- Ventura County Medical Center Immunology Clinic, Ventura, California, USA.
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Chalermskulrat W, Sood N, Neuringer IP, Hecker TM, Chang L, Rivera MP, Paradowski LJ, Aris RM. Non-tuberculous mycobacteria in end stage cystic fibrosis: implications for lung transplantation. Thorax 2006; 61:507-13. [PMID: 16601086 PMCID: PMC2111233 DOI: 10.1136/thx.2005.049247] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND WC and NS contributed equally. Non-tuberculous mycobacteria (NTM) frequently colonise patients with end stage cystic fibrosis (CF), but its impact on the course of the disease following lung transplantation is unknown. METHODS Lung transplant recipients with CF who underwent lung transplantation at our institution between January 1990 and May 2003 (n=146) and CF patients awaiting lung transplantation in May 2003 (n=31) were studied retrospectively. RESULTS The prevalence rate of NTM isolated from respiratory cultures in patients with end stage CF referred for lung transplantation was 19.7%, compared with a prevalence rate of 13.7% for NTM isolates in CF lung transplant recipients. The overall prevalence of invasive NTM disease after lung transplantation was low (3.4%) and was predicted most strongly by pre-transplant NTM isolation (p=0.001, Fisher's exact test, odds ratio (OR) 6.13, 95% CI 3.2 to 11.4). This association was restricted to Mycobacterium abscessus (p = 0.005, Fisher's exact test, OR 7.45, 95% CI 2.9 to 16.9). While NTM disease caused significant morbidity in a small number of patients after transplantation, it was successfully treated and did not influence the post-transplant course of the disease. CONCLUSION The isolation of NTM before transplantation in CF patients should not be an exclusion criterion for lung transplantation, but it may alert the clinician to patients at risk of recurrence following transplantation.
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Affiliation(s)
- W Chalermskulrat
- Lung Transplantation Program and Cystic Fibrosis Research and Treatment Center, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, USA
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Chai N, Deforges L, Sougakoff W, Truffot-Pernot C, De Luze A, Demeneix B, Clément M, Bomsel MC. MYCOBACTERIUM SZULGAI INFECTION IN A CAPTIVE POPULATION OF AFRICAN CLAWED FROGS (XENOPUS TROPICALIS). J Zoo Wildl Med 2006; 37:55-8. [PMID: 17312814 DOI: 10.1638/04-064.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A colony of captive Xenopus tropicalis became infected with Mycobacterium szulgai. Clinical signs, when observed, were lethargy, weight loss, and emaciation. Visceral granulomas were common findings at laparoscopy and necropsy. The diagnosis of mycobacteriosis was based on histologic appearance and Ziehl-Neelsen staining of tissues. The identification of M. szulgai organisms was based on comparison of the 16S rRNA gene sequence with several GenBank databases. There have been no reports of this mycobacterial species as the causative agent of naturally occurring disease in amphibians.
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Affiliation(s)
- Norin Chai
- Muséum National d'Histoire Naturelle-Menagerie du Jardin des Plantes, 57 rue Cuvier, 75005 Paris, France
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Abalain-Colloc ML, Guillerm D, Saläun M, Gouriou S, Vincent V, Picard B. Mycobacterium szulgai isolated from a patient, a tropical fish and aquarium water. Eur J Clin Microbiol Infect Dis 2003; 22:768-9. [PMID: 14605942 DOI: 10.1007/s10096-003-1036-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M L Abalain-Colloc
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Morvan, 5 avenue Foch, 29609 Brest, France.
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Holmes GP, Bond GB, Fader RC, Fulcher SF. A Cluster of cases of Mycobacterium szulgai keratitis that occurred after laser-assisted in situ keratomileusis. Clin Infect Dis 2002; 34:1039-46. [PMID: 11914991 DOI: 10.1086/339487] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2001] [Revised: 11/19/2001] [Indexed: 11/04/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is a recently developed ophthalmic procedure. When 2 patients developed keratitis caused by Mycobacterium szulgai after they underwent LASIK surgery, we conducted a retrospective cohort study of all LASIK procedures performed at Scott & White Clinic (Temple, Texas) during a 4.5-month period. Seven patients had compatible symptoms and signs, 5 of whom had confirmed M. szulgai keratitis. Five cases occurred among 30 procedures performed by doctor A, and there were no cases among 62 procedures performed by doctor B (approximate relative risk, 12.0; 95% confidence interval, 1.6-679.0; P=.0029). Doctor A had chilled syringes of saline solution in ice for intraoperative lavage-the only factor that differentiated the procedures of the 2 surgeons. Cultures of samples from the source ice machine's drain identified M. szulgai; the strain was identical to isolates recovered from all confirmed cases and differed from 4 standard M. szulgai strains, as determined by pulsed-field gel electrophoresis. Intraoperative contamination from ice water apparently led to M. szulgai keratitis in these patients.
