Post operative <i>Mycobacterium fortuitum infection</i> following laparoscopic inguinal hernia repair: A case report

Sharma, Kusum; Appannanavar, Suma B; Kumar, Shiv; Sharma, Meera

doi:10.5005/jogi-2-1-62

“…2b) and were presumptively identified as M. fortuitum on the basis of nitrate reduction and 68 °C catalase. They were later confirmed using PCR targeting specific primers for M. fortuitum [4] (Fig. 2c).…”

Section: Resultsmentioning

confidence: 99%

“…Presumptively, the organism was identified as M. fortuitum using standard biochemical reactions like nitrate reduction and 68 °C catalase. For further confirmation, the isolate was subjected for PCR targeting M. fortuitum complex specific SOD gene primers and yielded a PCR product of 275 bp as described previously [4] (Fig. 2c).…”

Section: Resultsmentioning

confidence: 99%

Ocular mycobacteriosis—dual infection of M. tuberculosis complex with M. fortuitum and M. bovis

Sharma

¹

,

Seth

²

,

Sharma

³

et al. 2017

J Ophthal Inflamm Infect

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BackgroundWe report unfavorable outcome in a patient with subretinal granuloma caused by dual infection of Mycobacterium tuberculosis complex with Mycobacterium fortuitum and Mycobacterium bovis in an immunosuppressed, non-HIV patient. We did a systematic review of literature on dual infection due to M. tuberculosis and M. fortuitum via MEDLINE and PUBMED and could not find any case reported of causing this kind of dual infection in the eye.ResultsA 38-year-old Indian male patient presented with decreased vision in the left eye for 3 months, diagnosed as tubercular choroidal granuloma with associated retinal angiomatosis proliferans (RAP) lesion. He also had multiple enlarged lymph nodes in the chest, and sternal pus sample was positive for acid-fast bacilli (AFB). M. tuberculosis complex was detected by gene expert. The patient was started on antitubercular treatment (ATT) whereby the lung lesions improved but the ocular lesion showed initial clinical improvement followed by worsening. Twenty-five-gauge diagnostic pars plana core vitreous surgery was done whereby sample demonstrated a large number of AFB on Ziehl-Neelsen stain and auramine-rhodamine stain. The vitreous sample showed growth on routinely inoculated mycobacteria growth indicator tube (MGIT) 960 tubes, and multiplex polymerase chain reaction (PCR), Gene Xpert MTB/ RIF assay (Cepheid, Sunnyvale, CA), and line probe assay (LPA) were positive for ocular tuberculosis. In view of nonresponse to conventional ATT, a suspicion of dual infection of M. tuberculosis complex with a nontubercular mycobacteria was kept and a subculture was made onto the solid Lowenstein-Jensen (LJ) medium from the positive MGIT 960 tubes. Two morphologically distinct types of colonies were obtained on LJ slopes. Subsequently, the two etiological agents were identified as M. fortuitum and M. bovis by PCR from the vitreous sample.ConclusionsCo-infection of M. tuberculosis complex with nontubercular mycobacterium (NTM) has never been reported from ocular tuberculosis before. In immunosuppressed individuals, who test positive for MTB, not responding to the standard ATT, one needs to have a high index of clinical suspicion to rule out associated NTM infection and initiate appropriate multidrug systemic antibiotic therapy early.

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“…Several mycobacterial species have been known to be associated with acute and chronic infections of abdomen and gastrointestinal (GI) tract. 1,2 Due to therapeutic relevance, the chronic mycobacterial intestinal diseases, TB, and CD deserve special attention. Besides the disease caused by M. tuberculosis, there has been tremendous interest about the role of Mycobacterium paratuberculosis in the etiology of CD.…”

