Pulmonary infection caused by Mycobacterium gordonae]

A 57-year-old woman who had been operated on for colon cancer and given chemotherapy, presented in September 1995 with worsening cough and abnormalities on her chest X-ray film. Acid-fast bacilli were isolated from the sputum. The organism was classified as M. gordonae by biochemical tests and DNA/DNA hybridization. The patient was treated with rifampicin and clarithromycin. Subsequently, sputum cultures became negative and the chest x-ray film showed a decrease infiltration. The findings in the present case suggest that M. gordonae may cause pulmonary infection and should be considered as an opportunistic pathogen.     

Pulmonary infection caused by Mycobacterium gordonae (M. gordonae) in a healthy middle-aged male]

A 51-year-old man was admitted to our hospital in July 1989 because of an abnormality in his chest radiograph. On his yearly health check-up, an abnormality of his chest radiography was first noted in June 1988. At that time, examinations including bronchoscopy were performed but no specific diagnosis was made. On admission, his chest radiograph revealed new infiltrates at the apex of the right lung which were not present in June 1988. Three out of 5 consecutive sputum specimens after admission produced a pure growth of 100 colonies to 1+ of acid-fast bacilli (AFB). This AFB was scotochromogenic, and hydrolysis of Tween 80 at 5 days was positive. It did not reduce nitrate, and niacin test was negative. It was sensitive to ethambutol at a concentration of 5 micrograms/ml, and was not tolerant to 0.2% picric acid. We thus identified this AFB to be M. gordonae. The patient was treated with rifampicin (450 mg/day), isoniazid (400 mg/day), and ethambutol (1000 mg/day) for 9 months. After 2 months of treatment the sputum cultures became negative, and the chest radiograph showed improvement of the infiltrates. M. gordonae is considered to be one of the least pathogenic AFB to man. Most recent reports of M. gordonae infection have been in immunocompromized hosts or patients with a history of pulmonary tuberculosis. The present case is a very rare example of this organism affecting a healthy male, and thus yields new information on the pathogenesis of M. gordonae in man.     

Pulmonary Mycobacterium gordonae infection treated with clarithromycin

We reported a case of 51-year-old female immunocompetent patient with pulmonary Mycobacterium gordonae infection. The patient complained persistent cough and sputum and occasionally hemosputum. Chest radiograph and computed tomography (CT) of the lung showed bronchiectasis and small nodules in middle lobe. Bronchofiberscopy was performed twice, and bronchial washing specimen repeatedly revealed acid-fast bacilli. The organism was identified as Mycobacterium gordonae by biochemical tests and direct sequence method. She was treated with clarithromycin (400 mg/day) over 6 months and the chest CT findings showed improvement. The case was considered to be sensitive to clarithromycin in vitro drug susceptibility test. The case suggested that clarithromycin was a useful therapeutic agent to Mycobacterium gordonae infection.     

Mycobacterium triplex pulmonary infection in an immunocompetent patient

We present the case of a 47-year-old immunocompetent patient with clinical evidence of pulmonary mycobacterial disease which was found to be due to Mycobacterium triplex. This novel organism is an uncommon, emerging, pathogen for which few reports of clinical infection exist in the medical literature.     

Cutaneous infection with Mycobacterium gordonae

A case of cutaneous infection with Mycobacterium gordonae and other reports of extrapulmonary infection due to this organism are reviewed. This case confirms the pathogenic potential of M. gordonae which must now be included among the scotochromogens capable of causing cutaneous disease. Isolates of this organism should be tested against a full range of antimicrobial agents since traditional antituberculous therapy may be of limited efficacy. Pending the results of in vitro susceptibility testing, amikacin, ethambutol, rifampicin and co-trimoxazole are suggested as empirical therapy for infections caused by this organism.     

A case of infected bulla caused by Mycobacterium gordonae]

A 65-year-old man was admitted to Tokyo Metropolitan Geriatric Medical Center because of dyspnea on effort, loss of appetite and general fatigue. Chest radiography on admission showed niveau formation in, and infiltration around, the bulla. Percutaneous drainage of the intrabullous fluid was performed and Mycobacterium gordonae was repeatedly cultured from it. The patient was treated with RFP, INH and CAM and the intrabullous fluid and infiltration around the bulla was markedly improved. Seven cases of pulmonary infection by M. gordonae have been reported in Japan, but this is the first case of bulla infected by this organism.     

Disseminated Mycobacterium avium infection in an immunocompetent aged patient]

We reported an immunocompetent elderly patient with disseminated Mycobacterium avium infection exhibiting bronchial, pulmonary, nodal, otitic and osteitic lesions. An 82-year-old man was initially hospitalized with cervical and mediastinal lymphadenopathy. M. avium was demonstrated in gastric juice and a lymph node. An endobronchial polypoid lesion was formed by perforation of mediastinal mycobacterial lymphadenitis into the right main bronchus. Combined treatment by CAM, RFP, EB, and SM caused the lesions to diminish and the treatment was continued for 18 months. One year after completion of treatment the patient was re-admitted with complaints of left ear pain, and a subcutaneous abscess on his back. M. avium was again demonstrated from external ear exudate and aspirated subcutaneous pus. Re-treatment with combined chemotherapy induced prompt resolution of the ear and bone lesions. It is unusual that immunocompetent patients suffer disseminated non-tuberculous mycobacterial infection, but chest physicians should pay attention to M. avium infection because of its worldwide dissemination.     

