Urinary Tract Infection with Atypical Mycobacteria

Abstract

We present a case of disseminated atypical mycobacterial (Mycobacterium intracellularis) infection of the urinary tract. The patient had anhydrous ectodermal dysplasia and an unrelated defect in cell-mediated immunity. The infection resulted in a lengthy ureteral stricture with resultant hydronephrosis and diminished kidney function. A review of the literature revealed only 13 previous cases of atypical mycobacterial infection of the urinary tract. It is important to distinguish between simple colonization by these organisms and actual infection. Differentiation between atypical mycobacterial infection and urinary tuberculosis is important in determining the therapeutic regimen.

Survey of Mycobacteria Isolated from Urine and the Genitourinary Tract in South‐East England from 1980 to 1989

“…Such disseminated disease is a common occurrence in patients with AIDS and is frequently due to M. avium-intracellulare (Smith and Grange, 1989). Similar disseminated disease with mycobacteria in the urine, usually this species or M. kansasii, has been reported in pancytopenic patients (Kilbridge er al., 1967;Listwan et al, 1975;Thomas et al, 1980), in those with congenital defects in cell mediated immunity (Thomas et al, 1980) and also in a patient with no identified underlying cause (Phillips and Larkin, 1964).…”

Mycobacterium Avium Complex Genitourinary Infections: Case Report and Literature Review

“…Most cases that have been documented of genitourinary NTM showed increased prevalence in women. Infections are more common in the elderly population, although a case of genitourinary MAC associated with disseminated infection has been reported in a child as young as 14 years [19]. Genitourinary infection does not appear to be isolated to the immunocompromised, as only one infection in a transplant recipient has been documented [20].…”

“…While it is not always clear that the presence of these pathogens in a urine culture is necessarily reflective of true infection, in several cases there has been clinical evidence of true disease, and antimicrobial treatment led to culture sterilization and clinical improvement (Table 3) [20,[28][29][30][31][32]. Urinary involvement with disseminated spread has been associated with underlining cell-mediated immune deficiencies or serum interferon-Y-neutralizing autoantibodies [19,28]. None of the patients appear to have any history of HIV which has been associated with disseminated MAC.…”