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Feizi S, Cooksley CM, Ramezanpour M, Nepal R, Psaltis AJ, Wormald PJ, Vreugde S. Colloidal silver against macrophage infections and biofilms of atypical mycobacteria. Biometals 2023; 36:913-925. [PMID: 36729280 PMCID: PMC10393856 DOI: 10.1007/s10534-023-00494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
Skin and soft tissue infection (SSTI) caused by atypical mycobacteria such as Mycobacterium abscessus and Mycobacterium avium intracellulare complex (MAIC) have increased in recent years. Current therapeutic options are limited, and hence new and better therapies are urgently required. Colloidal Silver (CS) has been identified for its widespread antibacterial properties and silver-impregnated dressings have been used for SSTIs caused by various pathogens. The efficacy of Green Synthesized Colloidal Silver (GSCS) was investigated for bacterial growth inhibition (BGI) using a microdilution method and minimum biofilm eradication concentration (MBEC) using resazurin assay and confocal scanning laser microscopy (CSLM) of M. abscessus (n = 5) and MAIC (n = 5). The antibacterial effect of GSCS against M. abscessus infected macrophages was also evaluated. The in vitro cytotoxicity of GSCS on a human keratinocyte cell line (HaCaT) and neonatal foreskin fibroblasts was analyzed by the crystal violet proliferation assay. Average BGI and MBEC of GSCS varied between 0.7 and 22 ppm for M. abscessus and MAIC. The concentration of 3 ppm reduced M. abscessus-infection in macrophages significantly. GSCS was not cytotoxic to HaCaT and neonatal foreskin fibroblast cells at concentrations < 3 ppm up to 2 h exposure time. GSCS therefore, has the potential for topical application against atypical mycobacterial SSTI.
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Affiliation(s)
- Sholeh Feizi
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Clare M Cooksley
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Mahnaz Ramezanpour
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Roshan Nepal
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia.
- The University of Adelaide, Adelaide, Australia.
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Abstract
Atypical microbial keratitis refers to corneal infections caused by micro-organisms not commonly encountered in clinical practice. Unlike infections caused by common bacteria, cases of atypical microbial keratitis are often associated with worse clinical outcomes and visual prognosis. This is due to the challenges in the identification of causative organisms with standard diagnostic techniques, resulting in delays in the initiation of appropriate therapies. Furthermore, due to the comparatively lower incidence of atypical microbial keratitis, there is limited literature on effective management strategies for some of these difficult to manage corneal infections. This review highlights the current management and available evidence of atypical microbial keratitis, focusing on atypical mycobacteria keratitis, nocardia keratitis, achromobacter keratitis, and pythium keratitis. It will also describe the management of two uncommonly encountered conditions, infectious crystalline keratopathy and post-refractive infectious keratitis. This review can be used as a guide for clinicians managing patients with such challenging corneal infections.
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Affiliation(s)
- Hon Shing Ong
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore.
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Lynette M Phee
- Department of Pathology, Sengkang General Hospital, SingHealth, Singapore
| | - Jodhbir S Mehta
- Corneal and External Diseases Department, Singapore National Eye Centre, Singapore; Tissue Engineering and Cell Therapy Department, Singapore Eye Research Institute, Singapore; Department of Ophthalmology and Visual Science, Duke-National University of Singapore (NUS) Graduate Medical School, Singapore; School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
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Roy CF, Balakrishnan K, Boudewyns A, Cheng A, Chun RH, Daniel SJ, Fayoux P, Hart C, Hemansson A, Hewitt R, Hsu WC, Kuo M, Liu C, Maddalozzo J, Messner AH, Pransky S, Rahbar R, Rickert S, Roy S, Russell J, Rutter MJ, Sie KCY, Sidell D, Smith R, Soma M, Spratley J, Watters K, White DR, Wolter N, Zalzal G, Yeung JC. International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of non-tuberculous mycobacterial cervicofacial lymphadenitis. Int J Pediatr Otorhinolaryngol 2023; 166:111469. [PMID: 36764081 DOI: 10.1016/j.ijporl.2023.111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/27/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. OBJECTIVES This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges. METHODS A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. SETTING Multinational, multi-institutional, tertiary pediatric hospitals. RESULTS Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. CONCLUSION The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation.
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Affiliation(s)
- Catherine F Roy
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Robert H Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sam J Daniel
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head and Neck Surgery, CHU Lille, F-59000, Lille, France
| | - Catherine Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ann Hemansson
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Richard Hewitt
- Department of Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Wei-Chung Hsu
- Division of Pediatric Otolaryngology, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan
| | - Michael Kuo
- Department of Pediatric Otolaryngology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Christopher Liu
- Division of Pediatric Otolaryngology, UT Southwestern Medical Center, Dallas, TX, USA
| | - John Maddalozzo
- Department of Otolaryngology/Head and Neck Surgery, Lurie Children's Hospital, Chicago, IL, USA
| | - Anna H Messner
- Department of Otolaryngology/Head & Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Seth Pransky
- Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
| | - Reza Rahbar
- Department of Pediatric Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Rickert
- Division of Pediatric Otolaryngology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA
| | - Soham Roy
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - John Russell
- Department of Pediatric Otorhinolaryngology, Children's Health Ireland (Crumlin), Dublin, Ireland
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kathleen C Y Sie
- Department of Otolaryngology Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, USA
| | - Douglas Sidell
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Richard Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marlene Soma
- Department of Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Faculty of Medicine, S. Joao Hospital Center, CINTESIS, Porto, Portugal
| | - Karen Watters
- Department of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA, USA
| | - David R White
- Division of Pediatric Otolaryngology, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Nikolaus Wolter
- Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - George Zalzal
- Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington, DC, USA
| | - Jeffrey C Yeung
- Department of Otolaryngology Head & Neck Surgery, McGill University Health Center, Montreal, QC, Canada.
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Lam JTW, Lam SC, Kwok TYT, Yuen HKL. Atypical mycobacterium infection following upper eyelid Müller's muscle-conjunctival resection - case report. Orbit 2022:1-4. [PMID: 35073223 DOI: 10.1080/01676830.2022.2025856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Periorbital non-tuberculous mycobacterium (NTM) infections are uncommon. To the best of our knowledge, NTM infection as a complication following Müller's muscle-conjunctival resection (MMCR) surgery has not been reported before. We report a case of left upper lid M. Chelonae infection following MMCR surgery. A 61-year-old lady presented with left upper lid swelling and nodular mass 4 weeks after bilateral MMCR surgery for aponeurotic ptosis. Past medical and ocular history include systemic lupus erythematosus (SLE), chronic hepatitis B infection, bilateral cataract operation done 14 years ago and right eye Fuch's dystrophy with Descemet stripping automated endothelial keratoplasty done 3 years ago. She was initially treated with topical and oral antibiotics, as well as repeated incision and curettage and intralesional steroid injection with limited improvement. Seven months post-MMCR, repeated biopsy and nodule debulking were performed. Biopsy revealed granulomatous inflammation with mycobacterial infection and PCR identified M. Chelonae. A total of 6 months course of combination systemic antibiotics were given, with good response. Limited blepharoplasty with repeat nodular excision was performed 15 months after the initial MMCR surgery, and biopsy culture and PCR were both negative. No relapse of symptoms was noted and good lid height was maintained at 30 months of follow-up. Management of periorbital NTM infections can be challenging. Clinicians should consider early diagnostic workup with mycobacterial culture and PCR in suspicious cases, followed by prompt initiation of empiric treatment with systemic macrolides. A combination of surgical excision of nodules and prolonged systemic antimicrobial treatment is needed for complete organism eradication.
