Infection Due to Mycobacterium thermoresistibile: a Case Associated with an Orthopedic Device

Abstract

Mycobacterium thermoresistibile is a rapidly growing environmental nontuberculous mycobacterium, seldom reported in human infections. Here, we describe a rare case of tibial-nail-related osteomyelitis due to Mycobacterium thermoresistibile. We also review the literature about the infections caused by this pathogen. CASE REPORTA 43-year-old man with a history of intellectual disability fractured his right tibia in April 2011. A tibial intramedullary nailing was performed without any early postoperative complications. Five months later, he developed a progressive pain in his right knee. In February 2012, physical examination revealed arthritis, without fever, and an unaltered general condition. It is important to note that the patient lived on a farm with his family and frequently had superficial wounds caused by repeated falls, especially on his legs. The initial laboratory tests showed a leukocyte count of 17,000 cells/l, C-reactive protein at 172 mg/liter, and an erythrocyte sedimentation rate of 71 mm at the first hour. A bone Tc99m-MDP scintigraphy revealed a high osteoblastic reaction around the nail, suggesting tibial osteomyelitis. Right-tibial X-ray showed consolidation of the fracture. Surgery was performed in order to remove the nail. The macroscopic examination showed a large quantity of pus around the material. Gram staining was negative.Forty-eight hours after surgery, a mycobacterial strain that could not be identified through conventional phenotypic biochemical methods was grown on blood agar and chocolate plates from two distinct specimens with a high count of CFU/ml. The colonies were on-streak. The strain was sent to our University Hospital microbiological laboratory. The identification was performed using matrix-assisted laser desorption-ionization-time of flight mass spectrometry (MALDI-TOF MS) (Bruker Daltonik Bremen, Germany), and it revealed Mycobacterium thermoresistibile. The spectra were compared with the Bruker mycobacterium library 1.0, which contains 173 spectra of 93 mycobacteria, including one of M. thermoresistibile. Identification was carried out at the species level, with a score of Ն2. The confirmation for this identification was performed by sequencing the 16S rRNA and heat shock protein 65 (hsp65) genes. PCR amplification of the 16S rRNA and hsp65 genes was performed using previously described primers (references 1 and 2, respectively). The PCR products obtained were sequenced using a DNA sequencing kit (CEQ 2000 dye terminator cycle sequencing quick start kit; Beckman Coulter, Inc.) according to the manufacturer's instructions. The 16S rRNA and hsp65 sequences were compared to sequences deposited in the BLAST database of GenBank and were 98% and 99% similar, respectively, to those of M. thermoresistibile.Through antimicrobial susceptibility testing using the Etest The empirical treatment with 500 mg/day oral levofloxacin and 3 g/day pristinamycin (macrolide) introduced immediately after surgery was stopped after the organism was identified. A treatment including 1 g/day levof...

Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA

“…Previous case reports and series of NTM musculoskeletal infections have focused on the demographics, diagnosis, and treatment of patients with these difficult-to-manage infections (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Patients were often immunocompetent persons who contracted an NTM disease after direct inoculation via traumatic skin puncture (25)(26)(27)(28).…”

Nontuberculous mycobacterial osteomyelitis

“…Many slow-growing NTM species have demonstrated the ability to cause NTM osteomyelitis, including M. avium-intracellulare complex (MAC) [ 3 , 8–48 ], M. ulcerans [ 49–51 ], M. marinum [ 52–57 ], M. kansasii [ 9 , 33 , 36 , 58–63 ], M. xenopi [ 64–66 ], M. gordonae [ 67 ], M. haemophilium [ 33 , 68 , 69 ], M. scrofulaceum [ 45 , 70 ], M. szulgai [ 71–74 ], M. longobardum [ 75 ], and M. flavescens [ 76 ]. Among the rapidly growing mycobacteria, osteomyelitis can be caused by M. abscessus [ 3 , 77–81 ], M. fortuitum [ 82–94 ], M. chelonae [ 5 , 25 , 83 , 95–104 ], M. smegmatis [ 105 ], M. peregrinum [ 82 ], and M. thermoresistibile [ 106 ]. Some authors have argued that the otomastoiditis attributed to M. fortuitum or M. chelonae was actually caused by M. abscessus [ 107 ], though this disagreement is actually a taxonomic issue.…”

Mycobacterial panniculitis caused byMycobacterium thermoresistibilein a cat

“…In human medicine it has been hypothesized that traumatic inoculation with M thermoresistibile present in soil results in local infection, 2 which may also have been the case in this cat with outdoor exposure. Mycobacterial infection was strongly suspected in this cat despite failure to isolate a mycobacterial species owing to clinical presentation and histopathology.…”

“…They are distributed ubiquitously in nature, and can be isolated commonly from soil and bodies of water. 2 Commonly isolated bacteria in this group include M fortuitum, M smegmatis, Mycobacterium chelonae and Mycobacterium abscessus . 3 Mycobacterium thermoresistibile is an NTM that is rarely reported in human and animal infections.…”

“… 2 , 6 – 8 Half of the infections in people occurred 3 months after surgery. 2 , 4 The three previously reported cases of M thermoresistibile infections in cats included two cats with skin infections, 5 , 7 and one with pneumonia. 5 , 6 One cat with M thermoresistibile panniculitis was reported from the Netherlands in 1985.…”