MYCOBACTERIUM FORTUITUM IN ABSCESSES OF MAN

Mycobacterium monacense: a mycobacterial pathogen that causes infection of the hand

We present a report of a diabetic patient with an infection of his left thumb and thenar eminence. Standard cultures of drainage and tissue biopsy were unrevealing. The infection progressed despite empiric antibacterial agent therapy and multiple debridements. Two intraoperative tissue biopsies revealed a yellow-pigmented, rapidly growing Mycobacterial nontuberculous species. The organism was identified as Mycobacterium monacense, a newly described species. The patient was cured with a 6-week course of clarithromycin and levofloxacin.

Forty years of disinfectant failure: outbreak of postinjection Mycobacterium abscessus infection caused by contamination of benzalkonium chloride

Benzalkonium chloride (BC) continues to be used as an antiseptic and contributes to serious outbreaks of disease. In July 1999, 6 postinjection joint infections caused by Mycobacterium abscessus were reported to the Texas Department of Health (Austin). We investigated this outbreak and identified 12 case patients who had been seen by the same physician and who had received an intra-articular or periarticular steroid injection during the period of 1 April through 31 July 1999. M. abscessus was cultured from either joint fluid or periarticular soft-tissue specimens obtained from 10 patients. We cultured environmental samples, and we compared isolates recovered from case patients with environmental isolates by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). Four environmental samples containing diluted BC yielded M. abscessus. Clinical and environmental strains of M. abscessus were indistinguishable by RAPD-PCR. The case patients' strain was resistant to BC. The use of BC as an antiseptic should be discontinued.

Mycobacterium fortuitum infections of the hand. Report of five cases

Five cases are reported of infection due to Mycobacterium fortuitum involving the hand following contaminated injection or traumatic wounds. Synovectomy, debridement, or amputation together with prolonged chemotherapy using kanamycin or amikacin were required. Doxycycline and sulphamethoxasole also seemed to be the effective antibiotics for this organism. A high index of suspicion is important in order to obtain the correct diagnosis.

Postoperative osteomyelitis due to Mycobacterium fortuitum. A case report

A rare case of osteomyelitis of the tibia caused by Mycobacterium fortuitum which developed after closed intramedullary Küntscher nail fixation is reported. After extraction of the nail, combination therapy with antituberculous drugs, ofloxacin, and interleukin 2 was undertaken and bony union was achieved. Since a bone cyst formed during union, curettage and conventional cancellous bone grafting were performed. The patient is now pain-free even with prolonged weight-bearing. The success of treatment in this case is in contrast to other reports of the disease.

Adjunctive surgical management of cutaneous Mycobacterium fortuitum infection

Atypical mycobacteria of the fortuitum-chelonei complex are being identified with increasing frequency as causes of resistant, cutaneous infection. We report a case of Mycobacterium fortuitum infection of the face, unresponsive to conventional antimicrobial therapy, which resolved following adjunctive surgical resection. We believe that prompt surgical debridement of affected tissue in such infections, combined with appropriate antimicrobial therapy, will shorten both the duration and morbidity often associated with this disease.

Preseptal cellulitis caused by Mycobacterium intracellulare

A case of preseptal cellulitis caused by Mycobacterium intracellulare is presented. A 56-year-old white woman developed erythema, induration, and tenderness of the lids of her right eye after chalazion removal, which did not respond to three weeks of broad spectrum antibiotics. Incision and drainage with biopsy revealed granuloma, and acid-fast bacilli were seem. Mycobacterium intracellulare was isolated on culture, resistant to all the antimicrobials that the patient was given. Antimicrobial therapy was discontinued, and the infection resolved over 15 months.

Renal infection with Mycobacterium chelonei

A case of renal infection with Mycobacterium chelonei is described. The infection probably occurred via haematogenous spread from an infected arteriovenous shunt in a uraemic woman. Prolonged treatment with intravenous cefoxitin combined with oral erythromycin and rifampicin eradicated the organism from the urine. Although renal function stabilised for one year, gradual deterioration to end-stage renal failure occurred.

Cervical lymphadenitis in childhood due to mycobacteria of the Fortuitum group

Two children with cervical lymphadenitis due to Mycobacterium fortuitum infection are described; both presented with erythema nodosum.

