An Outbreak of Keratitis Caused by
            <i>Mycobacterium immunogenum</i>

Sampaio, Jorge Luiz Mello; Nassar, Doraldo; Freitas, Denise de; Höfling-Lima, Ana Luísa; Miyashiro, Kozue; Alberto, Fernando; Leão, Sylvia Cardoso

doi:10.1128/jcm.00656-06

Cited by 38 publications

(28 citation statements)

References 24 publications

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“…Eight outbreaks following laser in situ keratomileusis (surgery for myopia correction), mesotherapy sessions (intradermal injections), or breast implants have been described, most of them associated with species belonging to the M. chelonae-M. abscessus group. (16,(30)(31)(32). Recently, two outbreaks of surgical-site infection following video-assisted surgeries were reported in Brazil (9,40).…”

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Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense

et al. 2009

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An epidemic of infections after video-assisted surgery (1,051 possible cases) caused by rapidly growing mycobacteria (RGM) and involving 63 hospitals in the state of Rio de Janeiro, Brazil, occurred between August 2006 and July 2007. One hundred ninety-seven cases were confirmed by positive acid-fast staining and/or culture techniques. Thirty-eight hospitals had cases confirmed by mycobacterial culture, with a total of 148 available isolates recovered from 146 patients. Most (n ‫؍‬ 144; 97.2%) isolates presented a PRA-hsp65 restriction pattern suggestive of Mycobacterium bolletii or Mycobacterium massiliense. Seventy-four of these isolates were further identified by hsp65 or rpoB partial sequencing, confirming the species identification as M. massiliense. Epidemic isolates showed susceptibility to amikacin (MIC at which 90% of the tested isolates are inhibited [MIC 90 ], 8 g/ml) and clarithromycin (MIC 90 , 0.25 g/ml) but resistance to ciprofloxacin (MIC 90 , >32 g/ml), cefoxitin (MIC 90 , 128 g/ml), and doxycycline (MIC 90 , >64 g/ml). Representative epidemic M. massiliense isolates that were randomly selected, including at least one isolate from each hospital where confirmed cases were detected, belonged to a single clone, as indicated by the analysis of pulsed-field gel electrophoresis (PFGE) patterns. They also had the same PFGE pattern as that previously observed in two outbreaks that occurred in other Brazilian cities; we designated this clone BRA100. All five BRA100 M. massiliense isolates tested presented consistent tolerance to 2% glutaraldehyde. This is the largest epidemic of postsurgical infections caused by RGM reported in the literature to date in Brazil.Outbreaks, pseudooutbreaks, and cases of health-care-associated infections caused by rapidly growing mycobacteria (RGM) have been reported since the first case was described in 1938 (13). In virtually all nosocomial infections caused by this group of microorganisms, there were failings in the sterilization processes of solutions, surgical instruments, or medical devices (13,14,45). Recent publications indicate an increasing number of infections secondary to breast augmentation and video-assisted surgeries (7,9,19,23,25,(40)(41)(42)(43).The growing number of cases and reports may be due, at least in part, to the well-known tolerance to alkaline glutaraldehyde among Mycobacterium chelonae-Mycobacterium abscessus group isolates and to the low susceptibility to high-level disinfectants (20,22,39).Outbreaks of RGM infections unrelated to medical procedures also can occur and usually are associated with exposure to recreational water containing a large number of bacteria and inadequate chlorination (15,44), highlighting the ubiquity of these organisms in the environment. In fact, RGM have been recovered from many different environmental sources, including soil and water distribution systems (8,45). RGM are considered opportunistic pathogens and can cause chronic lung disease, particularly the species included in the M. chelonae-M. abscessus group (8, 46)...

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Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense

et al. 2009

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“…It was isolated from metalworking fluids and was associated with cases of hypersensitivity pneumonitis in factory workers. This species has also been detected in cutaneous, catheter-related, articular, and lung infections; in an outbreak related to ophthalmologic surgeries; and in a pseudo-outbreak related to bronchoalveolar lavage procedures (19,27). Mycobacterium massiliense was validated as a species separate from the M. chelonae-M. abscessus group in 2006 (11).…”

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Molecular Characterization of Mycobacterium massiliense and Mycobacterium bolletii in Isolates Collected from Outbreaks of Infections after Laparoscopic Surgeries and Cosmetic Procedures

