Spinal infection by Mycobacterium xenopi in a non-immunosuppressed patient

Rahman, Mohammed Abdel; Phongsathorn, Virach; Hughes, Thomas D; Bielawska, C

doi:10.1016/0962-8479(92)90047-n

Cited by 15 publications

(6 citation statements)

References 13 publications

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“… / Left shoulder pain and notalgia(2 m) ESR:31 mm/h / / without granuloma / 7 W I, CCR, C(9 m) No Clinical and radiographic improvement [ 11 ] 70/F T3/4 / Hypertensie cardiovascular disease; II diabetes mellitus; Radical left mastectomy Back pain; weakness of both legs(6w) WBC:5700/mm − / Granuloma − / R, P, I(4 m) R, P, I, CCR, E(4 m) P, I, CCR, E(4 m) Continue the 3 program for a total of 2 years. Yes Radiographic improvement No clinical change Radiographic improvement4.no record [ 12 ] 46//F T8/9 SLE(15); prednisolone (10 mg daily) pyelonephritis of the right kidney,mitral valve insufficiency and aphasia Skelasthenia, walking disorder and notalgia(10 m) ESR: 27 mm/h; CRP:49.7 mg/L / − Granuloma − 37d E, Rfb, A(5 m) Yes Clinical and radiographic improvement [ 13 ] 77/F L1/2 Her husband had tuberculosis 40 years previously. hypertension lower back pain radiating to the right buttock.…”

Section: Resultsmentioning

confidence: 99%

Mycobacterium xenopi related spine infections: A case report and systematic literature review

Peng

et al. 2023

One Health

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Section: Resultsmentioning

confidence: 99%

Mycobacterium xenopi related spine infections: A case report and systematic literature review

Peng

et al. 2023

One Health

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“…xenopi vertebral infections have been described after discovertebral surgery, induced by contact with contaminated surgical instruments (2). In the absence of surgery, vertebral osteomyelitis has been reported for five non-HIV-infected patients and recently for one HIV-infected patient (3,7,10,12,14,15). Clinical presentation is rather similar to that of M. tuberculosis vertebral infections, but clinical progression seems slower with M. xenopi infection.…”

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confidence: 78%

Spondylitis Due to Mycobacterium xenopi in a Human Immunodeficiency Virus Type 1-Infected Patient: Case Report and Review of the Literature

Meybeck¹,

Fortin²,

Abgrall³

et al. 2005

J Clin Microbiol

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Nontuberculous mycobacterial infections are well known to occur in patients with human immunodeficiency virus infection. However, spondylitis due to mycobacteria other than Mycobacterium tuberculosis is uncommon. We report a case of biopsy-and culture-proven Mycobacterium xenopi spondylitis in an AIDS patient and discuss approaches to diagnosis and therapy. This case serves to highlight the potential pathogenic role of this usually environmental commensal organism in severely immunosuppressed AIDS patients and uncertainties in their management, given the scarce data on appropriate therapy for this organism. CASE REPORTA 42-year-old man was diagnosed with AIDS in 1998 when he presented with Pneumocystis carinii pneumonia. Over the next few years, he developed several other opportunistic infections, as he was not adherent to antiretroviral therapy. In August 2003, he was admitted for cellulitis on the right side of his face. On admission, neurological examination found static cerebellar syndrome associated with kinetic gait instability. No sensory or motor deficit was found. The rest of the physical results were normal. Laboratory studies revealed normal full blood count, except for lymphopenia. The CD4 T-lymphocyte count was 41/mm 3 . Renal function and hepatic biology were within the normal limits. Three blood cultures were negative. Cerebral computed tomography (CT) scan showed several bilateral cortical hypodensities of frontal and temporal regions without enhancing after contrast product injection. Cerebral magnetic resonance imaging (MRI) revealed T2-weighed images without enhancing after gadolinium injection in the same areas. Cerebrospinal fluid showed 1 white blood cell as well as a protein level of 0.62 g/liter and a glucose level of 3 mmol/liter (serum level, 5.8 mmol/liter), and cultures were negative. The patient received intravenous oxacillin and needed surgical drainage for a facial soft-tissue abscess. Oxacillin was continued for 10 days. A presumptive standard treatment regimen against Toxoplasma gondii encephalitis was started, considering neurological signs and intracerebral abnormalities during CT scan and MRI. Progress was satisfactory at first, but after 2 weeks our patient developed sudden flaccid paralysis of both legs with a T8 sensory level. MRI of the spine revealed signs of spondylitis at the T7 to T8 level, with a locally compressing epidural mass and an anterolateral paraspinal soft-tissue-associated inflammatory process. Transoesophageal echocardiography showed no signs of endocarditis. A CT-guided vertebral biopsy was performed. Gram and acid-fast stains showed no organism, and standard bacterial cultures were negative after 48 h. Histology of the specimen showed nonspecific inflammation. Supposing that Staphylococcus aureus could be responsible for T7 to T8 spondylitis given the recent history of facial cellulitis, rifampin (600 mg twice a day) and ofloxacin (400 mg twice a day) were started after oxacillin was discontinued. Retrospective studies with chest X-rays taken 2 months ea...

