Disseminated infection by Mycobacterium genavense in an HIV-1 infected patient

Nunes, Tomás Robalo; Calderón, Ana Belén Mayo; Barroso, Clara; Marques, Nuno

doi:10.1016/j.idcr.2020.e00926

Cited by 2 publications

(3 citation statements)

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“…The disease pattern suggests an intestinal rather than a respiratory infection pathway. [11] Clinical features of M. genavense infection are similar to MAC, including asthenia, weight loss, fever, splenomegaly and diarrhea. [4] However, abdominal pain is more common in disseminated infection by M. genavense than by MAC, [6,11] which is probably related to the amount of acid-fast bacilli in the intestinal mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…[11] Clinical features of M. genavense infection are similar to MAC, including asthenia, weight loss, fever, splenomegaly and diarrhea. [4] However, abdominal pain is more common in disseminated infection by M. genavense than by MAC, [6,11] which is probably related to the amount of acidfast bacilli in the intestinal mucosa. [12] The diagnosis is challenging due to the fastidious growth requirements.…”

Section: Discussionmentioning

confidence: 99%

“…As in the present case, molecular techniques are necessary for an earlier identification. [11,13] As M. genavense does not grow in standard media, data on drug susceptibility is difficult to obtain. According to published data, most isolates are susceptible in vitro to fluoroquinolones, clofazimine, and amikacin, although susceptibility testing is not standardized; treatment success has been described with macrolides and ethambutol in addition to rifampicin, amikacin, or a fluoroquinolone.…”

Section: Discussionmentioning

confidence: 99%

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Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report

et al. 2022

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Rationale: Since its first identification in the early 1990s, Mycobacterium genavense has been considered and opportunistic pathogen. It mainly causes gastrointestinal symptoms, but also disseminated infections in severely immunosuppressed patients. Sclerosing mesenteritis is a long-term complication with high morbidity and mortality. As it is a rare condition, there are no specific guidelines for its management. We report a challenging case of persistent M. genavense infection, and propose surgery as an alternative treatment strategy.Patient concerns: A 38-year-old Caucasian man presented to the emergency room with fever, abdominal pain, and night sweats for 3 months. HIV screening revealed a previously unknown HIV-1 infection, with a CD4 cell count of 216 cell/µL and viral load of 361.000 copies/mL at diagnosis. A body CT-scan showed mild splenomegaly as well as mesenteric and retroperitoneal enlarged lymph nodes. Fine needle aspiration revealed the presence of acid-fast bacilli, but mycobacterial cultures were negative. In the second sample, 16S RNA sequencing yielded a diagnosis of M. genavense infection. Despite 2 years of corticosteroids and antimycobacterial treatment excluding rifampicin due to a severe cutaneous reaction, there was no clinical improvement and an increase in the mesenteric lymph node size was observed, with a sclerosing transformation of the mesentery. A surgical approach was proposed to release small bowel loops and to remove fibrin. A second surgery was required due to an acute peritonitis ought to yeyunal segmental isquemia and perforation. Finally, the patient evolved favorably, and antimycobacterial drugs were suspended without relapse.Lessons.Despite a prolonged multidrug strategy, some patients develop persistent M. genavense infection. Once sclerosing mesenteritis is established, clinicians have few treatment options. Surgery should be considered in patients with sclerosing mesenteritis or bowel obstruction. The combination of medical and surgical treatment could be a potential cure for these patients.Abbreviations: AIDS = acquired immunodeficiency syndrome, ART = antiretroviral therapy, FDG = fluorodeoxyglucose, HIV = human immunodeficiency virus, IGRA = interferon-gamma release assay, MAC = Mycobacterium avium complex, PCR = polymerase chain reaction, PET/CT = positron emission tomography/computed tomography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report

et al. 2022

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Mycobacterium genavense detection in a blood smear from a domestic ferret

Fonseca,

Silveira,

Duarte

et al. 2024

Vet Record Case Reports

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The domestic ferret is sensitive to mycobacterial infections, which are likely underdiagnosed. There are limited reports of therapy for mycobacteriosis in ferrets and most have failed. A ferret in poor body condition revealed marked organomegaly on diagnostic imaging. The complete blood count revealed a mild pseudoeosinophilia, which might be attributed to negatively stained bacilli phagocytised by monocytes observed in the blood smear. Ziehl–Neelsen stain was performed and showed acid‐fast bacilli within monocytes. Fine‐needle aspirates of the spleen and liver revealed the same finding. Mycobacterium genavense was identified by PCR and DNA sequencing from peripheral blood. Treatment with rifampicin, clarithromycin and enrofloxacin was initiated. The disseminated mycobacteriosis was suspected from the observation of bacilli on the blood smear. After 16 months, the ferret is still undergoing treatment. To prevent recurrence, continued monitoring of drug toxicity and effective therapy will be maintained even after the resolution of clinical signs (mostly organomegaly).

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Disseminated infection by Mycobacterium genavense in an HIV-1 infected patient

Cited by 2 publications

References 20 publications

Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report

Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report

Mycobacterium genavense detection in a blood smear from a domestic ferret

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