et al. 2008

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An outbreak of infections affecting 311 patients who had undergone different invasive procedures occurred in 2004and 2005 in the city of Belém, in the northern region of Brazil. Sixty-seven isolates were studied; 58 were from patients who had undergone laparoscopic surgeries, 1 was from a patient with a postinjection abscess, and 8 were from patients who had undergone mesotherapy. All isolates were rapidly growing nonpigmented mycobacteria and presented a pattern by PCR-restriction enzyme analysis of the hsp65 gene with BstEII of bands of 235 and 210 bp and with HaeIII of bands of 200, 70, 60, and 50 bp, which is common to Mycobacterium abscessus type 2, Mycobacterium bolletii, and Mycobacterium massiliense. hsp65 and rpoB gene sequencing of a subset of 20 isolates was used to discriminate between these three species. hsp65 and rpoB sequences chosen at random from 11 of the 58 isolates from surgical patients and the postinjection abscess isolate presented the highest degrees of similarity with the corresponding sequences of M. massiliense. In the same way, the eight mesotherapy isolates were identified as M. bolletii. Molecular typing by pulsed-field gel electrophoresis (PFGE) grouped all 58 surgical isolates, while the mesotherapy isolates presented three different PFGE patterns and the postinjection abscess isolate showed a unique PFGE pattern. In conclusion, molecular techniques for identification and typing were essential for the discrimination of two concomitant outbreaks and one case, the postinjection abscess, not related to either outbreak, all of which were originally attributed to a single strain of M. abscessus.Rapidly growing mycobacteria (RGM) are widely distributed in the environment, especially in water (rivers, lakes, potable water), and can contaminate reagents and medical equipment. Most RGM infections in humans are caused by species belonging to the Mycobacterium fortuitum, Mycobacterium chelonae-Mycobacterium abscessus, and Mycobacterium smegmatis groups (6).The M. chelonae-M. abscessus group comprises two genomospecies, M. chelonae and M. abscessus, which have been differentiated on the basis of Ͻ70% genomic homology by DNA-DNA hybridization (16, 18). These species have been isolated from sporadic cases of chronic lung disease associated with bronchiectasis and cystic fibrosis, disseminated cutaneous infections, and postsurgical wound infections. They have also been implicated in outbreaks in cardiac, ophthalmologic, and plastic surgeries and pseudo-outbreaks related to contaminated bronchoscopes and contaminated laboratory reagents (6,12,20,25,26). Mycobacterium immunogenum was included in this group in 2001. It was isolated from metalworking fluids and was associated with cases of hypersensitivity pneumonitis in factory workers. This species has also been detected in cutaneous, catheter-related, articular, and lung infections; in an outbreak related to ophthalmologic surgeries; and in a pseudo-outbreak related to bronchoalveolar lavage procedures (19,27). Mycobacterium massiliense was vali...

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“…In recent years, there has been a significant increase in the detection of diseases caused by NTM, which can be attributed to an increase in the number of infections affecting immunocompromised patients and the number and type of invasive procedures used for cosmetic and therapeutic purposes, as well as to advances in molecular identification techniques (5). In Brazil, several outbreaks of infections by rapidly growing mycobacteria (RGM) have been detected since 1998 in patients subjected to medical invasive procedures, such as ophthalmological, laparoscopic, arthroscopic, plastic and cardiac surgeries, or cosmetic procedures, such as mesotherapy (6)(7)(8)(9)(10). Between 2004 and 2008, Ͼ2,000 patients with surgical site infections caused by a unique strain of Mycobacterium abscessus were reported to the federal authorities in Brazil, and the problem was considered an epidemiological emergency (11).…”

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Multilocus Sequence Typing Scheme versus Pulsed-Field Gel Electrophoresis for Typing Mycobacterium abscessus Isolates

et al. 2014

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hOutbreaks of infections by rapidly growing mycobacteria following invasive procedures, such as ophthalmological, laparoscopic, arthroscopic, plastic, and cardiac surgeries, mesotherapy, and vaccination, have been detected in Brazil since 1998. Members of the Mycobacterium chelonae-Mycobacterium abscessus group have caused most of these outbreaks. As part of an epidemiological investigation, the isolates were typed by pulsed-field gel electrophoresis (PFGE). In this project, we performed a large-scale comparison of PFGE profiles with the results of a recently developed multilocus sequence typing (MLST) scheme for M. abscessus. Ninety-three isolates were analyzed, with 40 M. abscessus subsp. abscessus isolates, 47 M. abscessus subsp. bolletii isolates, and six isolates with no assigned subspecies. Forty-five isolates were obtained during five outbreaks, and 48 were sporadic isolates that were not associated with outbreaks. For MLST, seven housekeeping genes (argH, cya, glpK, gnd, murC, pta, and purH) were sequenced, and each isolate was assigned a sequence type (ST) from the combination of obtained alleles. The PFGE patterns of DraI-digested DNA were compared with the MLST results. All isolates were analyzable by both methods. Isolates from monoclonal outbreaks showed unique STs and indistinguishable or very similar PFGE patterns. Thirty-three STs and 49 unique PFGE patterns were identified among the 93 isolates. The Simpson's index of diversity values for MLST and PFGE were 0.69 and 0.93, respectively, for M. abscessus subsp. abscessus and 0.96 and 0.97, respectively, for M. abscessus subsp. bolletii. In conclusion, the MLST scheme showed 100% typeability and grouped monoclonal outbreak isolates in agreement with PFGE, but it was less discriminative than PFGE for M. abscessus.

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An Outbreak of Keratitis Caused by Mycobacterium immunogenum

Cited by 38 publications

References 24 publications

Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense

Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense

Molecular Characterization of Mycobacterium massiliense and Mycobacterium bolletii in Isolates Collected from Outbreaks of Infections after Laparoscopic Surgeries and Cosmetic Procedures

Multilocus Sequence Typing Scheme versus Pulsed-Field Gel Electrophoresis for Typing Mycobacterium abscessus Isolates

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