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Affiliation(s)
- Julia T W Lam
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Stacey C Lam
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tracy Y T Kwok
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Hunter K L Yuen
- Department of Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Gaballah A, Ghazal A, Almiry R, Emad R, Sadek N, Abdel Rahman M, El-Sherbini E. Simultaneous Detection of Mycobacterium tuberculosis and Atypical Mycobacteria by DNA-Microarray in Egypt. Med Princ Pract 2022; 31:246-253. [PMID: 35413718 PMCID: PMC9274830 DOI: 10.1159/000524209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Immunocompromised patients are a high-risk group for developing mycobacterial infections with either pulmonary and/or extrapulmonary diseases. Low-cost/density DNA-microarray is considered an easy and efficient method for the detection of typical and atypical mycobacterial species. MATERIALS AND METHODS Thirty immunocompromised patients were recruited to provide their clinical specimens (sputum, serum, urine, and lymph node aspirates). Real-time polymerase chain reaction (PCR) and DNA-microarray techniques were performed and compared to the conventional methods of Ziehl-Neelsen staining and Lowenstein Jensen culturing. RESULTS Mycobacterium tuberculosis complex was detected in all 30 clinical specimens (100% sensitivity) by real-time PCR and DNA-microarray. Additionally, coinfection with 4 atypical species belonging to nontuberculous mycobacteria was identified in 7 sputum specimens. These atypical mycobacterial species were identified as M. kansasii 10% (n = 3), M. avium complex 6.6% (n = 2), M. gordanae 3.3% (n = 1), and M. peregrinum 3.3% (n = 1). CONCLUSION This study documents the presence of certain species of atypical mycobacteria among immunocompromised patients in Egypt.
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Affiliation(s)
- Ahmed Gaballah
- Microbiology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
- *Ahmed Gaballah,
| | - Abeer Ghazal
- Microbiology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Reda Almiry
- Clinical Pathology Department, Military Academy of Medicine, Alexandria Armed Forces Hospital, Alexandria, Egypt
| | - Rasha Emad
- Clinical Pharmacy, Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
| | - Nadia Sadek
- Hematology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohamed Abdel Rahman
- Clinical Pathology Department, Military Academy of Medicine, Alexandria Armed Forces Hospital, Alexandria, Egypt
| | - Eglal El-Sherbini
- Microbiology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Olivas-Mazón R, Blázquez-Gamero D, Alberti-Masgrau N, López-Roa P, Delgado-Muñoz MD, Epalza C. Diagnosis of nontuberculous mycobacterial lymphadenitis: the role of fine-needle aspiration. Eur J Pediatr 2021; 180:1279-1286. [PMID: 33205252 DOI: 10.1007/s00431-020-03875-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
Nontuberculous mycobacterial lymphadenitis often presents a diagnostic challenge. This study aimed to evaluate the role of fine-needle aspiration cytology in the diagnosis of nontuberculous mycobacterial lymphadenitis in children. We conducted a retrospective review of fine-needle aspiration cytology performed in patients < 17 year-old with subacute lymphadenitis from 2003 to 2016 in a tertiary hospital in Spain. Confirmed nontuberculous mycobacterial lymphadenitis (isolation of nontuberculous mycobacterial in culture from fine-needle aspiration cytology or biopsy samples) and probable nontuberculous mycobacterial lymphadenitis ("granulomatous inflammation" in cytopathologic examinations from fine-needle aspiration cytology or biopsy and clinical-epidemiological history compatible with nontuberculous mycobacterial) were selected. Forty-one patients with nontuberculous mycobacterial lymphadenitis were included: 14 confirmed and 27 probable. Fine-needle aspiration cytology was done in all of them. For 34 patients with excised lymphadenopathy, cytopathology from fine-needle aspiration cytology was concordant with biopsy in 100% cases. Culture results were available from 78.0% (32/41) of patients with fine-needle aspiration cytology and from 85.3% (29/34) with excisional biopsy. Among 22 patients with microbiological results from fine-needle aspiration cytology and biopsy, fine-needle aspiration cytology allowed advanced results in concordance with biopsy or with positive isolation not found in biopsy in 90.1% (20/22) of patients. Sensitivity of nontuberculous mycobacterial cultures obtained by fine-needle aspiration cytology compared to biopsy was 45.5% vs. 36.4% (p = 0.07). Two patients with previous skin alterations presented fistulas after fine-needle aspiration cytology (4.9%); no other complications were described.Conclusion: Fine-needle aspiration cytology provides quick cytopathologic information and is an accurate and safe technique for the diagnosis of nontuberculous mycobacterial lymphadenitis, especially in cases with challenging work-up. What is Known: • Nontuberculous mycobacterial (NTM) infection is an important cause of subacute lymphadenitis in children. • Fine-needle aspiration cytology (FNAC) is an available technique for the diagnosis of lymphadenitis of unknown etiology. What is New: • FNAC is an accurate and safe technique for the diagnosis of NTM lymphadenitis in children. • FNAC can provide reliable samples for cytopathological studies and even a better sensitivity for microbiological culture than excisional biopsy in the study of suspected NTM lymphadenitis.
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Affiliation(s)
- Raquel Olivas-Mazón
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain.
- Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain.
| | | | - Paula López-Roa
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Cristina Epalza
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avenida de Córdoba S/N, 28048, Madrid, Spain
- Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Madrid, Spain
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Pinitpuwadol W, Tesavibul N, Boonsopon S, Sakiyalak D, Sarunket S, Choopong P. Nontuberculous mycobacterial endophthalmitis: case series and review of literature. BMC Infect Dis 2020; 20:877. [PMID: 33228593 PMCID: PMC7685667 DOI: 10.1186/s12879-020-05606-2] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis. Methods Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized. Results We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients’ age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60. Conclusions NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner’s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05606-2.
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Affiliation(s)
- Warinyupa Pinitpuwadol
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Darin Sakiyalak
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Sucheera Sarunket
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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Keyur B, Dhaval M, Daxa K. Atypical Mycobacterial Infection a Threat for Developing Countries with Improper Sterilization Techniques. J Gastrointest Surg 2020; 24:2661-2663. [PMID: 32666498 DOI: 10.1007/s11605-020-04731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Bhatt Keyur
- SIDS Hospital & Research Center, Majura Gate, Ring Road, Surat, Gujarat, 395001, India.
| | - Mangukiya Dhaval
- SIDS Hospital & Research Center, Majura Gate, Ring Road, Surat, Gujarat, 395001, India
| | - Kachhadiya Daxa
- SIDS Hospital & Research Center, Majura Gate, Ring Road, Surat, Gujarat, 395001, India
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Sédillot-Daniel È, Voizard B, Vallières É, Woods O, Quintal MC. Chronic suppurative otomastoiditis due to nontuberculous mycobacteria: A case series. Int J Pediatr Otorhinolaryngol 2020; 138:110375. [PMID: 33152966 DOI: 10.1016/j.ijporl.2020.110375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/05/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center. METHODS All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec's provincial public health and reference laboratory. RESULTS All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically. CONCLUSION Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control.
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Affiliation(s)
- Ève Sédillot-Daniel
- Division of Pediatric Otorhinolaryngology, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montreal, Quebec, Canada.
| | - Béatrice Voizard
- Division of Pediatric Otorhinolaryngology, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montreal, Quebec, Canada.
| | - Émilie Vallières
- Department of Clinical Laboratory Medicine, Division of Microbiology, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montreal, Quebec, Canada; Department of Pediatrics, Division of Infectious Diseases, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montreal, Quebec, Canada
| | - Owen Woods
- Division of Pediatric Otorhinolaryngology, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montreal, Quebec, Canada.
| | - Marie-Claude Quintal
- Division of Pediatric Otorhinolaryngology, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montreal, Quebec, Canada.