Section: Introductionmentioning

confidence: 99%

Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract

Katoch¹

2017

Journal of Gastrointestinal Infections

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Abdominal tuberculosis (TB) is an important public health problem in developing countries. Because of overlap in the signs and symptoms of the chronic mycobacterial diseases like intestinal tuberculosis (ITB), Crohn's disease (CD), ulcerative colitis, and other inflammatory diseases, there is a need to arrive at a specific diagnosis. Several investigations like computed tomography scan, different endoscopy procedures, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert, laparoscopy, etc., are being increasingly used to diagnose TB. Advances in imaging methods and direct access to affected sites by endoscopy have made significant contribution in improving the diagnosis. A combined evaluation of clinical features, endoscopy, histology, and response to treatment has been recommended to differentiate between CD and ITB. Various studies show that clinical features and histopathology, especially granuloma characteristics, have a major role in moving toward specific diagnosis of these conditions. Development of a large number of probes and gene amplification (different variants of PCR and isothermal methods) for TB and other mycobacteria has provided very powerful tools. If used properly they can significantly help in arriving at specific diagnosis of chronic mycobacterial diseases of intestinal tract. Detection of mycobacterial genetic/antigenic components in biopsies by in situ hybridization (ISH), in situ PCR, and immunohistochemistry (IHC) has been observed to be quite useful in differentiating ITB from CD. A number of newer methods based on expression of angiotensin converting enzyme (ACE), aptamers and biosensors have already appeared on the horizon and have potential diagnostic as well as therapeutic value for various forms of TB including abdominal TB. While many of these approaches/techniques have shown promise, they have not been adequately studied to become part of diagnostic strategy for clinical settings in countries like India.

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“…Several mycobacterial species have been known to be associated with acute and chronic infections of abdomen and gastrointestinal (GI) tract. 1,2 Due to therapeutic relevance, the chronic mycobacterial intestinal diseases, TB, and CD deserve special attention. Besides the disease caused by M. tuberculosis, there has been tremendous interest about the role of Mycobacterium paratuberculosis in the etiology of CD.…”

Section: Introductionmentioning

confidence: 99%

Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract

Katoch¹

2017

Journal of Gastrointestinal Infections

1

0

View full text Add to dashboard Cite

Abdominal tuberculosis (TB) is an important public health problem in developing countries. Because of overlap in the signs and symptoms of the chronic mycobacterial diseases like intestinal tuberculosis (ITB), Crohn's disease (CD), ulcerative colitis, and other inflammatory diseases, there is a need to arrive at a specific diagnosis. Several investigations like computed tomography scan, different endoscopy procedures, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert, laparoscopy, etc., are being increasingly used to diagnose TB. Advances in imaging methods and direct access to affected sites by endoscopy have made significant contribution in improving the diagnosis. A combined evaluation of clinical features, endoscopy, histology, and response to treatment has been recommended to differentiate between CD and ITB. Various studies show that clinical features and histopathology, especially granuloma characteristics, have a major role in moving toward specific diagnosis of these conditions. Development of a large number of probes and gene amplification (different variants of PCR and isothermal methods) for TB and other mycobacteria has provided very powerful tools. If used properly they can significantly help in arriving at specific diagnosis of chronic mycobacterial diseases of intestinal tract. Detection of mycobacterial genetic/antigenic components in biopsies by in situ hybridization (ISH), in situ PCR, and immunohistochemistry (IHC) has been observed to be quite useful in differentiating ITB from CD. A number of newer methods based on expression of angiotensin converting enzyme (ACE), aptamers and biosensors have already appeared on the horizon and have potential diagnostic as well as therapeutic value for various forms of TB including abdominal TB. While many of these approaches/techniques have shown promise, they have not been adequately studied to become part of diagnostic strategy for clinical settings in countries like India.

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Post operative Mycobacterium fortuitum infection following laparoscopic inguinal hernia repair: A case report

Cited by 3 publications

References 4 publications

Ocular mycobacteriosis—dual infection of M. tuberculosis complex with M. fortuitum and M. bovis

Ocular mycobacteriosis—dual infection of M. tuberculosis complex with M. fortuitum and M. bovis

Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract

Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract

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