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Obeid KM, Hassan MA, Chinnakotla S, Young JH. Genitourinary Tract Infection Due to Mycobacterium avium intracellulare Complex Infection in Pretransplant Setting With Recurrence Following Transplant: A Case Report. Transplant Proc 2018; 50:3937-3939. [PMID: 30577290 DOI: 10.1016/j.transproceed.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Abstract
Genitourinary (GU) tract infection with Mycobacterium avium intracellulare complex (MAI) is very rare and, to our knowledge, has never been reported in the solid organ transplant literature. CASE DESCRIPTION: A 61-year-old Somali-born woman had a history of liver cirrhosis due to chronic hepatitis C infection. She was diagnosed as having and treated for latent tuberculosis infection and GU tract infection due to MAI. She received a total of 17 months antimycobacterial therapy consisting of azithromycin, ethambutol, and moxifloxacin. Within 5 months of the initiation of antimicrobial therapy, there was documented sterilization of urine mycobacterial cultures. Liver and kidney transplant was performed 3 months after finishing the treatment course. One year following transplant, GU tract infection due to MAI recurred. She declined further diagnostic testing as well as mycobacterial therapy. She died 15 months following transplant for reasons not related to infections. CONCLUSION: The treatment of MAI infection in solid organ transplant candidates and recipients is challenging, and the duration of therapy in this population is not known. The recurrence of infection following transplant in this case may argue in favor of a duration that extends beyond the date of transplant. The combination of a fluoroquinolone and ethambutol may successfully prevent reactivation of tuberculosis in patients with history of latent tuberculosis infection and deserves further evaluation.
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Affiliation(s)
- K M Obeid
- Program in Adult Transplant Infectious Disease, Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - M A Hassan
- Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - S Chinnakotla
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - J H Young
- Program in Adult Transplant Infectious Disease, Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Baldolli A, Daurel C, Verdon R, de La Blanchardière A. High mortality in peritonitis due to Mycobacterium avium complex: retrospective study and systematic literature review. Infect Dis (Lond) 2018; 51:81-90. [PMID: 30318980 DOI: 10.1080/23744235.2018.1519639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Mycobacterium avium complex (MAC) infection is often disseminated and mainly involves lymph nodes, spleen, liver or bone marrow. Peritonitis due to MAC infection (PMAC) is a very uncommon manifestation. METHODS In this report, after describing the case of the only PMAC infection in our 10-year retrospective study, which occurred in an AIDS patient who was non-adherent to highly active antiretroviral therapy (HAART), we performed a systematic literature review of documented bacteriological PMAC. RESULTS Including our patient, 51 cases of PMAC have been reported. Patients were most often male (sex ratio 2.14), with a median age of 41 years (2.8-72) and an immunodeficiency in all cases, most often AIDS (57%), cirrhosis (20%) and continuous ambulatory peritoneal dialysis (CAPD) (18%). Ascites was more often chylous (54%) than exudative (46%) and, in this case, lymphocytic (60%), with an inconstantly positive acid-fast bacilli smear (54%). Non-disseminated PMAC patients were more likely to have peritoneal dialysis (39% versus 6.5%, p < .01) or cancer with immunosuppressive therapy (39% versus 0%, p < .0001), while AIDS was the leading underlying disease in disseminated-PMAC patients (83% versus 11%, p < .001). Mortality was high (50%), with no difference between disseminated and non-disseminated PMAC. CONCLUSIONS This report highlights the need to be aware of an atypical presentation of PMAC infection, which is associated with a high rate of mortality even for non-disseminated infection.
