Chelonae Infection Research Articles

Critical Commentary to: Molecular Diagnosis of a Mycobacterium chelonae Infection

Critical Commentary to: Molecular Diagnosis of a Mycobacterium chelonae Infection

Granulomatous inflammation in the tails of mice associated with Mycobacterium chelonae infection.

This report describes a case series of granulomatous inflammation in the tails of seven immunocompromised mice. The disease was associated with Mycobacterium chelonae infection. The source and route of infection remained unclear. Spontaneous infection with M. chelonae has not previously been documented in mice. We conclude that M. chelonae, like in humans, should be considered as a facultative pathogen in laboratory animals, particularly under immunosuppressive conditions.

Disseminated cutaneous Mycobacterium chelonae infection after injection of bovine embryonic cells

A 50‐year‐old previously healthy white woman developed a tender erythematous draining subcutaneous nodule on her left cheek, 9 months after receiving multiple injections of bovine embryonic cells in different areas of the face, neck, and chest as a skin rejuvenation treatment. Over the subsequent 4 months, multiple similar nodules developed on the injected areas. The lesions, which were initially painful, became asymptomatic as they developed purulent drainage and ruptured onto the skin surface. There were no associated fevers, chills, or sweats. The nodules failed to respond to a 2‐month course of oral prednisone and intralesional triamcinolone acetonide.Physical examination showed red, firm, subcutaneous nodules some of which were draining a serosanguinous exudate ( Fig. 1). While a presumptive diagnosis of foreign body granuloma was made, the possibility of an atypical mycobacterial infection remained, and therefore tissue was submitted for culture. While awaiting culture results, the patient was started on minocycline, 50 mg twice daily.Neck with disseminated subcutaneous erythematous nodules due to M. chelonae that developed following injections of “bovine embryonic cells”imageThe biopsy showed a collection of chronic and granulomatous inflammatory cells, intermixed with a few areas of polymorphonuclear abscesses within the dermis ( Fig. 2). Doubly refractile foreign material was not detected. Although acid‐fast bacilli were not observed with Ziehl–Neelsen stain, tissue culture grew mycobacterial colonies after 1 week of incubation. The isolate was subsequently identified as Mycobacterium chelonae, and clarithromycin, 500 mg twice daily, was added to the antimicrobial regimen on the basis of the susceptibility profile. There was significant improvement and the lesions resolved clinically over the following 6 weeks.Skin biopsy specimen from facial nodule shows granulomatous inflammation within the papillary dermis (hematoxylin and eosin, ×40)image

Pathology attributed to Mycobacterium chelonae infection among farmed and laboratory-infected Atlantic salmon Salmo salar.

This study was promoted following concern over increasing mortality on 2 farms rearing Atlantic salmon Salmo salar in the Shetland Isles, Scotland. A Mycobacterium sp. was isolated from moribund, market-sized Atlantic salmon. Biochemical tests, lipid analysis and PCR (polymerase chain reaction) techniques confirmed the bacterium to be Mycobacterium chelonae. Multiple greyish-white miliary granuloma-like nodules were observed in several tissues. Dense hard-packed nodules contained abundant acid-fast bacteria. Atlantic salmon injected with M. chelonae remained sub-clinically infected, demonstrating the chronic nature of this disease. The source of the pathogen was not identified.

Development of resistance to clarithromycin after treatment of cutaneous Mycobacterium chelonae infection

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A Pseudo-Outbreak of Mycobacterium chelonae Infections Related to Bronchoscopy

A Pseudo-Outbreak of Mycobacterium chelonae Infections Related to Bronchoscopy

A pseudo-outbreak of Mycobacterium chelonae infections related to bronchoscopy.

Mycobacterium gordonae and rapidly growing "atypical" mycobacteria including Mycobacterium chelonae are commonly found in tap water. This article describes a pseudo-outbreak of M chelonae infections related to bronchoscopy. Because patients may be treated and isolated unnecessarily when positive with acid-fast bacilli before the species are known, the financial burden for patients and hospitals may be great.

Iatrogenic outbreak of M. chelonae skin abscesses.

We describe an outbreak of skin lesions due to Mycobacterium chelonae subsp. abscessus associated with injections of lidocaine (lignocaine) given by a 'bioenergetic' (a practitioner of alternative medicine) in Colombia. The lidocaine carpules and the lesions of the patients yielded mycobacteria with identical biochemical characteristics. Using the methodology of Sartwell and a case control design we examined the incubation period and assessed risk factors. Of 667 potentially exposed individuals, a total of 298 patients were interviewed, of whom 232 had skin lesions. The median incubation period was 30.5 days (range 15-59 days). Male sex (OR 2.85, 95% CI 1.26-6.51), increasing age (OR 1.25, 95% CI 1.03-1.53), subcutaneous injection route (OR 3.72, 95% CI 1.09-12.7) and number of injections (OR 1.01, 95% CI 1.00-1.03) were risk factors for disease. To our knowledge, this is the largest reported outbreak of M. chelonae infection, the first in which the organism has been isolated from the putative vehicle of infection, and the first in which the incubation period could be determined.

