Disseminated Cutaneous Infection Caused by Mycobacterium colombiense

Abstract

Mycobacterium colombiense belongs to the M. avium complex (MAC), a type of slow growing mycobacterium (1) which infects humans, both immunocompetent and incompetent patients. CASE REPORTWe wish to report a case of an apparently immunocompetent 17-year-old boy with disseminated cutaneous infection caused by M. colombiense. The patient presented with deep asymptomatic erythematous nodules on his face and extremities for 4 months without any preceding history of trauma or surgery. Some of the nodules on his extremities developed into discharging ulcers, others featured slightly scaly erythematous infiltrated plaques (Fig. 1). Two months earlier, he was admitted to a local hospital on account of irregular bowel movements and an occasional slight pain in the right lower quadrant. He was diagnosed with intestinal tuberculosis according to clinical features and biopsy of the intestinal mucosa, which indicated infectious granuloma. The patient received anti-tuberculosis chemotherapy for 2 weeks but ceased taking the drugs because of severe drug-induced liver hepatitis. The past medical history of the patient only revealed chronic hepatitis B with normal liver function. Routine blood test showed mild anaemia with haemoglobin of 101 g/l. Blood culture, purified protein derivative and human immunodeficiency virus antibody tests were negative.Systemic examinations of chest X-ray, type-B ultrasonography and CT scan indicated no abnormal lesions.A skin biopsy of a nodule on the patient's left leg displayed deep dermis showing nodular lesions with clear boundaries, collagen oedema, mucinous degeneration, blood vessel hyperplasia, infiltrated histiocytes and the absence of caseation necrosis, without special manifestation. Moderate growth of smooth, creamy, yolk yellow colonies was observed after 3 weeks of incubation only at 32 and 37°C on Löwenstein-Jensen (L-J) medium ( Fig. 2A). Ziehl-Neelsen staining confirmed that the cultured organisms were acid-fast bacilli (AFB) (Fig. 2B). Pigment production testing showed that the isolated AFB was non-chromogenic. Fungal and other standard bacterial cultures were negative. Sequence analysis of 16S rDNA genes showed 99% similarity with M. colombiense strain CIP108962, and hsp65 genes indicated 99% homology with M. colombiense strain InDRE 9m. Gene sequences were analysed using the BLAST V2.0 software available at http://www.ncbi.nlm.nih.gov/ BLAST/. Gene sequencing results indicated that the strain was most similar to M. colombiense.As indicated by drug susceptibility analysis, we administered an oral regimen of clarithromycin (500 mg/ day), rifabutin (750 mg/day) and moxifloxacin (300 mg/day). After 3 months of therapy, the patient's skin lesions greatly improved. However, his bowel symptoms did not completely improve and he continues to receive antibiotics. Fig. 1. Clinical manifestations. Several deep erythemas, reddish nodules on his extremities and face. On the surface of some nodules there were discharging ulcers and crusts. Some erythema with slight scales were also observed. A ...

A case report of fatal disseminated Mycobacterium colombiense infection in a renal transplant recipient

“…Following the incidental isolation of M. colombiense from blood specimens of four HIV positive patients in Columbia in 2006, 1 the spectrum of infection caused by this bacterium has expanded to include lymphadenitis in healthy pediatric patients [2][3][4] ; and fatal disseminated disease in immunocompetent and immmunocompromised hosts. 5,6 Infections due to nontuberculous mycobacteria (NTM) are uncommon in SOT recipients with the highest reported incidence in…”

“…The elaboration of urease coupled with the presence of a characteristic internal transcribed spacer sequence are unique identifying properties of this Mycobacterium species . The clinical expression of disease caused by M. colombiense ranges from disseminated blood stream and lower respiratory tract infection in HIV compromised individuals to localized lymphadenopathy and cutaneous manifestations in immunocompetent persons …”

“…1 The clinical expression of disease caused by M. colombiense ranges from disseminated blood stream and lower respiratory tract infection in HIV compromised individuals to localized lymphadenopathy and cutaneous manifestations in immunocompetent persons. [2][3][4] We describe the first case of disseminated M. colombiense infection in a solid organ transplant (SOT) recipient that occurred 108 months after an allogenic kidney transplant.…”

Investigation of non-tuberculous mycobacteria in a primary hospital from southeastern China

“…Our results showed that the most common NTM was represented by MAC strains, similar to the epidemiology of NTM in China and in many regions in the world. The predominant species among MAC in this study was M. chimaera, while M. intracellulare was the main one in other regions of China [15,16,23]. In addition, the M. colombiense and M. lentiflavum found in this study were hardly reported in China, indicating that some species of NTM were underestimated in clinical samples [23].…”

Draft Genome Sequence of Mycobacterium colombiense

“…It was initially isolated from the blood of four HIV-coinfected patients in Colombia in 1995 (1). Further isolates have been made from diseased lymph nodes and respiratory and stool specimens (2–4), as well as from the skin biopsy of a 17-year-old boy with disseminated cutaneous infection (5). M. colombiense was also isolated from hospital water in dental units.…”