Cases Of Mycobacterial Infection Research Articles

MYCO-TB: the first IVD kit suitable for the digestion and decontamination of extra-pulmonary specimens to detect Mycobacteria

Extra-pulmonary mycobacterial infections are characterized by a paucibacillary nature and extra-pulmonary samples consist of different matrices; the processing of these samples requires a high level of manual skills and non-standardized procedures. The aim of this study was to compare the performance of MYCO-TB with MycoPrep on extra-pulmonary samples in terms of Mycobacteria detection, culture contamination and suitability for molecular assay. This prospective study was conducted on 201 extra-pulmonary samples from suspected cases of mycobacterial infection. Specimens were divided into two equal aliquots; one was decontaminated with MYCO-TB the other with MycoPrep. The contamination rate of liquid cultures was significantly different: 2.5% (5/201) for MYCO-TB and 7.5% (15/201) for MycoPrep (p = 0.036). At least 1 Mycobacterium tuberculosis complex (MTBc) positive culture was detected in 6 specimens treated with MYCO-TB and 8with MycoPrep, without significant differences in times to positivity (TTP) in liquid culture. No Xpert MTB/RIF Ultra invalid results were obtained with samples decontaminated with MYCO-TB. The MYCO-TB kit had greater activity than MycoPrep in the digestion and decontamination of extra-pulmonary specimens for the detection of Mycobacteria, supporting the use of MYCO-TB in this type of sample. Ready-to use reagents, rapid protocol and single-sample formulation of MYCO-TB reduced the level of manual skills required as well as the risk of sample contamination.

Non-tuberculous Mycobacterium infection after transfer of autologous fat to the face: a rare case

Autologous fat has long been used as a filler in the face, and has recently gained popularity in plastic surgery with a wound infection rate of 1% − 5%. The incidence of mycobacterial infections has increased over recent decades, which is attributed in part to the increased popularity of these procedures.2 Infections by non-tuberculosis mycobacteria often cause chronic inflammation and progressive infection that may eventually manifest themselves as severe scars, fistulas, and hollows, and irregular facial contours. However, few cases of mycobacterial infection have been reported to have been caused by plastic surgery. We present a rare case of non-tuberculosis mycobacterial infection after transfer of autologous fat to the face.

A Ten Year Retrospective Review of Infections in the First 12 Months Post Paediatric Liver and Liver-Kidney Transplantation at a Single Centre in Johannesburg, South Africa

Introduction Two paediatric liver transplant centres exist in South Africa, one in Johannesburg and the other in Cape Town. The programme in Johannesburg at Wits Donald Gordon Medical Centre (WDGMC) began in 2005 and is now the largest volume paediatric liver transplant unit in the country. WDGMC also hosts the only live donor paediatric liver transplant programme in sub-Saharan Africa. This research determined the incidence and profile of infectious events in the first year after transplantation. Materials and Methods This retrospective record review included paediatric liver and liver/kidney transplants from 2005-2015. The paediatric population was defined as any recipient <18 years of age on the day of transplant. Only laboratory confirmed infections were included. Ethics approval was obtained from the University’s Institutional Review Board. Information was sourced from clinical records and pathology reports. Statistical analysis was carried out using SAS version 9.4 with a 5% significance level. Results and Discussion There were 69 transplants in 65 patients.Most were female (42/69;61%), median age was 49 months (IQR 27-152) and biliary atresia was the most common indication for transplant (42%).A total of 253 infections occurred, mainly in the first three months after transplant. The most common site was bloodstream, followed by the abdomen and urinary tract. Bacterial infections occurred most commonly (193/253;76.3%). Of these, gram negative organisms predominated (120/193; 62.2%) and klebsiella species (50/120; 41.7%) was most frequently identified. In the gram positive group (72/193; 37.3%), enterococcus faecium predominated (25/72; 34.7%). Drug resistance was higher in the gram negative group (75.0%; 36/48) when compared to the gram positives (22.9% (11/48). Prevalence of viral infection was 16.6% (42/253) and fungal was 7.1% (18/253). Candida parapsilosis was the most commonly identified fungus. TB prophylaxis is not routinely administered and there was only one case of mycobacterial infection. This is the first study of its kind from sub-Saharan Africa. Gram negative infections were the most common, mirroring findings from the USA and Israel. What differed was that candida parapsilosis, not albicans, was the most frequently identified fungus and the most common primary site of infection was not the abdomen, but rather the bloodstream. Risk factors that may predispose to infection are severe malnutrition at the time of transplant and delayed referrals of young children with advanced disease. Conclusion Our findings suggest that standard TB prophylaxis may not be warranted, even in a country with high TB infection rates. This research has resulted in an urgent policy review in the transplant unit which has prioritised the nutritional status of children pre-transplant and implemented stringent infection control measures to prevent bloodstream infections. Study data were collected and managed using REDCap1 electronic data capture tools hosted at University of the Witwatersrand. This research was supported by Wits Donald Gordon Medical Centre, Johannesburg, South Africa. Data capture performed by the medical student group, Chanceplant from the University of the Witwatersrand.