Pulmonary infection caused by Mycobacterium szulgai: a case report

We reported a case of pulmonary infection caused by Mycobacterium szulgai (M. szulgai) in an immunocompetent, asymptomatic 55-year-old man without underlying disease. A chest radiograph of an annual health examination revealed a right upper lobe infiltrate with thin-walled cavities, which was not present in the previous year. An acid-fast stain of bronchial washing fluid was positive, and antimycobacterial chemotherapy with isoniazid (400 mg/day), rifampin (450 mg/day), and ethambutol (750 mg/day) was initiated on presumptive diagnosis of the case as tuberculosis. DNA-DNA hybridization of sputum and bronchial washing samples identified M. szulgai as the causative organism. Antimicrobial susceptibility testing indicated that the isolate was sensitive to most common antimycobacterial drugs except capreomycin (CPM) and p-aminosalicylic acid (PAS), and was also sensitive to clarithromycin and fluoroquinolones including ofloxacin, levofloxacin, sparfloxacin, and ciprofloxacin. After 12 months of therapy, a repeat chest radiograph demonstrated improvement of the right upper lobe infiltrate. When M. szulgai is isolated, it almost always represents a true pathogen. Therefore, the detection of even a small number of M. szulgai warrants treatment based on susceptibility testing.     

Disseminated Mycobacterium gordonae infection in a renal transplant recipient

Abstract: The use of more intensive immunosuppressive regimens and the increasing number of patients that are exposed to immunosuppressive strategies in transplantation medicine have changed the spectrum of infections that is encountered by the clinician. We describe a 62‐year‐old female renal transplant recipient receiving immunosuppressive therapy who developed complaints of weight loss, diarrhoea, cough, and fever. Increased C‐reactive protein and pancytopenia were found. The presence of Mycobacterium gordonae, a non‐tuberculous mycobacterium, was eventually demonstrated in bronchoalveolar lavage fluid, bone marrow, spleen, and liver. Determination of the pathogen was accelerated using a Line Probe Assay, a reverse hybridisation technique using an RNA fragment specific for different mycobacterium species. Treatment was initiated using a combination of clarithromycin, ethambutol, and rifampicin. The initial response to treatment was good, but splenectomy and change of immunosuppressive and antimycobacterial therapy were necessary for long‐term control of the infection. Problems in the diagnosis and treatment of this uncommon pathogen are discussed.     

Mycobacterium gordonae urinary infection in a renal transplant recipient

Abstract: The authors present a case of urinary infection by a non-tuberculous mycobacteria (NTM) species, Mycobacterium gordonae , in a renal transplant recipient. A 29-year-old female patient had persistent sterile pyuria after her second kidney transplant. An NTM, M. gordonae , was isolated, and the patient was started on antituberculous treatment, with resolution of leukocyturia. Ureteral stenosis with hydronephrosis and deterioration of allograft function was diagnosed later on and, despite the introduction of intraureteral catheter and resolution of hydronephrosis, there was no recovery of baseline renal function. She ultimately resumed dialysis after a severe pyelonephritis. The authors discuss the problems of establishing diagnosis of infection (versus colonization) by NTM and highlight the difficulty of treating these infections, especially because of the possible interaction with immunosuppressant agents, facilitating anti-allograft immune response.     

Mycobacterium simiae infection in an immunocompetent patient, with DNA analyses verification

Mycobacterium simiae is a non-tuberculosis mycobacterium that does commonly cause clinical disease in immunocompromised patients with or without AIDS. We describe a case of M. simiae pulmonary infection in a patient without immunodeficiency syndrome, who had a history of Mycobacterium tuberculosis infections.     

Pulmonary disease caused by Mycobacterium malmoense

Mycobacterium malmoense was isolated from pulmonary material from 4 patients. Two patients had repeatedly positive smears and cultures along with roentgenographic progression of pulmonary disease in the absence of another pathogen. These 2 patients therefore meet the criteria for diagnosis of pulmonary mycobacteriosis. Isolation of the organism may represent colonization in a third patient, and M. malmoense has been isolated from a fourth patient on 2 occasions. It is not yet definite, however, that the pulmonary process is due to mycobacterial disease. Although uncommon, pulmonary disease caused by this organism has been reported from Europe. Only 1 prior case of pulmonary disease caused by M. malmoense, however, has been reported in the United States.     

Pulmonary disease caused by Mycobacterium asiaticum

A 62-year-old male residing in Los Angeles, California, presented with a right upper lobe nodule associated with dry cough and weight loss. Mycobacterium asiaticum was isolated from sputum on two separate occasions. The patient was subsequently treated with four antituberculous drugs, with bacteriologic conversion. This is the first report of pulmonary disease caused by M. asiaticum in the United States. The bacteriologic, immunologic and clinical aspects are reviewed.