Mycobacterium Abscessus One such infection, which is becoming more common worldwide among those with cystic fibrosis, is Mycobacterium abscessus, a bacterium found in soil and water which is distantly related to Mycobacterium tuberculosis, which causes tuberculosis. Here we report a case of injection abscesses due to an atypical mycobacterium, Mycobacterium chelonae . Background. A definitive diagnosis of Mycobacterium abscesses can often be made by culturing pus from an infected boil, or by examining a biopsy sample of infected skin. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780128012383001379, URL: https://www.sciencedirect.com/science/article/pii/B9780444642172000051, URL: https://www.sciencedirect.com/science/article/pii/B9780444537171011987, URL: https://www.sciencedirect.com/science/article/pii/B9780323448871000304, URL: https://www.sciencedirect.com/science/article/pii/B9781437701265000240, URL: https://www.sciencedirect.com/science/article/pii/B9780124157835000207, URL: https://www.sciencedirect.com/science/article/pii/S037860801830014X, URL: https://www.sciencedirect.com/science/article/pii/B9780444634078000265, URL: https://www.sciencedirect.com/science/article/pii/B9780323445856000217, URL: https://www.sciencedirect.com/science/article/pii/B9781455748013000734, Infections in Systemic Autoimmune Diseases: Risk Factors and Management, Meyler's Side Effects of Drugs (Sixteenth Edition), Stacey L. Martiniano MD, ... Charles L. Daley MD, in, Kendig's Disorders of the Respiratory Tract in Children (Ninth Edition), Nontuberculous Mycobacterial Skin Infections, Challenges in Clinical Microbiology Testing, Accurate Results in the Clinical Laboratory, A Worldwide Yearly Survey of New Data in Adverse Drug Reactions, Meenakshi R. Ramanathan, ... James M. Sanders, in, A worldwide yearly survey of new data in adverse drug reactions, Anna M. Stagner, ... Norman C. Charles, in, Diagnostic Pathology of Infectious Disease (Second Edition), Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), Diagnostic Microbiology and Infectious Disease. The RGM make up Runyon's group IV: They produce colonies on subculture in 7 days or less. The rapidly growing mycobacteria (RGM)—Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum—are increasingly recognized causes of skin infections. Infections with Mycobacterium abscessus can often cause serious symptoms. Infections with Mycobacterium abscessus can often cause serious symptoms. Whether a macrolide should be included in the regimen for M. abscessus or M. bolletii is debatable given the presence of an erm41 gene in most strains. Two patients with disseminated Mycobacterium abscessus infections who took linezolid for at least 9 months developed cytopenias and one also developed a peripheral neuropathy [102]. We use cookies to help provide and enhance our service and tailor content and ads. One such infection, which is becoming more common worldwide among those with cystic fibrosis, is Mycobacterium abscessus, a bacterium found in soil and water which is distantly related to Mycobacterium tuberculosis, which causes tuberculosis. While antibiotics are usually necessary to combat Mycobacterium abscessus infection, treatment can also involve cleaning pus from infected boils and even surgically excising infected tissue. This bacterium has global distribution, being found in numerous niches. In both patients the cytopenia resolved after administration of vitamin B6 and stabilized during prolonged linezolid therapy, although the peripheral neuropathy did not. Studies in CF98 and non-CF99–101 patients have clearly demonstrated that culture conversion is much more likely to occur in patients infected with M. massiliense compared with M. abscessus.98 These differences are presumably related to the presence of a functional erm41 gene in M. abscessus that results in inducible macrolide resistance, whereas in M. massiliense the gene is nonfunctional.99. Mycobacterium abscessus is a nonchromogenic and rapidly growing mycobacteria that is found in the environment. However, we need to look for other organisms that can cause problems so that appropriate treatment can be given. It usually spreads through direct physical contact with contaminated areas, rather than through person-to-person contact. The diagnosis of infection with Mycobacterium abscessus was established by correlation between dermatological and histopathological aspects, culture and molecular biology techniques. The infected area may be warm. The M abscessus complex is most pathogenic and comprises 3 subspecies, M abscessus subsp abscessus, M abscessus subsp bolletii, and M abscessus subsp massiliense. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of … Patients that already have a respiratory disease, such as cystic fibrosis or tuberculosis, are more susceptible to infection. When the specific medication causing a side effect was known, it was most com- As described previously, MABSC can be divided into three subspecies: M. abscessus, M. massiliense, and M. bolletii. Six cases involved Mycobacterium abscessus, two were Mycobacterium fortuitum and one Mycobacterium chelonae. 