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

Abstract

Mycobacterium haemophilum is an uncommonly encountered acid-fast staining bacillus (AFB) that can cause a broad range of infections. We describe a tertiary care center's experience with M. haemophilum infections identified from 2000 to 2015. Ten adult patients were identified with M. haemophilum infections, and most had immunocompromising conditions. M. haemophilum presented in one of two syndromes: a peripheral cutaneous infection presenting with skin nodularity and local invasion, and a cervicofacial infection involving regional lymph nodes. Duration of therapy was variable (0–18 months) and was dependent on the underlying syndrome and immunological status of the patient. Treatment responses were favorable in all patients. During therapy, three patients developed culture-negative aseptic cutaneous lesions, consistent with immunologic reconstitution inflammatory syndrome (IRIS); we postulate that such reactions may not be uncommon with select M. haemophilum infections.

Meningomyeloencephalitis secondary to Mycobacterium haemophilum infection in AIDS

“…Identification of this fastidious organism requires a strong index of suspicion, needing iron-supplemented media and culturing at cooler temperatures (30-32°C) [19]. These necessary temperatures for optimal growth have been suggested as to why the organism favors infection in distal limb sites [20]. 16S rRNA sequencing is another method of identification and was critical in this challenging post-mortem diagnosis.…”

Rare infection in patient with rheumatoid arthritis treated with adalimumab

“…NTM compromises over 140 species, many of which cause rare disease in humans 3. Since the acquired immunodeficiency syndrome (AIDS) epidemic in the 1930s, many pathogens emerged and are increasingly recognised 45…”

“…M. haemophilum disease most commonly presents in the immunocompromised population, especially in patients with HIV infections and haematological malignancies 4 6 7. The organism is ubiquitous in the environment.…”

“…haemophilum infections, and an even smaller number of patients reported to develop the infection in the setting of chronic inflammatory conditions. The most common symptom is painful, ulcerating, erythematous skin nodules 4 7. Less commonly, it presents as pulmonary or neurological infection 7 8.…”

“…This, along with the difficulty to grow the pathogen given its cooler temperature requirements and ferric ions, chocolate agar and supplemented media for growth,9 make it difficult to isolate and treat. Treatment includes clarithromycin, ciprofloxacin and one of the rifamycins; however, it is dependent on pathogen susceptibilities 4…”