Mycobacterium Haemophilum Research Articles

Mycobacterium haemophilum in a renal/pancreas transplant patient: A case report demonstrating multiple manifestations of the disease

Mycobacterium haemophilum in a renal/pancreas transplant patient: A case report demonstrating multiple manifestations of the disease

Diagnosing cutaneous Mycobacterium haemophilum by PCR

Diagnosing cutaneous Mycobacterium haemophilum by PCR

Facial Skin Lesions in Children Caused by Nontuberculous Mycobacteria.

Nontuberculous mycobacteria rarely cause facial skin lesions in immunocompetent children. I describe the clinical features and treatment of nontuberculous mycobacteria facial lesions. The diagnosis of a facial nontuberculous mycobacteria infection was established using polymerase chain reaction. Of 286 children with confirmed nontuberculous mycobacteria infection, 14 (4.9%; median age 50 mos, range 9-156 mos; 5 [36%] male, 9 [64%] female) had nontuberculous mycobacteria facial skin lesions. Six (43%) had lesions on the cheek and five (36%) in the medial eye corner. Polymerase chain reaction results confirmed the presence of Mycobacterium haemophilum in eight patients (57%) and Mycobacterium avium in six patients (43%). The facial lesions were treated using a combination of clarithromycin and rifabutin for 12 weeks, with a median healing time of 4 months. Nontuberculous mycobacteria facial lesions are rare in immunocompetent children. The diagnosis requires a high index of suspicion. Nonsurgical treatment is preferable, because surgical excision of the cutaneous lesions might lead to undesirable visible facial scars.

心移植後のPTLD（移植後リンパ増殖性疾患）と鑑別を要した非定型抗酸菌による多発骨髄炎の1例

心移植後のPTLD（移植後リンパ増殖性疾患）と鑑別を要した非定型抗酸菌による多発骨髄炎の1例

Intraventricular granulomatous mass associated with Mycobacterium haemophilum: A rare central nervous system manifestation in a patient with human immunodeficiency virus infection

We report a rare case of Mycobacterium haemophilum presenting as an intraventricular granulomatous mass with loculated hydrocephalus and seizures in a patient with human immunodeficiency virus. M. haemophilum, a slow-growing mycobacteria, causes localized and disseminated disease among immunocompromised hosts. Central nervous system infection with M. haemophilum is extremely rare. Preoperative laboratory testing of our patient for tuberculosis, toxoplasmosis, sarcoidosis and histoplasmosis were negative. Surgical resection of the mass revealed a caseating granuloma that stained positive for acid-fast bacillus suggesting possible tuberculoma. Despite negative testing for tuberculosis, a polymerase chain reaction analysis was ultimately performed from the resected mass which revealed M. haemophilum. To our knowledge, this is the first case of M. haemophilum presenting as an intraventricular mass. We review the clinical manifestations of this pathogen and discuss the medical and surgical management.

Bilateral Sporotrichoid Cutaneous Infection by Mycobacterium haemophilum in a Chinese Patient with Systemic Lupus Erythematosus

We report a case of an immunocompromised 30-year-old woman with systemic lupus erythematosus (SLE) with bilateral sporotrichoid cutaneous infection caused by M. haemophilum. The patient initially presented with painful deep erythematous nodules and ulcerations on her left forearms for several months. These nodular lesions were arranged along the lymphatic path and became suppurative, ulcerative, and crusted. Subsequently, the symmetrical part of the dorsum of the patient’s right hand showed a similar nodular lesion (Fig. 1A–C). Eight years earlier, she was diagnosed with SLE and intermittently treated with steroid therapy (dosage was unknown), however, the facial rash still relapsed. Currently, the patient is receiving 20 mg prednisone once daily. Her medical history revealed no other systemic diseases and she denied any preceding history of trauma, gardening, or dealing with fish tanks. Laboratory examination showed the platelets were 23 × 109/l (normal: 100–300 × 109/l) and the hemoglobin was 105 g/l (normal: 110–150 g/l). Urine routine examination showed proteinuria and occult blood. Immunological findings included positive results for ANA (1:1,000), anti-RNP, and anti-SSA. The purified protein derivative (PPD) test and human immunodeficiency virus (HIV) antibody test were negative. Histological examination of an erythematous nodule on the patient’s left forearm revealed an abscess and granulomas without caseous necrosis in the superficial and mid-dermis, which involved mainly neutrophils, as well as lymphocytes, histiocytes, plasmocytes, and a small amount of eosinophils (Fig. 1D, E). The epidermis was mildly hyperplastic and Ziehl–Neelsen staining of the histopathology lesions revealed acid-fast bacilli (AFB) (Fig. 1F). Other specific stains, such as periodic acid Schiff and Giemsa stains, for microorganisms were negative. Biopsy specimen culture for mycobacteria on a Lowenstein–Jensen medium was negative. Therefore, a direct sequencing protocol targeting hsp 65 and 16S rRNA genes of mycobacterium was applied in the tissue specimen. Sequence analysis of hsp65 genes indicated 100% homology with the M. haemophilum strain ATCC 29548, and 16S rRNA genes showed 99% similarity with M. haemophilum strain DSM 44634. Gene sequences were analysed using BLAST V2.0 software avail able at http://www.ncbi.nlm.nih.gov/BLAST/. The organism, when biopsy specimens were cultured for the second time on a blood Bilateral Sporotrichoid Cutaneous Infection by Mycobacterium haemophilum in a Chinese Patient with Systemic Lupus Erythematosus

