Chronic Tenosynovitis of the Hand Due to Mycobacterium nonchromogenicum: Use of High-Performance Liquid Chromatography for Identification of Isolates

Jc, Ridderhof; Rj, Wallace; Jo, Kilburn; Wr, Butler; Ng, Warren; Tsukamura, M; Lc, Steele; Es, Wong

doi:10.1093/clinids/13.5.857

Cited by 41 publications

(29 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, all four strains of mycobacteria were not identified to the species level with conventional biochemical tests, although the best match provided by fatty acid analysis was the same as the identification by 16S rRNA gene sequencing. The final identification of two strains as M. nonchromogenicum is in line with previous reports that this species is especially associated with tenosynovitis (29).…”

Section: Discussionsupporting

confidence: 89%

Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment

et al. 2002

View full text Add to dashboard Cite

Acupuncture has been gaining popularity as a form of alternative medicine. In the past, only blood-borne viruses and anecdotal reports of bacterial infections have been associated with acupuncture. We report on four patients with mycobacterial infections complicating acupuncture who were encountered in a 2-year period. All had clinical and/or radiological lesions at acupuncture point-and meridian-specific locations. There was no other history of trauma or other clinical foci of infections, and the chest radiographs were normal. Histological studies of biopsy specimens of all four patients showed changes compatible with chronic inflammation, with granulomatous inflammation present in three patients and acid-fast bacilli present in two. Conventional biochemical tests and whole-cell fatty acid analysis for identification were inconclusive for all four nonpigmented mycobacteria recovered from tissue biopsies. 16S rRNA gene sequencing showed that the strains from two patients were Mycobacterium chelonae and that those from the other two were Mycobacterium nonchromogenicum. Alcohol resistance assay using the quantitative suspension test revealed that all four strains showed prolonged survival in 75% alcohol compared to other skin flora. Mycobacterial infections transmitted by acupuncture are an emerging problem. A high index of suspicion is essential to recognize this clinical syndrome, and strict implementation of proper infection control guidelines for acupuncture is mandatory.Acupuncture has been gaining popularity as a form of alternative medicine in both Asian and Western countries for chronic pain problems, digestive disorders, allergic disorders, psychosomatic problems, menstrual disorders, and drug and alcohol rehabilitation. However, in most countries, monitoring and control over the practice and its associated complications are far from adequate. Although infection control guidelines for acupuncture are available (1), the implementation, especially in developing countries where acupuncture is very popular, is far from ideal. In the past, needles used for acupuncture were usually reused and often inadequately sterilized. Such inadequate disinfection has led to the transmission of infectious diseases from patient to patient. The best-documented acupuncture-transmitted microorganisms are the blood-borne viruses, including human immunodeficiency virus, hepatitis B virus, and hepatitis C virus (13,32,44). Apart from blood-borne infections due to patient-to-patient transmission, acupuncture can also be complicated by infections caused by environmental microorganisms or the patient's own skin flora, as the most commonly used skin disinfectant in acupuncture clinics is alcohol. There have been case reports of such bacterial infections as well as abscess formation without proven microbiological causes complicating acupuncture (4,10,11,12,14,16,19,24,26,45).Mycobacteria are well known to be relatively resistant to disinfectants, and the mechanism of disinfectant resistance has been described for some mycobacteria (18)...

show abstract

Section: Discussionsupporting

confidence: 89%

Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Previous reports have noted the benefits of a macrolide combined with one or more additional agents that included ethambutol, rifabutin, and/or a sulfonamide, including trimethoprim-sulfamethoxazole (TMP-SMX) (3,31). The major pathogens defined in the current study are M. arupense and M. heraklionense.…”

Section: Discussionmentioning

confidence: 83%

“…The initial MTC consisted of two nonchromogenic slowly growing species: M. terrae and Mycobacterium nonchromogenicum (1,2). Phenotypic separation within the group was often difficult, and molecular methods were not available, making establishment of species pathogenicity uncertain (3).…”

mentioning

confidence: 99%

“…The distribution of these 11 newer species of the complex as well as the two established members (M. terrae and M. nonchromogenicum) among clinical isolates from synovial fluid, tissue, or bone based on DNA sequencing is not known. Thus, we collected tendon, synovial, and bone isolates of the M. terrae complex recovered over 30 years, including isolates previously identified as M. nonchromogenicum using nonmolecular methods, and subjected them to molecular identification (3). We also present a case report of osteomyelitis due to a previously unrecognized taxa within the MTC.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Mycobacterium arupense, Mycobacterium heraklionense, and a Newly Proposed Species, “Mycobacterium virginiense” sp. nov., but Not Mycobacterium nonchromogenicum, as Species of the Mycobacterium terrae Complex Causing Tenosynovitis and Osteomyelitis