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Su C, Cowper SE, Ramachandran S, Little AJ. Erythema nodosum due to Mycobacterium abscessus infection complicating autologous fat transfer. Int J Womens Dermatol 2020; 6:340-341. [PMID: 33015302 PMCID: PMC7522915 DOI: 10.1016/j.ijwd.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chang Su
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Shawn E Cowper
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States.,Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Sarika Ramachandran
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Alicia J Little
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
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Zhukhovitskaya A, Chang DT, Huoh KC, Pham NS, Singh J, Ahuja GS. Surgical management of atypical mycobacterial cervical lymphadenitis in an outbreak of odontological infection. Int J Pediatr Otorhinolaryngol 2020; 131:109882. [PMID: 31981916 DOI: 10.1016/j.ijporl.2020.109882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/27/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We report on our experience with surgical management of nosocomial Mycobacterium abscessus cervical lymphadenitis in the setting of an epidemic linked to a dental practice in the community. METHODS This is an observational case series of children who required surgical treatment of cervical lymphadenitis as part of multidisciplinary management of nosocomial M. abscessus infections. We describe the criteria for surgical management of cervical lymphadenitis as well as patient characteristics and outcomes. RESULTS Over 1000 children undergoing pulpectomies and pulpotomies at a local dental practice with a contaminated water source were identified as potentially susceptible to atypical mycobacteria infection, identified as M. abscessus. Between August 2016 and May 2017 108 children underwent inpatient evaluation at our institution by general pediatricians and pediatric infectious disease specialists. 90 children required at least 1 surgical intervention by pediatric otolaryngology and/or oral and maxillofacial surgery (OMFS). Children were evaluated by the Pediatric Otolaryngology service if computer tomography (CT) scan of the neck demonstrated lymph nodes of at least 1.5 cm in shortest dimension or lymph nodes with central hypolucencies suspicious for infection with central necrosis. Pediatric Otolaryngology intervened on 11 patients all of whom required selective cervical lymphadenectomy with or without curettage. These patients ranged in age from 3 to 8 years; 8 were male, 6 had concurrent pulmonary nodules. Two patients underwent curettage in addition to lymphadenectomy. Five patients required at least 2 surgical interventions by Pediatric Otolaryngology. CONCLUSION We found M. abscessus to be an aggressive infection requiring early cervical lymphadenectomy in select patients.
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Affiliation(s)
- A Zhukhovitskaya
- University of California - Irvine, Department of Otolaryngology, Orange, CA, USA; CHOC Children's Hospital, Orange, CA, USA.
| | - D T Chang
- CHOC Children's Hospital, Orange, CA, USA
| | - K C Huoh
- CHOC Children's Hospital, Orange, CA, USA
| | - N S Pham
- CHOC Children's Hospital, Orange, CA, USA
| | - J Singh
- CHOC Children's Hospital, Orange, CA, USA
| | - G S Ahuja
- CHOC Children's Hospital, Orange, CA, USA
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Schubert N, Schill T, Plüß M, Korsten P. Flare or foe? - Mycobacterium marinum infection mimicking rheumatoid arthritis tenosynovitis: case report and literature review. BMC Rheumatol 2020; 4:11. [PMID: 32190818 PMCID: PMC7074991 DOI: 10.1186/s41927-020-0114-3] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Rheumatoid arthritis is the most common type of inflammatory arthritis affecting about 1% of the population. With the advent of disease-modifying anti-rheumatic drugs the disease can be well controlled in many cases. Patients, however, are prone to developing infectious complications. In rare cases, these can mimic a flare of the underlying itself. Case presentation We report the case of a 45-year-old female patient with a history of seronegative rheumatoid arthritis (RA) who presented with swelling and tenderness of the third metacarpophalangeal joint of the right hand. A flare of her RA was suspected based on clinical and ultrasound findings which showed a tenosynovitis with intense power doppler activity. Her steroid dose was increased but the clinical response to glucocorticoid therapy was very limited. Subsequently, she developed skin manifestations of ‘swimmer’s granuloma’ over the next 2 weeks after first presentation. Finally, a diagnosis of a Mycobacterium marinum infection was established with the help of tissue biopsy and culture, and the patient received appropriate antibiotic treatment with the desired effect. Conclusions This case highlights the difficulty of distinction between infection and inflammation in patients with joint swelling and pain, especially in the age of disease-modifying drugs (DMARDs) and the concomitant risk of atypical infections. A review of the literature identified eight additional published cases, which suggests that Mycobacterium marinum infection is a rare but recognized complication of DMARD therapy. It can mimic a flare of the underlying arthritis potentially leading to diagnostic delays, and requires differential diagnostic methods to identify the pathogen and pave the way for appropriate treatment.
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Affiliation(s)
- Nils Schubert
- 1Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| | - Tillmann Schill
- 2Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Marlene Plüß
- 1Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| | - Peter Korsten
- 1Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
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13
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Klann E, Beal SG, Tremblay EE. Evaluating differences in tuberculosis and nontuberculous mycobacterial lung disease in Florida. Am J Infect Control 2019; 47:1324-1328. [PMID: 31204093 DOI: 10.1016/j.ajic.2019.04.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Currently, very little data exists that compare the features of pulmonary nontuberculous mycobacteria (NTM) and Mycobacterium tuberculosis (TB). Both have similar symptomology and analogous preliminary laboratory results, as both present with positive acid-fast bacilli stains. The objective of this study was to provide data that would help guide clinicians in their decision making regarding isolation precautions for patients, with a preliminary positive result for mycobacteria, prior to species identification. METHODS We conducted queries for patients who had positive respiratory cultures for mycobacteria via our electronic medical record system, between January 1, 2011, and December 31, 2017. Additionally, we collected demographic and medical history, clinical presentation, and radiographic findings. The 2-sample unpaired Student t test, the Χ2 test, and logistic regression were used to compare each group. RESULTS Through logistic regression, 8 variables were significantly associated with patients who grew either TB or NTM. History of incarceration, born outside of the United States, cavitation, and lymphadenopathy were associated with TB; tobacco smoke exposure, pre-existing lung disease, immunosuppression, and bronchiectasis were associated with NTM. Incidence of HIV and hemoptysis was not significantly different between the 2 groups. CONCLUSIONS Through the use of our study findings, improper use of airborne isolation precautions may be reduced or avoided.
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Ku JH, Ranches G, Siegel SAR, Winthrop KL. 'Lady Windermere's counterpart? Pulmonary nontuberculous mycobacteria in men with bronchiectasis. Diagn Microbiol Infect Dis 2020; 96:114916. [PMID: 31740173 DOI: 10.1016/j.diagmicrobio.2019.114916] [Citation(s) in RCA: 5] [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: 06/24/2019] [Revised: 09/15/2019] [Accepted: 09/22/2019] [Indexed: 01/15/2023]
Abstract
Pulmonary nontuberculous mycobacterial (NTM) disease occurs frequently in older women, and phenotypes of men with NTM disease are largely undescribed. We conducted a case-control study of 34 men with non-cystic fibrosis pulmonary NTM disease (cases), and three male and female control groups with or without NTM disease. Cases were median 71 years of age (range 30-94) and mostly non-Hispanic white (85.3%). These men had similarly low BMI as their female NTM patient counterparts, which was lower than both healthy men (p < 0.001) and bronchiectatic men without NTM (p = 0.06). Kyphoscoliosis was also more common in cases than healthy men (p= 0.007) or bronchiectatic men without NTM (p = 0.02). Our study was the first study to our knowledge to examine demographic features and phenotypes of men with NTM disease. Larger studies are needed to ascertain whether these phenotypes are characteristic of men with NTM disease.