DISSEMINATEDMYCOBACTERIUM HAEMOPHILUMINFECTION IN AN ASSAM TRINKET SNAKE (ELAPHE FRENATA)

A sub-adult male Assam trinket snake (Elaphe frenata) that was confiscated from an exotic animal dealer was found dead in its enclosure after a 17-mo quarantine. The snake had grown well during that period and had no physical examination or bloodwork abnormalities during the quarantine. On gross necropsy, masses were found in the epaxial musculature and stomach, the lung was diffusely thickened, the ventricular wall was mottled, and there was intracoelomic and pericardial effusion. Histopathology revealed diffusely disseminated granulomatous infiltrates throughout the lung interstitium and multifocal granulomatous infiltrates in the transmural gastric mass, within the myocardium and pericardial adipose tissue, in the liver and kidney parenchyma, in the cervical region surrounding the trachea and thyroid, and replacing the myofibers of the craniolateral epaxial muscles. Fite-Farracho acid-fast staining revealed numerous intracytoplasmic acid-fast bacilli within macrophages, and polymerase chain reaction testing on frozen tissues followed by nucleic acid sequencing of polymerase chain reaction amplicons identified Mycobacterium 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.

Central nervous system infection due to Mycobacterium haemophilum in a patient with acquired immunodeficiency syndrome

Mycobacterium haemophilum is an environmental organism that rarely causes infections in humans. We report a patient with acquired immunodeficiency syndrome who had central nervous system infection due to M. haemophilum. The diagnosis required brain tissue procurement and molecular identification method while the treatment outcome was unfavourable.

Demyelinating Optic Chiasmopathy Due to Mycobacterium Haemophilum in a Patient with AIDS (P6.298)

Demyelinating Optic Chiasmopathy Due to Mycobacterium Haemophilum in a Patient with AIDS (P6.298)

Recurrent Mycobacterium haemophilum in a renal transplant recipient

Mycobacterium haemophilum is a rare isolate of non-tuberculous Mycobacterium which has been reported to affect immunocompromised patients. We report a case of a 32-year-old renal transplant patient with M. haemophilum infection initially involving his left sinus which was treated with appropriate antimicrobial therapy for thirteen months. Two weeks after cessation of antibiotics the infection rapidly recurred in his skin and soft tissues of his hands and feet. This case highlights the difficult diagnostic and therapeutic implications of atypical infections in transplant patients. To our knowledge this is the first reported case of relapsed M. haemophilum infection in a renal transplant recipient.

Reduced Macrophages IL-12 Production After Stimulation By BCG/INF-Gamma Suggestive Of Impaired INF-Gamma Pathway Signalling In a Child With Disseminated Atypical Mycobacterial Infection and History Of Chemotherapy For Langerhans Cell Histiocytosis

Impaired INF-γ mediated immunity is characterised by increased susceptibility to poorly virulent mycobacteria. Here, we present a case of a patient with disseminated atypical mycobacterial infection poorly responding to antimicrobial treatment and INF-γ. This in a setting of previous chemotherapy for LCH resulting in profound T-cell lymphopaenia and impaired Th1/Th17 function. Functional studies of INF-γ pathway together with sequencing of INFGR1, INFGR2 and STAT1 genes were performed. A 21 month old boy was diagnosed with a disseminated Mycobacterium haemophilum infection after previous chemotherapy for LCH following LCH III, LCH III Salvage and HLH 2004 protocols, completed by Alemtuzumab, resulting in severe T-cell lymphopaenia (<200/mm3). Despite treatment with multiple anti-microbial drugs and high dose INF-γ, the infection continued to progress. Functional in vitro studies showed impaired macrophage IL-12 production after stimulation by BCG/INF-γ and severely impaired T-cell IFN-γ and IL-17 production in response to PHA. Sequencing of INFGR1, INGR2 and STAT1 cDNA showed no pathogenic mutations. Progressive disseminated atypical mycobacterial infection despite multiple anti-microbial treatment and high-dose INF-γ is very suggestive of an underlying Interferon Gamma Pathway immunodeficiency. Despite no mutations found in previously described associated genes (INFGR1, INFGR2 and STAT1), we believe that a secondary immunodeficiency induced by chemotherapy alone is not a sufficient explanation to the character of the infection and that a yet not identified defect of the Interferon Gamma Pathway might be causative. This unique case also raises questions about the character of LCH, a condition which remains to be idiopathic.

Mycobacterium leprae and Mycobacterium haemophilum co-infection in an iatrogenically immunosuppressed patient

We present the case of a native Texan who was diagnosed with tuberculoid leprosy and later developed a cutaneous infection with M. haemophilum following iatrogenic immunosuppression. To our knowledge, there are no such reports of M. haemophilum and M. leprae infection occurring simultaneously in the same host.

