Mycobacterium chelonae hand infection following ferret bite

Abstract

We present a case of hand infection caused by Mycobacterium chelonae. The patient was a 58-year-old woman with Type II diabetes mellitus and stage 4 chronic kidney disease. The infection occurred following a ferret bite and had not responded to oral antibiotics in the primary care setting. She developed signs of pyogenic flexor tenosynovitis of the index and middle fingers of her left hand. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Ultrasound imaging confirmed the clinical diagnosis. Plain radiographs showed no osseous involvement. The infection was treated with surgical debridement and broad spectrum parenteral antibiotics. The intra-operative tissue specimens were initially negative on aerobic and anaerobic cultures. Following transient improvement of her inflammatory parameters and clinical signs, she developed a recurrence with added features of osteomyelitis of the index and middle finger metacarpal heads on repeat radiographs. A revision surgical debridement of the flexor tenosynovitis and osteomyelitis with specific long-term antibiotic cover has led to resolution of the infection. Extended cultures of the tissue specimens at the regional laboratory confirmed the causative organism to be M. chelonae. To our knowledge, this is the first reported case of M. chelonae infection resulting from a ferret bite. This case reminds us of the need for a high index of suspicion for infection with uncommon pathogens following animal bites, especially in patients with altered immune status.

Bite Injuries to the Hand - Review of the Literature

“…This patient later on had an osteomyelitis of the fingers and had to undergo another procedure. The authors feel that her altered immune status could have caused the events [40]. …”

A Retrospective Study of 17 Cases of Mycobacteriosis in Domestic Ferrets (Mustela Putorius furo) between 2005 and 2013

“…Question of treatment raises the important issues of zoonotic potential of the mycobacteria identified and the ethics of using antituberculous drugs intended for humans. [24][25][26] Few cases of mycobacteriosis have been described in domestic ferrets, with published works primarily being case reports involving 1 or 2 animals (Table 1). This article is the first retrospective study in which a substantial number (17 cases) of ferret mycobacteriosis cases have been assessed.…”

A Case of Disseminated Sepsis Caused by an Unusual Microorganism in a Patient With Diabetes

“…Our patient had disseminated M. chelonae infection despite being immunocompetent. Most reports in the literature describe disseminated infection in immunocompromised patients (11,12), and those reported in immunocompetent patients with diabetes are examples of localized infection (e.g., insulin injection or jet injector site abscesses [3,14], suppurative hidradenitis [15], and post-bite hand infection [16]). It is likely that our patient, who had longstanding and suboptimally controlled diabetes, advanced cardiac failure, and chronic kidney disease, was predisposed to dissemination of sepsis, and the probable infection of the intracardiac device was responsible for its persistence and resistance to treatment.…”