Notification of Nontuberculous Mycobacteria: An Australian Perspective.

In Queensland, Australia, all cases of mycobacterial infection (tuberculosis [TB] and nontuberculous mycobacteria [NTM]) are notifiable under the Queensland Public Health Act (2005). This process originally emerged to avoid NTM confounding with notification of cases of TB, but has facilitated awareness of the increasing incidence and changing epidemiology of NTM. Although initially not a public health priority, the notification process has facilitated research that has led to an appreciation of both public health and environmental health issues associated with these pathogens. When reports of NTM infections were low in frequency, reporting was managed largely by clinicians specializing in TB. However, as reports of NTM isolates surpassed those for TB, the workload associated with clinical reporting exceeded resources. The Communicable Diseases Branch transitioned to digital reporting of laboratory isolates of mycobacteria, thereby enabling weekly and quarterly reporting of data, and generation of more detailed annual reports. The reports now include species and geographic distributions by health service district, allowing identification of clusters requiring further investigation and systematic reviews of different species. With ecological and climate change, the distribution and virulence of these emerging pathogens are evolving. Evidence of transmission of highly virulent and antibiotic-resistant clones of Mycobacterium abscessus among patients with cystic fibrosis internationally heightens the need for timely reporting to public health authorities. Ongoing systematic monitoring by public health authorities will be crucial to our understanding of NTM diseases.

Identification of mycobacteria isolated at University Hospital of Santa Maria, Rio Grande do Sul, Brazil

This study evaluated the prevalence of nontuberculous mycobacterium (NTM) in relation to the total number of cases of mycobacterial infections detected in patients admitted at the University Hospital of Santa Maria from 2008 to 2010. From the positive samples for the genus Mycobacterium, 67% belonged to the Mycobacterium tuberculosis complex (MTBC) and 33% of them were classified as NTM. This investigation aims to contribute to the epidemiology of mycobacterioses, inasmuch as patients infected by NTM require distinctive treatment and monitoring in comparison with those infected by MTBC.

A case of Idiopathic CD4+ T-Lymphocytopenia with disseminated Mycobacterium kansasii infection and Pulmonary alveolar proteinosis

Idiopathic CD4+ T-lymphocytopenia is defined as a depletion of CD4+ lymphocytes below in the absence of HIV infection or other known causes of immunodeficiency. Many infectious diseases have been reported to be associated with idiopathic CD4+ T-lymphocytopenia, and there have also been a few cases of mycobacterial infection in idiopathic CD4+ T-lymphocytopenia. Until now, it has been unclear as to whether CD4+ T-lymphocytopenia is a predisposing factor for or a consequence of the mycobacterial infection. Pulmonary alveolar proteinosis is an uncommon disease characterized by the intraalveolar deposition of amorphous granular material that stains positive with PAS, and its association with mycobacterial infection has rarely been reported. Recently, we experienced a previously healthy young man who had been diagnosed as idiopathic CD4+ T-lymphocytopenia with disseminated mycobacterium kansasii infection and pulmonary alveolar proteinosis, and report this case.

Liver biopsy is not useful in the diagnosis of mycobacterial infections in patients who are infected with human immunodeficiency virus.

Liver biopsy (LB) has been advocated for the detection of mycobacterial infections in patients infected with human immunodeficiency virus (HIV). To determine the effect of the use of this procedure on survival, we compared it terms of yield with histological findings and noninvasive microbiological procedures. We reviewed the cases of 98 patients who underwent 106 LBs as part of the diagnostic screening for fever of unknown origin. LB revealed 17 cases of mycobacterial infection. For all but one patient, the results of at least one noninvasive procedure were positive. In 85 cases where infections were not diagnosed by LB, 17 had infections documented by other procedures. When all culture results are considered, the mean (+/- SD) incubation time to the first positive culture was 15 +/- 5 days, whereas the mean (+/- SD) incubation time to the first positive culture of an LB specimen was 28 +/- 9 days. The survival time was not significantly increased for patients who underwent LB and had positive Ziehl-Neelsen-stained smears; these patients survived a mean (+/- SD) of 12 +/- 11 months, whereas patients with negative smears survived a mean (+/- SD) of 9 +/- 10 months. Noninvasive studies are preferable to LB for the diagnosis of mycobacterial infections in HIV-infected patients.

