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Background Nontuberculous mycobacteria (NTM) are widely distributed in natural environments and are increasing causes of disease with significant morbidity and mortality in immunocompromised patients. We present a 5-year experience of NTM isolates at the Moffitt Cancer Center in Tampa, Fla. Methods We conducted a single-center, retrospective study of NTM isolates from January 2011 to February 2016. Records were searched to identify patients with NTM. Specimens included bronchial lavage, swabs, blood/body fluids, and tissue. Basic demographics of patients, clinical attributes, sites of isolation, and concomitant neoplasia were compared. Results There were a total of 196 isolates of NTM; 92 of 196 isolates (47%) were Mycobacterium avium complex (MAC). Mycobacterium abscessus, Mycobacterium gordonae, and Mycobacterium fortuitum accounted for 28%, 11%, and 7% of the top 4 isolates, respectively. There was no difference in types of NTM isolated based on the type of underlying neoplasm. Eleven percent of the respiratory isolates were from patients whose biopsy was negative for malignancy on workup of lung nodule. Skin/wound isolates accounted for 13%, and blood/serologic isolates accounted for 7%. Average age of patients was 68 (SD, 11) years; 92% were US born. Conclusions Nontuberculous mycobacteria isolated in our study were likely to be MAC and isolated from the respiratory tract; however, we did not find significant association between types of NTM and a given neoplasm. Mycobacterium abscessus was the next most frequent isolate from both respiratory and nonrespiratory specimens. More than 10% of isolates were from surgically excised pulmonary nodules that were benign. Improved NTM testing and scoring algorithms could reduce the need for surgical excision of pulmonary nodules.

The Herbaspirillum species are gram-negative bacteria that inhabit soil and water. Infections caused by this pathogen are an uncommon clinical entity. We describe a rare case of septic shock and bacteremia caused by Herbaspirillum huttiense in an immunocompetent adult female. The patient, a 59-year-old female, presented to the hospital with circulatory shock, fever, chills, and cough. Chest x-ray revealed right lower lobe lung consolidation consistent with pneumonia, and blood cultures with a positive concerning gram-negative curved rod which was later identified as H. huttiense. The patient was treated in the ICU for three days with cefepime and vasoactive agents. After improvement and an additional seven days of hospitalization, the patient was discharged home with a five-day course of oral levofloxacin. Although our patient responded well to cefepime and levofloxacin, meropenem and piperacillin-tazobactam were found to be the most commonly used and the most effective antibiotics to treat H. huttiense infections in other reported cases. This is amongst the few reported cases of H. huttiense bacteremia in an immunocompetent individual with pneumonia.

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