Haemophilum Infection Research Articles

42686 Mycobacterium haemophilum infection with cutaneous involvement: an updated review of literature

42686 Mycobacterium haemophilum infection with cutaneous involvement: an updated review of literature

Clinical manifestations, treatment and outcomes of patients infected with Mycobacterium haemophilum with a focus on immune reconstitution inflammatory syndrome: a retrospective multi-site study

Background Mycobacterium haemophilum is a nontuberculous mycobacterium with fastidious in vitro growth requirements and an increasingly reported cause of extrapulmonary disease. Timely diagnosis and management of M. haemophilum infections and the immune reconstitution inflammatory syndromes (IRIS) observed in a subset of patients during treatment remain challenging. Methods We conducted a retrospective chart review between January 1, 2010, and January 1, 2022 and identified 26 patients diagnosed with M. haemophilum infection at our institution. We describe their clinical presentation, diagnostic results, management, and outcomes. Results The majority of patients in our cohort had upper and/or lower extremity skin involvement, were immunosuppressed, and had generally favourable treatment outcomes. All tested M. haemophilum isolates were susceptible in vitro to clarithromycin and trimethoprim-sulfamethoxazole. Moreover, high rates of susceptibility were noted for ciprofloxacin (95%), linezolid (90%), and rifampin (85%). IRIS was identified in 31% of cases and should be considered in patients who develop worsening skin lesions or systemic symptoms following the initiation of effective antimicrobial therapy. Visualisation of acid-fast bacilli on initial tissue stains, a positive mycobacterial blood culture, and rapid de-escalation of tumour necrosis factor-α inhibitors and/or corticosteroids were more frequently encountered among patients in our cohort who developed IRIS. Conclusion M. haemophilum infection should be considered among patients receiving immunomodulatory therapy who develop discoloured or nodular skin lesions involving the extremities, worsening focal arthritis, tenosynovitis, or isolated adenopathy. A heightened awareness of this pathogen’s clinical and laboratory characteristics can lead to a timely diagnosis and favourable outcome.

Leprosy-like reaction occurred during the treatment of a cutaneous Mycobacterium haemophilum infection: A case report

Rationale: Mycobacterium haemophilum is a rare pathogen, belongs to the slowly-growing nontuberculous mycobacterium family, and shares a close evolutionary relationship with Mycobacterium leprae. It is a fastidious organism that requires special media(iron or hemin supplementation)and conditions (incubation at 30–32°C) for growth, which differs from most other pathogenic mycobacteria. Patient concerns: A 43-year-old Asian male presented to our outpatient department due to the appearance of multiple infiltrative erythematous nodules and ulcerations on the extremities for more than 2 months. Diagnoses: Acid-fast bacteria were detected in the specimen and sequencing for hsp65 and 16S rRNA genes of the pathogen extracted from the biopsy tissue identified as M haemophilum. The diagnosis of cutaneous M haemophilum infection was established. Interventions: The patient received a 3-drug regimen (oral clarithromycin 1.0 g/d, rifampicin 0.6 g/d, and moxifloxacin 1.0 g/d) and local hot compression therapy, the dose of immunosuppressant was reduced. Outcomes: The lesions gradually improved after 6 months of continuous antibiotic therapy. There is no recurrence of erythema papules and nodules. Lessons: This case shows that the patient’s condition may be exacerbated immediately after the initiation of anti-nontuberculous mycobacterium therapy, which is analogous to the leprosy reaction. A high degree of clinical suspicion for the underlying disease is critical to avoid unnecessary interruption of treatment.

Ocular Mycobacterium haemophilum infection originating in the cornea: a case report

