Report of Two Cases of Mycobacterium europaeum from Iran

Abstract

SUMMARY: Herein, we report repeated isolation of Mycobacterium europaeum from the sputum samples of an Iranian human immunodeficiency virus-infected patient and a cystic fibrosis patient with chronic pulmonary disease. To our knowledge, this is the first isolation of M. europaeum from human clinical specimens in Asia to be reported.Mycobacterium europaeum, a scotochromogenic species related to the Mycobacterium simiae complex, has only recently been described as a novel Mycobacterium sp. based on 5 irrelevant clinical isolates from Europe (1). The present study describes 2 independent cases of M. europaeum infection diagnosed using phenotypic and molecular methods. To our knowledge, this is the first report of isolation and identification of this species from Asia, which may provide further evidence of the clinical relevance of this newly characterized species.Case 1: A 48-year-old man with a history of human immunodeficiency virus (HIV) infection and intravenous drug use was admitted to hospital because of high temperature and cough. HIV infection had been diagnosed 1 year prior to admission when he presented with fever, weight loss, cough, dyspnea, and chest pain. His CD4 lymphocyte count was 18 cells/mm 3 .Upon admission, he appeared severely ill, with a productive cough and fever of 39.69 C. His tuberculin test was negative. Other laboratory testing revealed lymphopenia, an elevated C-reactive protein level of 33 mg/l, an erythrocyte sedimentation rate of 48 mm/h, and an HIV viral load of 300 copies/ml. He was negative for hepatitis B virus and hepatitis C virus antigens. Direct smear examination of sputum revealed the presence of acid-fast bacilli (AFB), and sputum culture revealed the formation of slow-growing colonies on L äowenstein-Jensen (LJ) medium after 2 weeks' incubation at 379 C. Based on these laboratory results and the clinical findings, the patient was administered antimycobacterial therapy.After 3 months, the patient was referred back to our hospital because of fever and cough. He reported taking his anti-mycobacterial medications for only 2 weeks after he was discharged from hospital. A second sputum examination was positive for AFB, and as with the previous laboratory tests, slow-growing colonies were observed on LJ medium.The initial and subsequent isolates were respectively designated as AFP-0001 and AFP-0002. These isolates were submitted to our laboratory for identification and antimicrobial susceptibility testing. The morphology of the colonies, their pigment production, and the niacin test led to presumptive identification as non-tuberculosis Mycobacterium sp. Therefore, the patient was treated with amikacin (15 mg/kg body weight/day), and he made a good recovery and improved markedly.Case 2: Strain AFP-0008 was isolated in 2009 in pure culture from 3 different sputum samples from a 13-yearold Iranian girl with chronic pulmonary disease. She had a history of weight loss, persistent cough, and repeated lung and sinus infections, and had been diagnosed with cystic fibrosis from the ident...

Molecular identification of non-tuberculous mycobacteria isolated from clinical specimens in Zambia

“…M. flavescens has been isolated from the synovial fluid of an AIDS patient [ 34 ], whereas M. bouchedurhonense and M. chimaera have been documented in some respiratory tract infections [ 35 ]. M. europaeum was isolated from the sputum samples of an Iranian human immunodeficiency virus-infected patient and a cystic fibrosis patient with chronic pulmonary disease [ 36 ] while M. nonchromogenicum has been associated with sarcoidosis [ 37 ].…”

Microbiological Features and Clinical Relevance of New Species of the Genus Mycobacterium

“…Two further cases of lung disease have been reported, concerning an HIV-positive subject and a patient with cystic fibrosis. The former was cured with amikacin, while the latter underwent an antituberculosis regimen (85).…”

Respiratory tract isolation of Mycobacterium europaeum following influenza infection in an immunocompromised patient: a case report

“…Three of the five seminal strains have been isolated from sputum. Of interest, two Iranian patients [ 2 ] with a history of acquired immunodeficiency syndrome and cystic fibrosis fulfilled the ATS/IDSA criteria for NTM pulmonary infection [ 3 ]. Here, clinical, radiological and microbiological findings classified this case as a colonized case [ 3 ].…”

“…Here, one M. europaeum isolate was made from broth culture whereas the eight previous isolates have been made from agar or egg-based solid medium [ 1 , 2 ], illustrating the capability of automatons routinely used in laboratories, to detect the growth of M. europaeum . Starting from colonies, this isolate was identified by MALDI-TOF-MS and its profile made freely available at Méditerranée Infection Foundation URMS Database [ 6 ] in order to complement the sole profile ( M. europaeum DSM 45397 T ) commercially available.…”

“…Mycobacterium europaeum , a slow-growing nontuberculous mycobacteria (NTM) belonging to the Mycobacterium simiae complex, was described after the seminal characterization of five isolates collected from three sputum specimens and a jaw gland biopsy in Italy, Greece and Sweden [ 1 ]. Five respiratory tract isolates were further reported in Iran [ 2 ] from two different infected patients according to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA criteria for NTM lung disease [ 3 ]. In fact, ATS/IDSA criteria for NTM lung infection combine clinical pulmonary criteria, new radiological opacities, and, positive culture results from several respiratory tract samples [ 3 ].…”