Successful treatment of pulmonary infection due to Mycobacterium chelonae: case report and review.

During the past decade, Mycobacterium chelonae has been recognized with increasing frequency as a pulmonary pathogen. A review of previously reported cases reveals that most patients with pulmonary infections due to M. chelonae are nonimmunosuppressed but have underlying chronic lung disease. The infection is notably absent among blacks. M. chelonae organisms are characterized by a high degree of in vitro resistance to antituberculous drugs, and attempts at eradicating the organism through chemotherapy have been largely unsuccessful. The case of a 63-year-old previously healthy woman with progressive bilateral pulmonary disease due to M. chelonae is reported; she was treated successfully with a combination of cefoxitin and orally administered ciprofloxacin. Our experience supports the use of quinolones in combination with other active agents for the treatment of pulmonary infection due to M. chelonae.     

Successful treatment of disseminated Mycobacterium chelonae infection with linezolid.

We describe a 57-year-old man with steroid-dependent myasthenia gravis and progressive ulcerating leg nodules due to clarithromycin-resistant Mycobacterium chelonae. The patient was successfully treated with linezolid.     

Primary Mycobacterium tuberculosis complex cutaneous infection: report of two cases and literature review.

Compared to other organs, skin is an uncommon site of tuberculosis involvement. In the era of HIV infection, increased intravenous drug abuse, and the use of immunosuppressive therapy for various systemic diseases, tuberculosis in all its forms, including skin tuberculosis, has reemerged. We report two cases of primary cutaneous tuberculosis in immunocompetent patients and review the literature of all cases described since 1935.     

Incubation period and sources of exposure for cutaneous Mycobacterium marinum infection: case report and review of the literature.

The diagnosis of cutaneous Mycobacterium marinum infection is often delayed for months after presentation, perhaps because important clinical clues in the patient's history are frequently overlooked. Knowledge of the incubation period allows the clinician to target questions about the patient's history. Prompted by a case with a prolonged incubation period, we sought to determine more precisely the incubation period of M. marinum infection. The MEDLINE database for the period 1966-1996 was searched for information regarding incubation period and type of exposure preceding M. marinum infection. Ninety-nine articles were identified, describing 652 cases. Forty cases had known incubation periods (median, 21 days; range, 5-270 days). Thirty-five percent of cases had an incubation period > or =30 days. Of 193 infections with known exposures, 49% were aquarium-related, 27.4% were related to fish or shellfish injuries, and 8.8% were related to injuries associated with saltwater or brackish water. Because the incubation period for cutaneous M. marinum infection can be prolonged, patients with atypical cutaneous infections should be questioned about high-risk exposures that may have occurred up to 9 months before the onset of symptoms.     

Skin, soft tissue, and bone infections due to Mycobacterium chelonae chelonae: importance of prior corticosteroid therapy, frequency of disseminated infections, and resistance to oral antimicrobials other than clarithromycin.

Little is known of clinical disease due to Mycobacterium chelonae chelonae. One hundred skin, soft tissue, or bone isolates of this rapidly growing mycobacterium were identified over 10 years. Clinical disease included disseminated cutaneous infection (53%); localized cellulitis, abscess, or osteomyelitis (35%); and catheter infections (12%). Underlying conditions with disseminated infection included organ transplantation, rheumatoid arthritis, and autoimmune disorders; 92% involved corticosteroid use. Trauma and medical procedures were risk factors for localized infections. Corticosteroids and chronic renal failure were risk factors for catheter infections. Overall, 62% of patients were receiving corticosteroids and 72% were immunosuppressed. MICs of six oral antimicrobials were obtained for 180 isolates by broth microdilution. Up to 20% of isolates were susceptible to doxycycline, ciprofloxacin, ofloxacin, and sulfamethoxazole. In contrast, 100% were susceptible to clarithromycin (MICs less than or equal to 1 microgram/mL). Disease due to M. chelonae chelonae usually occurs in the setting of corticosteroid therapy and is often disseminated; the organisms require high MICs of oral antimicrobials other than clarithromycin.     

