Mycobacterium Chelonae Infection Research Articles

Shedding light on Mycobacterium chelonae and its cutaneous intrusion: A case report

Background: Mycobacterium chelonae, a rapidly proliferating nontuberculous mycobacterium, is renowned for instigating diverse infections, notably those affecting the integumentary system. Despite its pervasive presence in the environment, its propensity for pathogenicity in human hosts often eludes recognition. In this case report, we endeavor to provide a thorough exposition encompassing the epidemiological characteristics, clinical presentations, diagnostic modalities, and therapeutic strategies pertinent to Mycobacterium chelonae infections, with particular emphasis on its manifestations in skin and soft tissues. Case Description: We describe the case of an immunocompromised patient with a history of rheumatoid arthritis that presented with a four-month history of erythematous nodules that started from her left hand and later extended up that arm. A diagnosis was not made until mycobacterial cultures grew Mycobacterium Chelonae. Patient was treated with a six-month course of antibiotics, including tigecycline and azithromycin, which resulted in a significant reduction of her cutaneous lesions. Conclusion: This report discusses the presentation, diagnosis, and treatment of Mycobacterium. Chelonae, a rare nontuberculous mycobacterium that presented as a skin infection in an immunocompromised patient. Early recognition followed by treatment with appropriate antibiotics is crucial in reducing to its spread to disseminated infections.

Bacteriophage treatment of disseminated cutaneous Mycobacterium chelonae infection

Mycobacterium chelonae is a rare cause of chronic disseminated cutaneous infections in immunocompromised patients. Multidrug-resistant M. chelonae infections present a challenge for treatment, and prolonged antimicrobial courses lead to significant toxicities and further antimicrobial resistance. We report a case of refractory cutaneous disseminated M. chelonae infection in a patient with seronegative arthritis on immunotherapy with tofacitinib that was treated with combination antimicrobial, surgical, and single bacteriophage therapy with excellent clinical response. The patient developed neutralizing antibodies against the bacteriophage but continues to have stable improvement of disease with negative biopsies and no evidence of bacterial resistance to the phage.

Review of Early Signs of Breast Implant Infection.

Breast implant infection remains a problem despite various prevention methods. Common pathogens such as staphylococcus aureus typically present acutely with fever, erythema, swelling, and pain. However, with the increasing occurrence of mycobacterial infections, associated early signs and symptoms are typically absent, making early detection difficult. A retrospective chart review of patients who underwent esthetic breast augmentation by senior surgeon FDP in an outpatient surgical facility from 1992 to 2021 was conducted. Cases of infections and related information including infection onset, presenting signs and symptoms, and culture results were recorded. Presentation differences between infections caused by common pathogens and mycobacteria were compared. A total of nine infections were reported in 365 patients. Seven cases were due to common pathogens: staphylococcus aureus, pseudomonas aeruginosa, methicillin-resistant staphylococcus aureus (MRSA), and staphylococcus epidermidis. Fever, erythema was presented within an average of 10 days after surgery. Two cases were due to mycobacterium chelonae (non-tuberculous mycobacterium) infection. In the latter, the earliest signs and symptoms consisted of mild pain and swelling in the absence of fever and erythema, which began on average of 54 days after the operation. Common breast implant infection pathogens usually present early with fever and erythema. However, our study found that non-tuberculous mycobacteria infections occur much later and fever and erythema are typically absent. The purpose of this study is to increase the awareness of clinicians with this rare but rapidly increasing variety of infections and to advise the operating surgeon to include mycobacteria infections in the differential diagnosis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mycobacterium chelonae infection in an immunocompromised patient presenting as multiple papulonodules on the leg

Mycobacterium chelonae is a rapidly growing nontuberculous mycobacteria that is a rare cause of cutaneous infections in both immunocompromised and immunocompetent patients. The clinical presentation is heterogeneous and non-specific, and therefore, despite an increasing incidence of these infections, patients are often misdiagnosed. Here we present the case of an immunocompromised 73-year-old female patient that developed tender, erythematous, violaceous to brownish papules and nodules on both the anterior and posterior aspects of her left lower leg. A histopathological examination revealed acid-fast bacilli, and a tissue culture identified M. chelonae. Disease resolution was achieved with long-term targeted antibiotic therapy based on susceptibility testing.