1 2 The incidence of infections caused by nontuberculous mycobacteria has increased significantly, 3–5 while the incidence of M. chelonae remains unknown. For the best chance of pulmonary disease cure, guidelines from the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) recommend multidrug macrolide-based therapy based on susceptibility testing … 4 Mycobacterium chelonae/abscessus skin infections are commonly associated with penetrating injury or surgery. abscessus, M. abscessus subsp. Summary Mycobacterium abscessus complex skin infections are concerning due to difficult diagnosis, burdensome treatment, drug resistance, and high cost of management. Meenakshi R. Ramanathan, ... James M. Sanders, in Side Effects of Drugs Annual, 2018. All but two cases involved exit-site infections, however the remaining two cases developed peritonitis with M. abscessus as the causative organism [15c]. DOI: 10.1159/000324766 Corpus ID: 16105781. CFZ therapy often results in gastrointestinal AEs along with skin and fluid discoloration. It is commonly associated with contaminated traumatic skin wounds and with post‐surgical soft tissue infections. Copyright © 2021 Elsevier B.V. or its licensors or contributors. When the specific medication causing a side effect was known, it was most com- Examples of RGM include M. abscessus, M. fortuitum and M. chelonae. These organisms can grow rapidly enough that they are recovered in routine culture. Kevin L. Winthrop, Emilie Emilie Roy, in Handbook of Systemic Autoimmune Diseases, 2020. Cutaneous Mycobacterium abscessus Infection Associated with Mesotherapy Injection @article{Wongkitisophon2011CutaneousMA, title={Cutaneous Mycobacterium abscessus Infection Associated with Mesotherapy Injection}, author={Pranee Wongkitisophon and P. Rattanakaemakorn and Somsak Tanrattanakorn and V. … haemophilum, are also more frequently associated with skin disease [3†, It usually causes nosocomial infection of the skin and soft tissues. Objective To compare the demographics, clinical features, susceptibility patterns, and treatment for skin and soft tissue infections due to Mycobacterium fortuitum and Mycobacterium chelonae or Mycobacterium abscessus.. Design Retrospective medical record review.. M. chelonae causes mostly skin and soft tissue disease in immunocompromised persons or in nosocomial infection of surgical wounds. However, 55.6% were due to M. abscessus and associated with a sharper decline in FEV1. Bechara C, Macheras E, Heym B, Pages A, Auffret N. Mycobacterium abscessus skin infection after tattooing: first case report and review of the literature. Infected persons are, however, generally advised to keep the infection site clean and wash their hands frequently, to avoid bacterial contamination of the environment. Mycobacterium abscessus symptoms. Mycobacterim abscessus infection is generally spread through contact with contaminated soil, water, or objects. In some cases, patients must be treated with intermittent courses of intravenous antibiotics to control spread of the infection. Abstract. Patients All patients seen at our institution with a positive culture for M … Acid-fast bacteria are seen in small clusters within the stroma (Fig. The rapidly growing mycobacteria commonly isolated from specimens such as blood, sputum, or tissues (e.g., Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum) may be misidentified as diphtheroids. This bacterium has global distribution, being found in numerous niches. Most common were nausea/vomiting (n = 17, 31%) and skin changes (n = 11, 20%) (Table 2). The rapidly growing mycobacteria (RGM)—Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum—are increasingly recognized causes of skin infections. bolletii, and M. abscessus subsp. Although M. abscessus complex most commonly causes chronic lung infection and skin and soft tissue infection (SSTI), the complex can also cause infection in almost all human organs, … In April 2008, we identified and investigated an outbreak of M. abscessus skin and soft tissue By continuing you agree to the use of cookies. Mycobacterium Abscessus. M. abscessus is the most common RGM isolated in human NTM infections. These are aerobic and non-motile bacteria which are acid fast. Drage LA, Ecker PM, Orenstein R, et al. Because continuing linezolid therapy was required, oral vitamin B6 50 mg/day was administered in an attempt to mitigate the cytopenia. Clofazimine (CFZ) demonstrates activity against multiple Mycobacterium species; therefore is utilized for the treatment of nontubercular mycobacterium (e.g., Mycobacterium abscessus), TB and leprosy [21R]. M. abscessus infection is commonly found to cause pulmonary disease, but M. abscessus can also cause skin, soft tissue, and central nervous system infection (Lee, 2015). The frequency of published reports of infection by rapidly growing mycobacteria associated with tattooing procedures has increased in recent years. A 41-year-old woman who was allergic to oxazolidinones was successfully desensitized with oral administration of an intravenous formulation of linezolid [103]. This article reviews the dermatologic manifestations of Mycobacterium avium-intracellulare (MAI, or MAC) infection.. MAI is an opportunistic pathogen that usually causes disease in the weakened immune system. Mycobacterium abscessus is one of the most pathogenic and drug-resistant opportunistic microorganisms among the nontuberculous mycobacteria (NTM) involved in skin and soft tissue infections (SSTI) associated with cosmetic surgical procedures. chelonae