Mycobacterium szulgai osteomyelitis

Hurr, Huda; Sorg, Timothy B.

doi:10.1016/s0163-4453(98)80178-3

Cited by 20 publications

(6 citation statements)

References 5 publications

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“…Second-line agents ciprofloxacin and rifampicin have also been reported to be effective. 1,12,14,15,17 Our patient was treated with clarithromycin and ethambutol and had a good clinical response. Similar to other NTM infections, we recommend a minimum of 12 to 24 months of therapy, depending on the clinical response.…”

Section: Discussionmentioning

confidence: 79%

“…5 It most commonly causes pulmonary disease in patients with chronic obstructive pulmonary disease or alcoholism and can be indistinguishable from pulmonary tuberculosis. 3,6 -8 However, it has also been reported to cause skin infections, 1,7,9 -11 olecranon bursitis, osteomyelitis, 1,7,12,13 and disseminated disease. 6,14 Most of the M. szulgai infections occur in the setting of immunodeficiency, and our patient had significant immunosuppression caused by his untreated HIV infection.…”

Section: Discussionmentioning

confidence: 99%

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Mycobacterium szulgai Causing Knee Abscess and Osteomyelitis in a Patient With Acquired Immunodeficiency Syndrome and Subsequent Immune Reconstitution Syndrome

Mehta¹,

Herndier²,

Smith³

2006

Infectious Diseases in Clinical Practice

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Mycobacterium szulgai is a rarely reported human pathogen that causes a variety of clinical syndromes. We report a case of an M. szulgai septic arthritis and osteomyelitis in a patient with human immunodeficiency virus infection manifesting as an immune reconstitution syndrome. (Infect Dis Clin Pract 2006;14:392-393) M ycobacterium szulgai is a nontuberculous mycobacte rium that is a relatively rare human pathogen and causes a variety of clinical syndromes. It is often associated with advanced human immunodeficiency virus (HIV) disease.1 Here, we report a case of M. szulgai causing septic arthritis and osteomyelitis of the knee in a patient with hepatitis C virus infection (HCV) and acquired immunodeficiency syndrome (AIDS) with subsequent immune reconstitution syndrome after the start of antiretroviral therapy (ART). CASE REPORTA 48-year-old man with chronic HCV and HIV infections presented to the infectious disease clinic for evaluation of pain, swelling, and stiffness in his right knee, which he reported as having persisted for more than 6 months. He was evaluated for his knee pain 4 months earlier, and a magnetic resonance imaging (MRI) at that time suggested a Brodie abscess or an osseous neoplasm. A biopsy was planned, but the patient refused, and several months later, he presented to the infectious disease clinic for management of his HIV and HCV. At that visit, the patient was afebrile but complaining of increased knee pain and difficulty in ambulating. He had not yet initiated ART, and his CD4 cell count was 28 cells/mL with an HIV viral load of 250,000 copies/mL (Amplicor; Roche Diagnostics, Basel, Switzerland) and an HCV viral load of more than 700,000 copies/mL (Amplicor HCV monitor 2.0; Roche Diagnostics). Physical examination revealed no erythema, warmth, or effusion of the knee, but there was a limitation in his range of motion. He continued to refuse patella biopsy. ART was initiated with lopinavir/ ritonavir, tenofovir, and emtricitabine, and the patient had a good response. Six weeks later, his viral load was 89 copies/mL, and his CD4 count had climbed to 136 cells/mL. Two months later, the patient presented with right knee effusion, erythema, tenderness to palpation, and an overlying eschar that was draining yellow purulent material. His CD4 count was 134 cells/mL, and viral load was not obtained. An MRI done at that time revealed tibial edema and a large 2.2 Â 1.1-cm destructive abscess within the patella extending anteriorly and posteriorly (Fig. 1). The patient underwent operative debridement and was treated with vancomycin and aztreonam. Operative specimens revealed acute and chronic inflammation on pathology, and acid-fast bacilli on culture. A sample was sent for tuberculosis polymerase chain reaction testing (Amplified Mycobacterium tuberculosis Direct Test; Gen-Probe, San Diego, Calif); the results of which were negative. The patient was empirically treated with clarithromycin, rifampicin, isoniazid, pyrazinamide, and ethambutol while pending pathogen confirmation, and his...