Mycobacterium haemophilum infection in immunocompromised patients: case report and review of the literature

Mycobacterium haemophilum, previously characterized as an unusual pathogen, is found primarily in immunocompromised hosts. This organism has stringent growth characteristics and may not be isolated using routine techniques. M. haemophilum infects the skin and underlying tissues, a circumstance which reflects the organism's propensity for growth in a cooler environment. Infections have been reported in renal transplant recipients, patients with Hodgkin's disease, and, more recently, patients with AIDS. The organism has also been isolated from children with cervical lymphadenitis in the absence of apparent immunodeficiency. Response to therapy has not been uniform, and in some instances improvement in immune status has been associated with regression of lesions. With proliferation of transplantation surgery, chemotherapy, and AIDS, the number of infections due to M. haemophilum is likely to increase.     

马赛分枝杆菌肺病一例并文献复习

目的 分析马赛分枝杆菌肺病的临床特征,探讨其鉴别诊断方法.方法 分析患者的临床表现及实验室检测结果,对其临床分离菌株进行细菌学检查和分子生物学鉴定,采用PCR扩增rpoB和hsp65基因片段和双向DNA测序,并与美国国立生物技术信息中心(NCBI)数据库比对进行菌种鉴定.结果 患者女,72岁,体质瘦弱,因反复出现呼吸道症状而入院,既往多次治疗无效.该病例的临床分离菌株经细菌学检查和分子生物学鉴定确定为马赛分枝杆菌,rpoB和hsp65基因片段测序结果与NCBI数据库马赛分枝杆菌相应片段的同源性分别为100%和99%,结合临床表现确诊为马赛分枝杆菌肺病.药敏试验结果显示该菌株对多种药物耐药,根据药敏试验结果和患者的身体条件确定治疗方案,采用静脉滴注头孢西丁和口服阿米卡星治疗有效.结论 马赛分枝杆菌肺病多发于免疫功能低下人群,其临床和影像学表现与结核病相似,通过实验室细菌学检测和菌种鉴定,可以对二者进行鉴别.

Abstract：

Objective To analyze the clinical features and differential diagnosis of pulmonary infection with Mycobacterium massiliease (M.ruassiliense ).Methods The clinical manifestations and laboratory test results of our patient were analyzed and the strain isolated from the patient was tested by bacteriological and molecular methods.The partial gene fragments of rpoB and hsp65 were amplified by PCR, sequenced and compared with GeneBank database in NCBI for identification of Mycobacterium species.Results The patient was a 72 year old female, who had been admitted to hospital several times because of recurrent respiratory symptoms which had failed to improve upon treatment.This time, pulmonary infection with M.massiliense was confirmed by clinical manifestation and laboratory results.M.massilence isolated from the sputum of our patient was confirmed by bacteriological and molecular methods.The results of specific segments of rpoB and hsp65 tested by PCR and sequence analysis, and compared with that of mycobacterium in NCBI, showed that the DNA homology was 100% and 99% respectively.The results of drug sensitivity test showed that this strain was resistant to multiple drugs.According to the results of drug susceptibility tests and the condition of the patient, therapy with cefoxitin sodium and amikacin was used and the drugs were effective.Conclusions The clinical manifestations and the chest imaging of pulmonary infection with M.massiliens were similar to those of Mycobacterium tuberculosis, which can be differentiated by laboratory tests.     

Disseminated infection with Mycobacterium gordonae: report of a case and critical review of the literature.

Mycobacterium gordonae is only rarely a cause of infection despite its ubiquity in the environment. We describe an 11-year-old girl with disseminated infection due to M. gordonae whose course was complicated by renal failure requiring hemodialysis but who recovered after 15 months of chemotherapy. In a literature search we identified 23 additional cases of infection attributed to M. gordonae, with involvement of the lungs (eight), soft tissue (seven), the peritoneal cavity (three), the cornea (one), and with disseminated disease (five patients, including ours). Two patients were infected with human immunodeficiency virus. We assessed the patterns of infection characteristic of each site and the antibiotic sensitivities of the isolates. Adequate documentation of M. gordonae infection (e.g., amount of growth per culture, detection of specific biochemical characteristics, and confirmation of the organism's identity by a reference center) was lacking in many reports. M. gordonae should not automatically be dismissed as a contaminant when isolated from clinical material. Additional studies are required to establish the extent of this organism's pathogenic role.     

