Mycobacterium Fortuitum Infection Research Articles

Необычная причина серпигинозоподобного хориоидита. Связь с инфекцией Mycobacterium Fortuitum в моче?

The purpose of these case reports is to present a case who developed bilateral serpiginous like choroiditis in association with urogenital infection of Mycobacterium Fortuitum. A 49-year-old female who presented with visual loss was diagnosed with bilateral serpiginous like choroiditis. Uveitis workup findings were negative except for a positive tuberculin skin test positivity. Considering the findings and her residence in an endemic area for m. tuberculosis, empirical treatment for tuberculosis was started. Later in the course of the disease, her urine cytology came back positive for ARB, and M. Fortuitum was isolated in the urine cultures. Treatment for atypical mycobacteria resulted in clinical improvement. No relapses of serpiginous like choroiditis occurred following the treatment. This is the first documented case of serpiginous choroiditis related to mycobacterium fortuitum infection in the literature. Non-tuberculous mycobacteria may also cause serpiginous like choroiditis. Keywords: Mycobacterium Fortuitum, Serpiginous-like choroiditis, Uveitis, Urinary tract infection

Mesh infection of Mycobacterium fortuitum after inguinal hernia repair: A rare case report and literature review

PURPOSE: Inguinal hernia repair is one of the most common operations worldwide. The standard procedure now is tension-free hernioplasty with mesh implantation. Mesh repairs obviously reduce the rate of hernia recurrence and alleviate the pain. However, mesh infection is one of the most serious complications, which usually causes secondary operation. At present, no standard treatment measures of mesh infections, especially for rare pathogens such as nontuberculous mycobacteria (NTM), are available. MATERIALS AND METHODS: We present an unusual case of Mycobacterium fortuitum infection of implanted mesh after inguinal hernia repair. Medline and PubMed databases were searched using the keywords mentioned subsequently, and the literature on treatment measures of mesh infection of M. fortuitum and other subtypes of NTM after inguinal hernia repair is reviewed. RESULTS: Mesh infections of M. fortuitum are very rare after inguinal hernia repair. The infection is hard to diagnose and complex to treat. However, it has characteristic clinical manifestations. With early recognition and specific tests, clinicians can still confirm the infection. Treatments include antibiotics and surgical intervention. Mesh displantation is considered to be necessary and needs to be conducted as soon as possible. CONCLUSION: When a mesh infection is present, it is important to check the wound before obtaining bacteriological evidence. Once the mycobacteria infection is suspected, corresponding tests should be taken immediately. With appropriate treatment, patients will likely make a full recovery.

Evaluation of haemato-biochemical changes, oxidative stress response and stress related gene expressions in juvenile Labeo rohita (Hamilton, 1822) in response to Mycobacterium fortuitum infection

Non-tuberculous mycobacteria present in aquaculture systems can infect and influence the physio-chemical blood parameters of captive fish. The aim of this study was to examine the changes in haematological and biochemical parameters along with expression of stress related genes in response to Mycobacterium fortuitum infection in the Indian major carp, rohu Labeo rohita (Hamilton, 1822). Juveniles of L. rohita were experimentally infected with M. fortuitum strain ATCC 6841, by immersion challenge at three different dosages of 5x105 cfu fish-1 (group T2 ), 5x106 cfu fish-1 (group T3 ) and 5x107 cfu fish-1 (group T4 ) along with a control group. After 60 days post-infection, fishes in groups T2 , T3 and T4 were observed with necrotic lesions in skin and M. fortuitum was recovered from moribund fishes. Heat shock protein (hsp) gene expression analysis was performed in liver tissues by RT-PCR and hsps were analysed by Western Blotting in fishes of all treatment groups and control. Significant changes (p<0.05) were found in haemato-biochemical parameters including glucose, cortisol, blood parameters, liver enzymes, serum proteins and catalase and superoxidase dismutase activity along with mRNA expression of hsp genes viz, hsp60, hsp70, hsp78, hsp90 and hsp47 within groups T3 and T4 in comparison to control. The results suggest the pathogenicity of M. fortuitum (ATCC 6841) to L. rohita by promoting stress parameters and the transcription level of stress related genes. Keywords: Fish tuberculosis, Heat shock protein, Mycobacterium fortuitum, Mycobacteriosis, Rohu

Mycobacterium fortuitum infection from needlefish impalement during diving: A diagnostic challenge