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Butt S, Tirmizi A. Mycobacterium smegmatis bacteremia in an immunocompetent host. IDCases 2019; 15:e00523. [PMID: 30937286 DOI: 10.1016/j.idcr.2019.e00523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/20/2022] Open
Abstract
Non-tuberculous mycobacteria can cause catheter associated blood stream infections. The causative agents are generally rapid growers that belong to the Mycobacterium fortuitum and Mycobacterium mucogenicum groups. A 65 year hospitalized patient with temporary central venous catheter who developed Mycobacterium smegmatis bacteremia. Bacteremia cleared after removal of the catheter. Patient was treated initially with 4 weeks of intravenous amikacin, intravenous meropenem, oral doxycycline and oral ethambutol and then deescalated to oral doxycycline and oral ciprofloxacin for 8 weeks. He improved clinically and remained stable. A literature search identified total of 22 articles that reported 47 unique cases of Mycobacterium smegmatis infection. To our knowledge, this is the first case of Mycobacterium smegmatis central venous catheter associated bacteremia in an immunocompetent host.
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16
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Le Turnier P, Bemer P, Guillouzouic A, Boutoille D, Asseray N. [Identification of Mycobacterium parascrofulaceum in a patient presenting with chronic osteomyelitis]. Med Mal Infect 2019; 49:78-80. [PMID: 30309663 DOI: 10.1016/j.medmal.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/03/2018] [Accepted: 09/04/2018] [Indexed: 11/20/2022]
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17
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Aliberti S, Codecasa LR, Gori A, Sotgiu G, Spotti M, Di Biagio A, Calcagno A, Nardini S, Assael BM, Tortoli E, Besozzi G, Ferrarese M, Matteelli A, Girardi E, De Lorenzo S, Seia M, Gramegna A, Del Prato B, Terranova L, Oriano M, Sverzellati N, Mirsaeidi M, Chalmers JD, Haworth CS, Loebinger MR, Aksamit T, Winthrop K, Ringshausen FC, Previdi G, Blasi F. The Italian registry of pulmonary non-tuberculous mycobacteria - IRENE: the study protocol. Multidiscip Respir Med 2018; 13:33. [PMID: 30151192 PMCID: PMC6101082 DOI: 10.1186/s40248-018-0141-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background A substantial increase in pulmonary and extra-pulmonary diseases due to non-tuberculous mycobacteria (NTM) has been documented worldwide, especially among subjects suffering from chronic respiratory diseases and immunocompromised patients. Many questions remain regarding the epidemiology of pulmonary disease due to NTM (NTM-PD) mainly because reporting of NTM-PD to health authorities is not mandated in several countries, including Italy. This manuscript describes the protocol of the first Italian registry of adult patients with respiratory infections caused by NTM (IRENE). Methods IRENE is an observational, multicenter, prospective, cohort study enrolling consecutive adult patients with either a NTM respiratory isolate or those with NTM-PD. A total of 41 centers, including mainly pulmonary and infectious disease departments, joined the registry so far. Adult patients with all of the following are included in the registry: 1) at least one positive culture for any NTM species from any respiratory sample; 2) at least one positive culture for NTM isolated in the year prior the enrolment and/or prescribed NTM treatment in the year prior the enrolment; 3) given consent to inclusion in the study. No exclusion criteria are applied to the study. Patients are managed according to standard operating procedures implemented in each IRENE clinical center. An online case report form has been developed to collect patients’ demographics, comorbidities, microbiological, laboratory, functional, radiological, clinical, treatment and outcome data at baseline and on an annual basis. An IRENE biobank has also been developed within the network and linked to the clinical data of the registry. Conclusions IRENE has been developed to inform the clinical and scientific community on the current management of adult patients with NTM respiratory infections in Italy and acts as a national network to increase the disease’s awareness. Trial registration Clinicaltrial.gov: NCT03339063.
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Affiliation(s)
- Stefano Aliberti
- 1Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.,2Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Luigi Ruffo Codecasa
- Regional TB Reference Centre, Istituto Villa Marelli, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Gori
- 4Clinic of Infectious Diseases, 'San Gerardo" Hospital-ASST Monza, University Milano-Bicocca, Milan, Italy
| | - Giovanni Sotgiu
- 5Clinical Epidemiology and Medical Statistics Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Maura Spotti
- 1Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.,2Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Antonio Di Biagio
- 6Clinica Malattie Infettive, Policlinico Ospedale S. Martino, Genoa, Italy
| | - Andrea Calcagno
- 7Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Stefano Nardini
- 8Ospedale Civile, Pulmonary and TB Unit, Vittorio Veneto, Italy
| | - Baroukh Maurice Assael
- 1Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.,2Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Enrico Tortoli
- 9Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maurizio Ferrarese
- Regional TB Reference Centre, Istituto Villa Marelli, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Matteelli
- 11WHO Collaborating Centre for TB/HIV co-infection and TB Elimination, Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Disease "L. Spallanzani, Rome, Italy
| | - Saverio De Lorenzo
- E. Morelli Hospital ASST, Reference Center for MDR-TB and HIV-TB, Sondalo, Italy
| | - Manuela Seia
- 14Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gramegna
- 1Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.,2Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Bruno Del Prato
- 15Unit of Interventional Pulmonology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Leonardo Terranova
- 16Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Martina Oriano
- 1Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.,2Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Nicola Sverzellati
- 17Scienze Radiologiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Mehdi Mirsaeidi
- 18Miami Veterans Administration Medical Center, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Miami School of Medicine, Miami, FL USA
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Charles S Haworth
- 20Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | | | | | - Kevin Winthrop
- 23Oregon Health and Science University, Portland, OR USA
| | - Felix C Ringshausen
- 24Dept of Respiratory Medicine, Member of the German Centre for Lung Research, Hannover Medical School, Hannover, Germany
| | - Giuliana Previdi
- Aziende Socio Sanitarie Territoriale Melegnano e della Martesana, Vizzolo Predabissi, Milan, Italy
| | - Francesco Blasi
- 1Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy.,2Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
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Abstract
PURPOSE OF REVIEW Many genetic conditions predispose affected individuals to opportunistic infections. A number of immunodeficiency diseases, including genetic defects termed Mendelian susceptibility to mycobacterial disease (MSMD), permit infection from many different strains of mycobacteria that would otherwise not cause disease. These include tuberculous and nontuberculous mycobacteria, and bacille Calmette-Guérin vaccine (BCG). Patients may present with infections from other organisms that depend on macrophage function for containment. Defects in multiple genes in the IL-12 and NFKB signaling pathways can cause the MSMD phenotype, some of which include IL12RB1, IL12B, IKBKG, ISG15, IFNGR1, IFNGR2, CYBB, TYK2, IRF8, and STAT1. RECENT FINDINGS Multiple autosomal recessive and dominant, and 2 X-linked recessive gene defects resulting in the MSMD phenotype have been reported, and others await discovery. This review presents the known gene defects and describes clinical findings that result from the mutations. If MSMD is suspected, a careful clinical history and examination and basic immunodeficiency screening tests will narrow the differential diagnosis. A specific diagnosis requires more sophisticated laboratory investigation. Genetic testing permits a definitive diagnosis, permitting genetic counseling. Mild cases respond well to appropriate antibiotic therapy, whereas severe disease may require hematopoietic stem cell transplantation.