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Mycobacterium szulgai Causing Knee Abscess and Osteomyelitis in a Patient With Acquired Immunodeficiency Syndrome and Subsequent Immune Reconstitution Syndrome

Mehta¹,

Herndier²,

Smith³

2006

Infectious Diseases in Clinical Practice

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“…28 In cases of localized osteomyelitis, surgical resection may also be helpful. 22 In conclusion, M. szulgai is a pathogenic organism capable of causing disseminated disease in immunocompromised individuals, including patients with CLL. The successful treatment of multifocal osteomyelitis in a patient with CLL was accomplished using isoniazid, rifampin and ethambutol for 24 months.…”

Section: Discussionmentioning

confidence: 96%

Multifocal osteomyelitis due to Mycobacterium szulgai in a patient with chronic lymphocytic leukemia

Meyer

Gelman

2008

Journal of Infection

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“…Other diseases, such as osteomyelitis, also have been reported in connection with this organism (6). In 1996, there was one case of lung infection caused by M. szulgai at the VAMC.…”

Section: Discussionmentioning

confidence: 96%

Pseudoepidemic Due to a Unique Strain of Mycobacterium szulgai : Genotypic, Phenotypic, and Epidemiological Analysis

Zhang¹,

Kennon

Koza

et al. 2002

J Clin Microbiol

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In mid-1999, we noted multiple isolations at the Veterans Affairs Medical Center (VAMC) Houston Tex. of an unusual nonpigmented Mycobacterium species. Since, on the basis of 16S rRNA gene sequence analysis, the strains were identical to the Mycobacterium szulgai type strain and since M. szulgai has been reported only rarely as a commensal or environmental isolate, we were concerned about laboratory contamination, nosocomial spread, or even the possibility that this could be a novel organism associated with disease. Our investigation found that from 1999 to 2000, 37 strains of M. szulgai were isolated from patients at the VAMC (the base rate for the previous 10 years had been <1 isolation per year). We compared the phenotypic properties and genetic relatedness of these 37 strains (31 of which were nonpigmented) as well as eight stock strains and the M. szulgai type strain. All strains were similar in cellular fatty acid patterns, growth rates, and biochemical characteristics. However, we found three genogroups by gene sequence analysis. Genogroup I comprised the M. szulgai type strain, all the tested nonpigmented strains (27 of the 31 strains were tested), two pigmented strains isolated in 1999 and 2000, and five pigmented stock strains. Genogroup II comprised five pigmented strains: three were isolated from 1999 to 2000 and two were stock strains. The single strain (isolated in 1996) in genogroup III was pigmented and was the only strain associated with disease. Whereas the randomly amplified polymorphic DNA (RAPD) patterns of all nonpigmented strains were identical, indicating that they came from a common source (the pseudoepidemic strain), the RAPD patterns of the other strains were varied. In our investigation for a possible source, we found that there were no common reagents, specimen-processing or patient locations, or procedures linking the 31 pseudoepidemic strains. However, a nonpigmented M. szulgai strain with a gene sequence and RAPD pattern identical to those of the pseudoepidemic strain was recovered from a water storage tank serving the hospital. We concluded that the strains most likely originated from hospital water, which transiently inoculated our patients. Although no disease was associated with this cluster of isolates, the event was costly because identification was problematic and we could not easily discount the isolations, since most of the patients were immunocompromised and were candidates for opportunistic infection.

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Mycobacterium szulgai osteomyelitis

Cited by 20 publications

References 5 publications

Mycobacterium szulgai Causing Knee Abscess and Osteomyelitis in a Patient With Acquired Immunodeficiency Syndrome and Subsequent Immune Reconstitution Syndrome

Mycobacterium szulgai Causing Knee Abscess and Osteomyelitis in a Patient With Acquired Immunodeficiency Syndrome and Subsequent Immune Reconstitution Syndrome

Multifocal osteomyelitis due to Mycobacterium szulgai in a patient with chronic lymphocytic leukemia

Pseudoepidemic Due to a Unique Strain of Mycobacterium szulgai : Genotypic, Phenotypic, and Epidemiological Analysis

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