Abstract
Introduction:Mycobacterium haemophilum is one of the non-tuberculous mycobacteria (NTM) that can cause cutaneous infection. As acid-fast staining cannot distinguish NTM from Mycobacterium tuberculosis, and as skin culture for M. haemophilum is not performed routinely, the diagnosis of M. haemophilum infection in Thailand is rarely made.Case presentation:Between 2006 and 2009, five patients with M. haemophilum infection were diagnosed in Ramathibodi Hospital, a tertiary care centre in Bangkok, Thailand. The patients were aged 3, 29, 47, 75 and 76 years, and four were immunocompromised. Three patients received immunosuppressive medication. Most patients presented with subacute cutaneous infection. A suboptimal response to conventional antibiotics raised suspicions of M. haemophilum cutaneous infections, which can occur in immunocompromised patients. Diagnoses of these cases were made by skin culture for mycobacteria at an incubating temperature of around 30 °C with iron supplementation, DNA sequencing, or PCR/restriction enzyme analysis. Rifampicin, ofloxacin and clarithromycin were active against all isolates, whereas ethambutol and streptomycin were inactive.Conclusion:Skin culture should be performed under special conditions or molecular technique should be used to identify M. haemophilum in susceptible patients.
Highlights
Mycobacterium haemophilum is one of the non-tuberculous mycobacteria (NTM) that can cause cutaneous infection
Skin culture should be performed under special conditions or molecular technique should be used to identify M. haemophilum in susceptible patients
Mycobacterium haemophilum is a fastidious organism that has rarely been documented as a cause of human infection
Summary
Mycobacterium haemophilum is a fastidious organism that has rarely been documented as a cause of human infection. Case 3 had an HIV infection, which was diagnosed as central nervous system (CNS) lymphoma with a skin lesion that was found incidentally on her upper extremities. Between 2006 and 2009, five patients with M. haemophilum infection were diagnosed in Ramathibodi Hospital, a medical school and tertiary care centre in Bangkok, Thailand (Table 1). Drug susceptibility testing was determined only for the isolates obtained from the second, third and fourth cases by the broth microdilution method supplemented with haemin (Bernard et al, 1993). The first patient was treated with azithromycin, ciprofloxacin and rifampicin Her skin lesions improved and she recovered completely after 9 months of treatment. Case 5 received one active drug, ofloxacin, but immunosuppressive drugs were decreased and the lesion still improved
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