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19
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Choi HY, Lee MH, Lee JS, Song IH, Cho KJ. Isolated subcutaneous nontuberculous mycobacterial infection: a rare case initially mischaracterized as a soft tissue malignancy. Skeletal Radiol 2018; 47:735-742. [PMID: 29273829 DOI: 10.1007/s00256-017-2851-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 09/27/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 02/02/2023]
Abstract
The occurrence of nontuberculous mycobacterial (NTM) infection is rare, and the involvement of the musculoskeletal system is even less common. However, the incidence of soft tissue and skin NTM infection is increasing, particularly in patients who undergo injections and minor surgical procedures. Given the non-specific clinical manifestations of NTM infection, the lack of knowledge among physicians regarding this rare infection could lead to inaccurate and delayed diagnosis. Herein, we present a case of an isolated subcutaneous NTM infection caused by Mycobacterium abscessus in the upper back of an immunocompetent 68-year-old woman. The clinical presentation, magnetic resonance imaging findings (including diffusion-weighted imaging), and pathologic findings of subcutaneous NTM infection are described and compared with those of tuberculosis and tumor presentations to provide a more accurate clinical picture for a differential diagnosis.
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Affiliation(s)
- Hee Young Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Seoul, Songpa-gu, 138-736, South Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Seoul, Songpa-gu, 138-736, South Korea.
| | - Jong-Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Lamuka PO, Njeruh FM, Gitao GC, Matofari J, Bowen R, Abey KA. Prevalence of bovine and avian tuberculosis in camel herds and associated public health risk factors in Isiolo County, Kenya. Trop Anim Health Prod 2018; 50:937-945. [PMID: 29582340 DOI: 10.1007/s11250-017-1486-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/03/2017] [Indexed: 02/02/2023]
Abstract
A cross-sectional study was conducted among 308 lactating camels selected from 15 herds from three different camel milk clusters in Isiolo County, Kenya, to determine prevalence of bovine and avian tuberculosis using Single Comparative Intradermal Tuberculin Skin test. Seventy-five (75) questionnaires were administered to pastoralists/herders, and focus group discussions were conducted among 3-5 pastoralists/herders selected from each camel herd to collect information on camel husbandry and health management practices and knowledge on tuberculosis in livestock and wildlife. An overall prevalence of bovine and avian reactors was 3.57 and 18.18%, respectively, with bovine and avian reactors for different clusters being 2.38, 3.82, and 4.48% and 25, 17.2, and 11.94%, respectively. There was significant difference (p < 0.05) in prevalence of bovine and avian reactors between different clusters. There was a negative correction (r = -0.1399) between herd size and bovine reactors, while there was a positive correlation (r = 0.0445) between herd size and avian reactors. The respondents indicated that camel herds are exposed to several risk factors like close contact with other herds or livestock or wildlife during grazing and at watering points. Pastoralists have poor knowledge on mode of infection and transmission of bovine or avian tuberculosis. The high prevalence of bovine and avian reactors and pastoralists' poor knowledge on mode of transmission signify potential risk to public health.
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Affiliation(s)
- Peter O Lamuka
- Department of Food Science, Nutrition and Technology, University of Nairobi, P.O. Box 29053, Nairobi, 00625, Kenya.
| | - Francis M Njeruh
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, P.O. Box 29053, Nairobi, 00625, Kenya
| | - George C Gitao
- Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, P.O. Box 29053, Nairobi, 00625, Kenya
| | - Joseph Matofari
- Department of Dairy and Food Technology, Egerton University, P.O. Box 536, Njoro, Kenya
| | - Richard Bowen
- Department of Biomedical Sciences, Colorado State University, W113 ARBL Building, Foothill Campus, Fort Collins, CO, USA
| | - Khalif A Abey
- Kenya Camel Association, P.O. Box 6067, Nairobi, 00100, Kenya
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Chavarria M, Lutwick L, Dickinson BL. TB or not TB? Mycobacterium celatum mimicking Mycobacterium tuberculosis: A case of mistaken identity. IDCases 2018; 11:83-87. [PMID: 29464177 PMCID: PMC5814372 DOI: 10.1016/j.idcr.2018.01.015] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/26/2022] Open
Abstract
Mycobacterium celatum is a slow-growing, non-tuberculous mycobacterium (NTM) and a rare cause of infection in humans. Infection occurs primarily by inhalation or direct inoculation from environmental sources, and this pathogen has been reported to cause localized infections in the lungs and lymph nodes of both immunocompetent and immunocompromised patients, and disseminated disease in immunocompromised patients. Here, we present a case of pulmonary infection with M. celatum in an immunocompetent 68-year-old male with clinical features similar to tuberculosis. The patient initially developed palpitations, worsening fatigue, night sweats, dyspnea, productive cough, and weight loss. Computed tomography angiogram of the chest revealed a right upper lobe pulmonary artery embolus and extensive biapical fibronodular cavitary densities. Two separate sputum samples were positive for acid-fast bacilli (AFB) and sputum cultures were positive for M. celatum. The patient responded well to treatment with clarithromycin, ciprofloxacin, and ethambutol. We advise physicians to consider M. celatum infection in the differential diagnosis of patients with symptoms and radiographic and microbiologic evidence suggestive of NTM pulmonary infection.
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Affiliation(s)
- Michael Chavarria
- Western Michigan University Homer Stryker, MD School of Medicine, 1000 Oakland Avenue, Kalamazoo, MI 49008, USA
| | - Larry Lutwick
- Western Michigan University Homer Stryker, MD School of Medicine, 1000 Oakland Avenue, Kalamazoo, MI 49008, USA
| | - Bonny L Dickinson
- Western Michigan University Homer Stryker, MD School of Medicine, 1000 Oakland Avenue, Kalamazoo, MI 49008, USA
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Pinitpuwadol W, Sarunket S, Boonsopon S, Tesavibul N, Choopong P. Late-onset postoperative Mycobacterium haemophilum endophthalmitis masquerading as inflammatory uveitis: a case report. BMC Infect Dis 2018; 18:70. [PMID: 29415658 PMCID: PMC5804003 DOI: 10.1186/s12879-018-2985-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background Although atypical mycobacteria had been increasingly found in various ocular infections in the past decades, a slow-growing Mycobacterium haemophilum (M. haemophilum) was scarcely reported. Similar to tuberculous infection, the presentation can masquerade as low-grade granulomatous intraocular inflammation with partial response to corticosteroids. Besides, the special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical presentation and notify the awareness of NTM endophthalmitis among clinicians. This is the first case report of late-onset, postoperative M. haemophilum endophthalmitis in the literature. Case presentation A 66-year-old man with non-insulin-dependent diabetes mellitus (NIDDM) manifested chronic granulomatous inflammation in the left eye after multiple glaucoma surgeries. With a diagnosis of noninfectious panuveitis, he was treated with systemic corticosteroids. The inflammation initially responded to therapy although it subsequently worsened and became purulent endophthalmitis. The vitreous cultures grew M. haemophilum. Intraocular and systemic antimicrobial treatments were administered early, but the patient eventually turned blind. Conclusions M. haemophilum endophthalmitis is a rare but serious intraocular complication leading to loss of vision or eyeball. Awareness of atypical mycobacterial infections is necessary especially in patients with impaired immune function, previous intraocular surgery, and corticosteroid resistance. Proper laboratory investigations and treatments should be performed. However, due to the rarity of the disease, the development of guidelines for its investigation and therapy is still challenging.
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Affiliation(s)
- Warinyupa Pinitpuwadol
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Sucheera Sarunket
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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Invernizzi A, Ricaboni D, Franzetti M, Staurenghi G, McCluskey P, Franzetti F. Bilateral choroiditis as the only sign of persistent Mycobacterium intracellulare infection following haematogenous spread in an immunocompromised patient. Infection 2018; 46:423-6. [PMID: 29224191 DOI: 10.1007/s15010-017-1109-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
An immunocompromised patient had positive blood cultures for Mycobacterium intracellulare and no identifiable organ seeding was started on treatment. One month later, the patient was clinically well with negative blood cultures but drug-induced myelotoxicity had developed. Ocular fundus examination at this time revealed bilateral choroidal granulomas which changed patient management.
