Cutaneous Mycobacterium haemophilum infection in iatrogenically immunocompromised patients without transplantation

Fifteen-year clinical experience with Mycobacterium haemophilum at the Mayo Clinic: A case series

“…One patient did not receive antimicrobial therapy and was cured with surgical lymph node resection. As most infections in our patients occurred among those with immunosuppressive conditions, the reduction of immunosuppressant therapies may be helpful when feasible [1], [2], [3]. This, however, was not always possible in our cases, and dependent upon the stability of the patients’ underlying comorbidities.…”

“…No standard guidelines are available for the treatment of M. haemophilum infection [19]; however, combination antimicrobial therapy is recommended. Clarithromycin, ciprofloxacin and a rifamycin have been successfully used and a prolonged duration may be needed for more severe and disseminated forms of disease [1], [2], [3], [20], [21]. Among the patients treated at Mayo Clinic, Rochester, the duration of therapy was variable, ranging from 2 weeks to 18 months depending upon the infection syndrome and underlying host immunology, with 12 months of therapy the most common duration.…”

“…Distinct from most other non-TB mycobacteria (NTM), M. haemophilum in vitro growth requires a lower incubation temperature and hemin or iron supplementation. M. haemophilum is unable to synthesize iron-binding siderophores, therefore it requires iron supplementation to grow in culture [1], [2], [3], [4], [5], [6]. Its preference for lower temperatures, similar to that of M. leprae and M. marinum , has been associated with a predilection for clinical infections to be located over the extremities.…”

Infecção Cutânea Por Mycobacterium Haemophilum Em Doente Imunodeprimido

“…haemophilum infection is a rare disease with less than 300 cases reported in the literature. Many aspects of its epidemiology are still unknown, namely the reservoir and the mode of transmission 3,4 . However an environmental source was suggested due to the absence of reported cases of person to person transmission and variable genetic pattern of isolates in different geographical areas 5 .…”

“…haemophilum is an acid-fast, aerobic, slow growing bacilli, with preferential temperatures between 30-32 o C, which explains its predilection for the extremities 5 . As other atypical mycobacteria usually affects immunocompromised adults, although disease in immunocompetent children and rarely in immunocompetent adults have also been described 3,4 .…”