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Riopel ND, Wood K, Stokes W. Disseminated cutaneous Mycobacterium chelonae infection secondary to an indwelling catheter in an immunocompetent host. J Clin Tuberc Other Mycobact Dis 2023; 32:100373. [PMID: 37139480 PMCID: PMC10149383 DOI: 10.1016/j.jctube.2023.100373] [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: 05/05/2023] Open
Abstract
Background Mycobacterium chelonae is a species of nontuberculous mycobacteria that typically causes localized cutaneous disease in immunocompetent hosts. There have been few reports of disseminated infections in immunocompetent individuals which have often been associated with invasive medical procedures. Case Presentation In this report, we describe a 43-year-old immunocompetent female with an implanted venous access device who presented with skin lesions increasing in size and frequency over the course of five months despite antimicrobial therapy. A diagnosis was not made until mycobacterial culture from a skin biopsy grew M. chelonae. Conclusion Disseminated cutaneous M. chelonae infection can be a rare complication of indwelling venous catheterization among immunocompetent patients.
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Affiliation(s)
- Nicholas D. Riopel
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberly Wood
- Department of Laboratory Medicine and Pathology, University of Alberta, Alberta, Canada
| | - William Stokes
- Department of Laboratory Medicine and Pathology, University of Alberta, Alberta, Canada
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author at: 2B4.58 WMC, 8440-112 St NW, Edmonton, AB T6G 2J2, Canada.
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2
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Martinez-Ortega JI, Perez-Hernandez FDJ, Rodriguez-Castellanos MA, Martinez-Jaramillo E, Guillermo-Herrera JC. Disseminated Cutaneous Mycobacterium chelonae Infection in an Immunocompetent Patient. Cureus 2023; 15:e43170. [PMID: 37692700 PMCID: PMC10484636 DOI: 10.7759/cureus.43170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
We present a case report on disseminated cutaneous Mycobacterium chelonae infection with a sporotrichoid pattern in an immunocompetent patient. The aim of this report is to contribute to the existing knowledge on the clinical presentation and management of this uncommon presentation.
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Affiliation(s)
| | | | | | - Elvis Martinez-Jaramillo
- Department of Pathology, Faculty of Medicine and Health Science, McGill University, Montreal, CAN
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3
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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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4
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Barbosa E, Wolinska A, Feighery C, Roche M, Szontagh-Kishazi P. Subcutaneous vacuoles with suppuration and granulomas: a histological clue to atypical mycobacterial infection. Clin Exp Dermatol 2021; 47:765-767. [PMID: 34856003 DOI: 10.1111/ced.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
An 83-year-old woman was referred to the Dermatology department with a papular eruption on her left arm, occurring below the scar site of a malignant melanoma in situ, which had been excised 6 months previously. On physical examination, multiple, tender, violaceous papules and nodules inferior to the scar were noted, with central pustules in some of the lesions.
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Affiliation(s)
- E Barbosa
- Departments of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - A Wolinska
- Departments of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - C Feighery
- Departments of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - M Roche
- Departments of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - P Szontagh-Kishazi
- Departments of Pathology, Our Lady of Lourdes Hospital, Drogheda, Ireland
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Dong S, Lin Z, Wu S, Cai L. Spondylitis following bloodstream dissemination of Mycobacterium chelonae disseminated in an immunocompetent patient: a case report and literature review. J Int Med Res 2021; 49:3000605211047766. [PMID: 34590879 PMCID: PMC8489759 DOI: 10.1177/03000605211047766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-tuberculous mycobacterial spondylitis is a rare spinal infection, especially among patients without acquired immunodeficiency syndrome or other immune impairments. Because of its rarity and non-specific clinical manifestations, diagnosis is often delayed or missed. Here, we present a case of Mycobacterium chelonae spondylitis in an immunocompetent patient and review the relevant literature.
