Mycobacterium chelonae valve endocarditis resulting from contaminated biological prostheses

Spontaneous endocarditis caused by rapidly growing non-tuberculous Mycobacterium chelonae in an immunocompetent patient with rheumatic heart disease

“…4 Most of the non-HIV cases have other immunocompromised conditions like haematological malignancy or comorbid condition like chronic kidney disease on hemodialysis. 5 Although widespread in the environment, they only rarely cause a wide array of infections in immunocompetent and immunocompromised hosts; typically include skin and soft-tissue infections following puncture wounds or inoculations as well as pulmonary infections, infections of foreign material (porcine and prosthetic cardiac grafts, tympanotomy tubes, intravenous and dialysis catheters). 5 These infections are difficult to diagnose because blood cultures are often negative.…”

Mycobacterium neoaurum Causing Prosthetic Valve Endocarditis

“…Nontuberculous mycobacteria (NTM) have been reported more frequently as a cause of infective endocarditis than Mycobacterium tuberculosis, especially of prosthetic valves [1,2]. The previously identified causative NTM species have included the following rapidly growing mycobacteria: M. fortuitum, M. abscessus, and M. chelonae [2,3]. M. neoaurum, a member of the Mycobacterium parafortuitum complex, has not been reported previously to cause infective endocarditis.…”

“…Although the origin of NTM infection of prosthetic valves is unclear, the most recent reports suggest a nosocomial source [9]. A recently proposed mechanism is the contamination of the prosthetic valve before or during the surgical procedure [3]. Many rapidly growing mycobacteria have been noted to contaminate water systems in hospitals: water supplies to operating rooms, sterilization fluids, cardioplegic and valve preservation solutions [3,4].…”

“…A recently proposed mechanism is the contamination of the prosthetic valve before or during the surgical procedure [3]. Many rapidly growing mycobacteria have been noted to contaminate water systems in hospitals: water supplies to operating rooms, sterilization fluids, cardioplegic and valve preservation solutions [3,4]. This is likely due to the organism's relative resistance to chemical decontamination.…”

“…This is likely due to the organism's relative resistance to chemical decontamination. The indolent nature of these mycobacteria also allows for the delayed onset of symptoms and signs in cases of PVE in which perioperative contamination was suspected [3]. However, reports of M. neoaurum contaminating hospital water systems are not available at this time [4,10].…”