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Harder S, Oberholtzer S, Shumilak G, Wudel B. Disseminated cutaneous Mycobacterium haemophilum infection in a patient on infliximab for rheumatoid arthritis. BMJ Case Rep 2022; 15:e245853. [PMID: 35039354 PMCID: PMC8768494 DOI: 10.1136/bcr-2021-245853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/04/2022] Open
Abstract
Mycobacterium haemophilum is a rarely encountered pathogen that is difficult to identify given its unique growth requirements. It is most often seen in adult patients who are immunosuppressed due to advanced HIV or haematological malignancy. Our case highlights a typical presentation of an atypical pathogen in a patient with rheumatoid arthritis receiving anti-tumour necrosis factor therapy. This case represents an important patient population in whom this previously rare infection is increasingly common.
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Affiliation(s)
- Samuel Harder
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Oberholtzer
- Department of Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Geoffrey Shumilak
- Department of Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Beverly Wudel
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
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Differential Sensitivity of Mycobacteria to Isoniazid Is Related to Differences in KatG-Mediated Enzymatic Activation of the Drug. Antimicrob Agents Chemother 2020; 64:AAC.01899-19. [PMID: 31767723 DOI: 10.1128/aac.01899-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022] Open
Abstract
Isoniazid (INH) is a cornerstone of antitubercular therapy. Mycobacterium tuberculosis complex bacteria are the only mycobacteria sensitive to clinically relevant concentrations of INH. All other mycobacteria, including M. marinum and M. avium subsp. paratuberculosis are resistant. INH requires activation by bacterial KatG to inhibit mycobacterial growth. We tested the role of the differences between M. tuberculosis KatG and that of other mycobacteria in INH sensitivity. We cloned the M. bovis katG gene into M. marinum and M. avium subsp. paratuberculosis and measured the MIC of INH. We recombinantly expressed KatG of these mycobacteria and tested in vitro binding to, and activation of, INH. Introduction of katG from M. bovis into M. marinum and M. avium subsp. paratuberculosis rendered them 20 to 30 times more sensitive to INH. Analysis of different katG sequences across the genus found KatG evolution diverged from RNA polymerase-defined mycobacterial evolution. Biophysical and biochemical tests of M. bovis and nontuberculous mycobacteria (NTM) KatG proteins showed lower affinity to INH and substantially lower enzymatic capacity for the conversion of INH into the active form in NTM. The KatG proteins of M. marinum and M. avium subsp. paratuberculosis are substantially less effective in INH activation than that of M. tuberculosis, explaining the relative INH insensitivity of these microbes. These data indicate that the M. tuberculosis complex KatG is divergent from the KatG of NTM, with a reciprocal relationship between resistance to host defenses and INH resistance. Studies of bacteria where KatG is functionally active but does not activate INH may aid in understanding M. tuberculosis INH-resistance mechanisms, and suggest paths to overcome them.
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The Brief Case: Disseminated Mycobacterium haemophilum Infection in a Kidney Transplant Recipient. J Clin Microbiol 2017; 56:56/1/e00561-17. [PMID: 29279349 DOI: 10.1128/jcm.00561-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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4
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Barr LK, Sharer LR, Khadka Kunwar E, Kapila R, Zaki SR, Drew CP, Bhatnagar J, Liu JK, Chew D. Intraventricular granulomatous mass associated with Mycobacterium haemophilum: A rare central nervous system manifestation in a patient with human immunodeficiency virus infection. J Clin Neurosci 2015; 22:1057-60. [PMID: 25818941 DOI: 10.1016/j.jocn.2014.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/26/2014] [Indexed: 11/17/2022]
Abstract
We report a rare case of Mycobacterium haemophilum presenting as an intraventricular granulomatous mass with loculated hydrocephalus and seizures in a patient with human immunodeficiency virus. M. haemophilum, a slow-growing mycobacteria, causes localized and disseminated disease among immunocompromised hosts. Central nervous system infection with M. haemophilum is extremely rare. Preoperative laboratory testing of our patient for tuberculosis, toxoplasmosis, sarcoidosis and histoplasmosis were negative. Surgical resection of the mass revealed a caseating granuloma that stained positive for acid-fast bacillus suggesting possible tuberculoma. Despite negative testing for tuberculosis, a polymerase chain reaction analysis was ultimately performed from the resected mass which revealed M. haemophilum. To our knowledge, this is the first case of M. haemophilum presenting as an intraventricular mass. We review the clinical manifestations of this pathogen and discuss the medical and surgical management.