Vasireddy

Brown‐Elliott

et al. 2016

J Clin Microbiol

View full text Add to dashboard Cite

Mycobacterium terrae complex (MTC) was first characterized in 1981 by the International Working Group in Mycobacterial Taxonomy (IWGMT). The initial MTC consisted of two nonchromogenic slowly growing species: M. terrae and Mycobacterium nonchromogenicum (1, 2). Phenotypic separation within the group was often difficult, and molecular methods were not available, making establishment of species pathogenicity uncertain (3).The complex is recognized as an environmental contaminant of sputum and a cause of tenosynovitis and osteomyelitis primarily of the fingers and wrist (3-35). Whether one or more members of the complex are true respiratory pathogens has not been established (1, 22).The first published case report of tenosynovitis caused by the MTC was by Hirata and Tomiyama in 1976 (4). There have been approximately 34 additional case reports published since then, identified using nonmolecular methods (3-25), with 14 cases identified using molecular methods (26)(27)(28)(30)(31)(32)(33)(34)(35)(36) (Tables 1 and 2). With the exception of four isolates of M. arupense, including the original description of M. arupense (28), details of the methods and/or explicitly stating a 100% 16S rRNA gene sequence identity to recognized species for the remaining cases with molecular identifications have been absent (Table 2).An excellent history and species update of the M. terrae complex based on multigene sequencing targets was published by Tortoli et al. (1). He noted that the presence of a two nucleotide insertion in helix 18 of the 16S rRNA gene (bp ϳ430 to 500; hypervariable region B or region V3) provided a consistent signature sequence for members of the MTC compared to other slowly growing mycobacteria (37,38). He also characterized several new species in the complex, including Mycobacterium heraklionense and Mycobacterium engbaekii (1).The greater availability of DNA sequencing (59) Citation Vasireddy R, Vasireddy S, Brown-Elliott BA, Wengenack NL, Eke UA, Benwill JL, Turenne C, Wallace RJ, Jr. 2016. Mycobacterium arupense, Mycobacterium heraklionense, and a newly proposed species, "Mycobacterium virginiense" sp. nov., but not Mycobacterium nonchromogenicum, as species of the Mycobacterium terrae complex causing tenosynovitis and osteomyelitis.

show abstract

“…However, such association in our clinical isolates was not found (data not shown). This might be caused by different phenotypic characteristics of our isolates or might depend on the laboratory (12,17,19,23). More importantly, there is a possibility that the M. terrae complex itself is too heterogeneous to be classified according to the current system.…”

Section: Discussionmentioning

confidence: 98%

The Genomic Heterogeneity among Mycobacterium terrae Complex Displayed by Sequencing of 16S rRNA and hsp65 Genes

Lee

Cho

et al. 2004

Microbiology and Immunology

View full text Add to dashboard Cite

Nontuberculous mycobacteria are opportunistic pathogens and can pose a serious threat to infected individuals (24). Mycobacterium terrae complex is composed of M. nonchromogenicum, M. terrae, and M. triviale. They are uncommon colonizers of human epithelia and generally regarded as nonpathogenic. However, M. nonchromogenicum may occasionally cause human disease such as pulmonary infection and tenosynovitis (10). M. terrae can cause debilitating diseases that are relatively resistant to antibiotic therapy. Disseminated M. terrae infection in a patient with advanced human immunodeficiency virus disease was recently reported (2).The identification of pathogenic versus nonpathogenic species is important for patient management, since treatment regimens for infection caused by one Mycobacterium species are often not effective against another.Conventional methods for species identification of mycobacteria mainly depend on morphological, cultural, and biochemical tests. These methods require diverse techniques and complex procedures that take a long time and yet the efficiency of identification is still limited (11,15). Other methods such as thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC) are more powerful, but are cumbersome, expensive and limited by the need for standardized growth conditions. Currently, these methods are used in very few clinical laboratories (1,5,8).In addition to these phenotypic methods, genotypic and phylogenetic methods were introduced for polyphasic taxonomy and complete identification of microor- Abstract: The species identification within Mycobacterium terrae complex has been known to be very difficult. In this study, the genomic diversity of M. terrae complex with eighteen clinical isolates, which were initially identified as M. terrae complex by phenotypic method, was investigated, including that of three type strains (M. terrae, M. nonchromogenicum, and M. triviale). 16S rRNA and 65-kDa heat shock protein (hsp65) gene sequences of mycobacteria were determined and aligned with eleven other references for the comparison using similarity search against the GenBank and Ribosomal Database Project II (RDP) databases. 16S rRNA and hsp65 genes of M. terrae complex showed genomic heterogeneity. Amongst the eighteen clinical isolates, nine were identified as M. nonchromogenicum, eight as M. terrae, one as M. mucogenicum with the molecular characteristic of rapid growth. M. nonchromogenicum could be subdivided into three subgroups, while M. terrae could be subdivided into two subgroups using a 5 bp criterion (>1% difference). Seven isolates in two subgroups of M. nonchromogenicum were Mycobacterium sp. strain MCRO 6, which was closely related to M. nonchromogenicum. The hsp65 gene could not differentiate one M. nonchromogenicum from M. avium or one M. terrae from M. intracellulare. The nucleotide sequence analysis of 16S rRNA and hsp65 genes was shown to be useful in identifying the M. terrae complex, but hsp65 was less discriminating than 16S rRNA.

show abstract

Chronic Tenosynovitis of the Hand Due to Mycobacterium nonchromogenicum: Use of High-Performance Liquid Chromatography for Identification of Isolates

Cited by 41 publications

References 17 publications

Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment

Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment

Mycobacterium arupense, Mycobacterium heraklionense, and a Newly Proposed Species, “Mycobacterium virginiense” sp. nov., but Not Mycobacterium nonchromogenicum, as Species of the Mycobacterium terrae Complex Causing Tenosynovitis and Osteomyelitis

The Genomic Heterogeneity among Mycobacterium terrae Complex Displayed by Sequencing of 16S rRNA and hsp65 Genes

Contact Info

Product

Resources

About