Neurologic manifestations of disseminated infection with Mycobacterium abscessus

Abstract

Mycobacterium abscessus is a ubiquitous, saprophytic organism with low pathogenic potential. The authors describe the previously unreported clinical features of meningitis and native valve endocarditis caused by this rapidly growing atypical mycobacterium. The fatal outcome of this unusual case coincides with the grim prognosis of this disseminated infection and the significant mortality rate associated with neurologic complications of infective endocarditis.

Mycobacterium abscessus, pathogène émergent dans la mucoviscidose

“…On a ainsi rapporté le cas d'un sujet immunocompétent chez lequel une infection généralisée à M. abscessus a été diagnostiquée dans un contexte clinique de forte fièvre [36]. M. abscessus a été isolé de prélèvements spléniques lors d'épisodes fébriles [26] ou d'hémocultures chez un patient atteint d'endocardite et présentant un anévrisme mycotique [31]. Ces cas, survenant chez des patients adultes sans connotation familiale, ne sont pas évocateurs de défi-cit héréditaire, mais pourraient être associés à des déficits acquis de l'axe IFN−␥ -IL-12.…”

Native valve endocarditis caused by rapidly growing mycobacteria: Case report and review of the literature

“…Findings described in the physical examination included cachectic appearance, cardiac murmurs in all cases, hepatosplenomegaly [8,9], embolic phenomena [7,8] immunologic phenomena (Roth spots) [8], and altered mental status [9] and nuchal rigidity [7] in the 2 cases associated with meningitis. Reported abnormal laboratory data included anemia [5,7,8], increased [6] or decreased [5] WBC, thrombocytopenia [5,9], elevated ESR [8], active urinalysis [7], and abnormal liver enzyme levels [9].…”

“…Reported abnormal laboratory data included anemia [5,7,8], increased [6] or decreased [5] WBC, thrombocytopenia [5,9], elevated ESR [8], active urinalysis [7], and abnormal liver enzyme levels [9]. Valvular vegetations were identified by ultrasonography in all cases but one [7].…”

“…Other tissues from which these organisms were recovered included bone marrow [8,9] and cerebrospinal fluid in the 2 cases associated with meningitis [7,9].…”

Treatment ofMycobacterium abscessussubsp.massilienseTricuspid Valve Endocarditis

“…M. abscessus is considered the most pathogenic and difficult to treat of the RGM and is most often associated with pulmonary, skin, and soft tissue infections; it has also been reported to cause ocular infections, otitis, lymphadenitis, arthritis, osteomyelitis, disseminated disease, and prosthetic valve endocarditis ( 1 , 2 ). Most prosthetic valve endocarditis cases have been fatal.…”