Atypical Mycobacterial Infection Research Articles

Rice Body Tenosynovitis without Tuberculosis Infection after Multiple Acupuncture Procedures in a Hand.

Rice Body Tenosynovitis without Tuberculosis Infection after Multiple Acupuncture Procedures in a Hand.

Atypical mycobacterial infection: Report of 4 cases

Atypical mycobacterial infection: Report of 4 cases

Iatrogenic Mycobacterium abscessus infection in a trigger finger

An immunocompetent 63-year-old lady developed Mycobacterium abscessus soft tissue infection of the hand following local corticosteroid injection for trigger finger. The patient was successfully treated with repeated radical debridement and prolonged antimicrobial therapy. Atypical mycobacterial infections, including those caused by M. abscessus, albeit rare, should be considered in cases of late-onset indolent infection following local injury surgical procedures, and injections. Clinical vigilance, timely diagnosis, combined directed antimicrobial treatment, coupled with adequate surgical debridement are key for successful management.

Atypical Osteomyelitis Caused by Mycobacterium chelonae in a Nonimmunocompromised Patient: A Case Report.

A previously healthy fifty-seven-year-old woman presented with an acute atypical mycobacterial infection of the first metatarsal bone of the left foot. Despite antimicrobial treatment, the infection was not controlled. First-ray amputation was performed, and antimicrobial treatment was continued for a total of six months. The patient was fitted with an orthotic (insole) and followed for eighteen months; there was no recurrence of infection. To the best of our knowledge, this is the first case report describing Mycobacterium chelonae osteomyelitis of the first metatarsal ray in an immunocompetent individual. This diagnosis should be considered in patients with osteomyelitis that persists despite the use of broad-spectrum antibiotics, even in healthy individuals.

Disseminated Atypical Mycobacterial Infection in Three Patients with Complete Digeorge Anomaly

Disseminated Atypical Mycobacterial Infection in Three Patients with Complete Digeorge Anomaly

A Clinico-Mycological Study on Suspected Cases of Chromoblastomycosis: Challenges in Diagnosis and Management.

Verrucous plaques mimicking chromoblastomycosis are frequently seen in dermatology outpatient departments (OPD). However, no scientific evaluation has been carried out till date from eastern India. So this present endeavour is aimed at a thorough study of those cases to readdress the challenges in diagnosis and management in chromoblastomycosis from this part of the country. The study is to observe the incidence of proved chromoblastomycosis cases from clinically mimicking conditions and to note therapeutic prospects by use of different antifungal agents. Twenty clinically suspected cases attending dermatology OPD were included in this study. Relevant histories were taken. Apart from routine hematological and biochemical investigations, scrapings from lesions were examined by direct microscopy with KOH wet mount, calcoflour white mount and fungal culture. Histopatholgical examination was also done. Any fungal growth was identified by growth characteristics and morphological features. Sclerotic bodies were detected in five samples. Of them three were found to be culture positive. Two growths were identified as Fonsecaea pedrosoi and one as Cladosporium carrionii. Rest 12 cases were diagnosed as either lupus vulgaris (3 cases; 15%), atypical mycobacterial infections (3 cases, 15%), Hypertrophic lichen planus (2, 10%), Hypertrophic DLE plaque (2; 10%), Wart (1, 5%) or fixed cutaneous sporothricosis (1, 5%), zygomycosis (1, 5%). Three cases (15%) were lost in follow up. Cases of chromoblastomycosis were managed with prolonged use of antifungal alone or in combination with saturated solution of potassium iodide and/or debridement. They were followed up for at least six months post treatment. A database comprising diagnostic clues and effective therapeutic intervention have been proposed for these rare subcutaneous mycoses.

Mycobacterial Co-Infection in Retroviral Disease

Atypical mycobacteria are increasingly afflicting pulmonary and extra pulmonary systems. Disease caused by these organisms are less common compared with tuberculosis caused by human strain of mycobacteria, but there has been a significant increase in pulmonary and extra pulmonary infections due to atypical mycobacteria especially in retroviral disease in the last two decades. 75 HIV positive patients who had pulmonary and/or extrapulmonary manifestations suggestive of Tuberculosis were included in our study. Of these, 48 (64%) were males and 27(36%)were females. Majority of these patients were in economically productive and sexually active age group of 31-50 years. Of the 75 samples, 25 were culture positive for Acid Fast Bacilli whereas 50 samples showed no growth on culture at end of 8 weeks. Of the 25 who had positive cultures, 15 showed growth for Mycobacterium TB and 10 showed growth for Atypical mycobacteria. Of the 25 patients who were Culture positive, 16 i.e 64% had Sputum smears by Z-N stain positive for AFB, which was statistically significant. It was observed that Atypical mycobacterial infection was more common in CD4 count < 100 cells/cu mm. Infection with Mycobacterium TB was more common in CD4 count between 101-200 cells/cu mm.

Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature.

Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome.

Long-term safety and efficacy of rituximab in 7 Japanese patients with ANCA-associated vasculitis

Objectives. The safety and efficacy of rituximab were examined in a multicenter open-label pilot study in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in Japan.Methods. Patients with refractory AAV were administered a rituximab infusion at a weekly dose of 375 mg/m2 for 4 weeks. All patients also received oral daily prednisolone. The primary outcome was complete remission, which was defined as a Birmingham Vasculitis Activity Score (BVAS) of 0 or 1.Results. The mean age of the 7 patients was 57 (range, 34–71) years. The mean follow-up period after rituximab treatment was 62.9 (range, 4.8–81) months. The mean BVAS at entry was 16.7 (range, 2–34). Complete remission occurred in all cases, except in 1 case in which the patient died, with a significant decline in BVAS from baseline at 12 months after initiation of rituximab. Rituximab reduced granulomatous orbital involvement in a patient with granulomatosis with polyangiitis. Relapse occurred in five patients. Adverse events included de novo hepatitis B in one patient, cancer (hepatocellular carcinoma and prostate cancer) in two patients, and transient visual disturbance, atypical mycobacterial infection, urinary tract infection, sepsis, and cytomegalovirus infection. Two patients died due to recurrent infections and airway obstruction, caused by an AAV lesion.Conclusions. Rituximab had a beneficial effect on refractory AAV in Japanese patients, but several adverse effects occurred during rituximab treatment.

Successful Haploidentical Hematopoietic Stem Cell Transplant for GATA2 Deficiency

▪Background: GATA2 deficiency results in a clinical syndrome known variably as: MonoMAC for the lack of monocytes and atypical mycobacterial infections (MAC); DCML, dendritic cell, monocyte and lymphoid cell deficiency; Emberger’s syndrome with lymphedema and monosomy 7; and familial myelodysplastic syndrome (MDS)/acute myelogenous leukemia (AML). Reconstitution of the deficient cell compartments in GATA2 deficiency with allogeneic hematopoietic stem cell transplant (HSCT) results in reversal of the infection susceptibility and represents the only curative therapy for both the myeloid disease and the virally driven malignancies seen in this disorder. However, only about one-half of patients that require HSCT will have an HLA-matched related or unrelated donor. Moreover, the use of umbilical cord blood has been reported to be suboptimal in this cohort of patients in whom infection susceptibility underlies much of the need for a transplant.Methods: We performed haploidentical, related donor HSCT with high dose post-transplant cyclophosphamide (PT/CY) in 3 patients with GATA2 deficiency in whom a suitable HLA matched donor was not available. All three patients had a first degree relative (sibling) who shared at least 1 HLA-haplotype. The first patient, a 21 year-old Chinese woman presented with Hydroa Vacciniforme like T-cell lymphoma involving her lung, bowel (resulting in multiple small bowel resections and ileostomy), and skin (with large ulcerative lesions); multiple thrombotic cerebral events; and macrophage activation syndrome requiring etoposide and high dose prednisone in the intensive care unit (ICU). The second patient, a 20 year-old Hispanic female, presented with myelodysplasia (MDS), profound neutropenia, an invasive fungal sinusits due to Fusarium sp., and recurrent bacteremias. The third patient, a 45 year-old woman, presented with Emberger’s Syndrome, multiple episodes of bacterial and fungal sepsis and hypocellular MDS. All three patients received cyclophosphamide 14.5mg/kg on day’s -6 and-5; fludarabine 30mg/m2 on day’s -6 through -2; 200cGy of total body irradiation (TBI) on day -1. Patients 2 and 3 also received busulfan 3.2 mg/kg on day’s -4 and -3 because of MDS. All 3 patients received high dose PT/CY 50mg/kg on day’s +3 and +4, and mycophenolate mofetil and tacrolimus starting on day +5.Results: All 3 patients engrafted at a mean of 18 days and all are alive at a median follow-up of 9 months (range, 5 to 13 months). All three patients achieved 100% donor myeloid and lymphoid chimerim by day +100 post-transplant. The first patient had complete resolution of her T-cell lymphoma and macrophage activation syndrome, the second patient has had complete reversal of her hematopoietic and infectious phenotype, and the third patient has had resolution of her infectious complications that required continuous IV Daptomycin for 5 years prior to transplant. In addition, all three patients had complete reconstitution of the monocyte, NK cell, and B-lymphocyte compartments that were severely deficient prior to transplant. The main toxicity was mucositis, which required intravenous narcotics in all three patients. Lastly, the first patient developed late grade I liver graft-versus-host disease (GVHD) that was responsive to cyclosporine, the second patient developed grade I acute GVHD of skin that was responsive to topical steroids, and the third patient had no evidence of acute or chronic GVHD.Conclusions: Haploidentical, related donor HSCT represents a safe and effective viable alternative for patients with GATA2 deficiency who lack an HLA-matched donor, including patients such as our first patient who was in the ICU at the time of transplant. DisclosuresNo relevant conflicts of interest to declare.

