<i>Mycobacterium abscessus</i> infections in lung transplant recipients: 15‐year experience from a single institution

Osmani, Morsal; Sotello, David; Álvarez, Salvador; Odell, John A.; Thomas, Mathew

doi:10.1111/tid.12835

Cited by 38 publications

(30 citation statements)

References 25 publications

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“…A potential benefit of early treatment is that reservoirs other than the native lungs, such as the sinuses and the upper airways beyond the anastomosis, could still harbor infection in those with disease pre‐transplant and could contribute to contamination of the new graft. This has been described with mycetomas in the explanted lungs and NTMs like M abscessus …”

Section: Discussionmentioning

confidence: 85%

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Kabbani

Kozłowski

Cervera

et al. 2020

Transplant Infectious Dis

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Introduction: The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post-transplant mycobacterial infection is unclear. Methods: A retrospective review comparing LTRs and heart-lung transplant (H-LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H-LTRs without granuloma. Patients were followed for 2 years post-transplant. Results: A total of 144 LTRs and 4 H-LTRs with granulomas (75 necrotizing and 73 non-necrotizing) and a comparator cohort of 144 LTRs and 4 H-LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (six NTM and seven fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre-transplant non-tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; P < .01. In the multivariate analysis, having granuloma or positive mycobacterial cultures at time of transplant were associated with increased risk of post-transplant mycobacterial infection (HR = 1.8 95% CI [1.024-3.154]; P = .041 and HR = 2.083 95% CI [1.011-4.292]; P = .047). Although there was a trend toward increase mycobacterial disease in those with granulomas P = .056, there was no difference in survival post-transplantation between those with or without granuloma in the explanted lung; P = .886. Conclusion: The presence of granuloma in the explanted lungs of LTRs or positive mycobacterial cultures at time of transplant is associated with an increased risk of mycobacterial infection post-transplant. K E Y W O R D S granuloma, lung transplantation, non-tuberculous mycobacterium

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Section: Discussionmentioning

confidence: 85%

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Kabbani

Kozłowski

Cervera

et al. 2020

Transplant Infectious Dis

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“…and cutaneous infection are rarer with MAC. Rapidly growing mycobacteria usually cause limited cutaneous disease; M. abscessus and M. chelonae may cause more severe and disseminated diseases [115]. NTM should be suspected in SOT recipients with pulmonary symptoms, particularly lung transplant recipients with chronic allograft dysfunction; all bronchoscopy specimens and all atypical skin lesions should be biopsied, stained and cultured for acid-fast bacilli.…”

Section: Viral Infectionsmentioning

confidence: 99%

Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients

et al. 2019

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Prognosis of solid organ transplant (SOT) recipients has improved, mainly because of better prevention of rejection by immunosuppressive therapies. However, SOT recipients are highly susceptible to conventional and opportunistic infections, which represent a major cause of morbidity, graft dysfunction and mortality. Methods: Narrative review. Results: We cover the current epidemiology and main aspects of infections in SOT recipients including risk factors such as postoperative risks and specific risks for different transplant recipients, key points on anti-infective prophylaxis as well as diagnostic and therapeutic approaches. We provide an up-to-date guide for management of the main syndromes that can be encountered in SOT recipients including acute respiratory failure, sepsis or septic shock, and central nervous system infections as well as bacterial infections with multidrug-resistant strains, invasive fungal diseases, viral infections and less common pathogens that may impact this patient population. Conclusion: We provide state-of the art review of available knowledge of critically ill SOT patients with infections.