and M. abscessus were formerly considered the same organism, but in 1992 they were reclassified as independent species. The M abscessus complex is most pathogenic and comprises 3 subspecies, M abscessus subsp abscessus, M abscessus subsp bolletii, and M abscessus subsp massiliense. A curative therapy may include surgical resection of focal (lung) involvements and/or a combined multidrug therapy with macrolides and amikacin, cefoxitin, or imipenem. A comparison of CFZ containing MDR-TB regimens against pyrazinamide (PZA) containing regimens found that CFZ regimens resulted in more hyperpigmentation and less arthralgia. Stacey L. Martiniano MD, ... Charles L. Daley MD, in Kendig's Disorders of the Respiratory Tract in Children (Ninth Edition), 2019, Treatment of pulmonary disease due to MABSC is complicated because of significant levels of in vitro resistance, the need for intravenous antibiotics, common adverse reactions, and generally poor treatment outcomes. Overall, 88% of the patients reported AEs with a median of 4 AEs. They may not be recognized as acid-fast organisms because they stain quite well with a Gram stain, and they may not always exhibit branching or beaded morphologies associated with rapid growers. The bacterial infection caused by Mycobacterium abscessus usually causes skin symptoms, including redness, swelling, and pain. Treatment of Mycobacterium abscessus Infection Side effects were common; 74 side effects were docu-mented among 34 (62%) of 55 patients who received treat-ment. Antibiotics can be prescribed to treat this infection, but are often effective only after prolonged use. RGM are primarily implicated in a broad spectrum of cosmetic and surgical procedures, including breast, cardiothoracic, and dermatologic surgery; mesotherapy; pedicures; and tattooing. They are primarily abscesses, nodules, papules, or plaques; the nodules, papules, or plaques may be erythematous or violaceous in color, and some may be scaling or draining purulent material (Figure 24-4). Interestingly, a study that included more than 27,000 patients detected NTM in 20% of cases (64% MAC and 36% M. abscessus), and chronic azithromycin use was less likely to be associated with NTM culture positivity.131 Despite this, it is still important to screen patients for NTM to help avoid drug resistance to azithromycin. The most commonly implicated pathogens belong to Runyon Group IV and include Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium fortuitum, and Mycobacterium smegmatis, which are characterized by their rapid growth and lack of pigmentation. Human infections are relatively uncommon, but an increase in the number of reported cases has been identified among immunocompromised persons. Skin infected with mycobacterium abscessus is usually red, warm, tender to the touch, swollen, and/or painful. Subspecies of M. chelonae; Found in water, soil, dust, animals; Rarely causes illness in humans but can be difficult to diagnose and treat; Can cause skin infection after puncture wounds, tattoos, skin trauma or surgery; May cause lung infection and disseminated infection in immunosuppressed people; Mycobacterium abscessus However, if this cannot be determined, or there is a potential benefit from the immunomodulatory activity of the macrolide, then the drug should be given. The safety of CFZ was reviewed in a cohort of 112 adult and pediatric patients, including cystic fibrosis patients. It is most known for being notoriously drug resistant and thus very difficult to treat, although it tends to be slightly less virulent than MAC. Mycobacterium abscessus complex (MABSC) is a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria (NTM) species that are common soil and water contaminants. Overall, the CFZ containing regimens caused hyperpigmentation, arthralgia, and gastrointestinal intolerance; however, this was confounded by multiple other drugs within the regimen [24C]. It can be commonly recovered from drinking water or soil and is the most pathogenic and chemotherapy-resistant rapidly growing mycobacterium. Skin infected with mycobacterium abscessus is usually red, warm, tender to the touch, swollen, and/or painful. It is a well-documented cause of pulmonary infection in patients with structural lung disease such as cystic fibrosis, and can cause skin and soft tissue infections in hospitalised post-surgical … The American Thoracic Society (ATS), Infectious Diseases Society of America (IDSA), and several case reports imply that like M. marinum, RGM may be ubiquitous, perhaps particularly in water, and may be transmitted to the host through breaks in colonized or contaminated skin. Current therapeutic guidelines for the infection … Most were identified as Mycobacterium avium complex (MAC, 72%) followed by Mycobacterium abscessus (16%).129 Risk factors associated with NTM included older age, geographic location (higher incidence in Southwest compared with Northeast), and milder lung disease based on FEV1, as well as a relatively higher association in those patients infected with S. aureus as compared with those infected with PA. Esther and colleagues130 reviewed 4862 CF culture data from patients older than 8 years and also found an 11% NTM prevalence rate. However, specific to the disease is the appearance of enlarged and opacified corneal nerves, resulting in