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“…11 The difficulties in isolating the organism and recommendations for improving culture techniques have been reported in the literature. 12,13 Increasingly, rRNA nucleic acid probe testing for M. xenopi is performed to confirm the diagnosis. 14 The American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) guidelines for the diagnosis of NTM lung disease include clinical, radiological and microbiological criteria.…”

Section: Introductionmentioning

confidence: 99%

Mycobacterium xenopi osteomyelitis of the spine: a case report

2021

SA orthop. j.

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BACKGROUND: Mycobacterium xenopi (M. xenopi) osteomyelitis is an uncommon infection which is found in immunosuppressed patients. It is reported to be a slow-growing, nonchromogenic or scotochromogenic nontuberculous mycobacterium. The lungs constitute the most common site for infection and extrapulmonary manifestations, and disseminated forms of the disease are rare. Only a few cases of spontaneous spinal involvement have been reported. We report a case of M. xenopi vertebral osteomyelitis of the spine PATIENT AND METHODS: A 41-year-old female patient, HIV reactive on antiretroviral therapy with a low CD4 count of 183 cells/mm3, presented with clinical and radiological features in keeping with thoracic spinal tuberculosis, complicated with thoracic myelopathy. She was managed surgically with costo-transversectomy and drainage of the paraspinal cold abscess. The Ziehl-Neelsen staining was negative for acid-fast bacilli. However, the histology result revealed a necrotising granulomatous inflammation. A delayed result of polymerase chain reaction (PCR)/line probe assay for Mycobacterium genus testing revealed the presence of M. xenopi, as the cause for the spine osteomyelitis and thoracic myelopathy. However, no M. xenopi susceptibility testing, and no specific photoreactivity techniques for strain identification, were performed. Anti-tuberculosis therapy (ATT) consisting of a two-month initiation phase using rifampicin, isoniazid, ethambutol and pyrazinamide, followed by a seven-month continuation phase using rifampicin and isoniazid, was initiated according to national guidelines. She was fitted with a thoraco-lumbar-sacral orthosis, and underwent a spinal rehabilitation programme. Upon receipt of the PCR result, and considering the good clinical and radiological response to ATT, a consensus was reached with the Infectious Disease Unit (IDU) to continue with ATT until 18 months due to the atypical nature of the pathogen. RESULTS: The patient was successfully treated with the standard TB regimen, but for a period of 18 months, and made full clinical neurological recovery, without any back pain. Furthermore, her CD4 count had also improved to 707 cells/mm3 with a viral load reported lower than 1 000 copies/ml CONCLUSION: This case report emphasises the importance of biopsy in suspected spinal tuberculosis and highlights the concerns with laboratory testing and the prognostic and therapeutic implications of a positive strain identification Level of evidence: Level 5 Keywords: Mycobacterium xenopi osteomyelitis, tuberculosis, anti-tuberculosis treatment

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Spinal infection by Mycobacterium xenopi in a non-immunosuppressed patient

Cited by 15 publications

References 13 publications

Mycobacterium xenopi related spine infections: A case report and systematic literature review

Mycobacterium xenopi related spine infections: A case report and systematic literature review

Spondylitis Due to Mycobacterium xenopi in a Human Immunodeficiency Virus Type 1-Infected Patient: Case Report and Review of the Literature

Mycobacterium xenopi osteomyelitis of the spine: a case report

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