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Affiliation(s)
- Luke K Barr
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA
| | - Leroy R Sharer
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Erina Khadka Kunwar
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rajendra Kapila
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sherif R Zaki
- Centers for Disease Control and Prevention, Infectious Diseases Pathology Branch, Atlanta, GA, USA
| | - Clifton P Drew
- Centers for Disease Control and Prevention, Infectious Diseases Pathology Branch, Atlanta, GA, USA
| | - Julu Bhatnagar
- Centers for Disease Control and Prevention, Infectious Diseases Pathology Branch, Atlanta, GA, USA
| | - James K Liu
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Suite 8100, 90 Bergen Street, Newark, NJ 07103, USA.
| | - Debra Chew
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
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Cross GB, Le Q, Webb B, Jenkin GA, Korman TM, Francis M, Woolley I. Mycobacterium haemophilum bone and joint infection in HIV/AIDS: case report and literature review. Int J STD AIDS 2015; 26:974-81. [PMID: 25577597 DOI: 10.1177/0956462414565403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/18/2014] [Indexed: 11/15/2022]
Abstract
We report a case of disseminated Mycobacterium haemophilum osteomyelitis in a patient with advanced HIV infection, who later developed recurrent immune reconstitution inflammatory syndrome after commencement of antiretroviral therapy. We review previous reports of M. haemophilum bone and joint infection associated with HIV infection and describe the management of M. haemophilum-associated immune reconstitution inflammatory syndrome, including the role of surgery as an adjunctive treatment modality and the potential drug interactions between antiretroviral and antimycobacterial agents.
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Affiliation(s)
- Gail B Cross
- Departments of Microbiology, Monash Health, Melbourne, Australia Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Quynh Le
- Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Brooke Webb
- Departments of Microbiology, Monash Health, Melbourne, Australia
| | - Grant A Jenkin
- Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Tony M Korman
- Departments of Microbiology, Monash Health, Melbourne, Australia Infectious Diseases, Monash Health, Melbourne, VIC, Australia Department of Medicine, Monash Health, Melbourne, VIC, Australia
| | - Michelle Francis
- Departments of Microbiology, Monash Health, Melbourne, Australia
| | - Ian Woolley
- Infectious Diseases, Monash Health, Melbourne, VIC, Australia Department of Medicine, Monash Health, Melbourne, VIC, Australia Department of Infectious Diseases, Monash University, VIC, Australia
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Tangkosakul T, Hongmanee P, Malathum K. Cutaneous Mycobacterium haemophilum infections in immunocompromised patients in a tertiary hospital in Bangkok, Thailand: under-reported/under-recognized infection. JMM Case Rep 2014; 1:e002618. [PMID: 28663805 PMCID: PMC5415928 DOI: 10.1099/jmmcr.0.002618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/22/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction: Mycobacterium haemophilum is one of the non-tuberculous mycobacteria (NTM) that can cause cutaneous infection. As acid-fast staining cannot distinguish NTM from Mycobacterium tuberculosis, and as skin culture for M. haemophilum is not performed routinely, the diagnosis of M. haemophilum infection in Thailand is rarely made. Case presentation: Between 2006 and 2009, five patients with M. haemophilum infection were diagnosed in Ramathibodi Hospital, a tertiary care centre in Bangkok, Thailand. The patients were aged 3, 29, 47, 75 and 76 years, and four were immunocompromised. Three patients received immunosuppressive medication. Most patients presented with subacute cutaneous infection. A suboptimal response to conventional antibiotics raised suspicions of M. haemophilum cutaneous infections, which can occur in immunocompromised patients. Diagnoses of these cases were made by skin culture for mycobacteria at an incubating temperature of around 30 °C with iron supplementation, DNA sequencing, or PCR/restriction enzyme analysis. Rifampicin, ofloxacin and clarithromycin were active against all isolates, whereas ethambutol and streptomycin were inactive. Conclusion: Skin culture should be performed under special conditions or molecular technique should be used to identify M. haemophilum in susceptible patients.
