Successful treatment of healthcare-associated Mycobacterium chimaera prosthetic infective endocarditis: the first Spanish case report

Abstract

BackgroundSince 2011, several cases of health care-related disseminated Mycobacterium chimaera infection outbreaks have been reported subsequent to cardiac surgery. Diagnosis is difficult and the prognosis is extremely poor despite long-term antibiotic treatment and surgery.Case summaryWe report a Spanish case of M. chimaera infective endocarditis (IE) with disseminated infection. The patient was treated with long-term antibiotic therapy, valve replacement, and the novel use of interferon-gamma as adjuvant therapy. In addition, [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) was used in combination with computed tomography (CT) to facilitate the diagnosis as well as to determine the duration of antibiotics and success of treatment.DiscussionDiagnosing M. chimaera IE is difficult and requires a high index of clinical suspicion. Controlling the infection is even more difficult. Interferon-g used adjuvant to surgery and antibiotic therapy could be useful in achieving this goal. Given that the appropriate duration of antibiotics is unknown, FDG PET/CT could also be a valuable tool for determining when antibiotic therapy can be withdrawn.

18F-FDG PET/CT in diagnosis and management of Mycobacterium chimaera infection following cardiac surgery: a single-centre experience with nine consecutive patients

“…Even if prosthetic valve endocarditis was the most common presentation, several studies documented M. chimaera infection spread to different sites and extracardiac manifestations often precede signs of IE. Most reported sites of disseminated disease were eyes (panuveitis, multifocal chorioretinitis), bone (osteoarthritis, vertebral osteomyelitis), liver, spleen and kidneys, surgical access, CNS [6,15] and for these reasons we recommend extending the PET/CT field of view to the whole brain and to the lower limbs [16,17]. Although the nonspecific nature of 18 F-FDG is a concern in differentiating infection from inflammation, in our series PET/CT scan at first diagnostic work-up was able to identify signs of systemic infection in all patients and of IE in 7/9 patients.…”

Contact Effect of a Methylobacterium sp. Extract on Biofilm of a Mycobacterium chimaera Strain Isolated from a 3T Heater-Cooler System

“…The increasing importance of this mycobacterium stems from the numerous cases of disseminated infection associated with the use of 3T HCD extracorporeal oxygenator (LivaNova) [7], an essential medical device employed in open-chest surgeries and one of the best sellers in the world, with 80% of the devices in commerce [8]. Since 2011, when the first case appeared in Munich (Germany), many similar cases have been reported around the world: in Europe (30 cases in United Kingdom, nine in Italy, five in Germany, four in The Netherlands and Ireland, three in France, andone in Spain), in America (18 in United States and, two in Canada), in Asia (at least one case in China), and in Oceania (15 cases in Australia and New Zeeland) [9][10][11][12][13][14][15][16][17][18][19]. Indeed, taking into account that not all the hospital cases are reported in scientific articles, the actual prevalence of M. chimaera infections related to the use of 3T HCD extracorporeal could range between 156 and 282 cases in Europe alone [20].…”

Disseminated Mycobacterium chimaera Following Open-Heart Surgery, the Heater–Cooler Unit Worldwide Outbreak: Case Report and Minireview

“…common reservoir was sought. Since 2015, cases were reported worldwide not only in Europe (Switzerland, Germany, Netherlands, England, France, Italia, Spain, and Ireland) (1)(2)(3)(4)(5)(6), but also in North America (United-States, Canada) (7,8), Hong-Kong (9), New-Zeeland, and Australia (10). Most of the cases were due to the same epidemic strain similar to those found also in the HCUs (11).…”