Clinical and Epidemiologic Characteristics of Mycobacterium haemophilum, an Emerging Pathogen in Immunocompromised Patients

Straus, Walter L.

doi:10.7326/0003-4819-120-2-199401150-00004

Cited by 113 publications

(80 citation statements)

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“…18,19 It has also been implicated in bacteraemia, osteomyelitis, septic arthritis, pneumonitis in the immunosuppressed, and lymphadenitis in otherwise healthy children. 20,21 The only other report of M. haemophilum in BMT recipients is from the Memorial Sloan-Kettering Cancer Center. Three patients presented with the classical cutaneous lesions and survived, and two others developed isolated pulmonary disease and died.…”

Section: Discussionmentioning

confidence: 99%

Mycobacterial central venous catheter tunnel infection: a difficult problem

Ward

Lam

Cannell

et al. 1999

Bone Marrow Transplant

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Summary:We report our experience of non-tuberculous mycobacterial infection associated with the tunnel of Hickman-Broviac central venous catheters in immunosuppressed patients with haematological malignancies undergoing high-dose chemotherapy supported by BMT. The problem is rare and difficult to treat. Our cases are unique in developing tunnel site mycobacterial infection well after the tunnelled catheters were removed. We diagnosed one case of Mycobacterium chelonae, which is a well-documented cause of such infections, and two cases of Mycobacterium haemophilum, which are the first reported cases in this setting. Early wide surgical excision of the infected tunnel site and prolonged antibiotic therapy is necessary. Despite these measures recurrence occurred in two cases. Close liaison with the microbiology laboratory is needed to ensure the appropriate culture media and conditions are used for these fastidious organisms. Empiric antibiotic regimens should be based on the likely organism. Drugs active against M. chelonae and M. haemophilum should be included. Keywords: mycobacteria; central venous catheter; Hickman line; infection; M. chelonae; M. haemophilum Tunnelled venous access devices are used commonly in bone marrow transplantation to allow long-term venous access. These lines are associated with infectious and thrombotic complications. Mycobacterial infections are rarely encountered. Tunnel-related infection is even less frequently reported. We discuss the problem, outline our experience and review the literature.

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Section: Discussionmentioning

confidence: 99%

Mycobacterial central venous catheter tunnel infection: a difficult problem

Ward

Lam

Cannell

et al. 1999

Bone Marrow Transplant

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“…This is especially important as there are no known risk factors, other than host immunosuppression, for acquiring M. haemophilum. In fact, the epidemiology of this organism is largely undefined [2,3,5]. M. haemophilum infections may elude diagnosis for several reasons.…”

Section: Discussionmentioning

confidence: 99%

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Fairhurst

Kubak

Pegues

et al. 2002

American Journal of Transplantation

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Non-tuberculous mycobacteria are becoming increasingly important pathogens among transplant recipients. We report a case of disseminated Mycobacterium haemophilum infection in a heart transplant recipient, manifesting as cellulitis, subcutaneous nodules, septic arthritis, and pneumonitis. Our case illustrates diverse challenges in the identification and treatment of this pathogen, such as its unique culture requirements and variable antimicrobial susceptibilities. Heightened clinical suspicion is necessary to establish a timely diagnosis so that optimal treatment can be administered.

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“…In recent years, Mycobacterium haemophilum has emerged as an important human pathogen (6,10,12), causing mainly opportunistic infections in severely immunocompromised patients with AIDS and those receiving immunosuppressive therapy after transplantation (1,4,7,8,12,16). M. haemophilum has also been isolated from localized lesions in immunocompetent pediatric patients with cervical lymphadenopathy (3,9).…”

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confidence: 99%

“…PRA correctly identified M. haemophilum in four smear-positive specimens. Direct identification by PRA takes 2 to 3 working days compared to the 3 to 5 weeks required for culture isolation and identification by conventional methods.In recent years, Mycobacterium haemophilum has emerged as an important human pathogen (6, 10, 12), causing mainly opportunistic infections in severely immunocompromised patients with AIDS and those receiving immunosuppressive therapy after transplantation (1,4,7,8,12,16). M. haemophilum has also been isolated from localized lesions in immunocompetent pediatric patients with cervical lymphadenopathy (3, 9).…”

