Mycobacterium Simiae Infection Research Articles

SUCCESSFULLY TREATED MULTIDRUG-RESISTANT MYCOBACTERIUM SIMIAE

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Mycobacterium Simiae (M. Simiae) is a slow-growing photochromogenic mycobacterium transmitted by inhalation of aerosols or by inoculation. It has been recognized as a causative agent of pulmonary and disseminated disease. Lack of a standardized treatment regimen makes treating M.Simiae a challenge. Here we present a case of multi-drug resistant M.Simiae with pulmonary involvement causing massive hemoptysis requiring coil embolization. CASE PRESENTATION: A 72-year-old female known to have bronchiectasis with multiple episodes of hemoptysis requiring coil embolization of bronchial artery presents for evaluation. Bronchoscopy cultures confirm M. Simiae. The patient was started empirically on clarithromycin, ethambutol, and ciprofloxacin while awaiting drug sensitivities. The patient had 2 more admissions for hemoptysis and weight loss, loss of appetite, and night sweats. Drug sensitivities showed resistance to fluoroquinolones, macrolides, trimethoprim/sulfamethoxazole, isoniazid, ethambutol, rifampin, rifabutin, and linezolid. The patient was referred to the National Jewish Medical Center and was started on clofazimine, bedaquiline, and inhaled amikacin. Therapy was continued for 18 months. The patient had no episodes of hemoptysis while being on therapy. The patient had negative bronchoscopic cultures and resolution of associated symptoms. DISCUSSION: The Infectious Diseases Society of America guidelines recommend a clarithromycin-based multi-drug regimen for treatment for M. Simiae, but due to limited in-vitro susceptibility and with little evidence of its correlation with clinical response, the treatment is challenging. In our case, the bacteria being multi-drug resistant makes it even more difficult to treat and hence required a multidisciplinary team approach to determine the best treatment option available. Only 9-21% of isolated M.Simiae are clinically relevant. It rarely affects immunocompetent patients and is mainly described in patients with immunodeficiency syndromes, pneumoconiosis, bronchiectasis, or cystic fibrosis. Very few cases of extra-pulmonary involvement including salivary glands, gastrointestinal tract, skin lesions, osteomyelitis, and lymphadenitis have been reported. The commonly used drug regimen includes clarithromycin with trimethoprim/sulfamethoxazole or moxifloxacin and amikacin. The duration of treatment ranges from 6 to 24 months. Drug susceptibility should be requested in each case. Clofazimine and bedaquiline are used in drug-resistant cases with skin pigmentation being the most common side effect. CONCLUSIONS: The approach to and duration for treatment of multidrug resistance M. Simiae is unclear due to few cases being reported, necessitating further research. Clofazimine and bedaquiline are available options. REFERENCE #1: Lotfi H, Aryan E, Sankian M, Meshkat Z, Khalifeh Soltani A, Alvandi AH, et al. A case of multidrug-resistant Mycobacterium simiae in an elderly woman. Respirol Case Rep [Internet]. 2021 Feb 1 [cited 2021 Apr 25];9(3). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848708/ REFERENCE #2: Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. Am J Respir Crit Care Med. 2007 Feb 15;175(4):367–416. REFERENCE #3: Javeri H, Vélez-Mejía C, Cadena J. Disseminated Mycobacterium simiae infection in a non-immunosuppressed patient in the USA. IDCases. 2018 Jan 8;11:58–60. DISCLOSURES: No relevant relationships by Mohammed Ali, source=Web Response No relevant relationships by Rahul Dadhwal, source=Web Response No relevant relationships by Jared Head, source=Web Response no disclosure on file for Lauren Howard; No relevant relationships by Salim Surani, source=Web Response

Successful treatment of disseminated Mycobacterium simiae infection in a patient with advanced HIV.

Successful treatment of disseminated Mycobacterium simiae infection in a patient with advanced HIV.

