Mycobacterium Chelonae Infection Research Articles

Mycobacterium chelonaeinfection: a complication of tattooing

We describe an outbreak of Mycobacterium chelonae infection in four young immunocompetent patients who were tattooed by the same artist. All had been previously tattooed without complication, but following the latest tattooing session, they all developed a very similar papular eruption confined to skin that had been newly coloured light grey. On histological examination of the eruption, granulomatous inflammation with microabscess formation was seen, in association with the tattoo pigment. Skin cultures grown under optimal conditions grew M.chelonae, sensitive to clarithromycin, from one patient. M. chelonae was also cultured from the contents and nozzle of an opened bottle of light-grey ink from the tattoo parlour frequented by the patients. Dermatologists should consider mycobacterial infection in patients who develop inflammatory changes within a new tattoo.

Mycobacterium Chelonae Infection after Total Knee Arthroplasty: A Case Report

We present a case of Mycobacterium chelonae infection after total knee arthroplasty in a 70-year-old woman. The patient underwent implant removal, drainage, debridement, and insertion of a gentamycin-load cement spacer. After 4 months, the second-stage surgery was performed. Intravenous amikacin (6 weeks) and oral clarithromycin (12 weeks) were given. At the 12-month follow-up, the patient achieved 90 degrees of flexion and could walk with a stick for up to 15 minutes. She was not taking any analgesics.

Disseminated Mycobacterium chelonae Infection in a Patient Receiving an Epidermal Growth Factor Receptor Inhibitor for Advanced Head and Neck Cancer

We report a case of disseminated cutaneous Mycobacterium chelonae infection in a patient with head and neck cancer on salvage chemotherapy, including the epidermal growth factor receptor inhibitor cetuximab. Mycobacterium chelonae should be considered in the differential diagnosis of cutaneous infections in cancer patients receiving epidermal growth factor receptor inhibitors.

Pulmonary Resection for Mycobacterium Chelonae Infection

Mycobacterium chelonae lung infection is rare and has long been recognized as an enigmatic infection resistant to medical therapy. Recently, we encountered a patient who underwent pulmonary resection for Mycobacterium chelonae infection. A 46-year-old man with no medical history was found to have an abnormal shadow in the left upper lung field on chest X-ray. Computed tomography showed a nodular shadow in the left upper lobe and disseminated shadows around it. Mycobacterium chelonae was detected from cultures of the sputum, bronchial washings, bronchoscopic biopsy specimens, and gastric fluid, and pulmonary infection with Mycobacterium chelonae was diagnosed. The shadow did not decrease in size despite antibiotic treatment. Since the lesion was confined to the left upper segment, we judged that a complete resection was possible, and performed left upper division segmentectomy. After surgery, no new foci of infection were observed in the lung. No effective therapy for Mycobacterium chelonae lung infection has been established to date, and reported cases of pulmonary resection for the treatment of Mycobacterium chelonae infection are extremely rare. However, surgery should be considered in patients in whom complete resection is deemed possible.

Mycobacterium chelonae infection involving the auricle

A 30-year-old man presented with a left side diffuse erythematous nodular, nontender, ulcerated auricular and periauricular skin lesion with serosanguineous discharge (Figure 1) after bilateral cervical lymphadenitis, which did not respond to a 6-month antituberculous medical therapy (i.e. isoniazide, ethambutol, rifampin and pyrazinamide) for suspected extra-pulmonary Tuberculosis bacillus (TB) infection. A battery of workup, including serology tests of anti-HIV antibody, CD4/CD8 counts, rheumatoid arthritis factor, human leukocyte antigen-B27, antinuclear antibody, anti-extractable nuclear antigen, cytomegalovirus antibody, cryptococcal antigen, Toxoplasma antibody and Epstein–Barr virus antibody titers were performed but all revealed negative results. Magnetic resonance imaging (MRI) showed multiple abnormally enlarged lymph nodes in the bilateral neck and an infiltrative skin lesion over the left external auricle (Figure 2 …