corneal anesthesia and neurotrophic keratopathy, as also seen in herpetic disease.40 Finally, limbal masses can form, resembling fibrous histiocytoma. Infectious involvement of the cornea by Mycobacterium leprae can manifest with nonspecific findings, such as fibrovascular pannus formation and interstitial keratitis. This bacterium has global distribution, being found in numerous niches. However, atypical mycobacterial infections (most commonly Mycobacterium chelonae, followed by Mycobacterium abscessus)38 have been reported in a number of post-refractive surgery eyes (especially after laser-assisted in situ keratomileusis [LASIK]) and are the most common cause of infectious keratitis following LASIK in some series.39 The clinical appearance may resemble crystalline keratopathy (discussed previously). DOI: 10.1159/000324766 Corpus ID: 16105781. Its presence in pulmonary specimens usually represents either laboratory contamination or nonpathogenic colonization. The RGM make up Runyon's group IV: They produce colonies on subculture in 7 days or less. Mycobacterium abscessus (M. abscessus) is a non-tuberculous mycobacterium widely present in the natural environment and is now being increasingly identified as a cause of human disease. As noted previously, azithromycin is preferred over clarithromycin and there is some evidence to suggest it is associated with better treatment outcomes in non-CF adults.101 The duration of the intensive phase will be determined by the severity of disease, the response to therapy, and the tolerability of the regimen. Mycobacterium abscessus symptoms. Cutaneous infections by this complex show a heterogeneous clinical presentation with varied histopathologic findings. C. Gutierrez, A. Somoskovi, in Reference Module in Biomedical Sciences, 2014. Their geographic distribution has not been completely described; RGM-borne cutaneous disease has been reported throughout the world. While an increased risk of mycobacterial infection has been observed in individuals with inborn errors within the IL12/23 pathway, the risk of tuberculosis infection with ustekinumab appears to be lower than for patients exposed to anti-TNF agents. These lesions may be asymptomatic or pruritic, tender, or both. Mycobacterium abscessus. Recent reports cite the transmissibility of M. abscessus among CF patients at care centers in the United States and United Kingdom.132,133 Gross and colleagues134 at Tripler Army Medical Center Hospital (Hawaii) described an outbreak among a large portion of their CF cohort. Atypical mycobacteria are classified into Runyon groups I-IV (Table 1). More generalized symptoms can include feelings of malaise, chills, fever, and muscle aches. Nontuberculous mycobacterial infections are increasingly a concern in patients requiring long-term or repeated antimicrobials. M. fortuitum is the most common RGM causing extrapulmonary infections. Certain members of the M. abscessus complex such as M. abscessus subsp. A 6-year-old child treated for XDR-TB spondylodiscitis with moxifloxacin + CFZ + linezolid (LNZ) + isoniazid (INH) + amoxicillin-clavulanate + para-aminosalicylic acid + capreomycin reported no adverse drug events following 18 months of treatment [25A]. Most common were nausea/vomiting (n = 17, 31%) and skin changes (n = 11, 20%) (Table 2). Mycobacterium abscessus (M. abscessus) is a non-tuberculous mycobacterium widely present in the natural environment and is now being increasingly identified as a cause of human disease. Mycobacterium Abscessus Infection is known commonly to be the cause of chronic lung infection and skin and soft tissue infections (SSTI), but can also cause infection to most human organs when one’s immune system does not have the ability to combat the bacteria/virus (immunodeficiency). It is also one of the mycobacteria that are most often isolated from cystic fibrosis patients. 2. chelonae [3†]. [] Although the prevalence of MAI infection has increased following the epidemic of acquired immunodeficiency syndrome (AIDS), MAI infection remains a rare cause of skin … M. abscessus: Mycobacterium abscessus complex is a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria. However, NTM infection is often wrongly diagnosed initially causing prolonged suffering. Diagnosing skin and soft tissue infections due to rapidly growing mycobacteria (RGM) can often prove difficult, leading to delays in treatment. Mycobacterium abscessus skin infection after tattooing: first case report and review of the literature. 1. Lesions present as firm, painless, subcutaneous nodules that gradually enlarge and suppurate, then form ulcers and sinus tracts in overlying skin. Prevention of cutaneous infection around the site of peritoneal dialysis catheter exit site with long-term topical gentamicin was associated with nine cases of rapidly growing nontuberculous mycobacterial infections. Outbreaks of cutaneous infections secondary to M. abscessus have been well-described, following surgical procedures or environmental exposures. It is one of the most clinically relevant, rapidly growing mycobacteria, which are environmental organisms that usually grow in culture within 1 week. Although outbreaks of Mycobacterium abscessus infection have been reported, none of these reports has identified the potential sources of infection and modes of transmission.