Urinary Mycobacterium fortuitum infection

Summary Mycobacterium fortuitum, a common saprophyte usually found in water and soil, can also be isolated from sputum and gastric secretions of healthy carriers. Under certain conditions, significant clinical infections due toM. fortuitum do occur. Urinary tract infections are rarely caused by atypical mycobacteria. This report describes a urinary tract infection caused byM. fortuitum in a 73-year-old patient treated with corticosteroids for bronchial asthma, who was successfully treated with ofloxacin.

---

Harnwegsinfektion durch mycobacterium fortuitum

Zusammenfassung Mycobacterium fortuitum ist ein Saprophyt, der für gewöhnlich in Wasser und Erde nachzuweisen ist, aber auch aus Sputum und Magensekret gesunder Träger isoliert wird. Unter bestimmten Bedingungen können schwere klinische Infektionen durchM. fortuitum ausgelöst werden. Harnwegsinfektionen durch atypische Mykobakterien sind selten. Im folgenden Bericht wird eine Harnwegsinfektion durchM. fortuitum bei einem 73 Jahre alten Patienten beschrieben, der wegen Asthma bronchiale mit Kortikosteroiden behandelt wurde. Die Therapie mit Ofloxacin war erfolgreich.

     

Meningitis caused by Mycobacterium fortuitum

A previously healthy 16-yr-old Caucasian male developed a relapsing purulent meningitis shortly after a motor accident in Venezuela, in which he received a small wound with a retained foreign body in the sacral region. Repeated initial physical examinations, radiographs of lumbar and sacral regions, and contrast myelography failed to demonstrate a cerebrospinal fluid leak or bone involvement, and Mycobacterium fortuitum was repeatedly isolated from the cerebrospinal fluid. Finally, from the originally "cured" lumbar wound a purulent material was obtained from which M. fortuitum was also isolated. A retained foreign body was removed, and an abscess and fistulous tract were incised and drained. The patient responded dramatically to the combination of isoniazid plus co-trimoxazole and surgery.     

Aortitis caused by Mycobacterium fortuitum

Aortic valve replacement was complicated by sternal wound infection with Mycobacterium fortuitum. The wound was treated with débridement and antibiotic therapy. Five months later the patient developed fever, and blood cultures yielded M fortuitum. At surgery, aortitis with pseudo-aneurysm formation was encountered. Mycobacterium fortuitum grew from the aortic lesion. This is the first report of M fortuitum causing aortitis, although this organism is known to infect sternal wounds and mediastinum. Mediastinal infection can progress despite a normal wound appearance. Its manifestations may be delayed and may include infections of the aorta as well as of the sternum and mediastinum.     

Mycobacterium fortuitum in systemic lupus erythematosus

When she was five years old, this patient - aged 20 time of death - had had two diagnoses: Leri-Weill's disease and SLE. The latter led to uninterrupted use of systemic corticosteroids. Twelve months before death, multiple purulent bursitis were followed by cutaneous nodules. From the latter, but not from the former, Mycobacterium fortuitum was isolated. Our case is in agreement with what is generally accepted: this saprophyte organism becomes pathogenic in disseminated infections, only if the immune system deteriorates.     

Perianal fistulae caused by Mycobacterium fortuitum

Mycobacterium fortuitum is a rapidly growing Mycobacterium , which usually colonizes the soil, dust and water. It commonly causes skin and soft tissue infections especially in patients who have preceding trauma. We report a case of perianal fistulae caused by M. fortuitum.     

Pacemaker infection due to Mycobacterium fortuitum

Pacemaker infection with Mycobacterium fortuitum has not been reported previously. We describe a case of pacemaker generator pocket infection and intravascular lead endocarditis due to Mycobacterium fortuitum. The entire pacing system was removed and the patient was treated successfully with a multidrug regimen for a total of 6 months.     