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Lutz Z, Orbán K, Bóna Á, Márk L, Maász G, Prókai L, Seress L, Lóránd T. Mannich Ketones as Possible Antimycobacterial Agents. Arch Pharm (Weinheim) 2017; 350. [PMID: 28752666 DOI: 10.1002/ardp.201700102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/07/2022]
Abstract
Twenty-three known unsaturated and fused Mannich ketones and their reduced derivatives (amino alcohols) were selected for an antituberculotic study. They were screened against several mycobacterial strains including Mycobacterium tuberculosis, M. xenopi, and M. gordonae, and minimum inhibitory concentration values were also determined using the standard antituberculotic drug isoniazid (INH) as a reference. Structure-activity relationships were also studied. The mode of action of the test compounds was investigated using transmission electron microscopy, high-performance liquid chromatography, and matrix-assisted desorption/ionization mass spectrometry. Several test substances proved to be as potent as INH, but their antimycobacterial spectra were broader than that of INH. Our findings suggest that their mode of action is probably through the inhibition of mycobacterial cell wall biosynthesis.
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Affiliation(s)
- Zsolt Lutz
- Faculty of Medicine, Department of Medical Microbiology and Immunology, University of Pécs, Pécs, Hungary
| | - Katalin Orbán
- Department of Infectology, Mor Kaposi General Hospital, Kaposvár, Hungary
| | - Ágnes Bóna
- Faculty of Medicine, Department of Biochemistry and Medical Chemistry, University of Pécs, Pécs, Hungary
| | - László Márk
- Faculty of Medicine, Department of Biochemistry and Medical Chemistry, University of Pécs, Pécs, Hungary
| | - Gábor Maász
- Faculty of Medicine, Department of Biochemistry and Medical Chemistry, University of Pécs, Pécs, Hungary
| | - László Prókai
- University of North Texas Health Science Center, Institute for Healthy Aging, Fort Worth, TX, USA
| | - Lázló Seress
- Central Electron Microscopic Laboratory, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Tamás Lóránd
- Faculty of Medicine, Department of Biochemistry and Medical Chemistry, University of Pécs, Pécs, Hungary
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Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) were considered saprophytic organisms for many years but now are recognized as human pathogens. Although humans are routinely exposed to NTM, the rate of clinical infection is low. Such infections usually occur in the elderly and in patients who are immunocompromised. However, there has been an increasing incidence in recent years of infections in immunocompetent hosts. NTM infections in immunocompetent individuals are secondary to direct inoculation either contamination from surgical procedures or penetrating injuries rather than hematogenous dissemination. Clinically and on histopathology, musculoskeletal infections caused by NTM resemble those caused by Mycobacterium tuberculosis but are mostly resistant to routine antituberculosis medicines. MATERIALS AND METHODS Six cases of NTM infection in immunocompetent hosts presenting to the department from 2004 to 2015 were included in study. Of which two cases (one patella and one humerus) of infection were following an open wound due to trauma while two cases (one hip and one shoulder) of infection were by inoculation following an intraarticular injection for arthrogram of the joint, one case was infection following arthroscopy of knee joint and one case (calcaneum) was infection following local injection for the treatment of plantar fasciitis. All patients underwent inaging and tissue diagnosis with samples being sent for culture, staining, and histopathology. RESULTS Clinical suspicion of NTM inoculation led to the correct diagnosis (four cases with culture positive and two cases with histopathological diagnosis). There treatment protocol for extrapulmonary NTM infection was radical surgical debridement and medical management based on drug sensitivity testing in culture positive cases. At a mean follow up of 3 years (range1-9 years) all patients had total remission and excellent results. CONCLUSIONS Whenever a case of chronic granulomatous infection is encountered that does not respond to standard anti-tuberculous treatment, with a history of open trauma, surgical intervention, or injection as shown in this study, a possible NTM infection should be considered and managed appropriately.
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Affiliation(s)
- Manit K Gundavda
- Department of Orthopaedics, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India,Address for correspondence: Dr. Manit K Gundavda, B/204, Hilton CHS, Shastri Nagar, Andheri West, Mumbai - 400 053, Maharashtra, India. E-mail:
| | - Hitendra G Patil
- Department of Orthopaedics, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Vikas M Agashe
- Department of Orthopaedics, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Rajeev Soman
- Department of Infectious Diseases, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Camilla Rodriques
- Department of Microbiology, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Ramesh B Deshpande
- Department of Pathology, Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
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Bonali M, Mattioli F, Alicandri-Ciufelli M, Presutti L. Atypical mycobacteriosis involving parotid and para-retropharyngeal spaces. Eur Arch Otorhinolaryngol 2016; 273:4031-4033. [PMID: 27098613 DOI: 10.1007/s00405-016-4053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
The incidence of retro-parapharyngeal localization of cervical adenitis due to non-tuberculous mycobacteria is very rare. We present a case of an 18-months-old child with an involvement of parapharyngeal and retropharyngeal areas, right parotid and submandibular regions by atypical mycobacteriosis in the CT and MRI scan. The masses were surgically removed and the frozen-section histological exam upheld their atypical mycobacterial origin.
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Affiliation(s)
- Marco Bonali
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
| | - Francesco Mattioli
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
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Abstract
Leprosy and tuberculosis are chronic mycobacterial infections that elicit granulomatous inflammation. Both infections are curable, but granulomatous injury to cutaneous structures, including cutaneous nerves in leprosy, may cause permanent damage. Both diseases are major global concerns: tuberculosis for its high prevalence and mortality, and leprosy for its persistent global presence and high rate of neuropathic disability. Cutaneous manifestations of both leprosy and tuberculosis are frequently subtle and challenging in dermatologic practice and often require a careful travel and social history and a high index of suspicion.
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Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, 1770 Physician Park Drive, Baton Rouge, LA 70816, USA.
| | - Mara M Dacso
- Center for Dermatology and Cosmetic Laser Surgery, 5026 Tennyson Parkway, Plano, TX 75024, USA; Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9069, USA
| | - Ma Luisa Abad-Venida
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Rizal Avenue, Manila 1008, Philippines
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Hung JH, Chang TC, Wu JJ, Lai CC, Huang FC, Huang YH. A cluster of Mycobacterium massiliense keratitis in foundry workers. Clin Microbiol Infect 2016; 22:386.e5-386.e8. [PMID: 26721784 DOI: 10.1016/j.cmi.2015.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
Abstract
Three consecutive workers from the same foundry had Mycobacterium massiliense keratitis. The strains isolated from each patient were identical. This is the first report of a non-surgery-related outbreak of non-tuberculous mycobacterial ocular infection. An investigation revealed that injured cornea with exposure to aerosolized non-tuberculous mycobacteria might account for this outbreak.
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Affiliation(s)
- J H Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan
| | - T C Chang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - J J Wu
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C C Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan
| | - F C Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan
| | - Y H Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan.
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Sasmal PK, Mishra TS, Rath S, Meher S, Mohapatra D. Port site infection in laparoscopic surgery: A review of its management. World J Clin Cases 2015; 3:864-871. [PMID: 26488021 PMCID: PMC4607803 DOI: 10.12998/wjcc.v3.i10.864] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/08/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic surgery (LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection (PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.