CIRURGIA VIDEOLAPAROSCÓPICA E INFECÇÃO CUTÂNEA POR MICOBACTÉRIAS DE CRESCIMENTO RÁPIDO (MCR) - UMA ASSOCIAÇÃO MAIS QUE FORTUITA

As micobactérias de crescimento rápido são patógenos oportunistas geralmente associados com infecções pós-operatórias. Estas infecções têm sido relatadas após procedimentos estéticos, diálise peritoneal, hemodiálise, mamoplastia e artroplastia. O objetivo deste relato é mostrar a importância e alertar os clínicos e dermatologistas para a ocorrência das infecções micobacterianas atípicas após procedimentos cirúrgicos.

An unusual mycobacterial infection

The frequency of atypical mycobacterial or nontuberculous mycobacterial (NTM) infections has increased during the last three decades with the emergence of HIV/AIDS and more use of immunosuppressive treatments. We present a case of pulmonary mycobacterial infection secondary to Mycobacterium kansasii in a patient with chronic obstructive pulmonary disease (COPD) and malnutrition. M. kansasii is a ubiquitous organism, most commonly found in the southern and central regions of the US. It can occur as a colonizer, but when it produces disease it usually involves the lung. The American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) have issued criteria to differentiate casual NTM isolation from true pulmonary NTM disease. Among the NTM infections, M. Kansasii is the pathogen which causes a clinical picture which most resembles pulmonary tuberculosis. It can produce a bronchiectasis, nodular lesions, and/or fibrocavitary infiltrates on x-rays. Treatment requires a rifampin based regimen, usually combined with isoniazid and ethambutol. If rifampin resistance is present, macrolides, quinolones, or sulfas are usually recommended.

Rarely seen infections

There are many rare cutaneous infections of the face. This phrase seems irrelevant, because rare infections in certain parts of the world are common in others. This is more apparent if applied to different sites of the body (eg, face). For instance, cutaneous leishmaniasis (CL) is common in Central and South America and uncommon in the United States. Because most medical practitioners in this country have never seen a case, it is easy for them to miss a diagnosis.Cutaneous leishmaniasis, a protozoan infection transmitted by phlebotomine sand flies, is typically divided into two forms: one found in the Middle East, Asia, Africa, and southern Europe, called Old World leishmaniasis, and one found in Latin and Central America, called New World leishmaniasis.Also atypical mycobacterial infection has been described in the medical literature since the mid-1950s. The development and introduction of a rapid radiometric mycobacterial detection system has advanced the field of mycobacteriology over the past 20 years. This method has allowed the distinction of Mycobacterium tuberculosis from other mycobacteria and enabled the performance of antimicrobial susceptibility testing of mycobacteria. The increased frequency of atypical mycobacterial infection stems from advances in the diagnostic procedures concerning the infection paired with the prevalence of mycobacterial disease in immunocompromised patients infected with HIV. Erysipelas and facial cellulitis are covered briefly in this paper.