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Affiliation(s)
- Shuangxia Dong
- Department of Respiratory Medicine, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhou Lin
- Department of Orthopaedic Surgery, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Shenghao Wu
- Department of Hematology, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Leyi Cai
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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6
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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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Lage R, Biccigo DGZ, Santos FBC, Chimara E, Pereira ESP, Costa AD. Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease. An Bras Dermatol 2015; 90:104-7. [PMID: 25672306 PMCID: PMC4323705 DOI: 10.1590/abd1806-4841.20152276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 10/21/2013] [Indexed: 11/21/2022] Open
Abstract
Around 50 mycobacteria species cause human disease. Immunosuppressive states
predispose to non-tuberculous mycobaterium infection, such as Mycobacterium chelonae:
AFB, non-tuberculous, fast growth of low virulence and uncommon as a human pathogen.
It may compromise the skin and soft tissues, lungs, lymph nodes and there is also a
disseminated presentation. The diagnosis involves AFB identification and culture on
Agar and Lowenstein-Jensen medium base. A 41-year-old female with MCTD (LES
predominance) is reported, presenting painless nodules in the right forearm. She
denied local trauma. Immunosuppressed with prednisone and cyclophosphamide for 24
months. Lesion biopsy has demonstrated positive bacilloscopy (Ziehl-Neelsen stain)
and M.chelonae in culture (Lowenstein-Jensen medium base), therefore clarithromycin
treatment has been started (best therapy choice in the literature).
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Affiliation(s)
- Renan Lage
- Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
| | | | | | | | | | - Adilson da Costa
- Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil
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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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Roukens AH, Mendels EJ, Verbeet NL, von dem Borne PA, Nicolae-Cristea AR, Bentvelsen RG, van Doorn R, de Boer MG. Disseminated Cutaneous Mycobacterium chelonae Infection in a Patient With Acute Myeloid Leukemia. Open Forum Infect Dis 2014; 1:ofu103. [PMID: 25734171 PMCID: PMC4324231 DOI: 10.1093/ofid/ofu103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/20/2014] [Indexed: 12/30/2022] Open
Abstract
We report a case of disseminated cutaneous Mycobacterium chelonae infection in a patient who was treated with chemotherapy for acute myeloid leukemia. We discuss the clinical manifestations, diagnosis, and treatment of this unusual infection in neutropenic patients.
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Salmanzadeh S, Honarvar N, Goodarzi H, Khosravi AD, Nashibi R, Serajian AA, Hashemzadeh M. Chronic mycobacterial meningitis due to Mycobacterium chelonae: a case report. Int J Infect Dis 2014; 27:67-9. [PMID: 25195074 DOI: 10.1016/j.ijid.2014.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 11/30/2022] Open
Abstract
We report a case of chronic meningitis due to Mycobacterium chelonae. This organism is a rapidly growing Mycobacterium (RGM) and can be found worldwide in environmental sources such as soil, dust, and water. M. chelonae is an uncommon cause of meningitis; the majority of infections caused by this organism are localized cutaneous or soft tissue infections, and rarely lung infections. The organism is indistinguishable phenotypically, so we applied PCR based on the rpoB gene sequence followed by restriction fragment length polymorphism (RFLP) for molecular identification. The subsequent sequencing of RFLP products revealed 99.7% similarity with M. chelonae.
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Affiliation(s)
- Shokrallah Salmanzadeh
- Infectious Diseases Ward, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Negin Honarvar
- Infectious Diseases Ward, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamed Goodarzi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Azar Dokht Khosravi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roohangiz Nashibi
- Infectious Diseases Ward, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Arsalan Serajian
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hashemzadeh
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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11
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Muramatsu K, Nomura T, Ito T, Hamade Y, Hirata Y, Fujita Y, Abe R, Shimizu H. Repeated skin sampling and prolonged incubation period identified cutaneous
M
ycobacterium chelonae
infection on the face in an immunocompetent man. Br J Dermatol 2014; 170:471-3. [DOI: 10.1111/bjd.12638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Muramatsu
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - T. Nomura
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - T. Ito
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Y. Hamade
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Y. Hirata
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - Y. Fujita
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - R. Abe
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
| | - H. Shimizu
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo Japan
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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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