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Vilstrup E, Dahl VN, Fløe A, Degn KB. Disseminated Mycobacterium genavense infection in a patient with a history of sarcoidosis. BMJ Case Rep 2023; 16:e254792. [PMID: 37147106 PMCID: PMC10163504 DOI: 10.1136/bcr-2023-254792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
We present a case of Mycobacterium genavense infection in a man in his 60s with a history of sarcoidosis, treated for 24 years with systemic corticosteroids and later methotrexate as monotherapy. He presented with low grade fever, dyspnoea and right-sided thoracic pain and was admitted due to a treatment-refractory infection. After a prolonged period of symptoms and diagnostics, acid-fast bacilli were demonstrated in pleural fluid and PCR revealed M. genavense The patient was treated with intravenous amikacin, peroral azithromycin, rifampicin and ethambutol for a total of 18 months, with a good clinical and radiological treatment response. Infection with M. genavense is rare in HIV-negative immunocompromised hosts. Diagnosing and treating mycobacterial infections, especially for more rare species, remains a challenge as clinical evidence is sparse. Nonetheless, the disease-causing infection must be considered in symptomatic and immunocompromised patients.
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Affiliation(s)
- Emil Vilstrup
- Department of Internal Medicine Viborg, Viborg Regional Hospital, Viborg, Denmark
| | - Victor Næstholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
| | - Kristine Bruun Degn
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
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Eskandari SK, Jonkers SY, Almesned MAM, Akkerman OW, Verschuuren EAM, Gan CTJ. Recurrent fever 3 years post-lung transplantation: A treacherous case of Mycobacterium genavense. Transpl Infect Dis 2021; 23:e13741. [PMID: 34607392 DOI: 10.1111/tid.13741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Siawosh K Eskandari
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Transplantation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sterre Y Jonkers
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mohammad A M Almesned
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Tuberculosis Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren, Netherlands
| | - Erik A M Verschuuren
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Christiaan Tji-Joong Gan
- Department of Pulmonary Disease and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Ekermans P, de Gama R, Kock C, Hoosien E, Slavik T, Marshall T, Corcoran C, van Ingen J. An unusual case of abdominal mycobacterial infection: Case report and literature review. South Afr J HIV Med 2019; 20:993. [PMID: 31534791 PMCID: PMC6739527 DOI: 10.4102/sajhivmed.v20i1.993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/13/2019] [Indexed: 11/30/2022] Open
Abstract
This article presents a case of an HIV-infected paediatric patient with an unusual Mycobacterium genavense infection with predominantly abdominal organ involvement.
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Affiliation(s)
- Pieter Ekermans
- Department of Microbiology, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Rene de Gama
- Department of Paediatrics, Netcare Unitas Hospital, Centurion, South Africa
| | - Celeste Kock
- Department of Paediatrics, Mediclinic Midstream Hospital, Midstream, South Africa
| | - Ebrahim Hoosien
- Department of Microbiology, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Tomas Slavik
- Department of Histology, AMPATH Laboratories, Pretoria, South Africa
| | - Terry Marshall
- Department of Molecular Medicine, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Craig Corcoran
- Department of Molecular Medicine, National Reference Laboratory, AMPATH Laboratories, Centurion, South Africa
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Holland SM, Pierce VM, Shailam R, Glomski K, Farmer JR. Case 28-2017. A 13-Month-Old Girl with Pneumonia and a 33-Year-Old Woman with Hip Pain. N Engl J Med 2017; 377:1077-1091. [PMID: 28902581 DOI: 10.1056/nejmcpc1706097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Steven M Holland
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Virginia M Pierce
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Randheer Shailam
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Krzysztof Glomski
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
| | - Jocelyn R Farmer
- From the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (S.M.H.); and the Departments of Pediatrics (V.M.P.), Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Massachusetts General Hospital, and the Departments of Pathology (V.M.P., K.G.), Radiology (R.S.), and Medicine (J.R.F.), Harvard Medical School - both in Boston
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Ombelet S, Van Wijngaerden E, Lagrou K, Tousseyn T, Gheysens O, Droogne W, Doubel P, Kuypers D, Claes K. Mycobacterium genavenseinfection in a solid organ recipient: a diagnostic and therapeutic challenge. Transpl Infect Dis 2016; 18:125-31. [DOI: 10.1111/tid.12493] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 01/23/2023]
Affiliation(s)
- S. Ombelet
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - E. Van Wijngaerden
- Department of General Internal Medicine; University Hospitals Leuven; Leuven Belgium
| | - K. Lagrou
- Department of Laboratory Medicine; University Hospitals Leuven; Leuven Belgium
| | - T. Tousseyn
- Department of Pathology; University Hospitals Leuven; Leuven Belgium
| | - O. Gheysens
- Department of Nuclear Medicine; University Hospitals Leuven; Leuven Belgium
| | - W. Droogne
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - P. Doubel
- Department of Nephrology; AZ Groeninge; Kortrijk Belgium
| | - D. Kuypers
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
| | - K.J. Claes
- Department of Nephrology; University Hospitals Leuven; Leuven Belgium
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Wassilew N, Ciaffi L, Calmy A. Mesenterial involvement of Mycobacterium genavense infection: hard to find, hard to treat. BMJ Case Rep 2015; 2015:bcr-2014-208241. [PMID: 25976189 DOI: 10.1136/bcr-2014-208241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mycobacterium genavense is a rare pathogen affecting severely immunosuppressed patients. We report the case of persistent relapsing M. genavense infection in a 48-year-old African man with a positive diagnosis of HIV infection. Despite being under effective antiretroviral therapy with partial immune reconstitution, he developed irreversible long-term abdominal complications, possibly due to persistent M. genavense infection and sustained inflammation. Case management consists of individual risk assessment, close follow-up and personalised treatment strategies concerning the duration of antimycobacterial therapy and early application of steroids. Patients with profound immunosuppression, a high viral load at HIV diagnosis and a high burden of M. genavense, appear to be at higher risk. The pathogenicity of this complication is not well known and its optimal management has still to be determined.
