Cutaneous infection with Mycobacterium fortuitum: an unusual presentation

Cutaneous infection with rapidly growing mycobacteria is uncommon and its diagnosis can be missed unless there is strong clinical suspicion coupled with microbiological confirmation. We report a case of localized recurrent soft tissue swelling of the foot by Mycobacterium fortuitum in a healthy adult male. The case is being reported for its uncommon clinical presentation and the associated etiological agent. The patient recovered completely following therapy with amikacin and clarithromycin.     

Unusual presentation of disseminated histoplasmosis in an immunocompetent patient

Disseminated histoplasmosis (DH) is a systemic granulomatous disease caused by the fungus Histoplasma capsulatum . This disease occurs mainly in immunocompromised individuals with CD 4 counts less than 200 cell/µL and is rarely noted in immunocompetent person. In India, this disease has been reported from several parts of the country of which most cases are from eastern India which is considered to be endemic for this disease. Inhalation of the spores can lead to a self‐limiting flulike illness in immunocompetent hosts. The most common organs involved are liver, spleen, bone marrow, lymphoreticular system, and gastrointestinal tract. Cutaneous manifestations of histoplasmosis are rare and are seen predominantly in persons with advanced human immunodeficiency virus (HIV) infections. We present a case of DH with generalized cutaneous lesions in a non‐HIV infected adult which posed a diagnostic challenge to our clinical colleagues.     

Mycobacterium simiae complex infection in an immunocompetent child

Nontuberculous mycobacteria are ubiquitous in the environment but rarely infect immunocompetent patients. We describe a pediatric case of Mycobacterium simiae complex lymphadenitis in an immunocompetent child and review the natural history, clinical manifestations, diagnosis, and current management of the disease.     

Prolonged and fatal disseminated cytomegalovirus infection in an immunocompetent woman

The case of an immunocompetent woman who died of disseminated cytomegalovirus infection with encephalitis and skin ulcerations is reported. The duration of the disease, from onset to death, was five months. Cytomegalovirus was found in the blood, urine, skin, muscle, liver and periventricular brain tissue, but not in frontal cortex tissue. This case underlines the fact that cytomegalovirus may exceptionally cause life-threatening illness in immunocompetent adults.     

Unusual clinical presentation of infection due toFlavimonas oryzihabitans

Six cases ofFlavimonas oryzihabitans infection are presented, four of which were community-acquired pneumonia and two of which were nosocomially acquired bacteremia. All four cases of pneumonia occurred in immunosuppressed hosts, three of whom were HIV-positive individuals and one of whom was a young man affected by chronic myeloid leukemia.Flavimonas oryzihabitans is recognized with increasing frequency as a cause of opportunistic infection, but the present cases of community-acquired pneumonia due to this organism are believed to be the first four reported in the English literature. The findings emphasize thatFlavimonas oryzihabitans should be included in the list of pathogens that cause community-acquired infections in the immunocompromised host.     

Disseminated basidiobolomycosis in an immunocompetent woman

Basidiobolomycosis is a chronic subcutaneous infection of the trunk and limbs due to Basidiobolus ranarum. The disease is well known in tropical areas, although recent cases of gastrointestinal basidiobolomycosis have also been reported in Arizona. We describe a young immunocompetent women who had presented with eosinophilia and lung infiltrates. She subsequently died, and diagnosis of disseminated basidiobolomycosis was made on the basis of histological features at autopsy.     

Mycobacterium fortuitum infection of a Hickman catheter site

A patient with histiocytic lymphoma who developed a Hickman catheter exist site infection due to Mycobacterium fortuitum is described. Due to the risk of dissemination in immunosuppressed patients and the resistance to antibiotic therapy, rapid-growing mycobacteria should be considered when gram-positive bacilli are associated with infections in patients with these catheters.     

Mycobacterium fortuitum bacteraemia in an immunocompromised patient

A case of Mycobacterium fortuitum bacteraemia in an immunocompromised patient confirmed by four positive serial blood cultures is reported here. The patient was a known case of acute lymphoblastic leukemia (ALL) on intensive chemotherapy. The source of bacteraemia was most probably a peripherally inserted vascular catheter. After initiation, of treatment with amikacin to which the strain was sensitive and clarithromycin and removal of the central line the patient's fever defervesced and repeat blood cultures were negative. This is the first time we have encountered an immunocompromised patient with M. fortuitum septicaemia in our hospital. The possibility of an infection with rapidly growing mycobacteria is important to consider when conventional organisms are not isolated in culture especially in the context of patients with malignancy.     

Mycobacterium fortuitum spinal infection: case report.

Acute paraplegia followed a vertebral infection with Mycobacterium fortuitum. There was a satisfactory response to surgery and antibiotics. No predisposing factors for this primary bone infection could be found.     

Fatal pulmonary infection due to Mycobacterium fortuitum.

