Mycobacterial central venous catheter tunnel infection: a difficult problem.
We report our experience of non-tuberculous mycobacterial infection associated with the tunnel of Hickman-Broviac central venous catheters in immunosuppressed patients with haematological malignancies undergoing high-dose chemotherapy supported by BMT. The problem is rare and difficult to treat. Our cases are unique in developing tunnel site mycobacterial infection well after the tunnelled catheters were removed. We diagnosed one case of Mycobacterium chelonae, which is a well-documented cause of such infections, and two cases of Mycobacterium haemophilum, which are the first reported cases in this setting. Early wide surgical excision of the infected tunnel site and prolonged antibiotic therapy is necessary. Despite these measures recurrence occurred in two cases. Close liaison with the microbiology laboratory is needed to ensure the appropriate culture media and conditions are used for these fastidious organisms. Empiric antibiotic regimens should be based on the likely organism. Drugs active against M. chelonae and M. haemophilum should be included. (+info
Mycobacterium haemophilum in immunocompromised patients.
Mycobacterium haemophilum, a recently described pathogen, can cause an array of symptoms in immunocompromised patients. To date, 90 patients with this infection have been described worldwide. We report our institution's experience with 23 patients who were treated from 1990 through 2000. Fourteen patients had undergone bone marrow transplantation, 5 were infected with human immunodeficiency virus, 3 had hematologic malignancies, and 1 had no known underlying immunosuppression. Clinical syndromes on presentation included skin lesions alone in 13 patients, arthritis or osteomyelitis in 4 patients, and lung disease in 6 patients. Although patients with skin or joint involvement had favorable outcomes, 5 of 7 patients with lung infection died. Prolonged courses of multidrug therapy are required for treatment. A diagnosis of M. haemophilum infection must be considered for any immunocompromised patient for whom acid-fast bacilli are identified in a cutaneous, synovial fluid or respiratory sample or for whom granulomas are identified in any pathological specimen. (+info
Skin indurations in response to tuberculin testing in patients with nontuberculous mycobacterial lymphadenitis.
Mantoux results were examined for 29 children with culture-proven nontuberculous mycobacterial lymphadenitis, and 4 species were isolated: Mycobacterium avium-intracellulare complex (from 14 patients [48%]), Mycobacterium haemophilum (from 12 [41%]), Mycobacterium simiae (from 2 [7%]), and Mycobacterium scrofulaceum (from 1 [3%]); the median indurations for each species were 15.5 mm, 14.5 mm, 20 mm, and 23 mm, respectively, and in 17 cases (59%), they were > or =15 mm. In regions with a low incidence of tuberculosis, lymphadenitis thought to be due to nontuberculous mycobacteria should be managed as such, regardless of Mantoux results, thereby avoiding antituberculosis treatment. (+info
Remission of cutaneous Mycobacterium haemophilum infection as a result of antiretroviral therapy in a Human Immunodeficiency Virus--infected patient.
We describe the first Mycobacterium haemophilum infection that occurred in a patient with human immunodeficiency virus in Germany and report 7 newly diagnosed cases of M. haemophilum infection. In the former case, a local M. haemophilum skin infection resolved as a result of successful antiretroviral therapy only; however, that clinical outcome may not be possible for more invasive forms of the disease. (+info
Mycobacterium haemophilum infections in heart transplant recipients: case report and review of the literature.
Non-tuberculous mycobacteria are becoming increasingly important pathogens among transplant recipients. We report a case of disseminated Mycobacterium haemophilum infection in a heart transplant recipient, manifesting as cellulitis, subcutaneous nodules, septic arthritis, and pneumonitis. Our case illustrates diverse challenges in the identification and treatment of this pathogen, such as its unique culture requirements and variable antimicrobial susceptibilities. Heightened clinical suspicion is necessary to establish a timely diagnosis so that optimal treatment can be administered. (+info
Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury.
A 61-year-old previously healthy man developed chronic dermal granulomata in his right arm after receiving a coral injury in Thailand. After 7 biopsies, infection caused by Mycobacterium haemophilum was diagnosed. This case highlights the difficulty of isolating this fastidious organism in the laboratory and suggests that seawater or coral was the source of the infection. (+info
Direct identification of Mycobacterium haemophilum in skin lesions of immunocompromised patients by PCR-restriction endonuclease analysis.
PCR-restriction endonuclease analysis (PRA) was used for direct identification of Mycobacterium haemophilum in clinical specimens from immunocompromised patients. PRA correctly identified M. haemophilum in four smear-positive specimens. Direct identification by PRA takes 2 to 3 working days compared to the 3 to 5 weeks required for culture isolation and identification by conventional methods. (+info
Cutaneous Mycobacterium haemophilum infections in immunocompromised patients in a dermatology clinic in Singapore.
INTRODUCTION: Mycobacterium haemophilum, a nontuberculous mycobacterium (NTM) that was first described in 1978, is a pathogen that can cause an array of symptoms in immunocompromised patients, predominantly cutaneous. CLINICAL PICTURE: We report our hospital's experience with the first 3 patients diagnosed with this infection from 1994 to 2002. All were women; one had systemic lupus erythematosus (SLE), one had mycosis fungoides and the last had Sjogren's syndrome with recurrent bacterial infections, although the specific nature of her immunocompromised state has not been defined. All were HIV negative. All 3 women presented with cutaneous lesions--the first with recurrent erythematous plaques on the limbs and back, the second with tender nodules and abscesses on the knees, and the third with papular eruptions on the cheek. TREATMENT/OUTCOME: All responded to a combination of antibiotics and are presently still undergoing treatment and follow-up. CONCLUSION: Infections caused by M. haemophilum occur mainly in immunocompromised patients. They can present with a variety of cutaneous manifestations, which require a high index of suspicion and coordination between the treating physician and the laboratory for diagnosis. Combination antibiotic treatment is recommended, and patients should be followed up after treatment to survey for possible relapse. (+info