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Affiliation(s)
| | - Poonpilas Hongmanee
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumthorn Malathum
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Dou H, Song Y, Liu X, Yang L, Jiang N, Chen D, Li E, Tan R, Hou Y. A novel benzenediamine derivate rescued mice from experimental sepsis by attenuating proinflammatory mediators via IRAK4. Am J Respir Cell Mol Biol 2014; 51:191-200. [PMID: 24588661 DOI: 10.1165/rcmb.2013-0411oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We designed and synthesized a novel benzenediamine derivate, FC-99, that was tested for its ability to protect mice from experimental sepsis. Moreover, we sought to determine whether FC-99 could control a bacterial infection and to clarify the mechanism by which FC-99 inhibited LPS-activated macrophages. The effects of FC-99 on inflammation were evaluated in two experimental sepsis models and in cultured macrophages. Microarrays and docking and molecular dynamics simulations were used to determine the target of FC-99. Surface plasmon resonance and molecular detection were performed to confirm the direct interaction of FC-99 with its target. FC-99 protected mice from experimental sepsis. The mice that received FC-99 exhibited a diminished inflammatory response, had a lower local bacterial burden, and experienced a significantly improved survival rate. Genome-wide transcriptional profiling of FC-99-treated macrophages identified IRAK4 as a drug-regulated gene involved in LPS/TLR4 signaling. A computer search and calculations indicated that IRAK4 directly interacted with FC-99. Surface plasmon resonance, IRAK4-regulated signaling pathway analysis, and gene expression profiling of proinflammatory mediators confirmed the direct interaction between FC-99 and IRAK4. FC-99 is a potential therapeutic molecule for sepsis that alleviated experimental sepsis by directly inhibiting IRAK4 activation, which represents a novel target for sepsis therapy.
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Affiliation(s)
- Huan Dou
- 1 The State Key Laboratory of Pharmaceutical Biotechnology, Division of Immunology, Medical School
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Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev 2012; 24:701-17. [PMID: 21976605 DOI: 10.1128/cmr.00020-11] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium haemophilum is a slowly growing acid-fast bacillus (AFB) belonging to the group of nontuberculous mycobacteria (NTM) frequently found in environmental habitats, which can colonize and occasionally infect humans and animals. Several findings suggest that water reservoirs are a likely source of M. haemophilum infections. M. haemophilum causes mainly ulcerating skin infections and arthritis in persons who are severely immunocompromised. Disseminated and pulmonary infections occasionally occur. The second at-risk group is otherwise healthy children, who typically develop cervical and perihilar lymphadenitis. A full diagnostic regimen for the optimal detection of M. haemophilum includes acid-fast staining, culturing at two temperatures with iron-supplemented media, and molecular detection. The most preferable molecular assay is a real-time PCR targeting an M. haemophilum-specific internal transcribed spacer (ITS), but another approach is the application of a generic PCR for a mycobacterium-specific fragment with subsequent sequencing to identify M. haemophilum. No standard treatment guidelines are available, but published literature agrees that immunocompromised patients should be treated with multiple antibiotics, tailored to the disease presentation and underlying degree of immune suppression. The outcome of M. haemophilum cervicofacial lymphadenitis in immunocompetent patients favors surgical intervention rather than antibiotic treatment.
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Kelley CF, Armstrong WS, Eaton ME. Disseminated Mycobacterium haemophilum infection. THE LANCET. INFECTIOUS DISEASES 2011; 11:571-8. [DOI: 10.1016/s1473-3099(11)70029-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Da Mata O, Pérez Alfonzo R, Natera I, Sucre RDC, Bello T, de Waard JH. The diagnosis of two cases of cutaneous ulcer caused by infection with Mycobacterium haemophilum: direct identification in a clinical sample by polymerase chain reaction-restriction endonuclease analysis. Int J Dermatol 2008; 47:820-3. [PMID: 18717862 DOI: 10.1111/j.1365-4632.2008.03702.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mycobacterium haemophilum was first recovered from subcutaneous lesions of a patient with Hodgkin's disease. Because of its special growth requirements (it grows at 30-32 degrees C and requires iron-supplemented medium), the organism cannot be isolated using routine culture techniques for other mycobacteria. Only a few developed countries have reported infection with this mycobacterium. We report the first two cases diagnosed in Venezuela. METHODS The diagnosis of the first case was established using polymerase chain reaction (PCR)-restriction endonuclease analysis of the gene encoding the 65-kDa heat shock protein (hsp65) for the direct identification of M. haemophilum in a clinical specimen in which bacilli were observed on acid-fast smear, but growth was not detected by standard culture procedures. RESULTS After recognizing this bacterium as a possible cause of infection in our setting, clinical samples of cutaneous lesions were routinely cultured on blood agar at 30 degrees C for at least 6 weeks, which resulted in the diagnosis of the second case. CONCLUSIONS Dermatologists should consider this bacterium in immunocompromised patients with cutaneous ulcerating lesions. Material from the lesions can be screened for mycobacteria using an acid-fast stain and, if acid-fast bacilli are seen, PCR analysis of mycobacterial hsp65 can be an effective tool for early diagnosis. Appropriate culture methods are required for bacteriologic confirmation of infection with M. haemophilum.
