Mycobacterium avium complex endocarditis: Spurious diagnosis resulting from laboratory cross contamination

Hedderwick, S.; Bonilla, Hector; Barg, Neil L.; Arbeit, Robert D.; Kauffman, Carol A.

doi:10.1016/s0732-8893(97)00030-8

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Other authors have hypothesized that an NTM-contaminated implanted bioprosthetic valve might be the source of a mycobacterial prosthetic valve endocarditis (10,11). The detection of NTM in cultures of valve tissue might also be false positive, e.g., represent cross-contamination with MAC-positive sputum samples processed at the same time in the microbiology lab (12). Contaminated tap water has been described as another possible source of sample contamination (2).…”

Section: Discussionmentioning

confidence: 99%

Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

et al. 2013

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dProsthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected. Infective endocarditis due to nontuberculous mycobacteria (NTM) is a rare complication after heart valve surgery. The reported cases in the literature are associated with the insertion of biological and also of mechanical valves (1). Cases of prosthetic valve endocarditis (PVE) due to NTM often involve rapidly growing mycobacteria. To date, there have been no concise reports on slowly growing mycobacteria, such as the Mycobacterium avium complex (MAC), as the agent causing PVE. However, the MAC is found occasionally on resected heart valves. A case series examining microbiological cultures from valves found slowly growing NTM in 5.5% of the cases without further clinical or histopathological evidence of infective endocarditis (IE) (2).MAC members are the most common cause of NTM infections in humans. M. intracellulare and M. avium are the main representatives of the MAC, but different MAC sequevars, e.g., M. chimaera, have been identified in recent years (3). Similar to other members of the MAC, M. chimaera has been reported to cause mainly pulmonary disease (3). In the summer of 2011, we encountered one fatal case of definite PVE and one fatal bloodstream infection due to M. chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR was used to study the relatedness of the M. chimaera isolates from these two patients.(Part of this research was presented at the 101st Annual Meeting of the United States and Canadian Academy of Pathology, Vancouver, BC, Canada, 17 to 23 March 2012.) CASE REPORTS Patient 1. In June 2011, a 58-year-old male was admitted to the hospital for mitral and aortic valve replacement. In 2008, the patient had undergone aortic and mitral reconstruction with implantation of a mitral annuloplasty ring. Twelve months prior to the current admission, the patient experienced intermittent fever, weight loss, and respiratory distress. PVE was ruled out with repeated negative conventional blood cultures and a transesophageal echocardiogram that showed only moderate mitral and aortic insufficiency not suggestive of infective endocarditis. At that time, systemic sarcoidosis had been diagnosed based on unspecific granulomatous inflammation in liver and kidney biopsy specimens, a reticular pattern on the chest X ray together with a severely constrained CO diffusion capacity, and a bronchoalveolar lavage showing a predominance of lymphocytes but only a slightly elevated CD4/CD8 quotient. A Mycobacterium genus PCR from the preserved liver and kidney biopsy specimens was performed retrospectively 1 year later and showed negative re...

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Section: Discussionmentioning

confidence: 99%

Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

et al. 2013

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“…These patients presented with symptoms typical of endocarditis, such as fever, chills, night sweats, anorexia, and headaches (43,146). The role of M. avium complex in causing endocarditis is still debated (117,149); Butany, Letter), and misdiagnoses could result from laboratory contamination by water (117).…”

Section: ͻ150 ϫ 10mentioning

confidence: 99%

Endocarditis Due to Rare and Fastidious Bacteria

2001

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The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation

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Nosocomial Infections Due to Nontuberculous Mycobacteria

2001

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Nontuberculous mycobacteria (NTM) are ubiquitous in the environment and cause colonization, infection, and pseudo-outbreaks in health care settings. Data suggest that the frequency of nosocomial outbreaks due to NTM may be increasing, and reduced hot water temperatures may be partly responsible for this phenomenon. Attention to adequate high-level disinfection of medical devices and the use of sterile reagents and biologicals will prevent most outbreaks. Because NTM cannot be eliminated from the hospital environment, and because they present an ongoing potential for infection, NTM should be considered in all cases of nosocomial infection, and careful surveillance must be used to identify potential outbreaks. Analysis of the species of NTM and the specimen source may assist in determining the significance of a cluster of isolates. Once an outbreak or pseudo-outbreak is suspected, molecular techniques should be applied promptly to determine the source and identify appropriate control measures.

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Mycobacterium avium complex endocarditis: Spurious diagnosis resulting from laboratory cross contamination

Cited by 3 publications

References 24 publications

Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

Endocarditis Due to Rare and Fastidious Bacteria

Nosocomial Infections Due to Nontuberculous Mycobacteria

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