Case reportMycobacterium malmoense infection in HIV positive patients
Summary
Mycobacterium malmoense is a non-tuberculous mycobacterium which has previously been associated with underlying pulmonary pathology and depressed immunity.
We describe two patients infected with human immunodeficiency virus from whom M. malmoense was isolated, and discuss its treatment and possible pathogenic role.
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Cited by (27)
Recently recognized mycobacteria of clinical significance
1999, Journal of InfectionTo determine the clinical and radiographic findings of nontuberculous mycobacteria (NTM) other than Mycobacterium avium complex (MAC) and Mycobacterium kansasii in AIDS compared with non-AIDS patients.
A retrospective chart review of all patients in whom NTM other than MAC complex and M kansasii were isolated between April 1, 1989, and October 31, 1995.
University-affiliated hospital.
Fifty-four patients met the criteria for uncommon pulmonary NTM disease: (1) repeated isolation of atypical mycobacterium in colony counts of ≥3 from two or more sputum specimens; or isolation of the organism from transbronchial or open lung biopsy specimen with histologic changes suggestive of mycobacterial disease in the absence of other pathogens; and (2) either an abnormal chest radiograph, the cause of which had not been attributed to an active infection other than atypical mycobacterial disease; or the presence of one or more symptoms indicative of pulmonary disease coupled with exclusion of other illnesses with similar symptoms and signs.
Thirty-five patients were HIV positive. Fever was the only clinical symptom more commonly seen in HIV-infected patients with NTM than non-HIV-infected patients. Sixty-six percent of all patients with AIDS were infected by Mycobacterium xenopi. Chest radiographs of AIDS patients showed a tendency for predominance of interstitial infiltrate and rarity of fibronodular disease. No specific radiographic pattern was observed for any particular organism. Adenopathy was not a feature of uncommon pulmonary NTM in AIDS, and it should suggest an alternate diagnosis. In two patients, NTM isolation from respiratory specimens preceded dissemination. Six of 8 AIDS patients treated for pulmonary NTM remained alive at the end of the study compared with only 4 of 15 patients who were not treated for pulmonary NTM (p<0.05).
Uncommon NTM isolated from respiratory specimens ought to be considered as serious pathogens in the presence of clinical and radiographic manifestations unexplained by other pathologic processes. Colonization with NTM could precede dissemination. Treatment of uncommon pulmonary NTM disease could possibly confer a survival benefit in AIDS patients.
Chest imaging in AIDS
1998, Clinical RadiologyA review of imaging in the acquired immune deficiency syndrome (AIDS) is presented. The imaging features can be conveniently categorized according to whether the presenting complications are infective (bacterial, protozoal, or fungal), bronchiectasis, neoplastic (Kaposi's sarcoma, AIDS-related lymphoma, or lymphoproliferative disease), or a miscellaneous group (non-specific interstitial pneumonitis, persistent generalized lymphadenopathy, or bronchogenic carcinoma).
Bronchopulmonary infection with Mycobacterium malmoense presenting as a bronchoesophageal fistula
1996, Tubercle and Lung DiseaseWe report a bronchopulmonary infection with Mycobacterium malmoense in a patient with severe immunosuppression due to insulin-dependent diabetes mellitus, humoral immunodeficiency after thymoma (Good's syndrome) and prolonged immunosuppressive treatment after myasthenic crisis. It presented as non-resolving pneumonia of the left lower lobe. Bronchoscopically, a bronchoesophageal fistula was detected. Numerous acid-fast organisms were found in the sputum specimen and in the bronchial biopsy around the fistula. M. malmoense was isolated from sputum, bronchoalveolar lavage and bronchial biopsy. Whereas conventional in vitro susceptibility testing revealed susceptibility only to ethambutol, multi-drug susceptibility testing confirmed susceptibility to rifampicin, ethambutol, clarithromycin and prothionamide. The clinical outcome after 12 months of therapy resulted in a stable remission and considerable suppression of the mycobacterial load, but not in complete eradication.
Exposé d'un cas d'infection bronchopulmonaire àMycobacterium malmoense chez un patient atteint d'immunodépression sévère par suite d'un diabète sucré insulino-dépendant, d'une immunodéficience humorale après thymome (syndrome de Good) et d'un traitement immunosuppressif prolongé après une crise myasthénique. L'aspect clinique est celui d'une pneumonie non résolutive du lobe inférieur gauche. Détection d'une fistule broncho-oesophagienne à la bronchoscopie. Présence de nombreux bacilles acido-résistants dans l'expectoration, ainsi que dans la biopsie bronchique prélevée autour de la fistule. M. malmoense était isolé de l'expectoration, du lavage bronchoalvéolaire et de la biopsie bronchique. Alors que les tests de sensibilité conventionnels in vitro out révélé une sensibilité pour le seul ethambutol, un test de sensibilité à multidrogues a confirmé la sensibilité pour la rifampicine, Pethambutol, la clarithromycine et le prothionamide. Le résultat clinique après 12 mois de traitement est une rémission stable, une diminution considérable de la charge mycobactérienne, mais non une éradication complète.