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Affiliation(s)
- Omaira Da Mata
- Laboratorio de Tuberculosis and Centro Clínico de Dermatología y Enfermedades Tropicales, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas
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11
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Millar MJ, Bulliard C, Balachandran C, Maloof AJ. Mycobacterium hemophilum infection presenting as filamentary keratopathy in an immunocompromised adult. Cornea 2007; 26:764-6. [PMID: 17592336 DOI: 10.1097/ico.0b013e318059b571] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report a case of Mycobacterium hemophilum of the eye. METHODS Case report with pathologic correlation. A 55-year-old Malaysian man with a 3-year history of graft-versus-host disease presented with dry eye and keratopathy. RESULTS The diagnosis was not initially evident, despite biopsy specimens of the conjunctiva. Definitive diagnosis was made after dermatology consultation suggested a histoid variant of lepromatous leprosy, prompting Ziehl-Neelsen staining of the initial and subsequent conjunctival biopsies with subsequent polymerase chain reaction testing. Anti-M. hemophilum treatment resulted in prompt resolution of ocular signs. CONCLUSIONS Mycobacterium hemophilum is a rare condition, affecting mainly immunocompromised patients. Although filamentary keratopathy has been described as common manifestations of leprosy, to date, no ocular manifestations of M. hemophilum have been described. Conjoint management with infectious disease and clinical microbiology is imperative to ensure accurate diagnosis and appropriate early intervention. The effect of systemic immunosuppression is relevant in such patients.
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12
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Jang EY, Lee SO, Choi SH, Sung H, Kim MN, Kim BJ, Choi SH, Kim YS, Woo JH. Case of pyomyositis due to Mycobacterium haemophilum in a renal transplant recipient. J Clin Microbiol 2007; 45:3847-9. [PMID: 17898155 PMCID: PMC2168520 DOI: 10.1128/jcm.01067-07] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of pyomyositis due to Mycobacterium haemophilum in a renal transplant recipient. M. haemophilum was identified by PCR-mediated sequence analysis of the heat shock protein gene in the DNA of the specimen. The patient was successfully treated with repeated surgical debridement and prolonged antimycobacterial therapy.
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Affiliation(s)
- Eun-Young Jang
- Division of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea
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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: 3913] [Impact Index Per Article: 230.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Infección cutánea esporotricoide por Mycobacterium haemophilum en un paciente con sida. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70044-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Cameselle D, Hernández J, Francès A, Montenegro T, Cañas F, Borrego L. Sporotrichoid Cutaneous Infection by Mycobacterium Haemophilum in an AIDS Patient. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Elsayed S, Read R. Mycobacterium haemophilum osteomyelitis: case report and review of the literature. BMC Infect Dis 2006; 6:70. [PMID: 16606464 PMCID: PMC1456972 DOI: 10.1186/1471-2334-6-70] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 04/10/2006] [Indexed: 01/29/2023] Open
Abstract
Background Mycobacterium haemophilum is a slow-growing, fastidious, iron-requiring microorganism that, relative to other non-tuberculous mycobacterial species, has rarely been documented as a cause of human infection. This microorganism appears to be acquired via environmental exposure although its natural habitat and mode of acquisition are unknown. It has primarily been implicated as a cause of ulcerating cutaneous or subcutaneous nodular skin lesions, particularly in immunocompromised patients, although infections at extracutaneous sites have also been described. Osteomyelitis, while rarely documented, appears to be an important complication of infection with M. haemophilum in these patients. Case presentation We describe a unique case of culture-confirmed M. haemophilum osteomyelitis in an adult woman with polycythemia vera and review the world literature on bone infections due to this organism. Conclusion Mycobacterium haemophilum is an important but infrequently encountered cause of osteomyelitis in immunocompromised patients, often requiring months to years of medical therapy, with or without surgery, to effect a clinical cure.