In order to evaluate the diagnostic value of schistosome circulating anodic antigen (CAA) detection, serum and urine CAA-levels were determined in a single cluster of 34 Belgian tourists at three timepoints within a period of 14 weeks following proven Schistosoma exposure in South Africa and compared with two in-house antibody assays.Samples were collected 4–5 and 7–8 weeks post-exposure and subsequently 5–6 weeks following praziquantel treatment. Schistosoma antibodies were detected by an adult worm antigen-immunofluorescence assay (AWA-IFA) and a soluble egg antigen-enzyme-linked immunosorbent assay (SEA-ELISA), while CAA concentrations were determined by the Up-Converting reporter Particle labelled Lateral Flow (UCP-LF) test.Antibodies were detected in 25/34 (73%) travellers pre-treatment and in 27/34 (79%) post-treatment, with the AWA-IFA showing better performance than the SEA-ELISA. Pre-treatment, CAA was detected in 13/34 (38%) and 33/34 (97%) of the travellers in urine and serum, respectively. Post-treatment, all except one traveller became serum CAA negative. This in contrast to the detected antibodies, as well as the previously reported diagnostic results of this cluster.The UCP-LF CAA serum assay has been demonstrated as the most sensitive method for the diagnosis of early Schistosoma infections and post-treatment monitoring in travellers.

Disseminated Mycobacterium Fortuitum Infection in Bilateral Lung Transplant Recipient

Introduction Lower respiratory tract secretions from lung transplant recipients are known on rare occasions to yield a low inoculum of non-tuberculous mycobacteria. However, despite the intense systemic immunosuppression required in these recipients, disseminated mycobacterial disease has rarely been reported. Case Report A 66-year-old male with history of right total knee arthroplasty in 2007 and bilateral lung transplant in 2019 (cytomegalovirus [CMV] donor seropositive/recipient negative) was admitted with two days of fevers, chills, and dyspnea. Immunosuppression therapy included basilixumab induction and maintenance immunosuppression with mycophenolate mofetil, tacrolimus, and prednisone. A CT chest demonstrated patchy opacities in the left lung allograft and right middle lobe with a moderate partially loculated left pleural effusion. A bronchoscopy with bronchoalveolar lavage (BAL) was performed and cultures demonstrated Veillonella parvula, anaerobic gram negative bacilli, and M. fortuitum. Two months earlier, BAL cultures had demonstarted M. fortuitum, but treatment had been deferred at that time as recipient was asymptomatic. Now, with rapid improvement on cephalosporin therapy, treatment for M. fortuitum was again not pursued. The recipient was readmitted one month later with left knee pain, fever, and diarrhea, and was diagnosed with hemarthrosis and CMV colitis. Four weeks later the recipient experienced right knee pain and when joint aspiration demonstrated M. fortuitum he underwent two stage revision at which time intraoperative cultures again yielded M. fortuitum. Following this surgery the recipient then was found to have a chest wall abscess, which when incised also yielded M. fortuitum. Treatment with imipenem and ciprofloxacin for six weeks was initiated, with transition to oral ciprofloxacin for one year. Summary This case illustrates the potential for M. fortuitum pulmonary infections to result in disseminated disease in lung transplant recipients. While rarely reported in the literature, non-tuberculous mycobacterium infections have been associated with bronchiolitis obliterans syndrome and mortality in lung transplant recipients. Dissemination of M. fortuitum is uncommon and prompt recognition is crucial for appropriate source control and antibiotic therapy initiation.

MON-235 Mycobacterium Fortuitum Infection Mimicking Sellar Chondrosarcoma in a Non-Immunosuppressed Patient: An Unusual Cause of Hypopituitarism and Oculomotor Nerve Palsy

