Mycobacterium marinum infections in transplant recipients: case report and review of the literature

Abstract: Infections due to Mycobacterium marinum are rarely encountered following organ and tissue transplantation. Herein, we report a case of M. marinum infection in a kidney and pancreas transplant recipient who manifested clinically with multiple locally spreading sporotrichoid‐like cutaneous nodules in his left forearm. In order to provide a general overview of post‐transplant M. marinum infections, we reviewed and summarized all previously reported cases of this infection that occurred after transplantation. Including our index case, all 6 cases presented with multiple cutaneous and subcutaneous nodules that had spread locally in the involved extremity. One patient had lesions located in non‐contiguous body sites suggesting either systemic dissemination or multiple sites of inoculation. In all but 1 patient, the cutaneous nodules appeared in an ascending pattern and following exposure to fish tanks or after contact with the marine environment. The diagnosis of M. marinum infection was suspected on clinical grounds and confirmed by mycobacterial culture. Treatment consisted of at least 2 active antibiotics (such as rifamycins, ethambutol, tetracyclines, or macrolides) for 4–9 months, resulting in clinical cure or improvement. Relapse was observed in 1 patient despite completing 6 months of antibiotic therapy. One patient had surgical excision of the lesions. In conclusion, M. marinum should be considered as the cause of cutaneous and subcutaneous nodules in transplant recipients, particularly in the context of fish tank or marine exposure. Compared with the immunocompetent hosts, M. marinum infection may have a more aggressive clinical course after transplantation, and may require a longer duration of antibiotic treatment. Early diagnosis and treatment may prevent local spread and potential systemic dissemination.     

Mycobacterium marinum tenosynovitis: three case reports and review of the literature

Mycobacterium marinum is one of the nontuberculosis mycobacteria responsible for skin infections. There have been very few case series of M. marinum infections reported in the English literature. Herein, we describe three patients with M. marinum tenosynovitis. All patients had positive cultures and were exposed to pricking by a fishbone. The incubation period ranged from 7 to 60 days. Key elements in the diagnosis of this infection were a high index of suspicion raised by negative bacterial tissue cultures, poor response to conventional antibiotics treatment, a history of exposure to tropical fish and tissue biopsy for culture and histology. The treatment is essentially antimicrobial therapy supplemented by an appropriate surgical debridement, especially when deep structures are involved.     

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.     

Emergence of resistance to clarithromycin during treatment of disseminated cutaneous Mycobacterium chelonae infection: case report and literature review.

Results of in vitro susceptibility studies and one clinical trial have led to recommendations of clarithromycin monotherapy for the treatment of disseminated cutaneous Mycobacterium chelonae infections. We describe the case of a 65-year-old woman, immunocompromised by the use of chronic steroid therapy, who developed disseminated cutaneous infection with M. chelonae and failed clarithromycin monotherapy due to the development of drug resistance. In the relapse isolate we document the presence of a single point mutation at position 2058 in the gene coding for 23S rRNA peptidyltransferase regions, a mutation previously implicated in the development of resistance to clarithromycin. Two susceptible control isolates lacked the mutation. Three additional reports in the literature of patients developing recurrent skin lesions with clarithromycin-resistant M. chelonae following initial response to monotherapy are summarized. We demonstrate that clarithromycin monotherapy in patients with disseminated cutaneous infections can lead to clarithromycin resistance and therapeutic failure associated with a single point mutation at position 2058 of 23S rRNA.     

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.     

Systemic sclerosis associated with cutaneous exposure to solvent: case report and review of the literature

Sclerodermatous skin changes and systemic sclerosis have been reported to occur as a result of contact with several different organic solvents. We describe a 41-year-old man who developed systemic sclerosis after working for 15 years in a foundry, where he had extensive cutaneous contact with multiple organic solvents (trichloroethane, xylene, trimethylbenzene, and naphthalene). Cutaneous exposure to organic solvents may be a factor in the etiology of some cases of systemic sclerosis.     

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,     

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.     

Endovascular Mycobacterium abscessus infection in a heart transplant recipient: a case report and review of the literature

Nontuberculous mycobacteria are ubiquitous in the environment. Although rarely a cause of infection in immunocompetent individuals, increased risk and severity of infection are seen in patients who are immunocompromised, such as those with solid organ transplants. In this report, we describe the first case of disseminated endovascular Mycobacterium abscessus in a heart transplant recipient. A review of the literature regarding this infection in heart transplant recipients and its therapeutic options and concerns are summarized.     

Mycobacterium marinum infection of the hand

Mycobacterium marinum is an atypical mycobacterium which may cause skin infections, tenosynovitis, arthritis, and osteomyelitis, especially in association with exposure to marine environments. We describe a 59‐year‐old chef with left wrist dorsal tenosynovitis and left third metacarpophalangeal synovitis due to M. marinum. Ultrasonography assisted in confirming the diagnosis of tenosynovitis and obtaining tissue for culture. In comparison to CT scan and MRI scan, ultrasonography has the advantage of being a cheaper imaging modality with no risk of radiation.     

Dermatomyositis and HIV infection: case report and review of the literature

Since the 1980s, a host of autoimmune phenomena and rheumatologic illnesses have been linked to infection with the human immunodeficiency virus (HIV). Given the broad effects of this virus on both the humoral and cell-mediated arms of the immune system, illnesses such as polymyositis and Reiter’s syndrome appear to be more prevalent in HIV-infected individuals and occur in the absence of well-described predispositions. The activities of some rheumatologic illnesses exhibit an inverse relationship with the course of HIV infection, such as rheumatoid arthritis, which becomes more quiescent with advancing disease. Dermatomyositis is a rheumatologic illness that very infrequently occurs and during our review of literature only three other cases were reported. We present the case of a Caucasian male in his mid-20s who presented with acquired immunodeficiency syndrome and subsequently developed dermatomyositis. In this review, we highlight the current relationship between HIV infection and autoimmunity, the possible ways HIV infection may foster an environment favorable for the development of dermatomyositis, and review the previously reported cases of individuals with HIV infection who developed dermatomyositis. The complex issues of how to treat individuals with HIV and dermatomyositis is also discussed.     

Amiodarone-induced cutaneous leukocytoclastic vasculitis: a case report and a review of the literature

Clinical Rheumatology - Amiodarone can be used in a variety of arrhythmias. Given its widespread use, the probability of clinicians encountering its cutaneous adverse effects is high. A few cases...     

Pediatric septic bursitis: case report of retrocalcaneal infection and review of the literature.

Septic bursitis in children is rarely discussed in the medical literature. This review summarizes the clinical manifestations and management of 10 cases of septic bursitis involving patients aged <16 years. In every case in this series, acute trauma was the predisposing condition. Group A streptococci were frequently isolated from the infected bursa. Septic bursitis, an underappreciated infection in children, should be considered in the differential diagnosis of common childhood conditions.     

Perinatal dengue infection: a case report and review of literature

A case of vertical transmission of dengue infection in the perinatal period is reported. The mother, a term pregnancy, had acute dengue the day before admission. The infant was born at term and developed fever on the fifth day of life which lasted for 5 days. No bleeding or plasma leakage was detected during the course of fever in infant or mother. A liver function test showed elevated SGOT and SGPT in the infant. The infant developed a convalescent rash on day 5 of the fever. The diagnosis of secondary dengue hemorrhagic fever in the mother was confirmed by serology and primary dengue infection in the infant was confirmed by serology and serotyped as dengue type 2 by PCR. The clinical course and management of mothers and infants with perinatal dengue infection are reviewed.