Mycobacterium chelonae infection following a total knee arthroplasty

Infection following total knee arthroplasty is a major cause of implant failure, with an incidence of infections between 1 and 12%. Although there have been no previously reported cases of infection with Mycobacterium chelonae following total knee arthroplasty, this mycobacterium appears to be a potential pathogen in arthroplasty. When infection following total knee arthroplasty is evident but standard cultures come back negative, atypical mycobacterium infection should be considered. Mycobacterium chelonae does not grow in the normally allotted culture time, so false negative results are common. Once identified, M. chelonae is difficult to treat because of its resistance to standard drug therapies. Details of the first reported successful diagnosis and treatment of an infection with M. chelonae following a total knee arthroplasty are reported.

A pseudoepidemic of Mycobacterium chelonae infection caused by contamination of a fibreoptic bronchoscope suction channel.

An unusual increase in the frequency of isolation of Mycobacterium chelonae subspecies chelonae from specimens of bronchial washings was found between September and December 1992 in National Taiwan University Hospital. During this period, a total of 123 patients underwent fibreoptic bronchoscopy with an Olympus P20. Seventy six patients had bronchial washing for bacteriological study and cytological examination. Acid-fast bacilli were found in 21 patients, in 18 of whom Mycobacterium chelonae were isolated from bronchial washing cultures. Eight patients were treated as mycobacterial infected, because of the presence of unexplained pulmonary lesion, positive acid-fast stain and culture for Mycobacterium chelonae. Diagnosis of lung cancer was delayed in one patient because of the initial negative cytological study and positive bacterial culture. The fibreoptic bronchoscope was disinfected by automated washing machine (EW-20, Olympus) using 2.3% glutaraldehyde according to a standard protocol. From a survey to search for possible sources of contamination, they were identified at the suction channel of four different bronchoscopes. This episode proved to be a pseudoepidemic. The contamination was controlled by extensive suction and rinsing of the channel with 70% alcohol immediately after disinfection by the automated bronchoscope disinfection machine. This study shows that, despite using the disinfection machine, the suction channel could still be contaminated with Mycobacterium chelonae. This may cause diagnostic confusion and unnecessary antimycobacterial treatment.

In vitro and in vivo antimycobacterial activities of a new quinolone, DU-6859a

A new fluoroquinolone, DU-6859a, was studied for its in vitro and in vivo antimycobacterial activities. MIC determination by the agar dilution method with 7H11 medium revealed that DU-6859a had MICs at which 90% of M. kansasii (0.78 microgram/ml), M. marinum (1.56 micrograms/ml), M. scrofulaceum (1.56 micrograms/ml), M. fortuitum (0.39 microgram/ml), M. chelonae subsp. abscessus (6.25 micrograms/ml), and M. chelonae subsp. chelonae (1.56 micrograms/ml) were inhibited were 4 to 32 times lower than those of ofloxacin and sparfloxacin. The MICs of DU-6859a at which 90% of M. tuberculosis (0.2 microgram/ml) and M. avium-M. intracellulare complex (12.5 micrograms/ml each) were inhibited were comparable to those of sparfloxacin but were four- to eightfold lower than those of ofloxacin. Thus, DU-6859a possessed more potent in vitro activity than sparfloxacin and ofloxacin against most mycobacterial species. DU-6859a exerted significant efficacy against infections caused by M. intracellulare and M. chelonae subsp. abscessus induced in mice when it was given at a dose of 1 mg per mouse (ca. 50 mg/kg of body weight) in terms of reducing the frequency of occurrence and the degree of gross pulmonary or renal lesions and bacterial loads in the lungs, spleens, or kidneys. The efficacy of DU-6859a was greater than that of ofloxacin and was more pronounced against M. chelonae infections than against M. intracellulare infections.