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Affiliation(s)
| | - Ron Read
- 9-3535 Research Rd NW, Calgary, Alberta, Canada T2L 2K8
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Martinelli C, Farese A, Carocci A, Giorgini S, Tortoli E, Leoncini F. First case of Mycobacterium haemophilum infection in an AIDS patient in Italy. J Eur Acad Dermatol Venereol 2004; 18:83-5. [PMID: 14678539 DOI: 10.1111/j.1468-3083.2004.00781.x] [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: 11/28/2022]
Abstract
Mycobacterium haemophilum, a strongly acid- and alcohol-fast bacillus belonging to the group of non-tuberculous mycobacteria was first described in 1978 as the cause of cutaneous ulcerating lesions in a woman with Hodgkin's disease. Infection due to M. haemophilum is rare but increasing in prevalence in immnunosuppressed subjects, particularly in patients with acquired immunodeficiency syndrome (AIDS) patients. The skin is the most common site of infection with erythematous or violaceous papules and/or nodules that are usually painless at first, but some elements develop into abscesses or ulcers that can become very painful. The incidence of M. haemophilum is unknown, but cases of infection have been reported in Australia, Canada, the United States, France, Israel, the United Kingdom and Taiwan; to date no cases have been reported in Italy, thus the case reported here is apparently the first one observed in our country.
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Affiliation(s)
- C Martinelli
- Infectious Diseases Unit, Microbiology Unit, Azienda Ospedaliera Careggi, Viale Pieraccini 17, 50139 Florence, Italy.
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18
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Smith S, Taylor GD, Fanning EA. Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury. Clin Infect Dis 2003; 37:e100-1. [PMID: 13130418 DOI: 10.1086/377267] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Accepted: 05/06/2003] [Indexed: 11/03/2022] Open
Abstract
A 61-year-old previously healthy man developed chronic dermal granulomata in his right arm after receiving a coral injury in Thailand. After 7 biopsies, infection caused by Mycobacterium haemophilum was diagnosed. This case highlights the difficulty of isolating this fastidious organism in the laboratory and suggests that seawater or coral was the source of the infection.
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Brown-Elliott BA, Griffith DE, Wallace RJ. Newly described or emerging human species of nontuberculous mycobacteria. Infect Dis Clin North Am 2002; 16:187-220. [PMID: 11917813 DOI: 10.1016/s0891-5520(03)00052-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The advent of molecular testing in the laboratory has brought about the recognition of multiple newly characterized mycobacterial species not previously recognizable with most standard techniques. Some of the species are nonpathogenic, but the majority may cause clinical disease. Each is likely to have its own biology, drug susceptibility pattern, and response to drug/surgical therapy. Thus, it is important to try to recognize these new species in the laboratory. A study of the phenotypic and genotypic characteristics of these new species also may help to elucidate the epidemiology and pathogenesis of these organisms. In addition, there are multiple emerging species of nontuberculous mycobacteria including M. ulcerans, M. haemophilum, M. xenopi, and M. malmoense. [table: see text] These species are being recognized increasingly as a cause of human disease and recovered within the laboratory. The clinician must learn about these new pathogens to recognize them clinically and assist the laboratory in their recovery.
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Affiliation(s)
- Barbara A Brown-Elliott
- Mycobacteria/Nocardia Laboratory, Department of Microbiology, University of Texas Health Center, Tyler, Texas, USA.