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confidence: 99%

“…M. haemophilum has also been isolated from localized lesions in immunocompetent pediatric patients with cervical lymphadenopathy (3,9). Superficial lesions such as cutaneous lesions and multiple skin nodules are not uncommon clinical presentations of M. haemophilum infection (6,10,12). Though necessary, culture isolation and identification of mycobacteria by conventional methods, especially for M. haemophilum, are time-consuming and laborious, usually taking 3 to 5 weeks (5).…”

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confidence: 99%

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Direct Identification of Mycobacterium haemophilum in Skin Lesions of Immunocompromised Patients by PCR-Restriction Endonuclease Analysis

Wang¹,

Sng²,

Leong

et al. 2004

J Clin Microbiol

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PCR-restriction endonuclease analysis (PRA) was used for direct identification of Mycobacterium haemophilum in clinical specimens from immunocompromised patients. PRA correctly identified M. haemophilum in four smear-positive specimens. Direct identification by PRA takes 2 to 3 working days compared to the 3 to 5 weeks required for culture isolation and identification by conventional methods.In recent years, Mycobacterium haemophilum has emerged as an important human pathogen (6, 10, 12), causing mainly opportunistic infections in severely immunocompromised patients with AIDS and those receiving immunosuppressive therapy after transplantation (1,4,7,8,12,16). M. haemophilum has also been isolated from localized lesions in immunocompetent pediatric patients with cervical lymphadenopathy (3, 9). Superficial lesions such as cutaneous lesions and multiple skin nodules are not uncommon clinical presentations of M. haemophilum infection (6, 10, 12). Though necessary, culture isolation and identification of mycobacteria by conventional methods, especially for M. haemophilum, are time-consuming and laborious, usually taking 3 to 5 weeks (5). PCR-restriction endonuclease analysis (PRA) of an amplified 439-bp segment of the hsp65 gene encoding the 65-kDa heat shock protein has been successfully used for the rapid identification of mycobacterial isolates to the species level and has gained wide acceptance (11,13,14). This study is aimed at applying PRA as a means of rapid identification of M. haemophilum directly from acid-fast bacillus (AFB) smear-positive skin lesion specimens from immunocompromised patients.Organisms. We used four superficial lesion specimens from three immunocompromised patients with suspected nontuberculous mycobacterial infections (two skin biopsy specimens from erythematous nodules, one skin abscess specimen from a patient's left foot, and one pus drainage specimen from a patient with skin bursitis). Reference strains M. haemophilum ATCC 29548, M. intracellulare ATCC 13950, M. tuberculosis ATCC 27294, and M. kansasii ATCC 35775 were utilized as controls for PRA.Specimen processing. Specimens (1 g of skin biopsy specimen and 0.3 to 0.6 ml of pus and abscess drainage specimens) were digested and decontaminated using MycoPrep (Becton Dickinson). The derived sediment was used for smears and cultures. An aliquot of the original specimen was kept at Ϫ70°C for molecular analysis. AFB microscopy. Auramine O fluorescent stain was used, and positive smears were counterstained with Ziehl-Neelsen stain to confirm the presence of AFB (5).Mycobacterial cultures. Each specimen was inoculated into two sets of BACTEC 460 12B vials (Becton Dickinson) and Lö-wenstein-Jensen (LJ) medium slants (BBL, Becton Dickinson), and each set was incubated at either 30 or 37°C. In addition, one blood agar plate was inoculated and incubated at 30°C. Broth and solid medium cultures were held for 6 and 8 weeks, respectively, and examined periodically for growth. The culture isolates were identified using DNA probes (AccuProbe; Gen-Pr...

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Clinical and Epidemiologic Characteristics of Mycobacterium haemophilum, an Emerging Pathogen in Immunocompromised Patients

Cited by 113 publications

References 0 publications

Mycobacterial central venous catheter tunnel infection: a difficult problem

Mycobacterial central venous catheter tunnel infection: a difficult problem

Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Direct Identification of Mycobacterium haemophilum in Skin Lesions of Immunocompromised Patients by PCR-Restriction Endonuclease Analysis

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