Disseminated Mycobacterium chelonae infection in a heart transplant recipient.

Disseminated Mycobacterium chelonae infection in a heart transplant recipient.

CUTANEOUS MICROABSCESSES BY MYCOBACTERIUM CHELONAE : CASE REPORTS FROM A TERTIARY CARE CENTRE, TRIPURA

Nontuberculous mycobacterial (NTM) infections are on the rise. They often cause skin diseases that are misdiagnosed.Two cases of Mycobacterium chelonae infection in immunocompetent patients were presented. First case showed infection of cutaneous and subcutaneous tissue without any preceeding history of skin injury by any intervention like trauma or injection, which was a rare manifestation. The second case showed M chelonae infection as a port site infection in a non healing ulcer. The history and clinical presentation of both the cases were documented. Treatment was also reported with subsequent output during further follow ups. Here both the cases showed resistance to commonly used amtimicrobial agents which increased the suspicion of nontuberculous mycobacterial infection among clinicians and microbiologist and made the diagnosis easier.

Rapidly expanding cutaneous Mycobacterium chelonae infection in eosinophilic granulomatosis with polyangiitis

Rapidly expanding cutaneous <i>Mycobacterium chelonae</i> infection in eosinophilic granulomatosis with polyangiitis

Investigation of two cases of Mycobacterium chelonae infection in haemato-oncology patients using whole-genome sequencing and a potential link to the hospital water supply

Haemato-oncology patients are at increased risk of infection from atypical mycobacteria such as Mycobacterium chelonae which are commonly found in both domestic and hospital water systems. To describe the investigation and control measures following two patient cases of M.chelonae and positive water samples in the study hospital. Water testing was undertaken from outlets, storage tanks and mains supply. Whole-genome sequencing (WGS) was used to compare patient and positive water samples. The subsequent infection control measures implemented are described. The WGS results showed two main populations of M.chelonae within the group of sampled isolates. The results showed that the patient strains were unrelated to each other, but that the isolate from one patient was closely related to environmental samples from water outlets, supporting nosocomial acquisition. WGS was used to investigate two patient cases of M.chelonae and positive water samples from a hospital water supply. Relevant control measures and the potential for chemical dosing of water systems to enhance proliferation of atypical mycobacteria are discussed.

Successful treatment of Mycobacterium chelonae skin infection in a patient on long-term immunosuppressive therapy for myasthenia gravis

Successful treatment of Mycobacterium chelonae skin infection in a patient on long-term immunosuppressive therapy for myasthenia gravis

Cutaneous Mycobacterium Chelonae Infection in a Heart Transplant Recipient

<h3>Introduction</h3> Mycobacterium Chelonae (MC) is a rapid grower of non Tuberculous Mycobacterium. It is rarely reported in heart transplant recipients. Here, we present a case of MC cutaneous infection in a heart transplant recipient. <h3>Case Report</h3> A 53-year-old male presented with a 3-month history of painful itchy discoid lesions, with the largest on the ulnar aspect of his right arm. One month prior, he underwent heart transplantation following an inpatient 6 month stay. On examination, multiple raised erythematous lesions with firm consistency were noted over the hand, wrist, and forearm. A skin biopsy was taken. MC was identified by whole genome sequencing. He was initiated on 4 weeks of intravenous imipenem and tobramycin with oral clarithromycin followed by oral azithromycin, clofazimine and linezolid for another 6 months with reduction in pain and lesion size. <h3>Summary</h3> Only 4 previous cases of MC following heart transplantation have been reported in the literature over the last 15 years. Our review was conducted using PubMed, MEDLINE, EMBASE. Cutaneous manifestation of MC is described as pigmented papules, nodules and granulomas, commonly found on the extremities. These can progress to pustules, haemorrhagic crusts and abscesses. In retrospect, the lesions seen in this case are typical of this presentation, but this was not clinically suspected. Diagnosis was ultimately made based on skin biopsy. These rapidly growing mycobacteria are resistant to the usual antituberculous drugs and can be associated with life-threatening complications such as mediastinitis and pulmonary infections. Reduction in immunosuppression was limited due to the early post transplant presentation in this case, however MC is reported up to 3 years post-transplant. There is no robust trial data regarding treatment of this organism, therefore early recognition of the presentation is crucial. In our case, early dermatology review facilitated prompt diagnosis and multidisciplinary approach to treatment resulted in a good outcome for the patient.