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“…There have been cases of M. abs outbreaks following the use of contaminated needles and other surgical instruments (39) and even, as was the case in a cohort of 'lipotourists' (i.e., people who travel abroad for cosmetic surgery for fat removal), severe outbreaks following cosmetic surgery (40). Interestingly, M. abs has also been linked to late-onset wound infections following crush trauma sustained by Swedish survivors of the 2004 tsunami that killed over 200,000 people and caused serious crush injuries in another >2000 (41) M. abs also causes serious disseminated infections following transplantation (42). A single case study involving post-transplant M. abs SSTI resulted in disseminated pulmonary infection and eventually the death of the patient, despite aggressive pre-and peri-operative anti-mycobacterial therapy (43) intensity of exposure.…”

Section: Abscessus Infection In Non-cf Populationsmentioning

confidence: 99%

<em>Mycobacterium abscessus: </em>Environmental Bacterium Turned Clinical Nightmare

Lopeman

Harrison

Desai

et al. 2019

Preprint

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Mycobacteria are a large family of over 100 species, most of which do not cause diseases in humans. The majority of the mycobacterial species are referred to as nontuberculous mycobacteria (NTM), meaning they are not the causative agent of tuberculous (TB) or leprosy, i.e. Mycobacterium tuberculous complex and Mycobacterium leprae, respectively. The latter group is undoubtedly the most infamous, with TB infecting an estimated 10 million people and causing over 1.2 million deaths in 2017 alone (1). TB and leprosy also differ from NTM in that they are only transmitted from person to person and have no environmental reservoir, whereas NTM infections are commonly acquired from the environment (2) (3). It took until the 1950's for NTM to be recognised as a potential lung pathogen in people with underlying pulmonary disease and another 3 decades for NTM to be widely recognised by the medical community when NTM, particularly Mycobacterium avium complex (MAC) was recognised as the most common group of opportunistic pathogens in AIDS patients (4). This review focusses on an emerging NTM called Mycobacterium abscessus (M. abs). M. abs is a rapidly growing (RGM) NTM that is responsible for opportunistic pulmonary infections in patients with structural lung disorders such as cystic fibrosis (CF) and bronchiectasis (5), as well as a wide range of skin and soft tissue infections (SSTIs) in humans (6) (7). M. abs is a weakly staining Gram-positive mycobacterium that is neverand is, like other NTM, most often seen in soil and aquatic environments (8). The bacillus-shaped bacterium is 1-6µm long and 0.2-0.5µm in diameter, with curved ends and the presence of cord factor, or trehalose 6-6'-dimycolate, a glycolipid found in the cell wall of virulent species of mycobacteria that results in "serpentine cord" cell morphology is sometimes observed (8) (9). On solid growth medium, M. abs can display either a rough (M. abs-R) or smooth (M. abs-S) morphotype, with the rough morphotype displaying a more virulent phenotype than its smooth variant (10). The rough morphotype is characterised by irregular parallel filaments that form ridges across the colony, whereas a smooth morphology is displays a wet, smooth colony with no filaments or ridges (79). This morphology is driven by cell wall glycopeptidolipid (GPL); a loss of GPL results in the reversion from rough to smooth morphotype (80) (81). Moreover, it has been shown using human tissue culture models of infection that M. abs-R is able to persist and multiply within the host macrophage whereas M. abs-S lacks this capacity, hence its role in virulence (82). Like all other mycobacteria, M. abs are aerobic, non-motile and acid-fast organisms with a characteristically thick, lipid-rich cell wall that is hydrophobic. Due to their unusually impermeable, thick cell wall, mycobacteria are notoriously resistant to many antibiotics, disinfectants and heavy metals (11). When the genome of M. abs became available in 2009, elucidation of the resistance mechanisms of M. abs became an area of focus for scientific research, as the considerable threat it poses to public health became more apparent (12) (13) (14). In this review we will discuss how we came to understand the pathogen, how it is currently treated, as well as a discussion of drug resistance mechanisms and novel treatments currently in development.

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Mycobacterium abscessus infections in lung transplant recipients: 15‐year experience from a single institution

Abstract: Mycobacterium abscessus infection in LTR is rare and can lead to severe complications. Eradication is difficult and usually requires prolonged combination antibiotic therapy and occasionally surgical management.

Cited by 38 publications

References 25 publications

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Diagnostic and therapeutic approach to infectious diseases in solid organ transplant recipients

<em>Mycobacterium abscessus: </em>Environmental Bacterium Turned Clinical Nightmare

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