DisseminatedMycobacterium interjectumInfection with Bacteremia, Hepatic and Pulmonary Involvement Associated with a Long-Term Catheter Infection

Abstract

We present a 49-year-old female with one year of intermittent fevers, chills, night sweats, and significant weight loss. Liver and lung biopsy showed evidence of a granulomatous process. Blood and liver biopsy cultures yielded growth of presumed Mycobacterium interjectum, thought to be related to a disseminated long-term central venous catheter infection. She successfully received one year of combined antimicrobial therapy after catheter removal without recurrence of disease. M. interjectum has been previously described as a cause of lymphadenitis in healthy children and associated with pulmonary disease in adults, although other localized infections have been reported. This is the first case described of a disseminated M. interjectum infection with bacteremia, hepatic and pulmonary involvement associated with a long-term catheter infection.

Mycobacterium interjectum causing submandibular lymphadenitis in a child

“…In immunocompetent children, lymphadenitis secondary to M. interjectum has been reported only in a handful of cases since 1993 [ 2 ], occurring in Germany, Belgium, Sweden, Australia and Italy [ 3–6 ]. Cervical lymphadenitis is thought to be caused by entry of NTM from the environment via route of oropharyngeal mucosa [ 1, 2 ].…”

“…In most reports, infection manifested as unilateral cervical lymphadenitis, with ages ranging from approximately 18 months to 3 years old [ 4 ]. After excision, cultures from surgical material grew in approximately 2–4 weeks [ 4 ], as expected from this slow-growing mycobacteria [ 2 ]. While ‘rapidly growing’ mycobacteria can be grown and identified in 3–7 days, ‘slow-growing’ mycobacteria requires weeks [ 1 ].…”

“…Mycobacterium interjectum is a recently identified species of mycobacteria, and limited data is available with regards to its susceptibility profile and treatment. As reported in the literature, M. interjectum infections have generally presented as lung manifestations in adults while causing cervical adenitis in the paediatric population [ 2 ]. The first case of paediatric cervical lymphadenitis caused by M. interjectum was reported in 1993 [ 3, 4 ].…”

“…The first case of paediatric cervical lymphadenitis caused by M. interjectum was reported in 1993 [ 3, 4 ]. Since then, at least ten cases of lymphadenitis in immunocompetent children caused by M. interjectum have been reported in the literature [ 2 ], with isolates expressing multi-drug resistance in vitro [ 3–6 ]. This case report highlights successful treatment of NTM lymphadenitis caused by M. interjectum in a paediatric patient, adding to our knowledge surrounding treatment for this rare mycobacterium species.…”

Mycobacteriophage ZoeJ: A broad host-range close relative of mycobacteriophage TM4

“…3). The infection by ZoeJ of M. avium Va14 (O) and M. interjectum in addition to M. tuberculosis is of interest as both are also associated with opportunistic infections of the lung 29,30 . However, there may be variation in infectivity of ZoeJ among different strains of these species, as it does not infect M. avium subsp.…”