Atypical Mycobacteriosis Caused by Mycobacterium haemophilum in an Immunocompromised Patient

We report a rare case of atypical mycobacteriosis diagnosed by F-FDG PET/CT. A 28-year-old man with a history of kidney transplantation presented with fever, painful nodular skin lesions, and elevated inflammatory markers. FDG PET/CT demonstrated multiple subcutaneous, cutaneous, and osseous areas of increased tracer uptake. Histopathologic and microbiological evaluation revealed disseminated infection with Mycobacterium haemophilum. FDG PET/CT is a valuable tool for early and correct diagnosis of occult sources of infection in immunocompromised patients.

Skin Nontuberculous Mycobacterial Infection in Systemic Lupus Erythematosus: An Unusual Skin Infection Mimicking Lupus Vasculitis

To report 2 cases of skin nontuberculous mycobacteria (NTM) occurring in lupus patients and to systematically review the medical literature addressing skin NTM in lupus. We reported 2 cases of skin NTM in lupus patients followed at the Toronto Lupus Clinic. We conducted a systematic review of the literature on NTM in lupus patients. Ovid Medline (1946 to March 12, 2012) and Embase (1980 to March 12, 2012) were searched for relevant publications. Of the 1356 retrieved abstracts, 19 publications were identified and 25 cases of skin NTM were extracted. Skin presentations in this review ranged from papules, plaques, and nodules to ulcerative lesions and abscesses. Skin lesions occurred in the setting of active and inactive lupus and while patients were maintained on steroids and sometimes immunosuppressants. The pathogen species included Mycobacterium chelonae, Mycobacterium haemophilum, Mycobacterium kansasii, Mycobacterium avium, Mycobacterium scrofulaceum, Mycobacterium fortuitum, Mycobacterium marinatum, and Mycobacterium szulgai. The duration of antimycobacterial drugs ranged from 3 to 12 months. Skin excision, drainage, and debridement might be required in some cases. Empirical monotherapy was used initially, and the final choice of antibiotics was based on the susceptibility determined in culture. Overall, the outcomes of the skin lesions resulted in either complete recovery or improvement. A high index of suspicion in lupus patients is required to diagnose NTM, as the initial presentation of NTM can mimic lupus skin manifestations.

INFECÇÃO CUTÂNEA POR MYCOBACTERIUM HAEMOPHILUM EM DOENTE IMUNODEPRIMIDO

A infecção cutânea por Mycobacterium haemophilum é uma patologia rara, de difícil diagnóstico e cujo tratamento constitui um desafio. Descreve-se o caso de um doente sob corticoterapia crónica no contexto de miosite com nódulos dos membros inferiores, nos quais foi detectada uma estirpe de Mycobacterium haemophilum pela téc- nica de PCR. Este caso enfatiza a necessidade de um alto nível de suspeição clínica para o diagnóstico. De facto, esta infecção pode actualmente estar sub-diagnosticada devido aos requisitos especiais de cultura. Deve ser considerada em doentes com processos granulomatosos crónicos em associação a exame cultural persistentemente negativo.PALAVRAS-CHAVE – Mycobacterium haemophilum; Micobactéria atípica; Imunossupressão.

Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient.

Opportunistic infections following immunosuppression in solid organ transplant (SOT) patients are common complications with the skin being a common sight of infection. Nontuberculous mycobacteria (NTM) are rare but potential causes of skin infection in SOT patients. We present a case of an adult male immunosuppressed following renal transplantation who presented with an asymptomatic rash for several months. The patient's skin eruption consisted of erythematous papules and plaques coalescing into an annular formation. After failure of the initial empiric therapy, a punch biopsy was performed that demonstrated nerve involvement suspicious for Mycobacterium leprae. However, culture of the biopsy specimen grew acid-fast bacilli that were subsequently identified as M. haemophilum. His rash improved after a prolonged course of clarithromycin and ciprofloxacin. Both organisms are potential causes of opportunistic skin infections and can be difficult to distinguish with similar predilection for skin and other biochemical and genetic similarities. Ultimately they can be distinguished with culture as M. haemophilum will grow in culture and M. leprae will not. This case was unique due to nerve involvement on biopsy which is classically seen on biopsies of leprosy.

CutaneousMycobacterium haemophiluminfection in a patient receiving infliximab for psoriasis

Cutaneous<i>Mycobacterium haemophilum</i>infection in a patient receiving infliximab for psoriasis

Mycobacterium haemophilum cutaneous infection in immunocompromised patients, 5-case report from a tertiary hospital, Bangkok, Thailand

Mycobacterium haemophilum cutaneous infection in immunocompromised patients, 5-case report from a tertiary hospital, Bangkok, Thailand

Case of Mycobacterium haemophilum infection in a Japanese renal transplant patient and a review of Japanese cases

Case of <i>Mycobacterium haemophilum</i> infection in a Japanese renal transplant patient and a review of Japanese cases