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Affiliation(s)
- Gary P Holmes
- Division of Infectious Diseases, Department of Medicine, Scott & White Memorial Hospital and Clinic, Temple, TX, 76508, USA.
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Zhang Q, Kennon R, Koza MA, Hulten K, Clarridge JE. Pseudoepidemic due to a unique strain of Mycobacterium szulgai: genotypic, phenotypic, and epidemiological analysis. J Clin Microbiol 2002; 40:1134-9. [PMID: 11923321 PMCID: PMC140331 DOI: 10.1128/jcm.40.4.1134-1139.2002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In mid-1999, we noted multiple isolations at the Veterans Affairs Medical Center (VAMC) Houston Tex. of an unusual nonpigmented Mycobacterium species. Since, on the basis of 16S rRNA gene sequence analysis, the strains were identical to the Mycobacterium szulgai type strain and since M. szulgai has been reported only rarely as a commensal or environmental isolate, we were concerned about laboratory contamination, nosocomial spread, or even the possibility that this could be a novel organism associated with disease. Our investigation found that from 1999 to 2000, 37 strains of M. szulgai were isolated from patients at the VAMC (the base rate for the previous 10 years had been <1 isolation per year). We compared the phenotypic properties and genetic relatedness of these 37 strains (31 of which were nonpigmented) as well as eight stock strains and the M. szulgai type strain. All strains were similar in cellular fatty acid patterns, growth rates, and biochemical characteristics. However, we found three genogroups by gene sequence analysis. Genogroup I comprised the M. szulgai type strain, all the tested nonpigmented strains (27 of the 31 strains were tested), two pigmented strains isolated in 1999 and 2000, and five pigmented stock strains. Genogroup II comprised five pigmented strains: three were isolated from 1999 to 2000 and two were stock strains. The single strain (isolated in 1996) in genogroup III was pigmented and was the only strain associated with disease. Whereas the randomly amplified polymorphic DNA (RAPD) patterns of all nonpigmented strains were identical, indicating that they came from a common source (the pseudoepidemic strain), the RAPD patterns of the other strains were varied. In our investigation for a possible source, we found that there were no common reagents, specimen-processing or patient locations, or procedures linking the 31 pseudoepidemic strains. However, a nonpigmented M. szulgai strain with a gene sequence and RAPD pattern identical to those of the pseudoepidemic strain was recovered from a water storage tank serving the hospital. We concluded that the strains most likely originated from hospital water, which transiently inoculated our patients. Although no disease was associated with this cluster of isolates, the event was costly because identification was problematic and we could not easily discount the isolations, since most of the patients were immunocompromised and were candidates for opportunistic infection.
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Affiliation(s)
- Qing Zhang
- Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, USA
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Affiliation(s)
- A Pozniak
- St Stephens Centre, Chelsea and Westminster Hospital, London, UK
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Fang CT, Chang SC, Luh KT, Chang YL, Hsueh PR, Hsieh WC. Successful treatment of disseminated Mycobacterium szulgai infection with ciprofloxacin, rifampicin, and ethambutol. J Infect 1999; 38:195-7. [PMID: 10424803 DOI: 10.1016/s0163-4453(99)90252-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Mycobacterium szulgai is a rare cause of human infections, and when present it is mostly known to cause lung infection. We report the first case of isolated Mycobacterium szulgai osteomyelitis in a 68-year-old woman on chronic immunosuppressive therapy. Review of the literature revealed a total of three other cases of M. szulgai osteomyelitis. In all these cases there was evidence of hematogenous or contiguous spread, including one with extensive dissemination. Pulmonary M. szulgai infections tend to occur in patients with chronic lung disease and/or concomitant lung infections, whereas osteomyelitis tends to occur in patients who have severe immunosuppression secondary to disease or drugs.
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Affiliation(s)
- H Hurr
- Department of Infectious Disease, Wright State University, Dayton, Ohio, USA
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