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Kuijper EJ, Wit FWNM, Veenstra J, Böttger EC. Recovery of Mycobacterium haemophilum skin infection in an HIV-1-infected patient after the start of antiretroviral triple therapy. Clin Microbiol Infect 2002; 3:584-585. [PMID: 11864191 DOI: 10.1111/j.1469-0691.1997.tb00317.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. J. Kuijper
- Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands
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21
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Shah MK, Sebti A, Kiehn TE, Massarella SA, Sepkowitz KA. Mycobacterium haemophilum in immunocompromised patients. Clin Infect Dis 2001; 33:330-7. [PMID: 11438898 DOI: 10.1086/321894] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2000] [Revised: 12/15/2000] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium haemophilum, a recently described pathogen, can cause an array of symptoms in immunocompromised patients. To date, 90 patients with this infection have been described worldwide. We report our institution's experience with 23 patients who were treated from 1990 through 2000. Fourteen patients had undergone bone marrow transplantation, 5 were infected with human immunodeficiency virus, 3 had hematologic malignancies, and 1 had no known underlying immunosuppression. Clinical syndromes on presentation included skin lesions alone in 13 patients, arthritis or osteomyelitis in 4 patients, and lung disease in 6 patients. Although patients with skin or joint involvement had favorable outcomes, 5 of 7 patients with lung infection died. Prolonged courses of multidrug therapy are required for treatment. A diagnosis of M. haemophilum infection must be considered for any immunocompromised patient for whom acid-fast bacilli are identified in a cutaneous, synovial fluid or respiratory sample or for whom granulomas are identified in any pathological specimen.
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Affiliation(s)
- M K Shah
- Infectious Disease Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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22
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Friedli A, Krischer J, Hirschel B, Saurat JH, Pechère M. An annular plaque due to Mycobacterium haemophilum infection in a patient with AIDS. J Am Acad Dermatol 2000; 43:913-5. [PMID: 11044820 DOI: 10.1067/mjd.2000.102455] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Infections with mycobacteria are of importance in the differential diagnosis of skin lesions in immunocompromised patients. We report the case of a human immunodeficency virus (HIV)-infected patient who presented with an annular plaque as cutaneous manifestation of Mycobacterium haemophilum. Improvement of the immunologic status is important for successful treatment. Complete resolution was only observed when the antimycobacterial therapy was combined with antiretroviral therapy.
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Affiliation(s)
- A Friedli
- Department of Dermatology, Division of Infectious Diseases, Geneva University Hospital, 1211 Geneva 14, Switzerland
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Abstract
Tuberculosis is the most common opportunistic infection worldwide and is caused by the only readily transmissible pathogen among persons with HIV infection. If treatment is initiated promptly and is supervised appropriately, cure, fortunately, is highly likely. Isoniazid preventive therapy substantially reduces the risk of tuberculosis in persons with HIV infection. Of the nontuberculous mycobacteria, Mycobacterium avium complex (MAC) is the most frequent cause of disease; however, disseminated MAC disease usually is not seen until the CD4+ cell count is less than 50 cells/L. Newer agents, such as the macrolides and rifabutin, form the nucleus of treatment regimens and also are effective in preventing the disease.
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Affiliation(s)
- D P Chin
- Department of Medicine, University of California, San Francisco, School of Medicine, USA
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Saubolle MA, Kiehn TE, White MH, Rudinsky MF, Armstrong D. Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans. Clin Microbiol Rev 1996; 9:435-47. [PMID: 8894345 PMCID: PMC172903 DOI: 10.1128/cmr.9.4.435] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Reports of the association of Mycobacterium haemophilum with disease in humans have greatly increased. At least 64 cases have now been reported, with symptoms ranging from focal lesions to widespread, systemic disease. The organism is now known to cause primarily cutaneous and subcutaneous infection, septic arthritis, osteomyelitis, and pneumonitis in patients who are immunologically compromised and lymphadenitis in apparently immunocompetent children. Underlying conditions in the compromised patients have included AIDS; renal, bone marrow, and cardiac transplantation; lymphoma; rheumatoid arthritis; marrow hypoplasia; and Crohn's disease. Reports have originated from diverse geographic areas worldwide. The epidemiology of M. haemophilum remains poorly defined; there appears to be a genetic diversity between strains isolated from different regions. The organism is probably present in the environment, but recovery by sampling has not been successful. M. haemophilum has several unique traits, including predilection for lower temperatures (30 to 32 degrees C) and requirement for iron supplementation (ferric ammonium citrate or hemin). These may in the past have compromised recovery in the laboratory. Therapy has not been well elucidated, and the outcome appears to be influenced by the patient's underlying immunosuppression. The organisms are most susceptible to ciprofloxacin, clarithromycin, rifabutin, and rifampin. Timely diagnosis and therapy require communication between clinician and the laboratory.
