Diagnosis and Treatment of Infections Caused by Rapidly Growing Mycobacteria

Colombo, Rhonda E; Olivier, Kenneth N.

doi:10.1055/s-0028-1085709

Cited by 56 publications

(77 citation statements)

References 66 publications

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“…Rapidly growing mycobacteria (RGM) represent a subgroup of environmental mycobacteria that includes the commonly recognized pathogen Mycobacterium abscessus as well as other species, such as M. fortuitum and M. chelonae (1). Accumulating evidence suggests that RGM are significant respiratory pathogens within patients with chronic lung diseases such as cystic fibrosis (CF) (2,8).…”

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Detection of Rapidly Growing Mycobacteria in Routine Cultures of Samples from Patients with Cystic Fibrosis

et al. 2011

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Rapidly growing mycobacteria (RGM) are respiratory pathogens in patients with cystic fibrosis (CF), but detection generally requires specialized cultures for acid-fast bacilli (AFB; AFB cultures). We determined that RGM could be recovered from routine cultures of samples from patients with CF by extending incubation of the Burkholderia cepacia selective agar (BCSA) from 5 to 14 days. To explore the impact of this modification, we compared results from routine and AFB cultures of samples from CF patients for 2 years before (4,212 samples by routine culture, 1,810 samples by AFB culture, 670 patients) and 2 years after (4,720 samples by routine culture, 2,179 samples by AFB culture, 695 patients) the change. Clinical relevance was assessed with samples from a subgroup of 340 patients followed regularly throughout both periods. Extending incubation of BCSA enhanced RGM recovery from routine cultures (0.7% before, 2.8% after; P < 0.001); recovery from AFB cultures was unchanged (5.5% before, 5.7% after). Estimates of RGM detection sensitivity by culture or patient-based methods ranged from ϳ65 to 75% for routine cultures (nonsignificantly lower than the ϳ80 to 85% for AFB cultures) and were adversely affected by coculture with mold or nonpseudomonal, nonfermenting Gram-negative rods. In the after period, 16 CF patients met the criteria for RGM infection by routine culture, including 4 who did not meet the criteria for RGM infection by AFB culture. We conclude that a simple methodological change enhanced recovery of RGM from routine cultures. The modified culture method could be utilized to improve screening for RGM in CF patients or as a simpler method to follow patients with known RGM infection. However, this method should be used cautiously in patients with certain coinfections.Rapidly growing mycobacteria (RGM) represent a subgroup of environmental mycobacteria that includes the commonly recognized pathogen Mycobacterium abscessus as well as other species, such as M. fortuitum and M. chelonae (1). Accumulating evidence suggests that RGM are significant respiratory pathogens within patients with chronic lung diseases such as cystic fibrosis (CF) (2,8). A large prospective study showed that RGM respiratory infection was relatively common in CF patients (prevalence, 2.3%) (12), and CF patients with chronic RGM infection have been shown to have greater declines in lung function over time (3).Although these data suggest that RGM are significant pathogens in patients with CF, detection of RGM respiratory infection poses considerable challenges. While RGM are capable of growth on many standard culture media, they grow relatively slowly (they are rapidly growing only relative to the rate of growth of other mycobacteria) and are typically overgrown by other common CF pathogens, such as Pseudomonas aeruginosa, on nonselective agar. As a result, detection of RGM in respiratory secretions from patients with CF is generally performed using culture for acid-fast bacilli (AFB; AFB culture) by techniques that involve a decontami...