New Macrolide Antibiotics: Usefulness in Infections Caused by Mycobacteria other Than Mycobacterium Tuberculosis

To compare the pharmacology, in vitro activity, and clinical use of the new macrolide antibiotics, azithromycin and clarithromycin, in the treatment of infections caused by mycobacteria other than Mycobacterium tuberculosis. An English-language literature search using MEDLINE (1987-1994), Index Medicus (1987-1994), Program and abstracts of the 31st (1991) and 32nd (1992) Interscience Conference on Antimicrobial Agents and Chemotherapy, and bibliographic reviews of related textbooks, review articles, and professional society publications. 105 articles were selected. In vitro and in vivo reports on the pharmacokinetics, microbiology, pharmacology, and effectiveness of clarithromycin and azithromycin were assessed to compare their effectiveness and safety. Emphasis was placed on the use of these new drugs in treating infections caused by Mycobacterium avium complex, Mycobacterium chelonae, and Mycobacterium fortuitum infections. A review of the in vitro activity of the new macrolides revealed moderate to very good activity against many strains of mycobacteria other than M. tuberculosis. Early clinical trials show promising results in pulmonary infections, lymphadenitis, cutaneous infections, and disseminated infections. The new macrolides, azithromycin and clarithromycin, show great promise for treating infections caused by these acid-fast bacteria. Clarithromycin is recommended as a component of combination therapy for the treatment of M. avium complex infections in patients with AIDS. The development of resistance in patients, particularly when these agents are used alone, has been reported.

Treatment of Mycobacterium chelonae-induced skin infection with clarithromycin

Mycobacterium chelonae, one of the Runyon group IV species of mycobacteria, I is ubiquitous in the environment2 and a potent human pathogen. Cutaneous infections have been described after skin injury (injection,3, 4surgery,S, 6 and minortrauma5). Treatment is difficult because of an incomplete response or a relapse. We report the efficacy of clarithromycin in the treatment ofM. chelonae skin infection.

Cutaneous nodules of Mycobacterium chelonae in an immunosuppressed patient with preexisting pulmonary colonization

A 30-year-old immunocompromised man with known pulmonary Mycobacterium chelonae colonization developed a systemic infection with cutaneous manifestations. The eruption consisted of multiple, nontender, subcutaneous nodules on the extremities. A diagnosis of disseminated M. chelonae was made on the basis of recovery of M. chelonae subspecies abscessus from blood and bronchoalveolar lavage fluid and histologic evidence of acid-fast bacilli in a skin biopsy specimen. We believe this is the first reported case of disseminated M. chelonae infection in an immunocompromised host in whom a primary source of the infection was identified.

Treatment of Mycobacterium chelonae infection with controlled localized heating

An immunocompetent man acquired a localized cutaneous infection caused by the atypical mycobacterium Mycobacterium chelonae. This was successfully treated with controlled localized heating with a hand-held radiofrequency heat generator. Possible mechanisms of effects of heat on this organism are discussed.

Treatment of disseminated Mycobacterium chelonae infection with ciprofloxacin

Treatment of disseminated Mycobacterium chelonae infection with ciprofloxacin

The turtle's revenge: a case of soft tissue Mycobacterium chelonae infection

A case of cutaneous Mycobacterium chelonae infection with sporotrichoid spread and extensive antibiotic resistance is presented. Control of this problem was only achieved after extensive debridement and grafting of the involved limb. The importance of surgery in management is discussed and the literature is reviewed.

Disseminated Mycobacterium chelonae subspecies chelonae infection with cutaneous and osseous manifestations

Disseminated Mycobacterium chelonae subspecies chelonae infection with cutaneous and osseous manifestations

Outbreak of Mycobacterium chelonae infection associated with use of jet injectors

Outbreak of Mycobacterium chelonae infection associated with use of jet injectors

Outbreak of Mycobacterium chelonae Infection Associated With Use of Jet Injectors

Between January 1 and May 15, 1988, foot infections due to Mycobacterium chelonae subspecies abscessus were diagnosed in eight persons who had undergone invasive procedures at a podiatry office. A cohort study was performed to evaluate risk factors for disease. Persons who underwent procedures before 10:30 AM were more likely to have developed infection than those with procedures after that time (relative risk, 5.6). In addition, procedures involving any of the second through fourth toes were more likely to have resulted in infection than procedures involving only the first and/or fifth toes (relative risk, 4.4). Persons with 0, 1, or 2 risk factors had attack rates of 5%, 14%, and 60%, respectively. Mycobacterium chelonae subspecies abscessus organisms of the same antimicrobial resistance pattern as the patients' strains were cultured from distilled water in a reusable, nonsterilized container. A jet injector used to administer lidocaine was held between procedures in a mixture of the distilled water and a disinfectant as recommended by the manufacturer. Inoculation of patients with mycobacteria by the jet injector may have only occurred early in the day due to slow killing of the bacteria by the disinfectant. The outbreak emphasizes the pathogenicity of this water-associated organism and the need for high-level disinfection of jet injectors.