Catheter-Related Bloodstream Infection Caused by Mycobacterium brumae

Abstract

Mycobacterium brumae is a rapidly growing environmental mycobacterial species identified in 1993; so far, no infections by this organism have been reported. Here we present a catheter-related M. brumae bloodstream infection in a 54-year-old woman with breast cancer. The patient presented with high fever (39.7°C), and >1,000 colonies of M. brumae grew from a quantitative culture of blood drawn through the catheter. A paired peripheral blood culture was negative, however, suggesting circulational control of the infection. The patient was treated empirically with meropenem and vancomycin, and the fever resolved within 24 h. The catheter was removed a week later, and from the tip M. brumae was isolated a second time, suggesting catheter colonization. The organism was identified by colonial morphology, sequence analysis of the 16S rRNA gene, and biochemical tests. CASE REPORTA 54-year-old woman with a history of breast cancer presented to the emergency department for evaluation of a fever she had had for several hours. The patient's breast cancer had been diagnosed 6 months earlier, requiring a modified radical mastectomy and subsequent plastic surgery for a skin flap complication. The patient had also been treated with paclitaxol for the cancer, which led to a hypersensitivity skin rash that required a tapering dose of dexamethasone for 2 months. One month earlier (after completion of the steroid therapy), the patient began experiencing repeated episodes of fever, and workup failed to reveal specific etiology, although some lung atelectasis, likely related to the paclitaxol treatment, was noted on imaging studies. Eventually, the fever resolved with multiple antibiotics (various combinations of levofloxacin, cefepime, azithromycin, and trimethoprim-sulfamethoxazole). The present episode of fever occurred after completion of a course of azithromycin and amoxicillin-clavulanate. Notably, during the anticancer chemotherapy the patient had not been neutropenic.Physical examination revealed a fever of 39.7°C with otherwise normal vital signs. A right subclavian central venous catheter (CVC) was in place, with no erythema or drainage surrounding the insertion site. The mastectomy site was notable for a large, thick, and brown eschar without evidence of infection. The remainder of the examination was normal. Her laboratory data revealed mild anemia, a normal white blood cell count and differential, and normal platelet count. Paired quantitative blood cultures were drawn from the CVC line and a peripheral vein. The patient was admitted to the hospital and was empirically treated with meropenem and vancomycin.On the second day of admission the fever resolved. Three days later, a quantitative culture of the CVC blood (9) became positive for an acid-fast bacillus (strain MDA0695) with Ͼ1,000 colonies growing on sheep blood agar from the 10 ml of blood cultured (lysis centrifugation method with an Isolator tube; Wampole Laboratories, Princeton, N.J.). The simultaneous peripheral blood culture remained negative, however. The pos...

Draft Genome Sequence of Mycobacterium brumae ATCC 51384

“…Growth occurs within 5 days at 30°C and 37°C. In liquid medium, M. brumae forms clumps with cording morphology ( 2 ). The cell wall of M. brumae contains only α-mycolic acids, which only release docosanoate after pyrolysis ( 1 ).…”

“…Until now, no attention has been paid to this mycobacterium species, because no cases of infection due to M. brumae have been described in animals or humans. In 2004, Han et al reported a catheter-infection case related to this species ( 2 ), but it was later confirmed that the isolate strain was not M. brumae ( 3 ).…”

Antimicrobial Susceptibility Testing, Drug Resistance Mechanisms, and Therapy of Infections with Nontuberculous Mycobacteria

“…The glycopeptide agents in clinical use are vancomycin and teicoplanin. Although there have been some reported successes with vancomycin as an antimycobacterial agent in humans and animals (150,176,208), mycobacteria are usually considered to be resistant to this agent. Although direct studies of the action of vancomycin in mycobacteria are lacking, indirect evidence for the peptidoglycan precursors present in mycobacteria following exposure to these agents suggests that the mechanism of action of vancomycin is the same as that in other bacteria (228).…”

“…Another newly described species, M. brumae, has also been the cause of catheter-related sepsis (208).…”

Mycobacterium barrassiae sp. nov., a Mycobacterium moriokaense Group Species Associated with Chronic Pneumonia

“…Rarely encountered species include Mycobacterium novocastrense, which is responsible for cutaneous infections (33); Mycobacterium hodleri, which causes opportunistic infections in the course of rheumatoid arthritis (40); Mycobacterium neoaurum, which was isolated from a patient with catheter-related bacteremia (46); Mycobacterium flavescens, which caused a disseminated infection in a probable case of chronic granulomatous disease (8); and Mycobacterium thermoresistible, which was responsible for an infection following kneereplacement surgery (20). Other species were isolated from human samples, such as Mycobacterium hassiacum from urine (32); Mycobacterium elephantis from the sputum and granulomatous tissue of an axillary lymph node (26,37,39); Mycobacterium doricum from cerebrospinal fluid (38); Mycobacterium brumae from sputum and a case of catheter-related bacteremia (21,22); Mycobacterium brisbanense from the antral sinus (31); Mycobacterium confluentis from sputum (17); Mycobacterium holsaticum from sputum, urine, and gastric fluid (28); Mycobacterium cosmeticum from a footbath drain and a granulomatous subdermal lesion in a female patient who was undergoing mesotherapy (12); and Mycobacterium canariasense from the blood of a patient with febrile syndrome (15).We report here on an additional novel RGM species isolated from respiratory specimens. …”