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Introducción: la micobacteria no terberculosa (NTM) forma un grupo heterogéneo de microorganismos que pueden causar infección en humanos. Las micobacterias no pigmentadas de rápido crecimiento (MNPCR) son de interés clínico debido al creciente número de pacientes infectados por ellos y a la dificultad del tratamiento. Dentro de este grupo, Mycobacterium fortuitum, Mycobacterium abscessus y Mycobacterium chelonae son reconocidos como patógenos potenciales; estas especies se han aislado de infecciones pulmonares y extrapulmonares. Objetivo: el objetivo de este trabajo es encontrar la frecuencia de aislamiento de especies micobacterianas de rápido crecimiento, específicamente el complejo Mycobacterium fortuitum, de muestras clínicas utilizando la técnica molecular de diagnóstico GenoType Mycobacterium CM. Material y Método: se analizaron 249 aislados de micobacterias no tuberculosas obtenidas de muestras pulmonares y extrapulmonares de pacientes sintomáticos en el período enero 2018-diciembre de 2022. La técnica molecular GenoType Mycobacterium CM se utilizó para identificar la especie. Resultados: Se obtuvieron 77 (3,9%) aislados de especies no pigmentadas de rápido crecimiento, estas se identificaron en orden decreciente: Mycobacterium fortuitum 65 (84,41%), Mycobacterium abcessus 9 (11,68%) y Mycobacterium chelonae 3 (4%). Conclusiones: los resultados reafirman que el complejo Mycobacterium fortuitum es responsable de la mayoría de las infecciones causadas por la micobacteria en rápido crecimiento en humanos. La técnica diagnóstica GenoType Mycobacterium CM es una herramienta útil para la rápida identificación de micobacterias; proporciona resultados precisos en menos tiempo, acortando significativamente el tiempo diagnóstico, permite la aplicación temprana de tratamiento específico, evitando así la propagación de la infección.
Introduction: non-tuberculous mycobacteria (NTM) form a heterogeneous group of mi-croorganisms that can cause infection in humans. Fast-growing non-pigmented my-cobacteria (MNPCR) are of clinical interest due to the increasing number of patients infected by them and the difficulty of treatment. Within this group, Mycobacterium fortuitum, Mycobacterium abscessus and Mycobacterium chelonae are recognized as potential pathogens; these species have been isolated from both pulmonary and ex-trapulmonary infections. Objective: the objective of this work is to find the frequency of isolation of fast-growing non-pigmented mycobacterial species, specifically the Myco-bacterium fortuitum complex, from clinical samples using the GenoType® Mycobacteri-um CM diagnostic molecular technique. Material and Method: 249 isolates of non-tu-berculous mycobacteria obtained from pulmonary and extrapulmonary samples from symptomatic patients in the period January 2018-December 2022 were analyzed. The G e n oTy p e® Mycobacterium CM molecular technique was used to identify the species. Results: 77 (30.9%) isolates of fast-growing non-pigmented species were obtained, these were identified in decreasing order: Mycobacterium fortuitum 65 (84.41%), Myco-bacterium abcessus 9 (11.68%) and Mycobacterium chelonae 3 (4%). Conclusions: the results reaffirm that the Mycobacterium fortuitum complex is responsible for most in-fections caused by fast-growing mycobacteria in humans. The GenoType® Mycobacte-riumCM diagnostic technique is a useful tool for the rapid identification of mycobacte-ria; it provides accurate results in less time, significantly shortening the diagnostic time, it allows the early application of specific treatment, thus avoiding the spread of infec-tion.
Assuntos
Humanos , Micobactérias não Tuberculosas/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Terapêutica , Técnicas de Diagnóstico Molecular/métodosRESUMO
Mycobacterium fortuitum is associated with skin and soft-tissue infections, yet isolated liver involvement is rare. A 67-year-old asymptomatic man was referred for endoscopic ultrasound (EUS) to evaluate a gastric lesion and an incidental liver mass. EUS revealed a heterogeneous liver mass that was sampled. Pathology revealed necrotic granulomatous inflammation and positive acid-fast bacilli stain with M. fortuitum deoxyribonucleic acid. Levofloxacin plus trimethoprim and sulfamethoxazole for 3 months were used for complete resolution of liver lesion. Isolated nontuberculous liver involvement is uncommon. We report the first case of a liver mass caused by M. fortuitum diagnosed by EUS-fine needle aspiration.