BackgroundMycobacterium haemophilum is a slow-growing non-chromogenic nontuberculous Mycobacterium species that can cause skin infection or arthritis in an immunocompromised population or in children. Primary infection of the healthy adult cornea is rare. The special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical manifestation and treatment process of corneal infection and notify the awareness of M. Haemophilus keratitis among clinicians. This is the first case report of primary M. haemophilum infection in the cornea of healthy adults reported in the literature.Case presentationA 53-year-old healthy goldminer presented with left eye redness and a history of vision loss for four months. The patient was misdiagnosed with herpes simplex keratitis until M. haemophilum was detected using high-throughput sequencing. Penetrating keratoplasty was performed, and a large number of mycobacteria were detected by Ziehl-Neelsen staining of the infected tissue. Three months later, the patient developed conjunctival and eyelid skin infections that manifested as caseous necrosis of the conjunctiva and skin nodules. After excision and debridement of the conjunctival lesions and systemic antituberculosis drug treatment for 10 months, the patient was cured.ConclusionM. haemophilum could cause primary corneal infection in healthy adults, which is an infrequent or rare infection. Owing to the need for special bacterial culture conditions, conventional culture methods do not provide positive results. High-throughput sequencing can rapidly identify the presence of bacteria, which aids in early diagnosis and timely treatment. Prompt surgical intervention is an effective treatment option for severe keratitis. Long-term systemic antimicrobial therapy is crucial.

MYCOBACTERIUM HAEMOPHILUM AND CRYPTOCOCCUS NEOFORMANS COINFECTION IN A SYSTEMIC LUPUS ERYTHEMATOSUS PATIENT

Mycobacterium haemophilum and Cryptococcus neoformans are human pathogens in immunocompromised individuals. They exhibit a diversity of cutaneous manifestations and could cause disseminated infections. Herein, we report a Thai female with an underlying disease of systemic lupus erythematous, end stage renal disease and hypertension who was on immunosuppressive therapy and diagnosed with disseminated M. haemophilum and C. neoformans coinfection. She presented with multiple indurated plaques on her back, oedematous plaques on both legs and feet with nodules and ulcers on her right leg. She was diagnosed by skin biopsy, acid-fast staining, real-time polymerase chain reaction, tissue culture and haemoculture. A combination of rifampicin, macrolide, fluoroquinolone, amikacin and co-trimoxazole were used to cure M. haemophilum infection. Cryptococcosis was treated with amphotericin B and flucytosine for 5 weeks, then followed by fluconazole. We aim to report a unique dermatological manifestation, microbiology, histopathology, and treatment of the disease. Successful diagnosis and multiple antimicrobials agents are key managements for Mycobacterium haemophilum infection and Cryptococcosis.

Fatal disseminated Mycobacterium haemophilum infection involving the central nervous system in a renal transplant recipient

Mycobacterium haemophilum is a slow growing nontuberculous mycobacterium which prefers cooler temperatures and requires iron for growth. It usually causes skin and soft tissue infections in immunocompromised hosts and cervical lymphadenitis in healthy children. We present the case of fatal disseminated M. haemophilum in an immunocompromised host with central nervous system (CNS) involvement. Our case is a 65-year-old Hispanic male with history of end-stage renal disease status post renal transplantation six years prior (on maintenance immunosuppression with mycophenolate, tacrolimus and prednisone), diabetes mellitus type 2, coronary artery disease, ventricular arrhythmias with implantable cardioverter defibrillator, prior stroke and cochlear implant. In the four months preceding admission to our institution he had frequent hospitalizations for altered mental status (AMS), sepsis syndromes and failure to thrive. Two months prior to presentation he developed progressive swelling and redness of the wrists, right third and left fifth digits. Computed tomography (CT) showed extensive cellulitis in distal right forearm and hand with chronic osteomyelitis. Serial incision and drainage (I&D) of right wrist yielded positive AFB stain and growth on AFB culture. PCR was negative for Mycobacterium tuberculosis. Patient was started on rifampin, clarithromycin and ethambutol. Two days later patient developed AMS and severe septic shock requiring transfer to our facility. CT head revealed indeterminate lesion in the left frontal lobe along with nonspecific hypodensities in the pons and thalamus. Repeat CT upper extremities showed osteomyelitis of distal radius and small hand bones with adjacent abscesses. I&D also revealed bilateral tenosynovitis. Cultures were resent. With suspicion for rapidly growing mycobacterial infection, the regimen was changed to linezolid, imipenem and azithromycin. Several changes in antimicrobials were necessary throughout hospitalization due to complicated hospital course. Unfortunately, despite aggressive measures, patient developed multiorgan failure culminating in death 10 days after starting anti-mycobacterial drugs. On the day of death, the organism was identified as M. haemophilum. Susceptibilities were not done as patient had died. On autopsy the brain was noted to have multiple abscesses containing AFB. The organism also grew from the wrists and right finger cultures. M. haemophilum of the CNS is extremely rare and has been reported in HIV or AIDS patients. To our knowledge this is the first reported case of M. haemophilum brain abscesses in a patient without HIV/AIDS. Because of its fastidious growth requirements, M. haemophilum usually shows on acid fast stains but does not grow on routine AFB cultures. Although it prefers lower temperatures for growth and is usually limited to skin and soft tissues, disseminated disease occurs in immunocompromised patients and has high mortality. It is usually treated with a multi drug regimen including clarithromycin, rifampin, ciprofloxacin and amikacin.