Atypical mycobacterial cutaneous infections in Egyptians: A clinicopathological study

Atypical mycobacteria comprise an uncommon heterogenous non-tuberculous group of acid-fast bacteria that rarely involve skin. The pattern of atypical mycobacterial cutaneous infections (AMCI) has not been previously studied in Egypt. The aim of this study was to describe the clinical characteristics, pathological features and species profile of AMCI among Egyptian patients. A retrospective study included 46 cases, diagnosed with AMCI during the period 2002 to 2012. The study included 34 males (73.9%) and 12 females (26.9%). The average age of patients was 39years while the average duration of lesions was 15months. The lesions were mostly located on the extremities (91.3%) and there was predominance of single (65.2%) and nodular (41.4%) lesions. History of trauma was confirmed in 91.3%. Histologically, the granulomas were mostly superficial (67.4%) with predominance of nodular suppurative pattern (84.8%). Other significant histological findings included epidermal hypertrophy (100%), presence of large-sized multinucleated giant cells (87%) and intrafollicular neutrophilic abscesses (84.8%). The diagnosis was proved by direct smear in 6.5%, skin biopsy in 10.9%, tissue culture in 47.8% and polymerase chain reaction (PCR) in 34.8%. Isolated species included Mycobacterium marinum (84.8%), Mycobacterium fortuitum (10.9%) and Mycobacterium kansasii (4.3%). Although the results of this study recommend that the diagnosis of AMCI is based mainly on culture and PCR, other clinicopathological features such as history of trauma, acral location of the lesion and suppurative granulomatous reaction with intrafollicular abscesses could be helpful clues in suspecting AMCI.

Integrative immunoinformatics for Mycobacterial diseases in R platform

The sequencing of genomes of the pathogenic Mycobacterial species causing pulmonary and extrapulmonary tuberculosis, leprosy and other atypical mycobacterial infections, offer immense opportunities for discovering new therapeutics and identifying new vaccine candidates. Enhanced RV, which uses additional algorithms to Reverse Vaccinology (RV), has increased potential to reduce likelihood of undesirable features including allergenicity and immune cross reactivity to host. The starting point for MycobacRV database construction includes collection of known vaccine candidates and a set of predicted vaccine candidates identified from the whole genome sequences of 22 mycobacterium species and strains pathogenic to human and one non-pathogenic Mycobacterium tuberculosis H37Ra strain. These predicted vaccine candidates are the adhesins and adhesin-like proteins obtained using SPAAN at Pad>0.6 and screening for putative extracellular or surface localization characteristics using PSORTb v.3.0 at very stringent cutoff. Subsequently, these protein sequences were analyzed through 21 publicly available algorithms to obtain Orthologs, Paralogs, BetaWrap Motifs, Transmembrane Domains, Signal Peptides, Conserved Domains, and similarity to human proteins, T cell epitopes, B cell epitopes, Discotopes and potential Allergens predictions. The Enhanced RV information was analysed in R platform through scripts following well structured decision trees to derive a set of nonredundant 233 most probable vaccine candidates. Additionally, the degree of conservation of potential epitopes across all orthologs has been obtained with reference to the M. tuberculosis H37Rv strain, the most commonly used strain in M. tuberculosis studies. Utilities for the vaccine candidate search and analysis of epitope conservation across the orthologs with reference to M. tuberculosis H37Rv strain are available in the mycobacrvR package in R platform accessible from the "Download" tab of MycobacRV webserver. MycobacRV an immunoinformatics database of known and predicted mycobacterial vaccine candidates has been developed and is freely available at http://mycobacteriarv.igib.res.in.

Particle exposures and infections

Particle exposures increase the risk for human infections. Particles can deposit in the nose, pharynx, larynx, trachea, bronchi, and distal lung and, accordingly, the respiratory tract is the system most frequently infected after such exposure; however, meningitis also occurs. Cigarette smoking, burning of biomass, dust storms, mining, agricultural work, environmental tobacco smoke (ETS), wood stoves, traffic-related emissions, gas stoves, and ambient air pollution are all particle-related exposures associated with an increased risk for respiratory infections. In addition, cigarette smoking, burning of biomass, dust storms, mining, and ETS can result in an elevated risk for tuberculosis, atypical mycobacterial infections, and meningitis. One of the mechanisms for particle-related infections includes an accumulation of iron by surface functional groups of particulate matter (PM). Since elevations in metal availability are common to every particle exposure, all PM potentially contributes to these infections. Therefore, exposures to wood stove emissions, diesel exhaust, and air pollution particles are predicted to increase the incidence and prevalence of tuberculosis, atypical mycobacterial infections, and meningitis, albeit these elevations are likely to be small and detectable only in large population studies. Since iron accumulation correlates with the presence of surface functional groups and dependent metal coordination by the PM, the risk for infection continues as long as the particle is retained. Subsequently, it is expected that the cessation of exposure will diminish, but not totally reverse, the elevated risk for infection.