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Affiliation(s)
- M A Saubolle
- Department of Pathology, Good Samaritan Regional Medical Center, Phoenix, Arizona 85006, USA
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26
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Abstract
OBJECTIVE To review the epidemiology, clinical manifestations, diagnosis, and treatment of nontuberculous mycobacterial infections other than Mycobacterium avium complex (MAC). DATA SOURCES A MEDLINE search of English-language literature pertaining to nontuberculous mycobacteria other than MAC was performed. Additional literature was obtained from reference lists of pertinent articles identified through the search. STUDY SELECTION AND DATA EXTRACTION All articles were considered for possible inclusion in the review. Information judged by the author to be pertinent was selected for discussion. DATA SYNTHESIS Mycobacterial infections, including those caused by nontuberculous mycobacteria other than MAC, have assumed greater importance over the past decade, due in part to the changing spectrum of immunosuppression as manifested by organ transplantation and HIV infection. Many pathogenic nontuberculous mycobacteria have been identified that are associated with a wide variety of localized, organ-specific, and systemic infections. Of concern, these organisms exhibit variable, species-specific susceptibility to traditional antimycobacterial drugs and other antimicrobials. In addition, long treatment courses and adjunctive surgical therapy are often required to effect cure. Important antimicrobials for the management of these infections include cefoxitin, imipenem/cilastatin, aminoglycosides (other than streptomycin), tetracyclines, macrolides, and trimethoprim/sulfamethoxazole, as well as traditional antimycobacterials. CONCLUSIONS Nontuberculous mycobacteria have assumed an increasing role in disease etiology in both nonimmunocompromised and immunocompromised individuals. Advent of rapid diagnostic techniques and susceptibility testing has allowed the clinician to identify these organisms and initiate effective treatment on a more timely basis with an improved chance for cure. Few therapeutic agents are available for treatment of these infections, many of which are not considered classic antimycobacterials.
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Affiliation(s)
- D R Guay
- Section of Clinical Pharmacology, St. Paul-Ramsey Medical Center, MN 55101, USA
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Affiliation(s)
- J O Falkinham
- Department of Biology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061-0406, USA.
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Fischer LJ, Quinn FD, White EH, King CH. Intracellular growth and cytotoxicity of Mycobacterium haemophilum in a human epithelial cell line (Hec-1-B). Infect Immun 1996; 64:269-76. [PMID: 8557350 PMCID: PMC173755 DOI: 10.1128/iai.64.1.269-276.1996] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We developed an in vitro model to study the temperature-regulated cytotoxicity and intracellular growth of Mycobacterium haemophilum in cultured human epithelial and endothelial cells. M. haemophilum associated with human epithelial and endothelial cells at similar rates when incubated at 33 and 37 degrees C, but only the epithelial cell line supported the multiplication of this organism. M. haemophilum grew equally well with epithelial cells at both temperatures. The aminoglycoside antibiotic amikacin was used to study the intracellular growth of M. haemophilum in the epithelial cells at 33 and 37 degrees C. Although an approximately equal number of bacteria were found within cells after 2 days of incubation at both temperatures, intracellular replication of M. haemophilum was 1,000-fold greater at 33 than at 37 degrees C. This intracellular multiplication was associated with destruction of the monolayers at 33 but not at 37 degrees C, and only culture filtrates from infected monolayers incubated at 33 degrees C were cytotoxic to fresh epithelial cell monolayers. This strain of M. haemophilum also produced contact-dependent hemolysis of sheep erythrocytes, demonstrating the possible presence of a cytolysin. These studies suggest that M. haemophilum has a preference for growth with cultured human epithelial cells. In addition, intracellular growth is best at 33 degrees C in epithelial cells, and this correlated with cytotoxicity at this temperature. This phenotype may be caused by induction of a soluble cytotoxic component, possibly a hemolytic cytolysin.
