Central nervous system infection caused by Mycobacterium houstonense: A case report

Abstract

BackgroundMycobacterium houstonense is a rapidly growing mycobacterium (RGM) that belongs to the unnamed third biovariant complex of the Mycobacterium fortuitum group, which is rarely responsible for human infection. Approximately 76% of infections caused by the M. fortuitum group occur after open fractures or skin, soft tissue, bone, or puncture wounds. To date, only a few cases of human infectious disease caused by M. houstonense have been reported worldwide.Case presentationWe present a case of a 26-year-old man with a central nervous system (CNS) infection caused by M. houstonense. The patient was transferred to our hospital because of headaches and muscle strength changes. One month prior to presentation at our hospital, the patient was diagnosed with tuberculous meningitis at the other two hospitals, but his condition did not improve after anti-tuberculous treatment, antibiotics, and anti-viral treatment before admission to our hospital. Lumbar puncture was performed at both previous hospitals, as well as at our hospital; the results consistently indicated high cerebrospinal fluid (CSF) opening pressure. M. houstonense was detected in the CSF of the second hospital's lumbar puncture by metagenomic next-generation sequencing (mNGS) but was not identified at our hospital. The patient was discharged from our hospital after receiving non-tuberculous mycobacterium (NTM) treatment for 1 month according to the Chinese NTM guidelines. However, the patient died 20 days after discharge.ConclusionSince it is difficult to identify M. houstonense, this is the first case of human CNS infection caused by M. houstonense in China. This case may be considered by neurologists and infectious physicians when CNS infection does not respond to conventional treatment, especially in the uncommon type of NTM.

Intracranial infection caused by Mycobacterium rhodesiae with specific imaging findings and good response to medication: a case report and literature review

“…In our review of the literature, cases span from the 1960s to the present. By the end of December 2023, there were 114 cases of intracranial NTM infection reported or summarized in the literature (5,6,(8)(9)(10)(11)(12)(13)(14)(15)(16)(21)(22)(23)(24)(25)(26)(27). Antonia Flor et al reported two cases and identified 50 cases of NTM meningitis in the English-language literature before 1994 (8).…”

“…The primary symptoms of patients affected by NTM infection in CNS are predominantly meningitis and meningoencephalitis, with ventriculitis also being reported. The rarely reported lesions include arteritis (30), cerebral thrombophlebitis (31), optic tract (9), and spinal cord (25). To date, no fixed or summarized description of brain imaging for NTM infection of the central nervous system is available.…”

Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review

“…Culture remains the gold standard for final diagnosis [ 41 , 42 ]. Metagenomic next-generation sequencing is now emerging as a rapid and effective tool for diagnosing NTM [ 30 , 43 ]. The treatment of extrapulmonary NTM disease is not well-defined, particularly in CNS disease, where the management depends upon anecdotal evidence in the form of case reports or expert opinion.…”

“…The first-line antitubercular drugs have no activity against RGM. Amikacin, clarithromycin, imipenem and Quinolones are used in various combinations (minimum 3–4 drugs, preferably with good CNS penetration) [ 43 , 44 ]. Cotrimoxazole could be an important drug in the maintenance phase due to its good CNS penetration.…”

A case report on Mycobacterium houstonense infection after total hip arthroplasty

“…Therefore, genetic testing such as NGS or mNGS is crucial for identifying pathogenic microorganisms in cases of RGM infection. Infections with Mycobacterium houstonense are extremely rare, with only the following three reported cases in the literature: ocular [ 13 ], intracranial [ 14 ], and infection of an open humerus fracture [ 15 ] (as shown in Table 2 ). All patients had a history of immunodeficiency or exposure to water or soil.…”