Clinical, microbiological, and epidemiological findings of an outbreak of Mycobacterium abscessus hand-and-foot disease

Dytoc, Marlene; Honish, Lance; Shandro, Cary; Ting, Patricia T.; Chui, Linda; Fiorillo, Loretta; Robinson, Joan; Fanning, Anne; Predy, Gerry; Rennie, Robert

doi:10.1016/j.diagmicrobio.2005.03.010

Cited by 31 publications

(24 citation statements)

References 28 publications

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“…Contamination and hypersensitive reactions are often due to environmental exposure (associated with, for example, hot tubs, metalworking fluids, or contaminated dust) (15-19), and many outbreaks following invasive medical procedures have been reported over the last decade (20-25). Tap water may be an important source of contamination in urban environments (13,18,(26)(27)(28)(29)(30).RGM are commonly recovered from water treatment and distribution systems (31-38), probably because they can form biofilms (2, 39-41) and resist chlorination and oligotrophic conditions (42,43). Mycobacterium chelonae and Mycobacterium fortuitum were the species most frequently detected in previous studies (31,34,35,40,44).…”

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Diversity, Community Composition, and Dynamics of Nonpigmented and Late-Pigmenting Rapidly Growing Mycobacteria in an Urban Tap Water Production and Distribution System

Dubrou¹,

Konjek

Macheras

et al. 2013

Appl Environ Microbiol

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e Nonpigmented and late-pigmenting rapidly growing mycobacteria (RGM) have been reported to commonly colonize water production and distribution systems. However, there is little information about the nature and distribution of RGM species within the different parts of such complex networks or about their clustering into specific RGM species communities. We conducted a large-scale survey between 2007 and 2009 in the Parisian urban tap water production and distribution system. We analyzed 1,418 water samples from 36 sites, covering all production units, water storage tanks, and distribution units; RGM isolates were identified by using rpoB gene sequencing. We detected 18 RGM species and putative new species, with most isolates being Mycobacterium chelonae and Mycobacterium llatzerense. Using hierarchical clustering and principal-component analysis, we found that RGM were organized into various communities correlating with water origin (groundwater or surface water) and location within the distribution network. Water treatment plants were more specifically associated with species of the Mycobacterium septicum group. On average, M. chelonae dominated network sites fed by surface water, and M. llatzerense dominated those fed by groundwater. Overall, the M. chelonae prevalence index increased along the distribution network and was associated with a correlative decrease in the prevalence index of M. llatzerense, suggesting competitive or niche exclusion between these two dominant species. Our data describe the great diversity and complexity of RGM species living in the interconnected environments that constitute the water production and distribution system of a large city and highlight the prevalence index of the potentially pathogenic species M. chelonae in the distribution network. N onpigmented and late-pigmenting rapidly growing mycobacteria (RGM) are ubiquitous in soil and water environments (1-6). Most are harmless saprophytes, but some, such as Mycobacterium chelonae and Mycobacterium abscessus, are opportunistic pathogens that are causing increasing concern (7-9). Potentially pathogenic RGM are associated with a wide spectrum of diseases in humans, including pulmonary tract, skin, soft tissue, and disseminated infections (10-14), mostly in patients with predisposing conditions (e.g., lung diseases, chronic obstructive pulmonary disease, cystic fibrosis, genetic predisposition, or immunosuppressive therapy). Contamination and hypersensitive reactions are often due to environmental exposure (associated with, for example, hot tubs, metalworking fluids, or contaminated dust) (15-19), and many outbreaks following invasive medical procedures have been reported over the last decade (20-25). Tap water may be an important source of contamination in urban environments (13,18,(26)(27)(28)(29)(30).RGM are commonly recovered from water treatment and distribution systems (31-38), probably because they can form biofilms (2, 39-41) and resist chlorination and oligotrophic conditions (42,43). Mycobacterium chelonae and Mycobact...

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confidence: 96%

Diversity, Community Composition, and Dynamics of Nonpigmented and Late-Pigmenting Rapidly Growing Mycobacteria in an Urban Tap Water Production and Distribution System

Dubrou¹,

Konjek

Macheras

et al. 2013

Appl Environ Microbiol

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“…In virtually all nosocomial infections caused by this group of microorganisms, there were failings in the sterilization processes of solutions, surgical instruments, or medical devices (13,14,45). Recent publications indicate an increasing number of infections secondary to breast augmentation and video-assisted surgeries (7,9,19,23,25,(40)(41)(42)(43).The growing number of cases and reports may be due, at least in part, to the well-known tolerance to alkaline glutaraldehyde among Mycobacterium chelonae-Mycobacterium abscessus group isolates and to the low susceptibility to high-level disinfectants (20,22,39).Outbreaks of RGM infections unrelated to medical procedures also can occur and usually are associated with exposure to recreational water containing a large number of bacteria and inadequate chlorination (15,44), highlighting the ubiquity of these organisms in the environment. In fact, RGM have been recovered from many different environmental sources, including soil and water distribution systems (8,45).…”

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confidence: 99%

“…Outbreaks of RGM infections unrelated to medical procedures also can occur and usually are associated with exposure to recreational water containing a large number of bacteria and inadequate chlorination (15,44), highlighting the ubiquity of these organisms in the environment. In fact, RGM have been recovered from many different environmental sources, including soil and water distribution systems (8,45).…”