Cutaneous Mycobacterium haemophilum infection: A rare cutaneous manifestation in a patient with Crohn's disease

Cutaneous Mycobacterium haemophilum infection: A rare cutaneous manifestation in a patient with Crohn's disease

Cutaneous nontuberculous mycobacterial infection in Thailand: A 7-year retrospective review.

A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited.This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand.The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital.From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02).M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.

1355. Efficacy and Tolerability of Linezolid Adjunctive Treatment for Nontuberculous Mycobacterial Infection in Patients with Acquired Anti-Interferon-Gamma Autoantibody

BackgroundDespite a long duration of combined oral antimycobacterial drugs, relapse/ reinfection of nontuberculous mycobacteria (NTM) is common among patients with anti-interferon gamma autoantibodies (anti-IFN-γ auto-Abs).MethodsWe reported here, an interim analysis of the prospective study of 25 patients with anti-IFN-γ auto-Abs, who received oral linezolid (LZD) adjunctive treatment for their NTM infections, at Siriraj Hospital, Bangkok, Thailand, between December 2017 and April 2019.Results8 patients (32%) were male, with a median age of 52.5 years. NTM identified among them included Mycobacterium abscessus (n = 19), M. avium complex (MAC) (n = 2), M. fortuitum (n = 2), M. kansasii (n = 1), and both M. abscessus and MAC (n = 1). The median duration of follow-up was 11 months (range 1.6–15 months). LZD 600 mg/day was given until clinical remission, then reduced to 300 mg/day for a total duration of at least 9 months. Other patient’s managements, including choice and duration of other antimycobacterial therapy were determined by the attending physician. Clinical remission was achieved, and LZD was discontinued at 9 months in 10 patients. NTM infection remained active and LZD was continued to 12 months in 4 patients. Two patients only completed 6 months of LZD. Culture proven relapse of M. abscessus occurred in 3 patients during LZD treatment, and 1 patient developed M. haemophilum infection after discontinuation of all drugs for 3 months. One patient was retreated with intravenous antimycobacterial drugs based on clinical suspicious of relapse NTM infection. LZD-related serious adverse events leading to discontinue of LZD occurred in 5 patients; severe myelosuppression (n = 1), peripheral neuropathy (n = 2), exfoliative dermatitis (n = 1), and idiopathic increased intracranial pressure (n = 1). Anemia occurred in 3 patients during the 600 mg LZD once-daily treatment period. No patient developed anemia after LZD was adjusted to 300 mg twice daily. The rate of peripheral neuropathy was similar throughout the study period.ConclusionLZD might reduce the rate of relapsed/ reinfection of NTM infection in these patients. LZD 300 mg twice daily was less toxicity and more tolerable than 600 mg once daily. Long-term study with this modified regimen is now on-going.Disclosures All authors: No reported disclosures.

Cutaneous Mycobacterium haemophilum infection in a patient on chronic immunosuppression with MCTD

Cutaneous Mycobacterium haemophilum infection in a patient on chronic immunosuppression with MCTD

Disseminated Mycobacterium haemophilum Infection and Pneumocystis jirovecii Pneumonia in a Patient Receiving Immunosuppressive Therapy

