Abdominal Abscess Caused by Mycobacterium llatzerense

Abstract

bMycobacterium llatzerense was cultured from a subdiaphragmatic abscess. To our knowledge, this is the first report of isolation of this rapidly growing mycobacterium from a human. Growth characteristics and antimicrobial susceptibilities different from those previously reported for environmental isolates were observed. CASE REPORTA 57-year-old morbidly obese woman was admitted to the Hospital of the University of Pennsylvania for drainage of a leftsided subdiaphragmatic abscess that resulted after multiple gastric surgeries for morbid obesity and gastroesophageal reflux disease over the course of several years. The main findings at laparotomy included a leaking Roux-en-Y anastomosis, a large subdiaphragmatic abscess, and a splenic infarct. The leak was repaired and the abscess drained. Approximately 50 ml of pus from the abscess was obtained and sent for bacterial, mycobacterial, and fungal culture studies.Gram staining of the abscess drainage showed few Gram-positive cocci, and a fluorochrome stain was negative for acid-fast bacilli. After 1 day of incubation, a few Candida albicans organisms were isolated from inhibitory mold agar (BD, Sparks, MD) at 27°C and moderate numbers of Enterococcus spp. from blood agar (BD) at 37°C. The patient was administered linezolid (600 mg every 12 h) for 14 days. Six days after the initial incubation, fewer than 10 colonies of a rapidly growing mycobacterium (isolate 9-9768) were detected on Middlebrook 7H11 nonselective plates (BD). The Bactec MGIT (BD) broth flagged positive after 10 days 19 h, and upon subculture, colonies were detected 5 days later. The 9-9768 mycobacterial colonies were dry and nonpigmented and grew at both 30°C and 37°C on Löwenstein-Jensen slants and Middlebrook 7H11 nonselective and selective plates.Mycobacterium 9-9768 was identified as M. llatzerense by both hsp65 (1) and gyrB gene PCR and sequence analysis. The gene sequences were deposited in GenBank (http://www.ncbi.nlm.nih.gov /GenBank/) under accession numbers KC737844 and KC737845, respectively. Because the published growth temperature phenotype of M. llatzerense did not match the growth phenotype of the clinical isolate, further molecular identification procedures were undertaken in Spain. A multilocus sequence analysis (MLSA) study that included 16S rRNA, internal transcribed spacer 1 (ITS1), gyrB, hsp65, recA, rpoB, and sodA genes was performed as described previously (2). The amplified products were purified with Multiscreen HTS PCR 96-well filter plates (Millipore). Sequence reactions were carried out using ABI Prism BigDye Terminator version 3.1, and the sequences were read with an automatic sequence analyzer (3130 genetic analyzer; Applied Biosystems). All sequences were deposited in the EMBL database under accession numbers HG810917 to HG810920.The closest type strain in the phylogenetic analysis for all the genes tested was M. llatzerense. The sequence of the ITS1 region was not included in the MLSA because some Mycobacterium type strains contain more than one operon. For five of the ...

Mycobacterium llatzerense, a waterborne Mycobacterium, that resists phagocytosis by Acanthamoeba castellanii

“…This NTM species, phylogenetically related to the opportunistic pathogens of the M. mucogenicum group, has been repeatedly identified within drinking water networks3435363738. The involvement of M. llatzerense was recently reported in immunocompromised patients, raising the possibility that it may be an opportunistic pathogen as well394041.…”

Two Rapidly Growing Mycobacterial Species Isolated from a Brain Abscess: First Whole-Genome Sequences of Mycobacterium immunogenum and Mycobacterium llatzerense

“…Mycobacterium llatzerense was first described in 2008 as a contaminant of hemodialysis water and is most closely related to M. aubagnense and M. mucogenicum (17). Subsequent case reports have isolated M. llatzerense from an abdominal abscess and infected lung in the setting of pneumonia (3,18). It is unlikely that our findings represent contamination, as M. llatzerense has not been previously isolated in our laboratory and no other rapidly growing mycobacteria were isolated in our laboratory during this time frame.…”

“…The different initial growth characteristics seen here may be related to medium formulation and/or temperature requirements. For example, some strains of M. llatzerense are reported to grow only at 22°C and 30°C, while other strains can grow at 37°C (3,17); in our laboratory, all mycobacterial media are incubated at 36°C. This case underscores the possibility, as shown here, that cultures containing rapidly growing mycobacteria may consist of more than one species, potentially impacting the response to therapy, and suggests one application of whole-genome sequencing in discriminating between mixed bacterial populations in polymicrobial infections.…”

The Right Frame

“…6 In our case, the patient's sputum grew M. llatzerense, an aerobic, nonfermenting mycobacterium found in water sources that has only infrequently been implicated as a human pathogen. 7,8 Subsequent AFB sputum cultures were negative, and serial imaging showed resolution of the pulmonary findings without additional antimycobacterial therapy, suggesting that this organism was not responsible for the disease process.…”