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Affiliation(s)
- Aurélie Baldolli
- a Infectious Diseases Department , CHU de Caen , Caen , France.,b Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie University , Caen , France
| | - Claire Daurel
- c Microbiology Department, CHU de Caen , Caen , France
| | - Renaud Verdon
- a Infectious Diseases Department , CHU de Caen , Caen , France.,b Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie University , Caen , France
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Koizumi Y, Sakagami T, Minamiguchi H, Makino A, Aoki A, Hodohara K, Mikamo H, Andoh A, Fujiyama Y. Chylous ascites, anti-interferon-gamma autoantibody, and angioimmunoblastic T-cell lymphoma: a rare but intriguing connection over Mycobacterium avium. Med Microbiol Immunol 2019; 208:33-7. [PMID: 30083859 DOI: 10.1007/s00430-018-0555-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 08/01/2018] [Indexed: 12/19/2022]
Abstract
We report a case of non-AIDS (acquired immunodeficiency syndrome), non-CAPD (Continuous Ambulatory Peritoneal Dialysis), non-cirrhotic, Mycobacterium avium peritonitis, which is a rare form of mycobacterial infection. A 66-year-old Japanese man who had been treated previously for angioimmunoblastic T-cell lymphoma (AITL), had developed disseminated M. avium infection. Antimycobacterial regimen improved his symptoms; however, following an interruption in treatment, he developed chylous ascites. The patient died of uncontrolled peritonitis despite intensive treatment. Anti-interferon-γ autoantibody was positive, and AITL was presumed to be involved in autoantibody production. A rare coexistence of chylous ascites, autoantibody, and AITL taught us an intriguing lesson on the pathogenesis of M. avium infection. Particularly, we conclude that treatment strategies for M. avium infection should aim to restore immunity.
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Toyoda M, Yokomori H, Kaneko F, Yoshida H, Takahashi A, Hoshi K, Takeuchi H, Tahara K, Kondo H, Motoori T. Hepatic granulomas as primary presentation of Mycobacterium avium infection in an HIV-negative, nonimmunosuppressed patient. Clin J Gastroenterol 2009; 2:431-437. [PMID: 26192801 DOI: 10.1007/s12328-009-0117-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 09/18/2009] [Indexed: 11/28/2022]
Abstract
Nontuberculous hepatic granuloma in patients not infected by human immunodeficiency virus (HIV) is rare. We report an 89-year-old woman who presented with hepatic granuloma without lung involvement. Ultrasonography and computed tomography (CT) of the abdomen showed low-density lesions in the liver. Histopathological examination of a liver biopsy revealed florid, caseating granulomatous reaction with aggregates of epithelioid histiocytes and Langerhans-type giant cells in a predominantly portal and periportal distribution. Gastric juice cultures were positive for Mycobacterium avium. The patient was treated with antimycobacterial therapy. Her clinical condition improved dramatically within 1 month of starting therapy, with marked reduction in hepatomegaly together with normalization of liver biochemistry and CT findings.
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Affiliation(s)
- Megumi Toyoda
- Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Hiroaki Yokomori
- Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
| | - Fumihiko Kaneko
- Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Hide Yoshida
- Division of Rheumatology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan
| | - Akihiko Takahashi
- Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Kenta Hoshi
- Division of Rheumatology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan
| | - Hajime Takeuchi
- Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Kumiko Tahara
- Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan
| | - Hirobumi Kondo
- Division of Rheumatology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan
| | - Tadashi Motoori
- Division of Pathology, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan
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Kawana M, Starr RS, Tashima KT, Treaba DO, Flanigan TP. Spontaneous perforation of the terminal ileum in an AIDS patient on highly active antiretroviral therapy with disseminated non-tuberculous mycobacterial infection. Int J Infect Dis 2008; 12:603-6. [PMID: 18434225 DOI: 10.1016/j.ijid.2007.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 12/04/2007] [Accepted: 12/10/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Despite the impact of highly active antiretroviral therapy (HAART), mycobacterial infections in patients with AIDS remain a frequent complication. In disseminated cases, both tuberculous and non-tuberculous mycobacterial infections may involve the gastrointestinal system and cause abdominal pain and diarrhea. While there have been cases of small bowel perforation in AIDS patients with Mycobacterium tuberculosis (MTB) infection, no case of bowel perforation in non-tuberculous mycobacterial (NTM) infection has been reported to date. CASE REPORT We report a case of spontaneous perforation of the terminal ileum in an AIDS patient with disseminated non-tuberculous mycobacterial infection who was responding to HAART. CONCLUSIONS Non-tuberculous mycobacteria can lead to spontaneous bowel perforation in patients with AIDS who are responding to HAART.
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Affiliation(s)
- Masataka Kawana
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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