Informamos acerca de una infección broncopulmonar con Mycobacterium malmoense en un paciente con inmunodepresión severa a causa de una diabetes mellitus insulino-dependiente, inmunodeficiencia humoral debido a un timoma (sindrome de Good) y un tratamiento inmunosupresor prolongado después de una crisis miasténica. El paciente presentaba una neumonia no resolutiva del lóbulo inferior izquierdo. A la broncoscopia se detectó una fistula bronco-esofágica. Se identificaron numerosos microorganismos ácidoresistentes en las muestras de esputo y en la biopsia bronquial alrededor de la fistula. Se aisló Mycobacterium malmoense del esputo, del lavado bronco-alveolar y de la biopsia bronquial. Aun cuando los tests de sensibilidad convencionales in vitro revelaron una sensibilidad sólo al etambutol, un test de sensibilidad multidrogas confirmó una sensibilidad a la rifampicina, el etambutol, la claritromicina y la protionamida. Después de 12 meses de tratamiento, el resultado clinico fue una remisión estable y una disminución considerable de la carga bacilar, pero sin una erradicación completa.
Mycobacterium malmonense : A new agent of mycobacteriosis in France
1994, Medecine et Maladies InfectieusesMycobacterium malmoense agent fréquent de mycobactériose en Suède, Finlande et Grande-Bretagne, reste rare en France (2 infections pulmonaires en 1983 et 1986). L'infection est généralement pulmonaire chez l'adulte et ganglionnaire chez l'enfant ; les autres infections (disséminées, cutanées ou des tissus mous) sont rares et concernent surtout des immuno-déprimés. Ces infections restent exceptionnelles chez les malades atteints de SIDA. Le traitement n'est pas codifié. Les associations les plus utilisées comprennent isoniazide, rifampicine et éthambutol ; l'efficacité in vivo de la clarithromycine n'est pas documentée. Le diagnostic est rendu difficile par la croissance lente (6 à 8 semaines) et dysgonique sur milieu solide. Cependant la culture peut être détectée en 8 jours par méthode Bactec. Les tests biochimiques caractéristiques sont l'hydrolyse du Tween 80 à 10 jours et la catalase thermolabile. La composition en acides mycoliques et la présence d'acides gras ramifiés en 21 et 27 atomes de carbone constituent des marqueurs spécifiques d'espèce. Nous présentons ici 8 cas français (6 infections pulmonaires dont une chez un malade VIH positif, 1 adénopathie cervicale, 1 infection cutanée) de mycobactérioses dues à M. malmoense, diagnostiquées de 1989 à 1992.
Mycobacterium malmoense is an agent of mycobacteriosis frequently encountered in Sweden, Finland and Great-Britain, but still rare in France (2 pulmonary infections in 1983 and 1986). Most infections represent pulmonary disease or cervical adenitis ; other infections (disseminated, cutaneous, soft tissue) are rare and usually occur in immunologically compromised patients. These infections are exceptional in AIDS patients. Treatment is not codified. Usual associations include isoniazide, rifampicin and ethambutol ; in vivo efficacy of clarithromycine is not documented. Diagnosis is complicated by the dysgonic and slow growth (6 to 8 weeks) on solid media. However culture may be detected in 8 days by Bactec method. Characteristic biochemical tests include Tween 80 hydrolysis and thermolabile catalase. Mycolic acid composition and branched fatty acids in 21 and 27 carbon atoms represent specific markers for identification. Eight french cases due to M. malmoense and diagnosed during 1989–1992 are presented including 6 pulmonary infections, 1 cervical adenitis and 1 cutaneous infection.
Cultural studies on two isolates of "Mycobacterium genavense" from patients with acquired immunodeficiency syndrome
1994, Diagnostic Microbiology and Infectious DiseaseTwo strains of the newly proposed species “Mycobacterium genavense” have been isolated, using the radiometric system (Bactec, Becton Dickinson), from the blood of two HIV-infected patients. Disseminated infections due to the new organism closely resemble those of the Mycobacterium avium complex, with prevalently intestinal symptomatology. We report here on the cultural behavior of the isolates, which are enhanced at pH 6, are inhibited by NAP, do not require supplements, and grow best at 37°C. We also report on the antibiotic susceptibility of the isolates.