Osteomyelitis Due to Mycobacterium haemophilum in a Cardiac Transplant Patient: Case Report and Analysis of Interactions Among Clarithromycin, Rifampin, and Cyclosporine

Plemmons, Robert M.; McAllister, C. Kenneth; Garces, Maria C.; Ward, R. L.

doi:10.1093/clinids/24.5.995

Cited by 39 publications

(27 citation statements)

References 8 publications

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“…Although dosage adjustments maintained our patient's therapeutic cyclosporin levels while on rifampin, antibiotic susceptibility testing later revealed that her M. haemophilum isolate was resistant to rifampin. Of note, simultaneous administration of rifampin and clarithromycin may stabilize cyclosporin levels (a result of opposing effects on liver metabolism) [11]. Despite antibiotic resistance and intolerance, our patient was treated successfully with only ciprofloxacin and a reduced dosage of clarithromycin.…”

Section: Discussionmentioning

confidence: 83%

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Fairhurst

Kubak

Pegues

et al. 2002

American Journal of Transplantation

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Non-tuberculous mycobacteria are becoming increasingly important pathogens among transplant recipients. We report a case of disseminated Mycobacterium haemophilum infection in a heart transplant recipient, manifesting as cellulitis, subcutaneous nodules, septic arthritis, and pneumonitis. Our case illustrates diverse challenges in the identification and treatment of this pathogen, such as its unique culture requirements and variable antimicrobial susceptibilities. Heightened clinical suspicion is necessary to establish a timely diagnosis so that optimal treatment can be administered.

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Section: Discussionmentioning

confidence: 83%

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Fairhurst

Kubak

Pegues

et al. 2002

American Journal of Transplantation

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“…Several small studies [6][7][8] and some case reports [9,10] have suggested that rifamycin derivates may significantly decrease serum clarithromycin concentrations. Drug interactions between rifabutin and clarithromycin include both induction and inhibition.…”

Section: Discussionmentioning

confidence: 99%

Drug Interactions With Cyclosporine-Rifampicin-Clarithromycin in a Kidney Transplant Recipient With Mycobacterium Malmoense

Perona

2013

J Med Cases

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A 38-year-old kidney transplant recipient was treated with antituberculous drugs due to mycobacterial joint infection due to Mycobacterium malmoense. Three days of starting combined therapy, cyclosporine blood concentration (CBC) decreased a 63% and was necessary to increase the cyclosporine dose. Clarithromycin was also added and the CBC and kidney function remained stable until 11 months later. Pirazinamide and isoniazide were withdrawn four months before without any analytical changes but when rifampicin and ethambutol were withdrawn, CBC showed an increase of 377% and creatinine level was worsened. It was necessary to reduce the cyclosporine dose and renal function improved within 6 weeks. When clarithromycin was discontinued, the CBC decreased a 69% which motivated gradually increasing the dose. CBC is liable to change in patients treated with drugs metabolized by cytochrome p450 system, and the effect and magnitude of a multiple interaction is unpredictable. Close monitoring is necessary to adjust the dosage.

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“…M. marinum has been reported to cause infections after renal and lung transplant, with most cases presenting as erythematous cutaneous, sometimes disseminated, nodules, with sporotrichoid spread (10,19,31). M. haemophilum has also rarely been associated with infections in immunocompromised patients, including renal, heart, lung, and bone marrow transplant recipients (12,16,17,21,26,35). Although infections due to other nontuberculous Mycobacterium species have been occasionally reported in liver transplant recipients (4,18), disseminated infections due to M. marinum and M. haemophilum in these patients have not been reported.…”

Section: Discussionmentioning

confidence: 99%

First Report of Disseminated Mycobacterium Skin Infections in Two Liver Transplant Recipients and Rapid Diagnosis by hsp65 Gene Sequencing

et al. 2011

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We present here the first report of disseminated skin Mycobacterium infections in two liver transplant recipients, in which hsp65 gene sequencing was used for rapid species identification. Both patients had hepatitis B virus-related cirrhosis and diabetes mellitus and presented with progressive generalized, nodular skin lesions. In one patient, a 50-year-old woman who had frequent contact with marine fish, an acid-fast bacillus was isolated from skin biopsy tissue after 2 months of culture. While awaiting phenotypic identification results, hsp65 gene sequencing showed that it was most closely related to that of Mycobacterium marinum with 100% nucleotide identity. The patient was treated with oral rifampin, ethambutol, and moxifloxacin. In the other patient, a 59-year-old woman, direct PCR for Mycobacterium using hsp65 gene from skin biopsy tissue was positive, with the sequence most closely related to that of M. haemophilum with 100% nucleotide identity. Based on PCR results, the patient was treated with clarithromycin, ethambutol, moxifloxacin, and amikacin. A strain of M. haemophilum was only isolated after 3 months. Skin lesions of both patients resolved after 1 year of antimycobacterial therapy. Nontuberculous Mycobacterium infections should be considered in liver transplant recipients presenting with chronic, nodular skin lesions. This report highlights the crucial role of hsp65 gene PCR and sequencing on both cultured isolates and direct clinical specimens for rapid diagnosis of slowgrowing Mycobacterium infection.Organ and tissue transplant recipients are predisposed to infections due to opportunistic pathogens, including various Mycobacterium species. While Mycobacterium tuberculosis is the most common Mycobacterium species associated with infections, nontuberculous Mycobacterium infections have been reported at an estimated incidence of 0.16 to 2.8% of transplant recipients in the United States (8). Nontuberculous Mycobacterium infections in these patients can be difficult to diagnose and often difficult to treat and are thus associated with significant morbidity and mortality.Identification of nontuberculous mycobacteria traditionally relies on isolation of the Mycobacterium and subsequent identification by phenotypic conventional biochemical tests or whole-cell fatty acid analysis. However, these methods are associated with a number of drawbacks. First, these bacteria are often slow growing, so the turnaround time for identification is long when conventional biochemical tests are used. Second, noncultivable species or isolates with ambiguous biochemical profiles are sometimes encountered, making them unidentifiable. As for whole-cell fatty acid analysis using gas chromatography, the special equipment and expertise required are not available in most routine clinical microbiology laboratories. Newer technologies, such as liquid chromatography-nuclear magnetic resonance/mass spectrometry, are being developed, which may help diagnosis of mycobacterial infections in the future (2).Molecular methods, especi...

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Osteomyelitis Due to Mycobacterium haemophilum in a Cardiac Transplant Patient: Case Report and Analysis of Interactions Among Clarithromycin, Rifampin, and Cyclosporine

Cited by 39 publications

References 8 publications

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Drug Interactions With Cyclosporine-Rifampicin-Clarithromycin in a Kidney Transplant Recipient With Mycobacterium Malmoense

First Report of Disseminated Mycobacterium Skin Infections in Two Liver Transplant Recipients and Rapid Diagnosis by hsp65 Gene Sequencing

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