Bone tuberculosis: an unusual case of mycobacterial infection in a renal allograft recipient

Bone tuberculosis: an unusual case of mycobacterial infection in a renal allograft recipient

Reactivity of fungal organisms in tissue sections using anti‐mycobacteria antibodies

Sixty-four cases of deep fungal infections diagnosed using PAS or silver stains and 18 control cases of sarcoidosis, M. tuberculosis and M. leprae infection were stained using commercial polyclonal antibody raised against M. paratuberculosis (MP), M. Duvalii (MD), and Bacillus Calmette-Guerin (BCG). Nine of 13 cases of sporotrichosis stained positively using anti-MP antibody only; 13 of 14 cases of histoplasmosis stained with anti-BCG, anti-MD, and anti-MP; seven cases of cryptococcosis had only focal staining of rare individual organisms within masses of negative organisms; seven of eight cases of coccidioidomycosis stained predominantly with anti-BCG and anti-MP; eight cases of aspergillus had focal (1 to 5% of organisms) staining of hyphae with anti-BCG and anti-MD; and four of 12 cases of Candida infection showed focal nonspecific staining with both antibodies and nonimmune serum. Control cases of sarcoidosis exhibited no staining with any of the three antibodies, whereas cases of mycobacterial infection showed staining of bacilli and intracellular debris with all three antibodies.

Negative images of bacilli and mycobacterial infection: A study of fine‐needle aspiration smears from lymph nodes in patients with aids

In patients with the acquired immunodeficiency syndrome (AIDS), four cases of mycobacterial infection in which bacilli appeared as cylindrical, nonstaining "negative images" have been previously described. These may have been extracellular or within histiocyte cytoplasm, and they have been described in aspirations from liver, lymph node, and bone marrow and in bronchoalveolar lavage fluid. We report three additional examples of this finding in fine-needle aspirations from lymph nodes in AIDS patients infected with Mycobacterium avium-intracellulare. Our findings support the concept that these negative images of bacilli are diagnostic of mycobacterial infection. Air-dried Romanovsky-stained material is required for their identification.

Diagnostic fine needle core biopsy of deep lymph nodes for the diagnosis of lymphoma in patients unfit for surgery.

The use of a technique for safe percutaneous fine needle biopsy of inaccessible lymph nodes is described. In a prospective study of 24 patients, including five cases positive for the human immunodeficiency virus (HIV), this technique was used to provide diagnostic material. A firm diagnosis was made in 21 cases; four cases of Hodgkin's disease, 14 non-Hodgkin's lymphomas, one case of Kaposi's sarcoma, one case of mycobacterial infection, and one which showed the features of persistent generalized lymphadenopathy (PGL). In the cases of lymphoma, available serial sections allowed characterization of the tumour with immunocytochemistry. In three cases, no diagnosis could be made, with one of these requiring a subsequent open biopsy. Percutaneous fine needle biospy is ideal for patients unfit or unsuitable for general anaesthesia or surgery. The biopsy obtained gives the pathologist sufficient tissue for an accurate diagnosis in the majority of cases. The preservation of architecture and multiple sections available are advantages over fine needle aspiration.

Broth culture: The modern ‘guinea-pig’ for isolation of mycobacteria

Three cases of mycobacterial infection were confirmed in our laboratory by exclusive isolation of the pathogen in Middlebrook 7H9 broth medium. The mycobacteria failed to grow in all three cases on three different solid media. In one patient Mycobacterium tuberculosis was isolated from a pleural biopsy; a lymph node biopsy from another patient also yielded M. tuberculosis and M. avium-intracellulare was isolated from the spinal fluid of a patient with acquired immunodeficiency syndrome (AIDS). Only the broth culture was positive in all three cases. We suggest these findings emphasise the need for laboratories to use a liquid medium in addition to egg-based or agar media, especially for isolation of mycobacteria from specimens with small numbers of bacilli.

The inoculation of tissue specimens into guinea-pigs in suspected cases of mycobacterial infection—does it aid diagnosis and treatment?

The record of guinea-pig inoculations carried out at the London Hospital during a 5-year period was examined. A total of 677 specimens were inoculated into guinea-pigs: 34 were positive on culture and guinea-pig post-mortem and 22 were positive on culture alone. Only five were positive on guinea-pig post-mortem when culture was negative and in only three of these five cases were mycobacteria isolated from the guinea-pig tissues. All three cases had been diagnosed effectively on histological grounds, although in one case the results of sensitivity testing did alter treatment. Despite this marginal benefit it is suggested, on grounds of cost, safety, and animal welfare, that the practice of routine inoculation of suspected tuberculous tissue specimens into guinea-pigs should be discontinued.

The value of microbial cultures in diagnostic lymph-node biopsy.

Microbial cultures were performed on 163 lymph-node biopsies from a variety of sites and in all age groups. Growth occurred in 76 (47%), 41 of which were considered contaminants. The final diagnoses were as follows: mycobacterial infection (27 biopsies), coccidioidomycosis (two cultures), nonspecific inflammatory changes (82 cultures), malignancy (51 cultures), and Whipple's disease (one culture). Microbial culture was the sole means of diagnosing nine cases of mycobacterial infection. The fluorescent stain demonstrated acid-fast bacilli in only 16 biopsies, twice the frequency with the standard Ziehl-Neelson stain. Other bacterial isolates were of uncertain significance in most instances. Routine culture for mycobacteria and fungi is recommended for all lymph nodes that show granulomatous changes.