Mycobacterium massiliense: an emerging pathogen in cardiovascular infections

Abstract

We describe 2 cases of Mycobacterium massiliense infection after cardiac surgery. A 68-year-old man developed high-grade fever and sternal wound infection 5 weeks after aortic valve replacement. He was discharged after antibiotic treatment but readmitted with pseudoaneurysm of the aortic root. He succumbed to hemorrhage 2 weeks after reoperation. A 7-year-old boy developed endocarditis after atrial septal defect patch repair, and underwent replacement of the patch. Samples from both patients grew Mycobacterium massiliense.

Mycobacterial endocarditis: a comprehensive review

“…The temperature of the febrile patients were 38.9±0.8℃ (n=12). Of the febrile patients, fever grade was not indicated in 22 [ 11 , 14 , 18 , 23 , 24 , 26 , 28 , 29 , 33 , 35 , 36 , 38 ] . In the remaining 13 patients, 5 (38.5%) had a high fever [ 12 , 17 , 19 , 20 , 22 , 29 ] , 5 (38.5%) had a moderate fever [ 13 , 15 , 21 , 25 , 34 ] and 3 (23.1%) had a low-grade fever [ 9 , 27 , 37 ] (χ 2 =0.9, P =0.630).…”

“…The latency from the presence of the predisposing risk factors to symptom onset was 21.9±25.9 (range, 0.067-96; median, 12) months (n=31) [ 7 , 9 , 11 , 12 , 14 - 18 , 20 , 21 , 23 , 26 , 27 , 31 - 33 , 37 ] . There were 9 (29.0%) early onsets (latency <8 weeks), 2 (6.5%) intermediate onsets (latency was between 8 weeks and 8 months) and 20 (64.5%) late onsets (latency >8 months) (χ 2 =23.9, P =0.000).…”

“…Of them, 12 (27.3%) patients did not have a visualized vegetation [ 7 , 9 , 11 , 14 , 17 , 28 , 31 ] , but one of them with an abscess along the inferior and septal walls, instead [ 31 ] and 32 (72.7%) patients had (χ 2 =18.2, P =0.000). The vegetation locations of the remaining 32 patients were mitral valve in 10 (31.3%) [ 11 , 20 , 21 , 30 , 36 , 37 ] (two of them were in the prosthetic mitral valve) [ 20 , 1 ] , aortic valve in 7 (21.9%) [ 11 , 13 , 18 , 32 , 33 , 38 ] (one was in the prosthetic aortic valve) [ 33 ] , pacemaker lead in 3 (12.5%) [ 16 , 26 , 27 ] , tricuspid valve in 3 (9.4%) [ 10 , 19 , 35 ] , both mitral valve and right subclavian catheter in 1 (3.1%) [ 36 ] , both mitral and aortic valves in 2 (6.3%) [ 12 , 15 ] , both aortic and tricuspid valves in 2 (6.3%) [ 22 , 24 ] , mitral, aortic and tricuspid valves in 1 (3.1%) [ 25 ] , tricuspid valve and ventricular septal defect patch in 2 (6.3%) [ 35 ] and atrial septal patch in 1 (3.1%) patient [ 23 ] , respectively. The detection time for a positive vegetation was described in 3 patients, which was 5 [ 13 ] , 21 [ 20 ] and 105 days [ 15 ] after admission, respectively.…”

“…Five vegetations of 5 patients from a single report [ 11 ] were recorded as "minimal", which were excluded from the calculation of the vegetation size. The size of the remaining 12 vegetations of 11 patients was 19.7±18.4 (range, 5-70; median, 15.5) mm [ 10 , 15 , 18 , 20 , 23 - 26 , 30 , 32 , 37 ] . Valve insufficiency was present in 23 (46%) patients: mitral valve regurgitation in 9 (39.1%) [ 11 , 30 , 31 , 37 ] (6 were prosthetic mitral valve leaks [ 11 ] ), aortic valve regurgitation in 5 (21.7%) [ 11 , 28 , 32 ] (4 were prosthetic aortic valve leaks [ 11 , 32 ] ), aortic and mitral valve regurgitation in 5 (21.7%) [ 11 , 12 , 14 , 38 ] (2 were prosthetic aortic and mitral valve leaks [ 11 ] ) and tricuspid valve regurgitation in 4 (17.4%) patients [ 10 , 27 , 35 ] .…”

“…The search identified 31 relevant studies from 2000 to 2013 [ 7 , 9 - 38 ] , including 24 case reports [ 7 , 9 , 10 , 12 , 13 , 15 , 17 - 22 , 24 - 28 , 30 - 33 , 36 - 38 ] , 2 case series [ 14 , 23 ] , 2 original articles [ 11 , 34 ] , 1 medical imaging [ 16 ] , 1 poster abstract session [ 29 ] , and 1 "letter to the editor" [ 35 ] . After reviewing selected articles, all 31 articles were included and no one was excluded.…”