Disseminated Mycobacterium simiae infection in a patient with adult-onset immunodeficiency due to anti-interferon-gamma antibodies \u2013 a case report

BackgroundMycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae are generally free-living organisms and Mycobacterium simiae is one of the slowest growing Non-tuberculous mycobacteria. This is the first case report of Mycobacterium simiae infection in Sri Lanka and only very few cases with extrapulmonary manifestation reported in the literature.Case presentationA 24-year-old, previously healthy Sri Lankan male presented with generalized lymphadenopathy with discharging sinuses, evening pyrexia, weight loss, poor appetite and splenomegaly. Lymph node biopsies showed sheets of macrophages packed with organisms in the absence of granulomata. Ziehl Neelsen, Wade Fite and Giemsa stains revealed numerous red coloured acid-fast bacilli within foamy histiocytes. Slit skin smear for leprosy was negative and tuberculosis, fungal and bacterial cultures of the lymph node and bone marrow did not reveal any growth. Later he developed watery diarrhea and colonoscopy revealed multiple small polyps and ulcers throughout the colon extending up to the ileum, Which was confirmed to be due to cytomegalovirus confirmed by PCR and successfully treated with ganciclovir. Positron emission tomography scan guided biopsies of the gut and lymph nodes confirmed presence of mycobacterial spindle cell pseudo-tumours and PCR assays revealed positive HSP65. The culture grew Mycobacterium Simiae. Flow cytometry analysis on patient’s blood showed extremely low T and B cell counts and immunofixation revealed low immunoglobulin levels. His condition was later diagnosed as adult onset immunodeficiency due to anti- interferon – gamma autoantibodies. He was initially commenced on empirical anti-TB treatment with atypical mycobacterial coverage. He is currently on a combination of daily clarithromycin, ciprofloxacin, linezolid with monthly 2 g/kg/intravenous immunoglobulin to which, he had a remarkable clinical response with complete resolution of lymphadenopathy and healing of sinuses.ConclusionsThis infection is considered to be restricted to certain geographic areas such as mainly Iran, Cuba, Israel and Arizona and this is the first case report from Sri lanka. Even though the infection is mostly seen in the elderly patients, our patient was only 24 years old. In the literature pulmonary involvement was common presentation, but in this case the patient had generalized lymphadenopathy and colonic involvement without pulmonary involvement.

Computed Tomography Findings of Pulmonary Mycobacterium simiae Infection.

Nontuberculous mycobacterial (NTM) pulmonary infections can be quite similar to tuberculosis, both clinically and radiologically. However, the treatment protocol is not similar. Mycobacterium simiae is a rare cause of NTM pulmonary infection. Herein, we aimed to evaluate and compare the computed tomography (CT) scan findings of M. simiae infection in lungs. For this reason, thirty-four patients (n = 34) with M. simiae lung infection were retrospectively evaluated. Diagnosis was confirmed by American Thoracic Society (ATS) guidelines and CT scans were reviewed in both lung and mediastinal windows. The average age of patients was 63 ± 14.54 years and 52.9% were male. The majority of patients had cough (91.2%) and sputum production (76.5%). Clinically, 41.2% of patients had previous history of TB (14/34), 38.2% had cardiac diseases (13/34), and 35.3% had diabetes mellitus (12/34). The most common CT findings in our study were nodular lesions (100%) and bronchiectasis (85.29%). Regarding the severity, grade I bronchiectasis was the most prevalent. Other prominent findings were tree-in-bud sign (88.2%), consolidation (52.94%), and lobar fibrosis and volume loss (67.6%). There was no significant zonal distribution of findings. In conclusion, nodular lesions and bronchiectasis are the most frequent features in CT scan of M. simiae pulmonary infection.

Pulmonary Mycobacterium Simiae infection and HTLV1 infection: an incidental co-infection or a predisposing factor?

There is little information on atypical mycobacterium and human T lymphotropic virus Type I (HTLV-I) co-infection. We present the first case of pulmonary M. simiae infection in co-infection with HTLV-1, confirmed by ELISA antibody test and Western Blot. We discuss the clinical characteristics and laboratory tests of the patient and presumptive immunological relation. We propose that in patients with the HTLV infection and pulmonary symptoms and signs compatible with tuberculosis, evaluation for atypical mycobacteriosis may be recommendable.