Investigating hospital Mycobacterium chelonae infection using whole genome sequencing and hybrid assembly.

Mycobacterium chelonae is a rapidly growing nontuberculous mycobacterium that is a common cause of nosocomial infections. Here we describe investigation of a possible nosocomial transmission of M. chelonae at the Hospital of the University of Pennsylvania (HUP). M. chelonae strains with similar high-level antibiotic resistance patterns were isolated from two patients who developed post-operative infections at HUP in 2017, suggesting a possible point source infection. The isolates, along with other clinical isolates from other patients, were sequenced using the Illumina and Oxford Nanopore technologies. The resulting short and long reads were hybrid assembled into draft genomes. The genomes were compared by quantifying single nucleotide variants in the core genome and assessed using a control dataset to quantify error rates in comparisons of identical genomes. We show that all M. chelonae isolates tested were highly dissimilar, as indicated by high pairwise SNV values, consistent with environmental acquisition and not a nosocomial point source. Our control dataset determined a threshold for evaluating identity between strains while controlling for sequencing error. Finally, antibiotic resistance genes were predicted for our isolates, and several single nucleotide variants were identified that have the potential to modulated drug resistance.

P26 Case of atypical cutaneous Mycobacterium chelonae infection in a patient with SLE after cyclophosphamide therapy

Abstract Background Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infection has been reported associated with surgical and cosmetic procedures. Disseminated infection is rare and usually occurs in individuals who are immunocompromised. We present a patient with severe SLE on immunosuppressive therapy who developed localised severe cutaneous infection of the foot. Methods A 69-year-old lady with complex SLE - RNP+, Raynaud's, arthritis, stable for several years had deteriorated within the last year with cardiac myositis and, peripheral neuropathy. Three months pulsed intravenous cyclophosphamide (EUROLUPUS regime) was completed in November 2018. Five weeks later she developed severe pain, inability to weight-bear and extensive erythema and swelling of the right ankle and lower leg. An MRI showed extensive skin thickening especially dorsally in the R foot and anteriorly in distal leg. There was also increased signal in the distal achilles tendon. Orthopedic review confirmed no evidence of septic arthritis or osteomyelitis. A skin biopsy was performed, cultures from which grew Mycobacterium chelonae. She was admitted and started on tobramycin, on which she developed long QTc, linezolid which caused thrombocytopenia and clarithromycin. In March 2019 she was re-admitted with confusion, weakness and AKI, secondary to clarithromycin. She was, then switched to clofazimine and low dose clarithromycin, on which she was stabilized. MRI brain scan was normal, lumbar puncture was negative for M chelonae PCR and MRI spine confirmed cervical cord compression and cervical and lumbar canal stenosis due to osteophytes and disc disease. Results The infection improved considerably after 5 months of successful mycobacterial treatment. It was then possible to treat with rituximab for a deteriorating peripheral neuropathy confirmed on EMG and cardiac myositis. Sadly, whilst awaiting rehabilitation, the patient died unexpectedly in April 2019 from an arrhythmia. Conclusion Mycobacterium chelonae is an uncommon cause of soft tissue infection, which is resistant to all anti-tuberculous drugs. It is susceptible to a wider range of antimicrobial agents including tobramycin, imipenem, clarithromycin, linezolid, co-trimoxazole. A high index of suspicion is necessary for diagnosis, particularly in immunocompromised patients. The incidence may be increasing, possibly due to enhanced detection. Infection can mimic MSK presentations including capsulitis, tendonitis and tenosynovitis. Close monitoring is required as anti-microbial therapy complications are common including prolongation of QTc on tobramycin. Vigilance for disseminated multiorgan involvement is essential due to high mortality, particularly with CNS and lung involvement. Atypical infections should always be considered in the immunocompromised, particularly mycobacteria, nocardia &amp; fungi. Disclosures S. Rasool None. A. Afifi None. D. De Lord None.