Diagnostic value of an enzyme-linked immunospot assay for interferon-γ in cutaneous tuberculosis

The aim of this study was to evaluate the diagnostic performance of an enzyme-linked immunospot (ELISPOT) assay (T-SPOT.TB; Oxford Immunotec, Oxford, UK) for interferon-γ in patients with suspected cutaneous tuberculosis (TB). From March 2007 to June 2010, a total of 45 patients with suspected cutaneous TB were enrolled. Data on clinical characteristics of the patients and conventional laboratory results were collected, and blood samples were obtained for ELISPOT assay. Ten subjects (22.2%) had culture-confirmed TB, 2 (4.4%) subjects had probable TB, and the remaining 33 (73.3%) subjects did not have TB. Twenty-one patients with mycobacterial infection had available biopsy or surgical specimens for histopathologic examination and 16 (76.2%) specimens had pathologic features (granulomatous inflammation, caseating necrosis, or acid-fast bacilli) consistent with mycobacterial infection. Among these 16 patients, all 6 patients with TB and 3 patients with Mycobacterium marinum infection had positive ELISPOT results, but none of the patients with Mycobacterium abscessus, Mycobacterium chelonae, or Mycobacterium avium infection had positive ELISPOT results. Overall, 9 of 10 patients with culture-confirmed TB and both patients with probable TB had positive ELISPOT assay. For patients with nontuberculous mycobacteria infections, ELISPOT assay was positive only in patients with M. marinum and M. kansasii infection. The sensitivity, specificity, positive predictive value, and negative predictive value for cutaneous TB diagnosis by the ELISPOT assay were 91.6% (95% CI, 64.6–98.5%), 75.8% (95% CI, 59.0–87.2%), 57.9% (95% CI, 34.0–78.9%), and 96.2% (95% CI, 59.0–87.2%), respectively. In conclusion, ELISPOT assay can provide useful support in the diagnosis of cutaneous TB.

Synchronous infection with Mycobacterium chelonae and Paecilomyces in a heart transplant patient

A 41-year-old male who was 3 years status post heart transplant presented with a 3-month history of painful erythematous nodules and ulcers on his lower legs and right hand. First, Mycobacterium chelonae infection was revealed through several biopsies with molecular sequence analysis, and combination treatment, including clarithromycin, was started. During the treatment, lesions of the legs showed an improvement, but a fluctuant erythematous nodule on the thumb did not respond. Repetitive biopsy from the thumb ultimately identified Paecilomyces species and the patient was treated with itraconazole and terbinafine sequentially. Our case is the first report, to our knowledge, of synchronous infection with non-tuberculous mycobacteria (NTM) and Paecilomyces in a solid organ transplant recipient. Our findings highlight the importance of recognizing cutaneous NTM infections or deep mycoses, as well as the importance of choosing an appropriate treatment.

ＳＬＥ患者に生じたＭｙｃｏｂａｃｔｅｒｉｕｍ ｃｈｅｌｏｎａｅ皮膚感染症の１例

ＳＬＥ患者に生じたＭｙｃｏｂａｃｔｅｒｉｕｍ ｃｈｅｌｏｎａｅ皮膚感染症の１例

Mycobacterium chelonae Infection Associated with Tattoos

Mycobacterium chelonae is a non-tuberculous Mycobacterium spp. classified in the rapidly growing mycobacteria group. M. chelonae has been isolated from various environmental sources, including tap water, water tanks, industrial sources, and even medical instruments. Disruption of the skin barrier caused by trauma, surgical intervention or cosmetic procedures facilitates the entry of different bacteria that can produce localized or, usually in immunosuppressed patients, systemic infections. We describe here an outbreak of M. chelonae infection in five immunocompetent patients who were being tattooed by the same artist.