First Report of Lung Transplantation in a Patient With Active Pulmonary Mycobacterium simiae Infection

Mycobacterium simiae is a slow-growing mycobacteria that in rare cases can cause chronic pulmonary infection. We report the first case of lung transplantation in a patient with active M simiae infection at the time of transplantation. A 56-year-old immunocompetent nonsmoking woman underwent bilateral lung transplantation for end-stage idiopathic bronchiectasis and chronic M simiae infection. The disease proved manageable on a regimen of clarithromycin, moxifloxacin, and cotrimoxazole with a successful outcome 1-year posttransplantation. There is increasing evidence that nontuberculous mycobacterium infection should no longer be an absolute contraindication for lung transplantation.

Fatal disseminated Mycobacterium simiae infection in a non-HIV patient

We report a fatal case of disseminated Mycobacteriumsimiae infection in an immunocompetent elderly man with fever of unknown origin. The diagnosis was based on culture isolation of non-tuberculous mycobacteria from cerebrospinal fluid and bronchoalveolar lavage. Both culture isolates were identified as M. simiae by 16S rRNA gene sequencing.

Clinical and radiological features of Mycobacterium kansasii infection and Mycobacterium simiae infection

This retrospective study sought to systematically identify clinical and radiological features of Mycobacterium kansasii and Mycobacterium simiae infections. The sample included consecutive patients with a culture-positive diagnosis of M. simiae infection (n=102) or M. kansasii infection (n=62) derived from the databases of the Laboratory of Microbiology of a tertiary medical centre and two outpatient tuberculosis centres. Data on patient background and clinical features were collected, and chest radiographs were analysed. Sixty percent of the M. kansasii group were native born compared to 18% of the M. simiae group (p=0.0001). M. simiae infection was associated with a higher rate of co-morbid disease, including diabetes mellitus, heart disease, and malignancy. A similar rate of lung disease was found in both groups. Clinical symptoms were significantly more common in patients with M. kansasii infection. On radiological study, M. kansasii infection was associated with more cavitations, and M. simiae infection with more pulmonary infiltrates. Patients with M. simiae infection had a higher likelihood of middle and lower lobe disease whereas patients with M. kansasii infection had more upper lobe disease (p=0.001). Pleural effusions and lymphadenopathy were found only in the presence of M. simiae infection. We concluded that there are major differences in the epidemiologic features of M. kansasii and M. simiae infection which have important diagnostic and therapeutic implications.

Pulmonary Mycobacterium simiae infection: comparison with pulmonary tuberculosis

To identify the clinical and radiological features distinguishing Mycobacterium simiae respiratory infection from pulmonary tuberculosis, the demographics, underlying conditions, and clinical and radiological findings of 121 consecutive patients with pulmonary tuberculosis and 102 with M. simiae respiratory infection were compared retrospectively. In the M. simiae group, the patients were older (mean age 69 +/- 16 years vs. 47 +/- 21 years, p = 0.0001), with a female predominance (62% vs. 45%, p = 0.008). Only 4% were of Ethiopian origin compared to 25% of the tuberculosis group (p = 0.0001). M. simiae infection was associated with significantly higher rates of smoking history, underlying chronic obstructive pulmonary disease, zero human immunodeficiency virus (HIV) infection compared to 10% in the tuberculosis group (p = 0.001), blunted symptoms, and noncavitary infiltrates in the lower/middle lobes on chest X-ray. HIV-negative patients with M. simiae respiratory infection are distinguishable from patients with pulmonary tuberculosis by several demographic, clinical, and radiological features. These findings have important diagnostic and therapeutic implications.

Mycobacterium simiae infection in a patient with common variable immunodeficiency

Introduction Mycobacterium simiae is a nontuberculous mycobacterium that does not commonly cause clinical disease. We describe a case of M. simiae pulmonary infection in a patient with common variable immunodeficiency (CVID). Case Our patient is a 74-year-old female with a history of bronchiectasis and Mycobacterium avium complex (MAC) pulmonary infection that prompted an immunodeficiency evaluation. After about one year of MAC therapy, the patient was diagnosed with CVID. Prior to starting IVIG, the patient presented with hemoptysis, increased cough and new airspace disease on chest CT. Bronchoalveolar lavage and five sputum cultures were positive for M. simiae sensitive to clarithromycin, sulfamethaxazole and gatifloxacin. The patient was started on these antibiotics and IVIG therapy was initiated one month later. The patient improved clinically over the next 6 months on this therapy. Discussion M. simiae is an environmental organism whose role in clinical disease remains to be established. Most reports of isolation, usually unrelated to clinical disease, have occurred in a small group of specific locations including Texas, Arizona, Israel and Guadelupe. Published cases of clinical pulmonary disease usually involved patients with chronic lung disease, namely bronchiectasis or prior mycobacterial disease, while reports of disseminated disease most often occurred in HIV infected individuals. It is likely that the bronchiectasis related to CVID in this patient contributed to her development of clinical M. simiae pulmonary infection. Conclusion To our knowledge, this is the first case of Mycobacterium simiae infection in a patient with common variable immunodeficiency.

