Mycobacterium genavense Infections in Immunocompromised Patients Without HIV: Case Series of Solid Organ Transplant Patients and Literature Review

Abstract

Background Mycobacterium genavense infection is rare and can occur in non-HIV immunocompromised patients. Methods We describe two cases of M. genavense infection in patients with solid organ transplant (SOT), and we performed a literature review of non-HIV immunocompromised patients. Results 52 cases are reported. Predisposing factors were recipients of SOT (40.4%) and autoimmune disease (36.5%). Infection was disseminated in 86.5% of cases. Organs involved were lymph nodes (72.3%), gastrointestinal tract (56.5%), lung (35.5%) and bone marrow (28.8%). Most patients were treated with at least 3 antimycobacterial agents (98%), with a clinical cure achieved in 54.9%. In multivariate analysis, lack for cure was associated with age of the time infection (OR 15.81 [2.92-152.93] p = 0.011) and positive bone marrow culture (OR 1.05 [1.01-1.12] p = 0.042). Conclusion M. genavense infection is a rare and generally disseminated disease with a poor prognosis. Optimal treatment regimen and its duration remain to be defined. Clinical trial registration not applicable

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

“…Indeed, the delay between the first symptoms of IRIS and the first treatment of IRIS is, on average, nine months, and between the first symptoms of IRIS and infliximab is, on average, 22 months in the case of our patients. Thus, unlike IRIS described by Manion and Baldolli [ 21 , 22 ] happened within weeks of infection diagnosis, the late-onset of IRIS presented by our patients and by the case of Laurent et al (17 months) has until now never been reported in scientific literature and should encourage clinicians to discuss this diagnosis in all patients with clinical worsening irrespective of the delay related to M. genavense initial diagnosis [ 23 ]. Therefore, late-onset IRIS has also been described in other opportunistic infections among HIV patients.…”

“…The use of anti-TNF-α in NTM IRIS is less described. Two case reports have been published concerning successful treatment with infliximab in steroid-dependent IRIS due to disseminated M. genavense disease, with a favorable clinical and radiological outcome for both patients [ 21 , 22 ]. To qualify, a case recently reported by Laurent et al described a late-onset (after seven years) fatal multi-refractory IRIS related to M. genavense in an HIV patient with ascites and portal thrombosis despite an increased dose of infliximab (10 mg/kg/month) and concomitant treatment with corticosteroids and colchicine [ 23 ].…”

Disseminated mycobacterium genavense infection with central nervous system involvement in an HIV patient: a case report and literature review

“…M. genavense has been detected more frequently in HIV patients [ 5 , 12 ]. Despite this fact, multiple reports have discussed M. genavense infection in non-HIV immunodeficiencies, namely sarcoidosis, solid organ recipients, and primary immunodeficiencies [ 14 – 17 ]. Diagnostic and treatment challenges are the most significant challenges in disease management.…”

Detection of non-tuberculous mycobacteria in native wildlife species at conservation risk of Argentina

“…Other NTM such as M. saskatchewanense and M. genavense are found in clinical samples from humans in North America and Europe, acting as opportunistic pathogens in immunocompromised patients ( 60 , 61 ). M. genavense has been reported in various wild and domestic animals, including birds, rabbits, cats, ferrets, snakes, and dogs ( 62 – 64 ). According to most authors, transmission to humans occurs through oral ingestion from contaminated water or close contact with infected animals.…”