Cutaneous Mycobacterium chelonae infection successfully treated with faropenem

Cutaneous Mycobacterium chelonae infection successfully treated with faropenem

A fatal Mycobacterium chelonae infection in an immunosuppressed patient with systemic lupus erythematosus and concomitant Fahr’s syndrome

We present a case of systemic Mycobacterium chelonae infection in an immunosuppressed patient with systemic lupus erythematosus (SLE), idiopathic hypoparathyroidism, and hypothyroidism. The patient was treated for 3 months for skin infection with clarithromycin monotherapy. Since her condition deteriorated, the antibiotic therapy was switched to intravenously administered clindamycin, cloxacillin, and meropenem. Due to further deterioration and isolation of M. chelonae from the blood culture, antimicrobial therapy was changed to azithromycin and amikacin. Drug-test sensitivity was performed, and the isolate was susceptible to clarithromycin only. The patient's deteriorating status prevented orally administered medication with clarithromycin (parenteral formulation is not registered in Croatia). The same antibiotic regime was continued until the isolation of Pseudomonas aeruginosa and Candida albicans. In addition, extensive calcifications in her brain were found on a computed tomography (CT) scan, which suggested Fahr's syndrome. Despite all measures and supportive care, the patient developed multiorgan failure and eventually died. There has been an increase in the number of infections by rapidly growing mycobacteria, but only a few cases of severe systemic infection with M. chelonae have been described. If the infection is diagnosed early and a patient is treated with appropriate drugs, dissemination can be avoided despite immunosuppression. For serious skin, bone, and soft-tissue disease, a minimum of 4 months of a combined drug therapy is necessary. This is the first report of M. chelonae infection in Croatia and the first-described M. chelonae infection in a patient with concomitant Fahr's syndrome.

Mycobacterium chelonae Infection After Fractionated Carbon Dioxide Facial Resurfacing (Presenting as an Atypical Acneiform Eruption): Case Report and Literature Review

Mycobacterium chelonae Infection After Fractionated Carbon Dioxide Facial Resurfacing (Presenting as an Atypical Acneiform Eruption): Case Report and Literature Review

Commentary: Mycobacterium chelonae Infection After Fractionated Carbon Dioxide Facial Resurfacing

Roy G. Geronemus, MD, has indicated no significant interest with commercial supporters.

An outbreak of Mycobacterium chelonae infections in tattoos

Nontuberculous mycobacteria infections may occur after cutaneous procedures. Review of the medical records of patients who developed a rash within a tattoo revealed 6 patients with skin infections caused by Mycobacterium chelonae after receiving tattoos by one artist at a single tattoo establishment. The interval between tattoo placement and the skin findings was 1 to 2 weeks. All patients received alternate diagnoses before mycobacterial infection was identified. Skin findings included pink, red, or purple papules; papules with scale; pustules; granulomatous papules; and lichenoid papules and plaques. Histopathologic examination revealed granuloma, lymphohistiocytic infiltrate, or mixed inflammation; acid-fast bacilli stains produced negative results. Diagnosis was made by culture in 3 patients, histopathology in two patients, and clinical/epidemiologic association in one patient. The M chelonae isolates were clarithromycin susceptible, and the infections responded to macrolide antibiotics. Physicians should consider mycobacterial infections in patients with skin findings within a new tattoo.