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30
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Gonzalez CD, Petersen MG, Miller M, Park AH, Wilson KF. Complex nontuberculous mycobacterial cervicofacial lymphadenitis: What is the optimal approach? Laryngoscope 2015; 126:1677-80. [PMID: 26372159 DOI: 10.1002/lary.25603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Assess the role of combined antimicrobial and surgical therapy for difficult-to-treat nontuberculous mycobacteria (NTM) lesions of the head and neck in children. STUDY DESIGN Retrospective cohort. METHODS Retrospective review of pediatric head and neck NTM lesions at a tertiary children's hospital from 1999 to 2012. RESULTS Seventy-one children were diagnosed with NTM lesions. Age of presentation ranged between 7 and 204 months of age. Most patients (62%) had multiple lesions. Treatments included incision and drainage, curettage, antibiotics, excision, and any combination of surgery and antibiotics. Upon initial presentation, the most common treatment was surgical excision alone (n = 34) with a high complication rate (50%). In 18 cases, patients were initially treated with a combination of antibiotics and surgical excision due to the extent or location of the lesion(s). Complication rate in these patients was also high (67%). The most common complications in surgically excised NTM lesions included temporary or persistent facial nerve dysfunction (24.6%), poor wound healing/scarring (10.8%), and Frey's syndrome (6.2%). CONCLUSIONS Surgical excision with or without medical therapy for NTM cervicofacial lymphadenitis in high-risk regions commonly resulted in marginal mandibular nerve dysfunction (24.6%). Postoperative facial nerve weakness generally resolved within a year. High rates of complications and a lack of proven best approaches suggest tailoring the approach to address the potential risks in that particular patient based on location and severity. LEVEL OF EVIDENCE 4 Laryngoscope, 126:1677-1680, 2016.
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Affiliation(s)
| | | | - Matthew Miller
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kevin F Wilson
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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31
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Gaspard W, N'Gampolo I, Rivière F, Lefloch H, Margery J, Marotel C, Soler C, Vaylet F. [Mycobacterial pulmonary infection due to Mycobacterium simiae]. Rev Mal Respir 2015; 33:248-52. [PMID: 26282361 DOI: 10.1016/j.rmr.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Mycobacterium simiae pulmonary infections remain exceptional in France. CASE REPORT We report a case of M. simiae lung infection and a 10-year follow-up in a non-immunocompromised host. CONCLUSION This case emphasizes the difficulties of choosing the appropriate drugs and their side effects in the absence of any existing gold standard.
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Affiliation(s)
- W Gaspard
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - I N'Gampolo
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - F Rivière
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - H Lefloch
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - J Margery
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Marotel
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - C Soler
- Service de biologie, hôpital d'instruction des armées Percy, 92023 Clamart, France
| | - F Vaylet
- Service des maladies respiratoires, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
| | - Ana Gameiro
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Leonor Ramos
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - José Carlos Cardoso
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Maria Manuel Brites
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Óscar Tellechea
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Américo Figueiredo
- Dermatology Department, Coimbra University Hospital Centre, Coimbra, Portugal
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Lefebvre MA, Quach C, Daniel SJ. Chronic suppurative otitis media due to nontuberculous mycobacteria: A case of successful treatment with topical boric acid. Int J Pediatr Otorhinolaryngol 2015; 79:1158-60. [PMID: 26026892 DOI: 10.1016/j.ijporl.2015.04.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 01/08/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 11/28/2022]
Abstract
Nontuberculous mycobacteria (NTM) are an increasingly recognized cause of chronic suppurative otitis media in children with tympanostomy tubes. Treatment of this condition is difficult and typically requires a combination of systemic antibiotics and surgical debridement. We present the first case of a 2-year-old male with chronic suppurative otitis media due to NTM who failed systemic antibiotic therapy and was successfully managed with topical boric acid powder. This report highlights the challenges involved in treating this infection, and introduces boric acid as a potentially valuable component of therapy.
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Affiliation(s)
- Marie-Astrid Lefebvre
- Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, C-1242, Montreal, Quebec, Canada H3H 1P3.
| | - Caroline Quach
- Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, C-1242, Montreal, Quebec, Canada H3H 1P3; Department of Medical Microbiology, McGill University Health Centre, 2300 Tupper Street, C-1242, Montreal, Quebec, Canada H3H 1P3; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, Quebec, Canada H3A 1A2.
| | - Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, C-1242, Montreal, Quebec, Canada H3H 1P3.
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Narkhede R, Shah NM, Dalal PR, Mangukia C, Dholaria S. Postoperative Mesh Infection-Still a Concern in Laparoscopic Era. Indian J Surg 2015; 77:322-6. [PMID: 26702240 DOI: 10.1007/s12262-015-1304-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction of synthetic mesh was a landmark breakthrough in the management of hernia repair and has significantly reduced recurrence rates. But in addition to the benefits, some more problems have come in picture major being 'mesh infection'. Prolene mesh has shown promise when used in abdominal and inguinal hernia repair, especially when used in planned surgeries. This material, derived from monofilament polypropelene, is found to be biologically inert in almost every person. Being a foreign material, a slightest breach in asepsis can lead to favourable environment for bacterial proliferation and form a 'biofilm'. This phenomenon especially after laparoscopic surgeries gives rise to chronic discharging sinus at the port site, abscess formation around mesh and even sepsis. It appears that laparoscopic hernia repair is a promising method but having chances of mesh infection owing to difficult approach and lack of uniformity in sterilization of laparoscopic instruments. Slightest breach in sterility or protocols might lead to such a large ventral wall sinus, increasing morbidity and cost of treatment. Treatment of infected mesh is possible by local debridement, irrigation, mesh removal and systemic antibiotics culminating in increased morbidity over duration of disease, but still it would be worth emphasizing-'Prevention is better than cure'.
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Akpinar T, Bakkaloglu OK, Ince B, Tufan F, Kose M, Poda M, Tascioglu D, Koksalan OK, Saka B, Erten N, Buyukbabani N, Kilicaslan Z, Tascioglu C. Case report of fatal Mycobacterium tilburgii infection. J Infect Chemother 2015; 21:538-40. [PMID: 25818194 DOI: 10.1016/j.jiac.2015.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/03/2015] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Abstract
There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.
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Affiliation(s)
- Timur Akpinar
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Oguz K Bakkaloglu
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burak Ince
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatih Tufan
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Murat Kose
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehves Poda
- Dept. of Genetics, DETAE, Istanbul University, Istanbul, Turkey
| | - Didem Tascioglu
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - O Kaya Koksalan
- Mol. TB. Epi. Lab., DETAE, Istanbul University, Istanbul, Turkey
| | - Bulent Saka
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nilgun Erten
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Dept. of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zeki Kilicaslan
- Dept. of Chest Diseases and Tuberculosis, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cemil Tascioglu
- Dept. of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Kannaiyan K, Ragunathan L, Sakthivel S, Sasidar AR, Muralidaran, Venkatachalam GK. Surgical site infections due to rapidly growing mycobacteria in puducherry, India. J Clin Diagn Res 2015; 9:DC05-8. [PMID: 25954616 DOI: 10.7860/jcdr/2015/10572.5638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 02/02/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rapidly growing Mycobacteria are increasingly recognized, nowadays as an important pathogen that can cause wide range of clinical syndromes in humans. We herein describe unrelated cases of surgical site infection caused by Rapidly growing Mycobacteria (RGM), seen during a period of 12 months. MATERIALS AND METHODS Nineteen patients underwent operations by different surgical teams located in diverse sections of Tamil Nadu, Pondicherry, Karnataka, India. All patients presented with painful, draining subcutaneous nodules at the infection sites. Purulent material specimens were sent to the microbiology laboratory. Gram stain and Ziehl-Neelsen staining methods were used for direct examination. Culture media included blood agar, chocolate agar, MacConkey agar, Sabourauds agar and Lowenstein-Jensen medium for Mycobacteria. Isolated microorganisms were identified and further tested for antimicrobial susceptibility by standard microbiologic procedures. RESULTS Mycobacterium fortuitum and M.chelonae were isolated from the purulent drainage obtained from wounds by routine microbiological techniques from all the specimens. All isolates analyzed for antimicrobial susceptibility pattern were sensitive to clarithromycin, linezolid and amikacin but were variable to ciprofloxacin, rifampicin and tobramycin. CONCLUSION Our case series highlights that a high level of clinical suspicion should be maintained for patients presenting with protracted soft tissue lesions with a history of trauma or surgery as these infections not only cause physical but also emotional distress that affects both the patients and the surgeon.