A 32-year old male patient of central African origin presented with diplopia and left eyelid ptosis. He described a 2-month history of fatigue, weight loss (8 Kg), headaches, diffuse myalgia and night sweats. Clinical examination revealed cavernous sinus syndrome with left eyelid ptosis and weakness of eye adduction. Magnetic resonance imaging of the brain demonstrated a 36 mm mass centered on the left petroclival suture, infiltrating the sella and the pituitary gland, the ipsilateral orbital apex as well as the cavernous sinus bilaterally. The mass showed heterogenous enhancement after gadolinium injection, with elements of central necrosis and was associated with an extensive bone destruction. These radiologic features raised the hypothesis of chondrosarcoma. Chest computed tomography demonstrated multiple lung micro-nodules suspect of metastasis. Laboratory testing of the anterior pituitary function revealed low free-T4 (11 pmol/l, n = 12-22) with normal TSH (0.4 mUI/l, n=0.3-4.2), low total testosterone (1.5 ugr/l, n = 3.3-8.1) with normal LH and FSH and slight hyperprolactinemia (27 ugr/l, n = 4-15). IGF-1, 24-h urinary free cortisol, as well as morning serum cortisol and cortisol after 250 mcg ACTH stimulation test were normal. There was no evidence of diabetes insipidus. Levothyroxine was prescribed. Craniotomy was performed, for left optic nerve decompression and biopsy of the mass. Pathologic examination revealed granulomatous, giganto-cellular and necrotizing inflammation, but no evidence of malignancy. PCR for Mycobacterium tuberculosis complex was negative but Mycobacterium fortuitum was detected in sputum and also confirmed in cerebral biopsy latter. Other causes of granuloma were excluded (brucellosis, cat scratch disease, histoplasmosis, syphilis, coccidioidomycosis, tropical germs etc.). Different causes of immunosuppression (including HIV) were excluded. The patient was treated with amikacin, isoniazid and ciprofloxacin for several months and improved gradually. MRI performed one year later demonstrated significant decrease on the size of the sellar mass (more than 50% of its initial size). Central hypogonadism regressed spontaneously with decrease in tumor size, and normal testosterone levels were achieved at one-year follow-up (7 ugr/l, n = 3.3-8.1). Mycobacterium fortuitum infections of the sella turcica are poorly described in literature in non-immunosuppressed individuals. Although usually not pathogenic, histopathological examination, identification in the CNS lesion and the lungs and response to treatment are convincing evidence of a causal relationship. Differential diagnosis from malignant lesions is challenging and biopsy is necessary in order to establish the cause and offer adequate treatment.

TNF-α-mediated ER stress causes elimination of Mycobacterium fortuitum reservoirs by macrophage apoptosis.

Mycobacterium fortuitum (MF), a rapidly growing nontuberculosis mycobacterium, is recognized as an important human pathogen. We investigated whether the endoplasmic reticulum (ER) stress response is associated with the apoptosis of MF-infected macrophages. The expression of ER molecular chaperones was significantly induced by MF infection. We found that MF-induced reactive oxygen species (ROS) generation plays a critical role in the induction of ER stress-mediated apoptosis. Excess TNF-α in the ER led to ER stress-mediated apoptosis during MF infection. The intracellular survival of MF was significantly increased by TNF-α knockdown compared with the control. This is the first report of MF-induced TNF-α as a cause of ER stress in macrophages. Furthermore, we found that TLR2-mediated ER stress response contributed to the elimination of intracellular MF in vivo. These results suggest that TNF-α-mediated ER stress during MF infection contributes to the suppression of intracellular survival of MF in macrophages. Our findings provide new insight into the importance of ER stress in mycobacterial infection.-Oh, S.-M., Lim, Y.-J., Choi, J.-A., Lee, J., Cho, S.-N., Go, D., Kim, S.-H., Song, C.-H. TNF-α-mediated ER stress causes elimination of Mycobacterium fortuitum reservoirs by macrophage apoptosis.

Arsenic exposure impels CD4 commitment in thymus and suppress T cell cytokine secretion by increasing regulatory T cells

Arsenic is globally infamous for inducing immunosuppression associated with prevalence of opportunistic infection in exposed population, although the mechanism remains elusive. In this study, we investigate the effect of arsenic exposure on thymocyte lineage commitment and the involvement of regulatory T cells (Treg) in arsenic-induced immunosuppression. Male Balb/c mice were exposed to 0.038, 0.38 and 3.8 ppm sodium arsenite for 7, 15 and 30 days through oral gavage. Arsenic exposure promoted CD4 lineage commitment in a dose dependent manner supported by the expression of ThPOK in thymus. Arsenic also increased splenic CD4+ T cells and promoted their differentiation into Treg cells. In parallel, arsenic exposure induced immunosuppression characterized by low cytokine secretion from splenocytes and increased susceptibility to Mycobacterium fortuitum (M. fortuitum) infection. Therefore, we linked arsenic-induced rise in Treg cells with suppressed Th1 and Th2 related cytokines, which has been reversed by inhibition of Treg cells in-vivo using wortmannin. Other parameters like body weight, kidney and liver function, histoanatomy of thymus and spleen as well as thymocyte and splenocytes viability were unaltered by arsenic exposure. Taken together our findings indicated that environmentally relevant dose of arsenic enhanced differentiation of Treg cells which in turn induce immunosuppression in experimental animals.