A Case in Point

Together with my wife, we read this article on the cost that might be saved by not performing group and save prior to elective breast cancer surgery. She had just had elective breast cancer surgery. She was having completion left mastectomy and right mastectomy following previous lumpectomy with sentinel node biopsy (November 2007) and subsequent level 2 left axillary clearance surgery (December 2007) for a grade 3 left breast cancer 1.5 cm with one micrometastasis and one metastasis confirmed in the axilla. ER and PR were both strongly positive, Herceptin negative. She completed 4 cycles of Epirubicin and 2.5 cycles of 4 scheduled of CMF complicated by Mycobacterium chelonae infection of her Hickmann line causing a severe atypical pneumonia. She was on a 3-month course of clarithromycin following on initial clarithromycin/ciprofloxacin/meripenem/ linezolid by infusion which brought rapid improvement in condition, as species were resistant to all except clarithromycin. Her tumour had arisen in an area of previous irradiation fields for Hodgkin' lymphoma treated in her early 20s (she had 4 relapses). She had been under follow-up in the local MR breast scanning screening programme started for long-term Hodgkin' survivors but sadly her lesion was not identified and she found the lump herself. At 6 h postoperatively, she had severe sudden haemorrhage with blood pressure dropping to 60/? and tachycardia of 120 requiring return to theatre. She was transfused with two units of irradiated blood of her own blood group (as previously grouped and saved) and had a further unit of irradiated universal donor blood. She had only recently found out re TA-GvHD from Lymphoma Matters (quarterly newsletter from the Lymphoma Association, Issue 74, Summer 2008) and also having come across the NHS leaflet Information for patients needing irradiated blood. (Blood for Hodgkin' disease patients is irradiated to prevent the life-long risk of graft versus host disease.) We were grateful for the rapidity of response of her surgical team and the availability of blood, otherwise her outcome may not have been so good. We would disagree with the assertion that money can be saved by not doing group and save for patients for elective breast cancer surgery as potentially losing the life (or having a significant hypotensive complication) of a comparatively young patient for lack of transfused blood would easily involve the clinicians/hospital involved in expensive litigation!

An outbreak of Mycobacterium chelonae infections in association with tattoos

An outbreak of Mycobacterium chelonae infections in association with tattoos

Cutaneous Mycobacterium chelonae Infection Presenting as Symmetrical Plaques on Both Shins in an Immunocompetent Patient

Sir, Mycobacterium chelonae exists widely in soil, fresh water, and dust throughout the world and is usually nonpathogenic in humans. The organism is a rapidly growing mycobacterium, and belongs to the Runyon group IV classification. Cutaneous M. chelonae infections can be classified into two types according to patient immune status. In immunocompetent patients, lesions usually follow trauma and present as localized abscesses, nodules, erythemas, or ulcers. In immunocompromised patients, however, lesions frequently develop without any trauma, and show a sporotrichoid or disseminated pattern. We report here a case of a 52-year-old immunocompetent man with bilateral symmetrical lesions but no history of trauma.

Disseminated Panniculitis in a Bottlenose Dolphin (Tursiops truncatus) due to Mycobacterium chelonae Infection

A 14-year-old female bottlenose dolphin was diagnosed with mycobacterial panniculitis based on punch biopsy specimens. The necropsy revealed numerous pyogranulomas in the blubber, as well as marked acute multifocal necrosuppurative pneumonia and lymphadenitis. In addition, the animal had marked scoliosis, which had first been noted clinically in the dolphin at about 1 mo of age. The animal had been treated with low-dose dexamethasone for approximately the last 19 mo to reduce perceived discomfort from spondyloarthritis and with the progestational agent altrogenest for approximately 8 yr to prevent pregnancy. Acid-fast positive bacilli were detected in the dermis but not in lung or lymph nodes. Mycobacterium chelonae was isolated from pooled skin, lung, and peripheral lymph-node tissue. Mycobacterial infection may be considered as a differential diagnosis in bottlenose dolphins with generalized cutaneous inflammation, particularly if chronic steroid and progesterone treatments were administered, both of which may have an immunomodulatory effect.

Conservative Management of Local Mycobacterium chelonae Infection After Combined Liposuction and Lipofilling

Conservative Management of Local Mycobacterium chelonae Infection After Combined Liposuction and Lipofilling

Disseminated cutaneous Mycobacterium chelonae infection with multidrug resistance in a patient with panuveitis

We report the case of a 43-year-old immunosuppressed woman who presented with cellulitis of the lower limbs and multiple widespread subcutaneous nodules in a sporotrichoid distribution. Microbiological findings from skin biopsy confirmed Mycobacterium chelonae infection.