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Affiliation(s)
- L J Fischer
- Pathogenesis Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Affiliation(s)
- B Watt
- Scottish Mycobacteria Reference Laboratory, Royal Infirmary of Edinburgh, City Hospital
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30
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Abstract
Mycobacterium haemophilum is emerging as a pathogen of immunocompromised patients particularly those with AIDS and organ transplants. Infection has also occurred in healthy children. Adults usually present with cutaneous manifestations, septic arthritis or occasionally pneumonia. Children have perihilar, cervical or submandibular adenitis. The organism grows on mycobacterial media supplemented with ferric ammonium citrate or hemin, incubated at 30 degrees C to 32 degrees C, two to three weeks after inoculation. The most active antimicrobial agents in vitro are amikacin, ciprofloxacin, clarithromycin, rifabutin and rifampin. Development of resistance to the rifamycins has been demonstrated after patients were treated for several months with several antimycobacterial agents, including the rifamycins. Treatment for several months with at least two agents demonstrated to have low MICs for the organism has been shown to be effective.
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Affiliation(s)
- T E Kiehn
- Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Kikuchi K, Bernard EM, Kiehn TE, Armstrong D, Riley LW. Restriction fragment length polymorphism analysis of clinical isolates of Mycobacterium haemophilum. J Clin Microbiol 1994; 32:1763-7. [PMID: 7929771 PMCID: PMC263787 DOI: 10.1128/jcm.32.7.1763-1767.1994] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Mycobacterium haemophilum is an emerging opportunistic pathogen, and since 1989, infections caused by this organism have been identified more frequently in the New York City area than in any other region of the United States. A DNA fingerprinting method, based on restriction fragment length polymorphisms (RFLPs) was developed. A genomic library of M. haemophilum isolate 1A was constructed; screening the library yielded a recombinant strain that incorporated a genetic element present in multiple copies in the M. haemophilum genome. This clone was used to produce a probe for RFLP analyses of PvuII digests of genomic DNA. We used this probe to determine the RFLP patterns of 43 clinical isolates of M. haemophilum from 28 patients. A total of six distinct patterns were observed. Two patterns, designated types 1 and 2, accounted for 91% of the infections in patients from the New York City area. Two isolates from Arizona had identical patterns but were distinct from those of New York isolates, and an isolate from Israel, the type strain, had another distinct pattern (type 6). The type 6 pattern was also seen in a recent isolate from Norway. All of the type 1 isolates and 60% of the type 2 isolates were recovered from patients with AIDS in the New York City area. This molecular subtyping method should provide a useful tool for epidemiological studies and may help identify the associated risk factors, vehicles, and possible reservoirs of this newly emerging pathogen.
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Affiliation(s)
- K Kikuchi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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Brogden RN, Fitton A. Rifabutin. A review of its antimicrobial activity, pharmacokinetic properties and therapeutic efficacy. Drugs 1994; 47:983-1009. [PMID: 7521834 DOI: 10.2165/00003495-199447060-00008] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rifabutin is a derivative of rifamycin S with activity against mycobacteria including atypical organisms such as Mycobacterium avium and M. intracellulare, also referred to as Mycobacterium avium-intracellulare complex (MAC). To date, rifabutin is the only drug to have been studied in large prospective placebo-controlled trials that has been shown to significantly reduce the incidence of disseminated MAC infection when administered prophylactically as a single agent to patients with acquired immune deficiency syndrome (AIDS). Initial studies also indicate that rifabutin may be a useful component of multiple drug regimens for the treatment of MAC infection, although further studies combining rifabutin with other recently available antimycobacterial drugs are required to determine the most effective regimens. When rifabutin is combined with at least two other antimycobacterial drugs, the combination appears to be of similar efficacy to rifampicin (rifampin)-containing regimens in patients with newly diagnosed pulmonary tuberculosis. Since available therapy for MAC infection in patients with AIDS is still suboptimal, rifabutin, at present the only first-line agent for prophylaxis against disseminated MAC infection in patients with advanced human immunodeficiency virus (HIV) infection, has the potential to make a valuable contribution to the continuing attempts to preserve the quality of life of patients with AIDS.
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Affiliation(s)
- R N Brogden
- Adis International Limited, Auckland, New Zealand
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Goldschmidt RH, Hearst N, Chambers DB. Rifabutin prophylaxis against Mycobacterium avium complex infection. N Engl J Med 1994; 330:436-7; author reply 438. [PMID: 7904328 DOI: 10.1056/nejm199402103300615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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