Reduced Macrophages IL-12 Production After Stimulation By BCG/INF-Gamma Suggestive Of Impaired INF-Gamma Pathway Signalling In a Child With Disseminated Atypical Mycobacterial Infection and History Of Chemotherapy For Langerhans Cell Histiocytosis

Impaired INF-γ mediated immunity is characterised by increased susceptibility to poorly virulent mycobacteria. Here, we present a case of a patient with disseminated atypical mycobacterial infection poorly responding to antimicrobial treatment and INF-γ. This in a setting of previous chemotherapy for LCH resulting in profound T-cell lymphopaenia and impaired Th1/Th17 function. Functional studies of INF-γ pathway together with sequencing of INFGR1, INFGR2 and STAT1 genes were performed. A 21 month old boy was diagnosed with a disseminated Mycobacterium haemophilum infection after previous chemotherapy for LCH following LCH III, LCH III Salvage and HLH 2004 protocols, completed by Alemtuzumab, resulting in severe T-cell lymphopaenia (<200/mm3). Despite treatment with multiple anti-microbial drugs and high dose INF-γ, the infection continued to progress. Functional in vitro studies showed impaired macrophage IL-12 production after stimulation by BCG/INF-γ and severely impaired T-cell IFN-γ and IL-17 production in response to PHA. Sequencing of INFGR1, INGR2 and STAT1 cDNA showed no pathogenic mutations. Progressive disseminated atypical mycobacterial infection despite multiple anti-microbial treatment and high-dose INF-γ is very suggestive of an underlying Interferon Gamma Pathway immunodeficiency. Despite no mutations found in previously described associated genes (INFGR1, INFGR2 and STAT1), we believe that a secondary immunodeficiency induced by chemotherapy alone is not a sufficient explanation to the character of the infection and that a yet not identified defect of the Interferon Gamma Pathway might be causative. This unique case also raises questions about the character of LCH, a condition which remains to be idiopathic.

Atypical mycobacterial infection of the wrist and hand: a case report

Atypical mycobacterial infection of the wrist and hand: a case report

Current status of atypical mycobacterial infections in Burkina Faso: results of a regional survey

IntroductionL’étude avait pour but de déterminer la fréquence d'isolement des mycobactéries atypiques chez les patients déclarés tuberculeux pulmonaire à microscopie positive (TPM+) au Burkina Faso.MéthodesIl s'est agit d'une étude transversale qui s'est déroulée de mars 2011 à février 2012. Les patients TPM+ de plus de 15 ans ont été inclus dans l’étude de manière systématique dans les centres de diagnostic et de traitement (CDT) de la région sanitaire des Hauts Bassins. Une culture des mycobactéries et une identification biochimique ont été réalisées sur les échantillons des patients TPM+ La sérologie VIH a été réalisée par des tests rapides.RésultatsUne fréquence de 11% (8/73) de mycobactéries atypiques et 89,0% (65/73) de mycobactéries du complexe tuberculosis ont été identifiées des 73 patients TPM+ inclus dans l’étude. La tranche d’âge de 20 à 40 ans était la plus touchée par les mycobactérioses en général et constituait 48% de l’échantillon. Nous avons trouvé 12,2% (8 / 66) de patients VIH positif, 83,3% (55 / 66) de patients VIH négatif et 4,5% (3 / 66) de patients dont le statut VIH était indéterminé.ConclusionNotre étude a mis en lumière l'implication des mycobactéries atypiques dans la pathogénie de certains patients déclarés TPM+. Le rôle des mycobactéries atypiques dans les infections pulmonaires est probablement sous estimé et devra être examiné avec plus de détails et sur un échantillon plus grand.

Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa

A 53-year-old Caucasian woman with a history of anorexia nervosa developed a bilateral lower extremity rash comprised of palpable red to violaceous, sub-centimeter papular lesions that increased in quantity rapidly. She also noted a 2-month history of non-productive cough. Imaging modalities revealed a thin-walled cavitary lesion in the right lung apex and scattered nodular opacities. Acid fast bacilli (AFB) were found in sputum and subsequently identified by culture as Mycobacterium avium-intracellulare (MAI). Punch biopsies of her skin lesions yielded a histological diagnosis of small-to-medium vessel vasculitis. Stains and cultures for organisms were negative. Her skin lesions resolved quickly after the initiation of antimicrobial therapy for MAI. Hypersensitivity vasculitis associated with an atypical mycobacterial infection is unusual. The postulated underlying mechanism is the deposit of immune complexes and not the bacillus itself. While cutaneous leukocytoclastic vasculitis (CLV) due to MAI is certainly a rare entity, it should be entertained in patients with vasculitic skin lesions and a concomitant pulmonary disease.