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Affiliation(s)
- Kavitha Kannaiyan
- Assistant Professor, Department of Microbiology, Aarupadai Veedu Medical College , Puducherry, India
| | - Latha Ragunathan
- Professor, Department of Microbiology, Aarupadai Veedu Medical College , Puducherry, India
| | - Sulochana Sakthivel
- Assistant Professor, Department of Anatomy, Aarupadai Veedu Medical College , Puducherry, India
| | - A R Sasidar
- Managing Director, Department of General Surgery, ARR Hospital , Cuddalore, India
| | - Muralidaran
- Managing Director, Department of General Surgery, S.M Hospital Cuddalore Tamil Nadu, India
| | - G K Venkatachalam
- Associate Professor, Department of General Surgery, Aarupadai Veedu Medical College , Puducherry, India
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Affiliation(s)
- O Rahama
- Hull and East Yorkshire Hospitals NHS Trust, UK
| | - H Thaker
- Hull and East Yorkshire Hospitals NHS Trust, UK
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Pham-Huy A, Robinson JL, Tapiéro B, Bernard C, Daniel S, Dobson S, Déry P, Le Saux N, Embree J, Valiquette L, Quach C. Current trends in nontuberculous mycobacteria infections in Canadian children: A pediatric investigators collaborative network on infections in Canada (PICNIC) study. Paediatr Child Health 2013; 15:276-82. [PMID: 21532791 DOI: 10.1093/pch/15.5.276] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2009] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) infections appear to be increasing in number and severity in developed countries worldwide. Surgical excision has been considered the standard treatment for NTM lymphadenitis, but the use of medical therapy seems to be increasing. OBJECTIVE To determine the disease characteristics as well as the current therapeutic management of NTM infections in Canadian children. METHODS Cases of definite or probable NTM infections were identified prospectively in children up to 18 years of age seen in 10 Canadian paediatric tertiary care centres from September 2005 to August 2006. Clinical, microbiological and pathological data were collected. RESULTS A total of 60 cases were identified. Data were complete for 45 patients, including 34 cases of lymphadenitis, four cases of skin and soft tissue infection, and seven cases of pulmonary NTM infection. Seventy-nine per cent of children (27 of 34) with lymphadenitis had an unsuccessful course of antibiotics before diagnosis. Sixty-eight per cent of purified protein derivative tests (15 of 22) were positive. NTM was detected in 76% of samples (29 of 38), of which 62% were Mycobacterium avium complex. All patients with lymphadenitis underwent surgical therapy and most patients (74%) also received antimicrobials. CONCLUSIONS Current trends indicate that the majority of the study centres are using medical therapy with variable regimen and duration as an adjunct to surgical excision in the treatment of NTM lymphadenitis. Larger numbers and longer follow-up times are needed to better evaluate the efficacy of medical therapy and outcome of disease. A randomized controlled study comparing surgical therapy alone and chemotherapy for NTM lymphadenitis is required.
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Affiliation(s)
- Anne Pham-Huy
- Infectious Diseases Division, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec
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Shah A, Stani A, Adalja M, George A. Immune reconstitution disease or mycobacteria other than tuberculosis or both: A dilemma in a patient of AIDS. Indian J Sex Transm Dis AIDS 2012. [PMID: 22529455 PMCID: PMC3326850 DOI: 10.4103/2589-0557.93824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A 35-year-old male diagnosed as HIV with tuberculous lymphadenopathy, presented with acute increase in size of neck swelling and fever. The patient was on antiretroviral therapy and antitubercular treatment. Investigations revealed raised CD4 counts and the pus from swelling showed mycobacteria other than tuberculosis (MOTT) on bacteriological examination.The patient was started on steroids, azithromycin, and ciprofloxacin to which he responded well. We report this case to highlight the occurrence of immune reconstitution disease in HIV patients and also to bring out the fact that atypical infection like MOTT may confound the diagnosis even in regions like ours where MOTT is rarely reported.
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Affiliation(s)
- Arti Shah
- Department of Pulmonary Medicine, SBKS Medical Institute and Research Centre, Vadodara, India,Address for correspondence: Dr. Arti Shah, Dhawal Nursing Home, Harni Ring Road, Karelibaug, Vadodara, Gujarat, India. E-mail:
| | - Ajay Stani
- Department of Pulmonary Medicine, SBKS Medical Institute and Research Centre, Vadodara, India
| | - Mayur Adalja
- Department of Pulmonary Medicine, SBKS Medical Institute and Research Centre, Vadodara, India
| | - Ajay George
- Department of ENT, SBKS Medical Institute and Research Centre, Vadodara, India
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Abstract
We describe here a case of abdominal abscesses due to Mycobacterium fortuitum following liposuction. The abscesses developed three months after the procedure and diagnosis was delayed for five months. The clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. This condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. Combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.
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Chaudhuri S, Sarkar D, Mukerji R. Diagnosis and management of atypical mycobacterial infection after laparoscopic surgery. Indian J Surg. 2010;72:438-442. [PMID: 22131651 DOI: 10.1007/s12262-010-0164-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 06/04/2010] [Indexed: 01/13/2023] Open
Abstract
Atypical mycobacterial infections at the laparoscopic port site are a frequent problem encountered in patients undergoing laparoscopic surgery. In this study we concentrate on the clinical diagnosis, management and prevention of this problem. In this series we assess 19 patients presenting with port hole infections after laparoscopic surgery and were treated with a combination of oral clarithromycin and ciprofloxacin. Seven patients who had persistent nodules were given injections of amikacin directly into the infection foci along with standard oral therapy. Most of the patients treated with standard oral therapy for 28 days showed recovery. The patients with persistent nodules 4 weeks after completion of therapy were treated with injections of amikacin directly into the nodule which lead to resolution of symptoms. For prevention of infection, proper sterilization and storage of instruments is recommended. Laparoscopic port hole infections is a preventable problem and can also be treated by nonsurgical method.
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Lee SH, Min JW, Um SW, Han SS, Han SK, Shim YS, Yim JJ. Sequential bilateral lung resection in a patient with Mycobacterium abscessus lung disease refractory to medical treatment. Yonsei Med J 2010; 51:141-4. [PMID: 20046529 PMCID: PMC2799965 DOI: 10.3349/ymj.2010.51.1.141] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 06/11/2008] [Accepted: 06/11/2008] [Indexed: 11/29/2022] Open
Abstract
Mycobacterium abscessus (M. abscessus) is the second most common nontuberculous mycobacteria (NTM) in South Korea. Nevertheless, the diagnosis and treatment of M. abscessus lung disease can be problematic. Surgical resection has been tried for patients with localized M. abscessus lung disease refractory to medical treatment. Here, we report on a 25-year-old woman with M. abscessus lung disease who had been diagnosed and treated three times for pulmonary tuberculosis. She was initially diagnosed as having M. intracellulare lung disease; however, M. abscessus was isolated after several months of medication. She had multiple bronchiectatic and cavitary lesions bilaterally, and M. abscessus was repeatedly isolated from her sputa despite prolonged treatment with clarithromycin, ethambutol, moxifloxacin, and amikacin. She improved only after sequential bilateral lung resection. Based on the experience with this patient, we suggest that, if medical treatment fails, surgical resection of a diseased lung should be considered even in patients with bilateral lesions.
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Affiliation(s)
- Seung Heon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Won Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seon-Sook Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Soo Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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