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Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense

et al. 2009

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An epidemic of infections after video-assisted surgery (1,051 possible cases) caused by rapidly growing mycobacteria (RGM) and involving 63 hospitals in the state of Rio de Janeiro, Brazil, occurred between August 2006 and July 2007. One hundred ninety-seven cases were confirmed by positive acid-fast staining and/or culture techniques. Thirty-eight hospitals had cases confirmed by mycobacterial culture, with a total of 148 available isolates recovered from 146 patients. Most (n ‫؍‬ 144; 97.2%) isolates presented a PRA-hsp65 restriction pattern suggestive of Mycobacterium bolletii or Mycobacterium massiliense. Seventy-four of these isolates were further identified by hsp65 or rpoB partial sequencing, confirming the species identification as M. massiliense. Epidemic isolates showed susceptibility to amikacin (MIC at which 90% of the tested isolates are inhibited [MIC 90 ], 8 g/ml) and clarithromycin (MIC 90 , 0.25 g/ml) but resistance to ciprofloxacin (MIC 90 , >32 g/ml), cefoxitin (MIC 90 , 128 g/ml), and doxycycline (MIC 90 , >64 g/ml). Representative epidemic M. massiliense isolates that were randomly selected, including at least one isolate from each hospital where confirmed cases were detected, belonged to a single clone, as indicated by the analysis of pulsed-field gel electrophoresis (PFGE) patterns. They also had the same PFGE pattern as that previously observed in two outbreaks that occurred in other Brazilian cities; we designated this clone BRA100. All five BRA100 M. massiliense isolates tested presented consistent tolerance to 2% glutaraldehyde. This is the largest epidemic of postsurgical infections caused by RGM reported in the literature to date in Brazil.Outbreaks, pseudooutbreaks, and cases of health-care-associated infections caused by rapidly growing mycobacteria (RGM) have been reported since the first case was described in 1938 (13). In virtually all nosocomial infections caused by this group of microorganisms, there were failings in the sterilization processes of solutions, surgical instruments, or medical devices (13,14,45). Recent publications indicate an increasing number of infections secondary to breast augmentation and video-assisted surgeries (7,9,19,23,25,(40)(41)(42)(43).The growing number of cases and reports may be due, at least in part, to the well-known tolerance to alkaline glutaraldehyde among Mycobacterium chelonae-Mycobacterium abscessus group isolates and to the low susceptibility to high-level disinfectants (20,22,39).Outbreaks of RGM infections unrelated to medical procedures also can occur and usually are associated with exposure to recreational water containing a large number of bacteria and inadequate chlorination (15,44), highlighting the ubiquity of these organisms in the environment. In fact, RGM have been recovered from many different environmental sources, including soil and water distribution systems (8,45). RGM are considered opportunistic pathogens and can cause chronic lung disease, particularly the species included in the M. chelonae-M. abscessus group (8, 46)...

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“…abscessus may cause cutaneous infections after contact with contaminated water in public baths. Such infections usually resolve without complications, but medical or surgical treatment is sometimes needed (7,20). M. abscessus is also capable of colonizing the respiratory tract and causes disease in certain groups of individuals.…”

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Molecular Epidemiology ofMycobacterium abscessus, with Focus on Cystic Fibrosis

et al. 2007

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Mycobacterium abscessus has been isolated increasingly often from the respiratory tracts of cystic fibrosis (CF) patients. It is not known whether these organisms are transmitted from person to person or acquired from environmental sources. Here, colony morphology and pulsed-field gel electrophoresis (PFGE) pattern were examined for 71 isolates of M. abscessus derived from 14 CF patients, three non-CF patients with chronic respiratory M. abscessus infection or colonization, one patient with mastoiditis, and four patients with infected wounds, as well as for six isolates identified as environmental contaminants in various clinical specimens. Contaminants and wound isolates mainly exhibited smooth colony morphology, while a rough colony phenotype was significantly associated with chronic airway colonization (P ‫؍‬ 0.014). Rough strains may exhibit increased airway-colonizing capacity, the cause of which remains to be determined. Examination by PFGE of consecutive isolates from the same patient showed that they all represented a single strain, even in cases where both smooth and rough isolates were present. When PFGE patterns were compared, it was shown that 24 patients had unique strains, while four patients harbored strains indistinguishable by PFGE. Two of these were siblings with CF. The other two patients, one of whom had CF, had not had contact with each other or with the siblings. Our results show that most patients colonized by M. abscessus in the airways have unique strains, indicating that these strains derive from the environment and that patient-to-patient transmission rarely occurs.

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Clinical, microbiological, and epidemiological findings of an outbreak of Mycobacterium abscessus hand-and-foot disease

Cited by 31 publications

References 28 publications

Diversity, Community Composition, and Dynamics of Nonpigmented and Late-Pigmenting Rapidly Growing Mycobacteria in an Urban Tap Water Production and Distribution System

Diversity, Community Composition, and Dynamics of Nonpigmented and Late-Pigmenting Rapidly Growing Mycobacteria in an Urban Tap Water Production and Distribution System

Epidemic of Postsurgical Infections Caused by Mycobacterium massiliense

Molecular Epidemiology ofMycobacterium abscessus, with Focus on Cystic Fibrosis

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