Mycobacterium fortuitum infection after acupuncture treatment

Actinic keratoses are cutaneous lesions that appear as the result of the proliferation of atypical keratinocytes. These lesions are considered pre-malignant and they can progress to squamous cell carcinoma. Ingenol mebutate has been approved as an effective treatment for AK on the face and trunk. We studied the local skin reactions to this therapy. Data about local skin reactions were collected in a series of 5 patients with photographic documentation, a visual analog scale, and a ranking of satisfaction of the patient. Moderate to severe reactions were reported in most of patients, but only one stopped treatment early. The short duration of treatment contributes to high adherence to the therapy.

Cloacal adenocarcinoma and mycobacteriosis in a White’s Tree Frog - case description

Mycobacterium fortuitum infection and adenocarcinoma were associated with cloacal prolapse in a White’s tree frog (Litoria caerulea). The disease was characterized by the presence of nodules in a cloacal mucous membrane. Bacteriological examination of the cloacal tissue revealed the presence of Enterococcus sp., E. coli and numerous acid-fast bacteria (AFB). The presence of AFB was confirmed by a Ziehl-Neelsen stain of the cloacal tissue and culture on the Löwenstein–Jensen medium. Post-mortem examination showed no changes typical of mycobacteriosis or neoplasia in other organs.

Visible Hand Hygiene Monitors are Critical to Improving and Sustaining Hand Hygiene Compliance

Pacemaker vendor was contacted and confirmed there were no reported Mycobacterium infections related to the device. No further Mycobacterium Fortuitum infections have been identified. LESSON LEARNED: The use of cardiac implantable electrophysiological device (CIED) implantation for the management of cardiac disease is increasing as are infections associated with these procedures. Mitigation of infection risk can be accomplished through teamwork and sustained follow up of instituted Infection Prevention measures. Supplemental cleaning support by Electrophysiology Lab staff is useful in high-volume procedure rooms. Forging interdepartmental collaborative teams to identify and address opportunities for improvement can result in enhanced patient outcomes.

Cutaneous Mycobacterium fortuitum Infection: Successfully Treated with Amikacin and Ofloxacin Combination.

Cutaneous infections caused by atypical mycobacteria are uncommon and the diagnosis can be missed unless there is strong clinical suspicion supported by laboratory confirmation. We report a case of chronic discharging sinus caused by Mycobacterium fortuitum in a young healthy immunocompetent individual. The patient recovered completely following amikacin and ofloxacin therapy.

Mycobacterium fortuitum infection arising in a new tattoo

We report an uncommon case of a cutaneous infection with Mycobacterium fortuitum arising in a new tattoo. A 29-year-old man presented with a several month history of a non-pruritic papular eruption within a tattoo; the papules developed 1-to-2 weeks after the tattoo procedure. He denied similar symptoms with previous tattoos. He had been treated unsuccessfully with cephalexin. Histopathologic examination revealed perifollicular chronic and granulomatous inflammation, consistent with chronic folliculitis. Acid-fast bacilli culture identified Mycobacterium fortuitum complex. The patient was treated with a 2-month course of oral trimethoprim-sulfamethoxazole (160mg/800mg twice daily) and ciprofloxacin (250 mg twice daily), with clinical improvement at follow up after three weeks of the antibiotic regimen. Rapidly growing mycobacteria have emerged as a cause of tattoo-associated cutaneous infection in recent years. Diagnosis and treatment can be difficult without clinical suspicion. M. fortuitum and other rapidly growing mycobacteria should be considered in the differential diagnosis of tattoo-associated dermatologic complications.

Mycobacterium fortuitum-related lymphadenitis associated with the varicella-zoster virus

Lymphadenitis caused by non-tuberculous mycobacteria is an uncommon manifestation in immunocompetent individuals. Here, we report a case of Mycobacterium fortuitum infection in a previously healthy 9-year-old patient who developed cervical lymphadenitis evolving to a suppurative ulcer associated with a varicella-zoster virus infection. We discuss the relationship between the varicella-zoster virus and the immune response of the host as an explanation for the unusual progression of the case.