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Affiliation(s)
- Nasstasja Wassilew
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Laura Ciaffi
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
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Mycobacterium genavense Infections in a Tertiary Hospital and Reviewed Cases in Non-HIV Patients. PATHOLOGY RESEARCH INTERNATIONAL 2014; 2014:371370. [PMID: 24693456 PMCID: PMC3945967 DOI: 10.1155/2014/371370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/10/2014] [Indexed: 11/18/2022]
Abstract
Mycobacterium genavense is a relatively new species of nontuberculous mycobacterium reported to cause disseminated infections in patients with AIDS and later on in non-HIV immunosuppressed patients. We describe clinical and laboratory features and response to therapy in 7 patients, three of them with HIV infection and four non-HIV-three organ transplant recipients and one with hyper-IgE syndrome-in Valencia, Spain, in a ten years period. We then summarize the published cases of M. avium complex infection, with invasion of peripheral blood, liver, spleen, bone marrow, lymph nodes, and lungs. In clinical samples a large number of acid-fast bacilli were observed. M. genavense grew only from liquid media and after a prolonged incubation period. Its identification was accomplished through molecular methods. Patients were treated with prolonged combinations of antimicrobial agents. There was clinical favourable outcome in 4 patients.
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Brackers de Hugo L, Ffrench M, Broussolle C, Sève P. Granulomatous lesions in bone marrow: clinicopathologic findings and significance in a study of 48 cases. Eur J Intern Med 2013; 24:468-73. [PMID: 23414770 DOI: 10.1016/j.ejim.2012.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Granulomas in bone marrow are an infrequent finding related to various disorders. The aim of this study was to review our clinical experience with granulomatous bone marrow disease and to describe the contributions of recent diagnostic tools, such as (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and molecular biology. METHODS Clinical, laboratory and morphological data on patients with a granuloma based on bone marrow biopsy analysed in the University Hospital Lyon from May 2004 to July 2010 were reviewed. RESULTS We identified 57 cases among 9641 bone marrow biopsies, representing an incidence of 0.59% in the series and an annual incidence of 9.5 cases per year. Nine biopsies performed for staging a known pathology were excluded from further analysis. Among the 48 remaining patients, associated disease was demonstrated in 79%, with infections being the most common (33%), following by sarcoidosis (21%), malignancy (19%) and therapy-induced granulomas (6%). One previously unpublished entity is described: infection with Bartonella henselae diagnosed using molecular biology from node and skin biopsies in two renal transplant patients. (18)F-FDG-PET, performed in 13 cases, showed hypermetabolic foci consistent with sarcoidosis in two cases. Positive PCR result for an infectious pathogen was obtained in three bone marrow samples (Mycobacterium tuberculosis, n=1; Mycobacterium genavense, n=2). CONCLUSION In comparison to previous research, our study reports high proportions of cases caused by sarcoidosis and unknown causes. (18)F-FDG-PET could show signs consistent with sarcoidosis and molecular biology is useful for the detection of fastidious bacteria in immunocompromised patients.
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Lhuillier E, Brugière O, Veziris N, Danel C, Mourvilliers B, Mal H, Dauriat G. Relapsing Mycobacterium Genavense Infection as a Cause of Late Death in a Lung Transplant Recipient: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2012; 10:618-20. [DOI: 10.6002/ect.2012.0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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