Uveitis during treatment of disseminated Mycobacterium avium-intracellulare complex infection with the combination of rifabutin,clarithromycin and ethambutol

Three patients with a cellular immunodeficiency were treated with rifabutin, clarithromycin and ethambutol for a disseminated infection with Mycobacterium avium-intracellulare complex (MAC). The patients developed uveitis, sometimes in combination with a transient rash, arthralgia, arthritis, jaundice and pseudojaundice. It seems likely that these reactions were caused by rifabutin, alone or together with other drugs such as clarithromycin. These adverse reactions probably depend on the dose, metabolism and excretion of the drug. Inhibition of cytochrome P450 seems to be an important mechanism.     

Tenosynovitis due to Mycobacterium avium-intracellulare: case report and a review of the literature.

A 57-year-old female patient presented with a tenosynovitis due to Mycobacterium avium-intracellulare (MAI). A relapse occurred following surgical treatment, after which she was successfully treated with ansamycin and ethambutol. Previously reported cases of tenosynovitis due to MAI are reviewed and the treatment modalities are discussed.     

华法林致皮肤坏死1例及文献复习

1病历资料患者女,42岁。因"左下肢水肿19个月,气短17个月,右下肢肿3个月"于2010-08-03入院。患者入院前19个月曾因左下肢水肿在外院行左下肢血管超声检查,确诊为"左下肢深静脉血栓形成",未规律治疗。2个月后开始出现活动后气短,上2层楼即感气短,伴胸闷、喘息,每次持续2～3 h,     

Choledochal cyst during pregnancy: case report and literature review of treatment

Choledochal cysts are uncommon conditions, usually diagnosed during childhood, but rarely during pregnancy. Choledochal cysts during pregnancy carry several risks, including development of biliary tract cancer and peritonitis due to rupture of dilated cysts induced by pregnancy itself. We present here a case of choledochal cyst during pregnancy, and discuss appropriate treatments for choledochal cysts first presenting during pregnancy. A 25-year-old primigravida at 15 weeks’ gestation was admitted to our hospital with abdominal pain. Magnetic resonance cholangiopancreatography diagnosed a type 1 choledochal cyst without a mass lesion. A healthy baby arrived without complication at 38 weeks’ gestation. The patient underwent cholecystectomy and choledochal cyst excision. The postoperative course was uneventful with discharge on day 8. Pathological examination diagnosed no malignant feature. Surgery may be performed after delivery for choledochal cysts first presenting during pregnancy, and monitoring with magnetic resonance imaging, blood tests, and ultrasonography is necessary during observation.     

Clopidogrel treatment during pregnancy: a case report and a review of literature

Management of ischemic heart disease in pregnant women is still difficult, as there is little experience with many of the newer treatments such as clopidogrel. The safety of clopidogrel in pregnancy is unknown, especially in combination with aspirin. Its use during gestation has been described in a few case reports. We describe the case of a 36-year-old woman in her 9th week of pregnancy with a history of chronic hypertension, dyslipidemia and CAD, who required antiplatelet treatment. Clopidogrel and aspirin were administrated until one week before delivery and a healthy child was born at 36 weeks of pregnancy by caesarean section, without any complication.     

支气管肺蠊缨滴虫感染1例报告及文献复习

目的分析目前支气管肺蠊缨滴虫感染的现状，进一步提高认识。方法报道1例长期随访病例的治疗情况，结合文献报道的16例，分析在治疗过程中的经验和不足。结果17例中，有12例报道用甲硝唑治疗临床观察提示有效，但有2例长期随访的病例提示甲硝唑类药物及其他抗原虫药物治疗无效。4例有支气管哮喘发作应用肾上腺皮质激素治疗能缓解症状。经支气管镜治疗可以作为辅助治疗方法。结论虽然甲硝唑治疗支气管蠊缨滴虫感染的药理作用机制不明，长期观察也有无效病例，但首次治疗仍应作为首选药物。肾上腺皮质激素能减轻变态反应，可适量使用。     

Aspergillus infection limited to renal allograft: case report and review of literature

We report a case of a 28-year-old recipient of a cadaveric renal transplant who developed Aspergillus infection in the allograft without having disseminated disease. We review the previously reported cases of isolated Aspergillus in kidney transplant recipients and discuss the possible route of transmission in our patient. We also discuss the alternate but successful treatment that our patient received.