Abstract A 53-year-old woman with mixed connective tissue disease and rheumatoid arthritis on successive treatment regimens consisting of rituximab then adalimumab + prednisone then azathioprine + hydroxychloroquine + prednisone developed multiple tender upper and lower extremity skin lesions followed shortly by dry cough and shortness of breath. Skin biopsy and blood cultures eventually revealed Mycobacterium haemophilum, and transbronchial lung biopsy and bronchial washings revealed Pneumocystis jirovecii pneumonia. The patient was treated with endotracheal intubation, clarithromycin/rifampin/ciprofloxacin, and trimethoprim-sulfamethoxazole and survived, gradually returning to baseline state after hospital course during which she was intubated for 17 days. She survived but continues on lower-dose azathioprine and prednisone for her mixed connective tissue disease and rheumatoid arthritis. We conducted a strict review of the literature for all patients with disseminated M. haemophilum infection and looked for concurrent opportunistic infections. There was only one other patient with concurrent disseminated M. haemophilum infection and P. jirovecii pneumonia. Three patients were diagnosed as having P. jirovecii before having a diagnosis of disseminated M. haemophilum infection. Other concurrent opportunistic infections found were herpesvirus-8–associated Kaposi sarcoma and disseminated histoplasmosis. As physicians become more aware of M. haemophilum and as diagnostic techniques improve and become more widely available, we may see more disseminated M. haemophilum infections and associated opportunistic infections.

Cutaneous Mycobacterium haemophilum infection with jarisch–herxheimer reaction: A case report from Taiwan

Cutaneous Mycobacterium haemophilum infection with jarisch–herxheimer reaction: A case report from Taiwan

2268. Clinical Difference of Mycobacterium haemophilum Infections Between HIV and Non-HIV-Infected Patients

Background Mycobaterium haemophilum has emerged as one of nontuberculous mycobacteria which caused localized and disseminated infections in immunocompromised patients. Infections caused by this pathogen were rarely diagnosed and reported because it can grow only in heme supplemented culture media.MethodsWe performed a case–control study at Siriraj hospital, the biggest tertiary care hospital in Thailand, to determine the clinical difference and treatment outcome of this infection between HIV-infected and non-HIV-infected individuals.ResultsFrom January 2012 to December 2017, there were 21 patients diagnosed with Mycobacterium haemophilum infections. Eight of them were HIV infected. Rest of the patients were non-HIV immunocompromised which SLE was the most common comorbidities (autoimmune diseases 6 patients, anti-IFN gamma auto Ab 2 patients, kidney transplant recipients 2 patients, diabetes mellitus 2 patients and nephrotic syndrome 1 patient). The most common clinical manifestation was cutaneous involvement (13 patients, 61.9%). The result revealed that HIV-infected patients were much younger in comparison with non-HIV-infected patients (mean age 39 ± 10 VS. 52 ± 14 years; P = 0.025). Disseminated infection was more common in HIV-infected patients (37.5% vs. 15.4%, P = 0.325) and three of eight HIV-infected patients (37.5%) had central nervous system involvement whereas none of non-HIV infected patients had it (P = 0.042). The prognosis was slightly worse in HIV-infected individuals (Unfavorable prognosis 27.5% in HIV-infected VS. 15.4% in non-HIV-infected patients; P = 0.325).ConclusionHIV infection is the most common immunocompromised condition related with Mycobacterium haemophilum infection. Central nervous system involvement is more common in HIV-infected patients.Disclosures All authors: No reported disclosures.

Disseminated Mycobacterium Haemophilum Infection Masquerading as Erythema Nodosum and Avascular Necrosis in an Immunocompromised Host

Abstract Mycobacterium haemophilum is likely an underrecognized cause of infection among patients with deficits in their cell-mediated immunity. Despite its name, which translates to “blood loving,” it remains unclear whether hyperferritinemic patients are also at higher risk of this infection. We present a 24-year-old woman with disseminated M. haemophilum infection who has hyperferritinemia and T-cell acute lymphoblastic leukemia in remission and was initially misdiagnosed as having erythema nodosum and avascular necrosis. This report highlights the clinical and histological similarities of M. haemophilum and erythema nodosum, discusses some diagnostic peculiarities, and also reviews similar cases within the literature.