Disseminated Mycobacterium simiae Infection in Patients with AIDS

Objectives: To report our experience with disseminated Mycobacterium simiae disease in patients with AIDS, and review other cases reported in the literature.Methods: We retrospectively reviewed all cases of M. simiae that were isolated from sterile body sites over a 9-year period at the University Health System Hospital at San Antonio, Texas, U.S.A. Data included patient demographics, clinical features, other accompanying opportunistic infections, in vitro susceptibility, therapy and outcome.Results: Ten cases of M. simiae disseminated disease were identified. All of them were inpatients with AIDS. Another nine cases of disseminated infection in AIDS patients were reported in the literature. Advanced AIDS with absolute CD4 counts of less than 50 and an associated AIDS-defining illness characterized all cases. Persistent fever and debilitation without localizing signs were the most common clinical features. Our patients responded poorly to antimycobacterial drugs and died within 6 months of diagnosis. The only reported successful therapy was in patients who responded well to highly active antiretroviral therapy and antimycobacterial regimens containing clarithromycin, ethambutol and ciprofloxacin.Conclusions: Clinical presentation of M. simiae infection mimics Mycobacterium avium complex, with fever and progressive debilitation, but is less responsive to therapy. Immuno-reconstitution with potent antiretroviral therapy may be the best therapy for such resistant disease.

Successful treatment of disseminated Mycobacterium simiae infection in AIDS patients.

Mycobacterium simiae is rarely isolated in clinical settings of non-HIV-infected patients. Isolation of M. simiae from clinical specimens in clusters has been limited to some parts of the world that include Israel, Cuba and the southern USA, mainly Texas. Only 8 patients with HIV and disseminated M. simiae infection have been previously described in the English literature. Successful treatment of disseminated M. simiae infection has never been reported and 6 of the cases have died within 8 months of diagnosis. We reviewed retrospectively the medical records of HIV-infected patients who had positive blood or bone marrow cultures for M. simiae at the Sheba Medical Center, Tel-Hashomer, Israel, between January 1992 and December 1996. A case of disseminated M. simiae infection was defined as isolation of M. simiae in blood or bone marrow culture in an HIV-infected patient with a compatible, otherwise unexplained, systemic disease. Mycobacterium simiae was isolated in blood and/or bone marrow cultures from 3 HIV-infected patients during the last 5 y. We describe the first successful treatment in AIDS patients with disseminated M. simiae infection. The patients are alive and well 20 months after instituting a combination of 3 antimycobacterial agents, clarithromycin, ethambutol and ciprofloxacin and intensive antiretroviral therapy.

Treatment of disseminated Mycobacterium simiae infection in AIDS

Treatment of disseminated Mycobacterium simiae infection in AIDS

Pulmonary and disseminated Mycobacterium simiae infection in humans.

Three patients with Mycobacterium simiae infection were seen during a 5-yr period. One patient with chronic infiltrative pulmonary disease had the diagnosis established by open lung biopsy. Two patients with normal chest roentgenograms had disseminated infection, one having had elective surgery for a nonfunctioning kidney. Caseating granulomata were discovered in kidney tissue sections. Both M. kansasii and M. simiae were subsequently recovered from bone marrow and urine cultures. The other patient had vertebral osteomyelitis, and M. simiae was isolated from tissue obtained by needle biopsy. To our knowledge, disseminated M. simiae infection has not been previously described.

Mycobacterium simiae infection in the United States. A case report and discussion of the organism.

The clinical and bacteriologic features of a case of mycobacteriosis in which Mycobacterium simiae was thought to be the causative agent are presented. The unique features of this organism, includeing its positive niacin reaction and photochromogenicity, which may lead to confusion with other mycobacterial species, are duscussed.