Environmental (atypical, opportunist, other) mycobacteria were first isolated nearly a century ago. The classification of these "other than Mycobacterium tuberculosis" organisms was initially chaotic until Runyon proposed a scheme of four groups in 1959. Mycobacterium fortuitum is a member of group IV: Rapid growers. These ubiquitous terrestrial and aquatic forms contaminate water supplies, reagents, and clinical samples. They may colonise the respiratory systems of patients whose local defence mechanisms have been impaired or those with congenital and acquired immune defects. They can also cause disease in immunocompetent individuals. There have been fewer than 20 published cases of pulmonary infection caused by M fortuitum. A further case is reported of fatal pulmonary infection in an elderly patient with long standing chronic obstructive airways disease (COAD). He had left upper zone shadowing on chest radiography and lung abscesses at post mortem examination yielded only M fortuitum.     

Simultaneous infection with two drug-susceptible Mycobacterium tuberculosis strains in an immunocompetent host

An important assumption for DNA fingerprinting of Mycobacterium tuberculosis is that patients are infected with only one strain at a time. Nonetheless, we demonstrate a case of simultaneous infection with two drug-susceptible strains of M. tuberculosis in an immunocompetent patient by IS6110 restriction fragment length polymorphism and spoligotyping. Epidemiological data prove the patient's involvement in two independent clusters. Thus, double infections should be suspected with fingerprints showing divergent band intensities.     

Cytomegalovirus encephalitis in an immunocompetent pregnant woman

Presented here is the case of an immunocompetent pregnant woman with probable cytomegalovirus encephalitis. The clinical picture was characterized by diffuse headache, drowsiness and the development of an acute confused state. Diagnosis was based on the documentation of recent cytomegalovirus seroconversion with low avidity for the immunoglobulin G class antibodies. Initially, the diagnosis of encephalitis was challenging due to the subtle findings in cerebrospinal fluid and the normal electroencephalograph results. However, repeated tests revealed findings compatible with the diagnosis of encephalitis. Due to the suspicion of herpes simplex encephalitis the patient was treated with acyclovir. Within a few days rapid resolution of the fever and complete recovery were observed. Cytomegalovirus encephalitis should be considered early in the evaluation of pregnant women if appropriate clinical symptoms are present.     

Mycobacterium flavescens vertebral osteomyelitis in an immunocompetent host

The aim of this paper is to describe a rare case of vertebral osteomyelitis caused by Mycobacterium flavescens in an immunocompetent patient. Mycobacterium flavescens is a rapidly growing, pigmented, non-tuberculous mycobacterium, usually described as non-pathogenic for humans but occasionally reported as the cause of serious infectious complications recognized in clinical practice. This study stressed the importance of recent reports that describe the occurrence of vertebral osteomyelitis due to non-tuberculous mycobacteria that have also been recognized with an increasing incidence among immunocompetent hosts. A brief review of the current literature on human disease caused by Mycobacterium flavescens is also reported.     

Mycobacterium fortuitum in abscesses of man

Myco. fortuitum was isolated from subcutaneous abscesses of two patients who had been inoculated with B.C.G. and one patient who had iron injections. The organisms were resistant to a wide range of anti-tuberculous drugs. They were highly virulent for mice in which they produced symptoms of spinning disease. It is thought that the infections originated from contamination of syringes or skin.     

Identification of Mycobacterium fortuitum and Mycobacterium chelonei.

The study of 52 strains of rapidly growing mycobacteria showed that Mycobacterium fortuitum and M. chelonei were clearly distinguished by the aid of seven key tests (nitrate reductase, iron uptake, beta-glucosidase, penicillinase, growth on fructose, resistance to pipemidic acid, and resistance to capreomycin) and by analysis of their respective mycolic acids. However, the subdivision of these species into M. fortuitum var. fortuitum and M. fortuitum var. peregrinum and M. chelonei subsp. chelonei and M. chelonei subsp. abscessus was not satisfactorily accomplished.     

Aggregatibacter aphrophilus pyogenic liver abscess in an immunocompetent young woman

Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus/paraphrophilus) is a small Gram-negative coccobacillus with fastidious growth requirements. It is a normal commensal of the human oropharynx and upper respiratory tract, and it can infrequently cause invasive human diseases, including bone and joint infections and subacute infective endocarditis. Cases of liver abscess caused by Aggregatibacter aphrophilus have been sparsely recorded in the English-language literature, but have not yet been reported in Taiwan. Here we present a case of Aggregatibacter aphrophilus pyogenic liver abscess in an immunocompetent young woman. She recovered uneventfully after repeated percutaneous abscess aspiration and antibiotic treatment for 5 weeks.     

Differential identification of Mycobacterium fortuitum and Mycobacterium chelonei.

Mycobacterium fortuitum and Mycobacterium chelonei are distinguished unambiguously by the combined use of five test characters: nitrate reductase, beta-glucosidase, acid production from fructose, penicillinase, and trehalase. Typically, M. fortuitum was nitrate reductase positive, beta-glucosidase positive; M. chelonei was nitrate reductase negative, beta-glucosidase negative, penicillinase positive, and trehalase positive and did not produce acid from fructose.