An unusual case of Mycobacterium chelonae infection

Introduction: A 32 year old lady developed multiple distinct, purple, raised, itchy lesions on her limbs, during a prolonged hospital admission. The lesions developed over six to eight weeks with no evidence of improvement. One lesion was biopsied and sent for analysis. The patient had a background of end stage renal failure from Anti-glomerular basement membrane (Anti-GBM) disease and she went on to receive a renal transplant. Eleven months prior to her hospital admission her transplant failed from de-novo focal segmental glomerulosclerosis. She had been admitted for 9 months with an eating disorder and malnutrition. She had been off any immunosuppressive agents for 6 months at the time that the lesions appeared. Methods: The lesion biopsied was consistent with a dermal abscess. The Ziehl-Neelsen stain was negative but a mycobacterium was cultured. This was confirmed to be Mycobacterium chelonae on reference lab testing (sensitivities awaited). She had no other lesions of concern on imaging. Results:Due to the disseminated nature of the lesions she was started on a 2 week course of intravenous amikacin with oral azithromycin and levofloxacin; the oral components to be continued for 2 to 6 months dependent on clinical response. Discussion:Mycobacterium chelonae is a nontuberculous mycobacterium abundant throughout the environment. It commonly causes skin lesions or cellulitis as well respiratory disease and urinary catheter colonization. It is a less common Rapidly Growing Mycobacterium (RGM) which usually occurs in patients on immunosuppression. The immunosuppressed state in this case was that caused by dialysis and malnutrition.

The Paradoxical Response in an Immunocompromised Patient With Disseminated Mycobacterium chelonae Infection

Abstract The paradoxical response, a form of immune reconstitution inflammatory syndrome, merits immunosuppression in addition to antimycobacterial therapy in patients with nontuberculous mycobacterial (NTM) infections. Well-described in Mycobacterium tuberculosis infections, the paradoxical response in NTM infections is less defined. We share an immunocompromised host with disseminated NTM and the paradoxical response.

Histopathological Features of Mycobacterium chelonae Infection in Two Farmed Japanese Pufferfish (Takifugu rubripes)

Granulomatous lesions were observed in the swim bladder, kidney, spleen and gills of two farmed Japanese pufferfish (Takifugu rubripes) infected with Mycobacterium chelonae. Three types of lesions were noted: unencapsulated clusters of epithelioid cells without central necrosis (type 1), encapsulated granulomas without central necrosis (type 2) and encapsulated granulomas with central necrosis (type 3). Type 3 lesions occurred most frequently in the swim bladder, while type 1 and type 2 lesions occurred frequently in the kidney and spleen, and the gills exhibited mostly type 1 lesions. This suggests that the lesions in the swim bladder were more fully developed than those occurring elsewhere and that the swim bladder may be more susceptible to infection with M. chelonae. This is the first report describing the histopathological features of M. chelonae infection in Tetraodontidae.

A Case of Cutaneous Mycobacterium chelonae Infection Induced by Body Scurbbing.

A Case of Cutaneous Mycobacterium chelonae Infection Induced by Body Scurbbing.

Mycobacterium chelonae infection after mesotherapy

Mycobacterium chelonae infection after mesotherapy

Response to Comment on Mycobacterium chelonae Infection of the Buttocks Secondary to Lipofilling: A Case Report and Review of the Literature.

Response to Comment on Mycobacterium chelonae Infection of the Buttocks Secondary to Lipofilling: A Case Report and Review of the Literature.

Necrotizing osteomyelitis in a man with disseminated Mycobacterium chelonae infection.

Cases of disseminated nontuberculous mycobacterial (NTM) infection are difficult to treat. We encountered an elderly man with disseminated Mycobacterium chelonae infection. The clinical evaluation and treatment of patients with this type of systemic infection pose unique challenges. Disseminated NTM infection with bone involvement often requires surgical intervention in addition to antimicrobial therapy.

A case of Mycobacterium chelonae infection at the site of acupuncture

A case of Mycobacterium chelonae infection at the site of acupuncture