Mycobacterium fortuitum group periprosthetic joint infection

The Mycobacterium fortuitum group of rapidly growing mycobacteria is recognized infrequently as a cause of periprosthetic joint infection. This report describes a case of periprosthetic joint infection due to a member of the M. fortuitum group where failure to consider this pathogen caused months of diagnostic delay. Aggressive surgery and 6 months of combination antimicrobial therapy eradicated the infection.     

Relationship between Mycobacterium simiae and Mycobacterium habana.

Strains of the species Mycobacterium simiae give a positive niacin test. On the basis of their cultural and biochemical characteristics and by seroagglutination they can be classified into 2 subspecies. (1) The strains of serotype M. simiae 1 hydrolyze urea regularly and nicotinamide and pyrazinamide irregularly. They are photochromogenic after prolonged exposure to light. (2) The strains of serotype M. simiae 2 hydrolyze urea only. Three of 4 strains are scotochromogenic; the fourth has a pale pink pigment. Two of these strains possess alpha- and beta-esterase activity. The other two are negative in this test. Strains of M. habana are culturally and biochemically identical with the serotype M. simiae 1 and show the same serologic specificity as M. simiae 1. M. habana sera, after having been absorbed by M. simiae 1, retain a small amount of agglutinins specific for M. habana. We believe that the M. habana strains belong to the species M. simiae and are closely related to the serotype M. simiae 1.     

Solitary pulmonary nodule due to Mycobacterium fortuitum

We report the case of an asthmatic man in whom a solitary pulmonary nodule was discovered after an episode of self-limited hemoptysis. Infection was suspected after initial response to empirical antibiotic therapy, and the pathogen was later identified to be a rare mycobacterium. The pulmonary nodule resolved without surgery after oral quinolone therapy. Mycobacterium fortuitum should be added to the list of possible causes of solitary pulmonary nodule in Spain.     

A gas-liquid and thin-layer chromatographic study of Mycobacterium fortuitum

Forty-two strains of Mycobacterium fortuitum were examined for fatty acid composition by gas-liquid chromatography and for mycolic acid pattern by two dimensional thin-layer chromatography of whole cell acid methanolysates. The strains studied contained saturated and mono-unsaturated fatty acids from 12 to 24 carbon atoms and tuberculostearic acid, and they showed a thin-layer chromatographic pattern of mycolic acids similar to the pattern previously reported for this species and characterised by the presence of alpha and alpha'-mycolates and several more polar components. The heterogeneity within the species M. fortuitum, of its antigenic, biochemical and chemical properties, previously noted by several authors was slightly reflected (but not correlated) in the fatty acid composition found in the strains studied; the mycolic acid pattern of all of them was, however, very stable.     

Problems in diagnosis and therapy of Mycobacterium fortuitum infections

Mycobacterium fortuitum was isolated 11 times from 8 patients during a 6-year period. Six of the isolates were from sputum; one was from aspiration of a lymph node, and 4 were from wound cultures. The isolation from sputum was believed not to be associated with pulmonary infection in all 6 instances. The difficulty in diagnosis and therapy of infections with Mycobacterium fortuitum is illustrated by these cases and by others from the literature. Amikacin and doxycycline may offer some therapeutic benefit for patients with Mycobacterium fortuitum infections.     

Cardiac device infections due to Mycobacterium fortuitum.

Two cases of cardiac device infection due to Mycobacterium fortuitum are reported along with a discussion of their clinical management. Long-term therapy and removal of the infected device is needed. The slow progression and absence of systemic signs and symptoms suggest a low pathogenicity of M fortuitum.     

Peritonitis due to Mycobacterium fortuitum Following Gastric Banding

Mycobacterium fortuitum is a rapid growing nontuberculous organism that has rarely been associated with peritonitis in an otherwise healthy host. We describe a patient who developed peritonitis due to the organism after gastric banding operation, which resolved after removal of the gastric band and institution of appropriate antibiotic therapy.