Disseminated Mycobacterium chimaera Infection After Cardiothoracic Surgery

Abstract

Ten case reports of disseminated Mycobacterium chimaera infections associated with cardiovascular surgery were published from Europe. We report 3 cases of disseminated M chimaera infections with histories of aortic graft and/or valvular surgery within the United States. Two of 3 patients demonstrated ocular involvement, a potentially important clinical finding.

Mycobacterium chimaera infections in post–operative patients exposed to heater–cooler devices: An overview

“…The infection usually presents as prosthetic valve endocarditis, vascular graft infection or disseminated infection although a variety of extracardiac sites may also be infected ( Table 1) (9)(10)(11)13,18,29,33). Clinical manifestations of infection are diverse and symptoms may be nonspecific (12,23).…”

Interim laboratory testing guidance for the detection of non-tuberculous Mycobacterium (NTM) infections in post-operative patients exposed to heater-cooler units

“…The majority of patients present three months to five years (median 18 months) after the index surgery, with symptoms of fever, fatigue, shortness of breath, night sweats, joint or muscle pain and unexplained weight loss (1,3,7). Cardiac manifestations include prosthetic valve endocarditis (PVE), prosthetic vascular graft infection (PVGI), paravalvular abscess, and pseudo and mycotic aneurysms (7.10).…”

“…Cardiac manifestations include prosthetic valve endocarditis (PVE), prosthetic vascular graft infection (PVGI), paravalvular abscess, and pseudo and mycotic aneurysms (7.10). Extracardiac manifestations include bone infection (osteomyelitis, spondylodiscitis), sternotomy wound infection, mediastinitis, hepatitis, and bloodstream infection (BSI) (3,7,10). Ocular manifestations due to emboli (panuveitis, multifocal chorioiditis, chorioretinitis) are observed in approximately 50% of patients (3).…”

“…Extracardiac manifestations include bone infection (osteomyelitis, spondylodiscitis), sternotomy wound infection, mediastinitis, hepatitis, and bloodstream infection (BSI) (3,7,10). Ocular manifestations due to emboli (panuveitis, multifocal chorioiditis, chorioretinitis) are observed in approximately 50% of patients (3). Immunologic manifestations include arthritis, cerebral vasculitis, pneumonitis, myocarditis, granulomatous nephritis) (7,10).…”

Mycobacterium chimaera Infections Associated With Contaminated Heater-Cooler Devices Among Open Cardiac Surgery Patients: A Global Outbreak

“…Kardiyak cerrahi sonrasında ise kontamine domuz kalp kapağından ve kontamine hastane su sistemlerinden kaynaklanan, tek merkezli, farklı türde NTM'lerin neden olduğu infeksiyonlar bildirilmişti (1,2). Ancak 2013 yılında ilk kez İsviçre'de iki hastada M. chimaera'ya bağlı yapay kapak endokarditi tanımlanmasını takiben (5), bugüne kadar Amerika Birleşik Devletleri (ABD), Almanya, Avustralya, Fransa, Hollanda, Hong Kong, İngiltere, İrlanda, İspanya ve Kanada gibi birçok ülkeden toplamda 100'ün üzerin-de benzer olgu bildirilmiş ve bu olgularda infeksiyon kaynağının, açık kalp ameliyatı sırasında kullanılan kontamine ısıtıcı-soğutucu cihaz (HCD)'lar olduğu anlaşıl-mıştır (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”