Mycobacterium fortuitum Infection following Reconstructive Breast Surgery: Differentiation from Classically Described Red Breast Syndrome.

Background:Red breast syndrome (RBS) has been described as an erythema that may be associated with 2-stage prosthetic reconstructive breast surgery using biologic mesh. RBS is differentiated from infectious cellulitis through absence of fever and laboratory abnormalities and usually has a self-limiting course. There have been no clinical reports on etiology, risk factors, or management of RBS. This report describes patient data that raise the need to rule out mycobacterial infection when RBS is being considered as a diagnosis.Methods:We present 6 cases of Mycobacterium fortuitum infection occurring after prosthetic breast reconstruction performed with a human-derived acellular dermal matrix, including the timing and course of erythema, laboratory results, treatments used, and long-term outcomes. We also describe the differential diagnoses of RBS in the context of these cases, including emergence of acid-fast bacilli and diagnostic and treatment considerations. Exact two-tailed 95% confidence intervals based on the F-distribution are provided with estimates of the incidence rates of infection.Results:The 6 cases presented here do not fit the typical description of RBS and were caused by mycobacterium infection. Statistical evaluation of the estimated incidence rate of M. fortuitum infection in a patient thought to have RBS, which occurred 100% of the time in this series, revealed a 95% confidence interval of 54.1–100%.Conclusions:When presented with possible RBS, surgeons must rule out cellulitis, culture for acid-fast bacilli such as mycobacterium species, and then determine the best course of treatment. Patient counseling regarding potential household sources of infection is warranted to minimize postoperative infection risk.

Disseminated Nontuberculous Mycobacterial Infection in Two Children with Different Immune Responses

A diffuse, infiltrating abdominal mass accompanied with fever and anemia in a child raises the possibility of a benign or malignant tumor, pseudotumor, or infection. Herein, we describe a 9-year-old girl and a 14-year-old boy with multiple large abdominal masses, fever, weight loss, and anemia. During the evaluation of the children, the girl was found to be immunocompetent, while the boy was found to be immunocompromised. Computerized tomography of the abdomen in both cases demonstrated multiple large intra-abdominal masses. Tumors in the girl were composed of wide-spread necrotizing granulomas and necrosis with dystrophic calcifications. In the boy, non-necrotic, homogenous histiocytic infiltrates with rare multinucleated giant cells and lymphocytes were observed histologically. Review of histologic sections identified gram-positive, nonbranching acid-fast bacillary organisms in both cases. Diagnoses of Mycobacterium fortuitum (MF) and Mycobacterium avium-intracellulare complex (MAC) were confirmed by tissue microbiologic cultures in the girl and boy, respectively. The girl with MF infection was appropriately treated and is currently doing well. The boy with MAC was found to have human immunodeficiency virus infection/acquired immune deficiency syndrome (AIDS) and is currently undergoing AIDS treatment. These cases highlight the striking contrast between responses to nontuberculous mycobacteria infection based on immune status.

Mycobacterium fortuitum infection following inguinal hernia repair with mesh: A case series

Rapid growing mycobacteria (RGM) are notorious for chronic infections and non-healing surgical wounds. There are reports of infections of implants by RGM, particularly Mycobacterium fortuitum . These conditions necessitate wound exploration to find out the actual pathogen. Herein, we report three cases of M. fortuitum infection following inguinal hernia repair with mesh.

Exogenous Lipoid Pneumonia Complicated with Mycobacterium fortuitum Infection

Exogenous Lipoid Pneumonia Complicated with Mycobacterium fortuitum Infection

湧水を用いた不適切な出口部ケアにてMycobacterium fortuitum出口部感染を発症した腹膜透析患者の1例

湧水を用いた不適切な出口部ケアにてMycobacterium fortuitum出口部感染を発症した腹膜透析患者の1例

Treatment of Mycobacterium fortuitum Infection of Total Knee Arthroplasty: A Case Report

Mycobacterium fortuitum is a rapidly growing bacterium that can cause infection at different sites in humans. Prosthetic infection caused by this bacterium has historically been a challenge, with reimplantation being unsuccessful in all but one case. M. fortuitum is resistant to almost all conventional antituberculous medications. There is no standardised treatment due to its rarity of occurrence. Here, we report a case of successful reimplantation with initial debridement surgery and 6 weeks of antibiotics.