Disseminated Cutaneous Mycobacterium Haemophilum Infection and Concomitant Crusted Scabies in an Iatrogenically Immunocompromised Patient - A Case Report

Mycobacterium haemophilum and crusted scabies are rare cutaneous diseases reported in distinct immunocompromised hosts. M. haemophilum is a skin and soft tissue infection, whereas crusted scabies is an infestation of the skin. Whereas scabies infestation is readily diagnosed, M. haemophilum infection poses a diagnostic challenge due to its rarity as well as varied clinical and histologic presentations. Although both scabies infestation and M. haemophilum have been reported in the literature separately, to our knowledge no previous reports have described these diseases occurring simultaneously in an iatrogenically immunosuppressed patient. We report herein a rare case of concomitant M. haemophilum and scabies infestation in a 38-year-old woman with dermatomyositis on multiple immunosuppressive agents.

Closing the Brief Case: Disseminated Mycobacterium haemophilum Infection in a Kidney Transplant Recipient.

Closing the Brief Case: Disseminated Mycobacterium haemophilum Infection in a Kidney Transplant Recipient.

Case of Mycobacterium haemophilum misdiagnosed as Mycobacterium intracellulare due to one base insertion in the bacterial genome

Mycobacterium haemophilum is a slow-growing, non-tuberculous mycobacteria that causes cutaneous infection. We describe a case of cutaneous infection in a 68-year-old Japanese man with polymyositis. This was caused by M. haemophilum harboring one base insertion in gene sequence. At first, the causal microorganism was misidentified as M. intracellulare by COBAS® TaqMan® MAI test. However, poor growth on Ogawa media and growth enhancement on 7H11C agar around a hemin-containing disk prompted us to reinvestigate the causal microorganisms, which were revealed to be M. haemophilum. Amplified polymerase chain reaction products were sequenced, and the 16S rRNA gene, rpoB, hsp65 and internal transcribed spacer region sequences showed a 100%, 100%, 99.66% and 99.7% match, respectively, with the corresponding regions of M. haemophilum, but it harbored a novel gene sequence in hsp65. The sequences determined by gene analysis of the M. haemophilum strain were deposited into the International Nucleotide Sequence Database. Although numerous cases of M. haemophilum infection have been reported in other countries, only six cases have been reported in Japan to date. It could be possible that this novel mutation lead to misdiagnosis. As M. haemophilum prefers a lower growth temperature (30-32°C) and it requires iron in the culture medium, M. haemophilum could be misidentified or overlooked. Accordingly, a M. haemophilum infection should be considered in cases of cutaneous infection of the body sites, of which surface temperature is low.

Fifteen-year clinical experience with Mycobacterium haemophilum at the Mayo Clinic: A case series

Mycobacterium haemophilum is an uncommonly encountered acid-fast staining bacillus (AFB) that can cause a broad range of infections. We describe a tertiary care center's experience with M. haemophilum infections identified from 2000 to 2015. Ten adult patients were identified with M. haemophilum infections, and most had immunocompromising conditions. M. haemophilum presented in one of two syndromes: a peripheral cutaneous infection presenting with skin nodularity and local invasion, and a cervicofacial infection involving regional lymph nodes. Duration of therapy was variable (0–18 months) and was dependent on the underlying syndrome and immunological status of the patient. Treatment responses were favorable in all patients. During therapy, three patients developed culture-negative aseptic cutaneous lesions, consistent with immunologic reconstitution inflammatory syndrome (IRIS); we postulate that such reactions may not be uncommon with select M. haemophilum infections.

Mycobacterium haemophilum infection in a renal transplant patient with inflammatory bowel disease

A 61-year-old immunosuppressed renal transplant patient with inflammatory bowel disease presented with tender pink nodules on the trunk and extremities. An initial biopsy was suggestive of metastatic Crohn disease, but after disease persistence, a second biopsy revealed disseminated Mycobacterium haemophilum. Atypical mycobacterial infections should be considered in immunosuppressed patients. This case highlights the complexities of diagnosing such infections in patients with an underlying granulomatous condition and the particular growth requirements of M. haemophilum.

Infection of the optic apparatus and hypothalamus by Mycobacterium haemophilum

Mycobacterium haemophilum is a nontuberculous mycobacterium that primarily manifests as cutaneous ulcerations in immunocompromised adults and cervical lymphadenitis in immunocompetent children.1 We present a case of M haemophilum infection of the optic chiasm, tract, and hypothalamus in a patient with AIDS. Acknowledgment: The authors thank Dr. Marshall Glesby, who cared for the patient.