Activity of amikacin, erythromycin and doxycyline against Mycobacterium chelonei and Mycobacterium fortuitum

The activity of amikacin, erythromycin and doxycycline was studied against 18 strains of M. fortuitum and 10 of M. chelonei. The agar dilution technique was used for the evaluation of the minimum inhibitory concentration. Between the three drugs tested, amikacin was the most active, since 66.6% of the M. fortuitum and 80% of M. chelonei strains were inhibited at 12.8 microgram/ml. It is possible that in some circumstances amikacin could be useful in the treatment of infections caused by M. fortuitum or M. chelonei.

Cutaneous nontuberculous mycobacterial infections

Nine patients exhibiting the characteristic clinical patterns in cutaneous atypical mycobacterial infections are presented. The verrucous plaque, sporotrichoid, ulcerated abscess, and scrophulous presentations are illustrated. The history, clinical appearance and treatment of cutaneous 'atypical' mycobacterial infections are reviewed.

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M. fortuitum and M. chelonei-fast growing mycobacteria. A review with a case report

Infection due to opportunist mycobacteria is considered in general and that due to the fast growing mycobacteria in particular. The group is now seen to contain two facultative pathogens, M. fortuitum and M. chelonei (abscessus), all other synonyms for these two species having been shown to be invalid. Both organisms are ubiquitous and normally harmless; however, following injury or injection, they may cause chronic sub-cutaneous abscesses. Pulmonary lesions have also been described. More recently M. fortuitum has been found to cause osteomyelitis and corneal ulceration and both organisms have been identified in cases of septicaemia associated with renal dialysis. In the past M. chelonei my have been identified as M. fortuitum but although it is more difficult to isolate, it may in fact be the more common cause of disease. A case is reported of an English girl who received a small injury to her shin in Spain. The initial lesion failed to heal and for 18 months there was repeated formation small sinuses in the area. Healing then occurred spontaneously. Histology showed a chronic granuloma and on two occasions a rapid growing mycobacteria resistant to all antibiotics was isolated. This was initially identified as M. fortuitum but finally as M. chelonei and the latter diagnosis was confirmed by differential skin tests. Difficulties in interpretation of these tests are discussed.

Primary isolation of Mycobacterium chelonei subspecies abscessus from pus inoculated into peptone broth

We have described the isolation of Mycobacterium chelonei subspecies abscessus which on two occasions grew out within 4 days in routine cultures after inoculation with purulent material from injection abscesses in a patient with diabetes mellitus. Media isolation and culture characteristics of this organism in comparison to others in the Mycobacterium fortuitum complex are described. Mycobacteria in routine laboratory media can be mistaken for diphtheroids or other "contaminants" or can be overlooked entirely. The possibility of clinical infection of mycobacterial species should be kept in mind when confronted with "sterile" abscesses at injection sites.

Tuberculoid lymphadenitis due to Mycobacterium chelonei

An 8-year-old boy developed cervical lymphadenitis four months after an injection of dental anaesthetic. Histology of the lymphatic tissue showed a tuberculoid granulomatous reaction with scanty acid-fast bacilli. Mycobacterium chelonei was isolated in pure culture (NCTC 10882). The patient showed specific skin hypersensitivity to an extract of M. chelonei, but not to that of M. ranae. This is thought to be the first recorded case of lymphadenitis in man caused by M. chelonei; it adds another possibility to be considered in the differential diagnosis of ;a lump in the neck'.

Atypical mycobacterial infections in ophthalmology

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Serological and bacteriological investigation of Mycobacterium ranae (fortuitum)

Twenty strains of a species of fast growing Mycobacterium, some named M. fortuitum and others said to be similar to the strain of M. peregrinum, in the possession of the National Collection of Type Cultures, were examined serologically and bacteriologically. They were all found to be of the same species, but they were divisible into four serotypes (I to IV), on a basis of three variable antigens, which do not exactly correspond to the subspecies described in previous reports. The strains varied in the number of years that they had been kept in culture and were of widely divergent origin. With the exception of serotype II strains, which all came from sputa from Welsh miners, the serotypes were independent of years in culture or site of origin. Based on bacteriological and serological identity and chronological priority, we consider that M. ranae (Kuster) Bergey et al. should be reinstated in place of M. fortuitum Cruz. A modified scheme for identification of the species is proposed, which would not exclude any of the four serotypes.

Revised classification of anonymous mycobacteria

Anonymous mycobacteria can be classified into 10 groups by methods and media usually available in the clinical bacteriology department. These groups are given names which reflect the species they are thought to contain or an important cultural characteristic.