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Detection of Rapidly Growing Mycobacteria in Routine Cultures of Samples from Patients with Cystic Fibrosis

et al. 2011

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“…They are ubiquitous in the environment and often can be isolated from tap water. Increasingly, they are being recognized as opportunistic pathogens [1]. The major important RGM are Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum complex.…”

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Postsurgical Wound Infection Caused byMycobacterium conceptionenseIdentified by Sequencing of 16S rRNA,hsp65, andrpoBGenes in an Immunocompetent Patient

et al. 2014

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Rapidly growing mycobacteria are ubiquitous in the environment and are increasingly being recognized as opportunistic pathogens. Recently, a new species, Mycobacteium conceptionense, has been validated from the Mycobacterium fortuitum third biovariant complex by molecular analysis. However, there are few reports, and postsurgical wound infection by this species is rare. We report a case of postsurgical wound infection caused by M. conceptionense in an immunocompetent patient that was identified by a sequencing analysis of 16S rRNA, hps65, and rpoB genes. (Ann Clin Microbiol 2014;17:23-27)

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“…RGM, characterized by visible growth on solid media within 7 days, are ubiquitous environmental organisms increasingly recognized as human pathogens (4). The RGM species most commonly associated with human infections are Mycobacterium abscessus and Mycobacterium fortuitum (4). Mycobacterium bolletii was recognized as a species separate from the M. chelonae-M. abscessus group in 2006 (11).…”

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“…However, follow-up mycobacterial sputum cultures have been persistently positive, although he remained well. RGM, characterized by visible growth on solid media within 7 days, are ubiquitous environmental organisms increasingly recognized as human pathogens (4). The RGM species most commonly associated with human infections are Mycobacterium abscessus and Mycobacterium fortuitum (4).…”

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First Case of Disseminated Mycobacterium bolletii Infection in a Young Adult Patient

et al. 2009

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Mycobacterium bolletii is a rapidly growing nontuberculous mycobacterium first characterized in 2006. Here, we report a case of disseminated infection caused by M. bolletii in a young adult patient. To our knowledge, this is the first case of disseminated M. bolletii infection in an otherwise healthy young adult. CASE REPORTA previously healthy 23-year-old man presented with a cough, sputum symptoms, and multiple enlarged lymph nodes in the neck. Three months before, he had been diagnosed with smear-negative pulmonary tuberculosis and had received first-line antituberculosis drugs. Despite 1 month of antituberculosis treatment, the patient failed to show any clinical improvement. After then, he was referred to Samsung Medical Center. A physical examination showed that the patient was 184.6 cm tall and weighed 64.5 kg. There were multiple enlarged lymph nodes in the bilateral neck and anticubital fossa of the right forearm. Mild pectus excavatum was noted.The leukocyte count was 6,300/l, with a differential of 66% neutrophils and 19% lymphocytes. The erythrocyte sedimentation rate was 50 mm/h, and the cyclic AMP receptor protein level increased to 2.88 mg/dl. A human immunodeficiency virus antibody test result was negative. The CD4-positive-T-lymphocyte count (CD4 count) in the peripheral blood cells was lower (260/mm 3 ) than normal (reference values of 430 to 1,010/mm 3 ). A chest computed tomography (CT) scan revealed bilateral mediastinal and hilar lymphadenopathy, with axial interstial thickening and multiple parenchymal nodules in both lungs. Bilateral pleural effusions and pericardial effusion were also noticed ( Fig. 1A and B). An abdominal CT scan showed mild hepatospelonomegaly, with multiple small nodules in the liver and spleen. Multiple intra-abdominal lymph node enlargements were associated.Bronchoscopic examination revealed multiple small endobronchial nodules, and a bronchial mucosal biopsy showed chronic granulomatous inflammation. An excisional biopsy of the lymph node at the right forearm also showed chronic granulomatous inflammation, with many multinucleated giant cells. The aspirated pleural fluid contained many white blood cells, with a differential of 94% lymphocytes. The level of adenosine deaminase in the effusion was elevated (65

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Diagnosis and Treatment of Infections Caused by Rapidly Growing Mycobacteria

Cited by 56 publications

References 66 publications

Detection of Rapidly Growing Mycobacteria in Routine Cultures of Samples from Patients with Cystic Fibrosis

Detection of Rapidly Growing Mycobacteria in Routine Cultures of Samples from Patients with Cystic Fibrosis

Postsurgical Wound Infection Caused byMycobacterium conceptionenseIdentified by Sequencing of 16S rRNA,hsp65, andrpoBGenes in an Immunocompetent Patient

First Case of Disseminated Mycobacterium bolletii Infection in a Young Adult Patient

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