Pacemaker Infection with Mycobacterium Avium Complex

Abstract

A 21-year-old. HIV negative, malnourished, homeless woman with congenital heart block had a pacemaker implanted at 7 years of age and multiple procedures thereafter. The most recent of these procedures was replacement of a pulse generator in the right pectoral region. Four months later she had fever, pain, and swelling over the implant site resulting from infection with mixed flora and Mycobacterium avium complex. The pacemaker system was removed by thoracotomy via a median sternotomy and a new DDD pacemaker simultaneously implanted. She was treated with systemic antibiotics--isoniazid, rifampin, ethambutol--for 2 weeks. Six months later she was healthy, pacing well, and apparently free of infection, off all medications.

Update on Cardiovascular Implantable Electronic Device Infections and Their Management

“…Corynebacterium species, Propionibacterium acnes, Gram-negative bacilli 37,38 including Pseudomonas aeruginosa, 43 and Candida species account for a minority of CIED infections. Fungi other than Candida 44 and nontuberculosis mycobacteria 45,46 are rarely identified as pathogens in CIED infection.…”

Pacemaker infection due to Mycobacterium fortuitum

“…These represented either pacemaker generator site infection or epicardial lead infection without documented endocarditis. One report [3] described a pacemaker generator site infection with Mycobacterium avium complex that included only the subcutaneous part of the transvenous leads. Another report described a case of pacemaker pocket infection due to both Mycobac- terium chelonae and Mycobacterium fortuitum [4].…”

Cardiac implantable electronic device infection due to Mycobacterium species: a case report and review of the literature

“…Review of literature showed 25 case reports of CIED related infections due to Mycobacterium species [17–39], with two different Mycobacteria species in one patient [20], and three cases in one report [31]. Tables 2 and 3 show Mycobacterial infections of implanted pacemakers and ICDs respectively, as reported in literature.…”

“…The infection occurred between 8 days and 20 years from the last device related procedure. It occurred with both transvenous [17, 18, 20–22, 24–27, 30, 31, 33–39] and epicardial device implantations [19, 23, 28, 29, 32]. Mycobacterium tuberculosis was reported in seven cases [18, 23, 28, 31, 36] with mostly pocket infection.…”

“…Mycobacterium goodii was reported in two cases [25, 29] with pocket infection plus bacteremia in the first case. Mycobacterium avium complex [17], and M. avium intracellulare complex [32] in one case causing epicardial PM and ICD pocket infection respectively. Also it was reported with M. chelonae [20], M. peregrinum [34], and M. phlei [37].…”