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Background: Rapidly growing mycobacteria (RGM) are a group of nontuberculous mycobacteria (NTM) implicated in difficult-to-treat pulmonary and extrapulmonary diseases, possibly associated with invasive procedures and failures in sterilization of materials and equipment. Methods: We report our experience with the laboratory identification of RGM in a routine work and give an overview of the RGM isolated in our setting. Laboratorial data from all RGM mycobacterial isolates received at Adolfo Lutz Institute of São José do Rio Preto were analyzed from January 2000 to December 2015. Results: Five hundred and seventy-nine isolates were identified with NTM, of which 193 were RGM, which affected 113 patients. Among the 113 patients, the female gender was more frequent (55%) and the average age was 50 years. Pulmonary samples were the most frequent (79%), and 54.9% of the cases were isolated from sputum. Twelve different species were found and the most identified were group Mycobacterium abscessus and Mycobacterium fortuitum, making up 77.9% of all identified RGM. The most frequent comorbidities were smoking (n = 21), alcoholism (n = 12), and human immunodeficiency virus (n = 16). Drug susceptibility test was performed for nine patients and all showed susceptibility to amikacin and seven resistances to doxycycline. Conclusions: This study showed the experience of mycobacterial diagnosis in a routine laboratory, revealing that failure to meet the bacteriological criteria generates losses in the establishment of cases of RGM and consequently its correct treatment.
Assuntos
Infecções por Mycobacterium não Tuberculosas , Mycobacterium , Antibacterianos/farmacologia , Brasil , Feminino , Humanos , Laboratórios , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Nigéria , Micobactérias não TuberculosasRESUMO
El aumento de las infecciones por micobacterias ambientales u oportunistas (MAO) coincide mundialmente con el declive de la infección tuberculosa e incremento de la infección por el virus de inmunodeficiencia humana (VIH). El presente trabajo es un estudio retrospectivo realizado en el Laboratorio Nacional de Referencia-Investigaciones de Tuberculosis/Micobacterias/Lepra (LNRI-TB/Lepra/Micobacterias), del Instituto de Medicina Tropical Pedro Kourí (IPK), La Habana, Cuba, durante el período enero 2014-diciembre 2018. El objetivo de nuestro estudio fue conocer la variabilidad de especies aisladas para establecer un referente actualizado sobre las infecciones causadas por estas. En este trabajo se clasificaron-identificaron 413 cepas procedentes de pacientes sintomáticos; 162 (39.22%) eran aislamientos de pacientes con VIH/sida atendidos en nuestro Hospital Nacional de Referencia a Atención al paciente VIH/sida (IPK), y el resto (n = 251 [60.77%]), procedentes de pacientes inmunocompetentes, incluyendo aislamientos recibidos de los Centros Provinciales de Higiene, Epidemiología, y Microbiología (CPHEM). Las muestras fueron analizadas con las técnicas convencionales establecidas: las pulmonares fueron descontaminadas por el método de Petroff modificado; las extrapulmonares, por el método del ácido sulfúrico al 4%; el cultivo se realizó en medio de Löwenstein-Jensen modificado. Posteriormente se realizó la clasificación-identificación de especies según el esquema fenotípico-bioquímico establecido. Las especies con mayor porcentaje de aislamiento pertenecieron a los Grupos III y IV, complejo Mycobacterium avium-intracellulare (34.14%) y complejo M. fortuitum (20.82%), respectivamente. Estos resultados permitirán conocer la prevalencia de estas especies en nuestro país, reafirmando la importancia diagnóstica de estos microorganismos para aplicar tratamiento específico, sobre todo en pacientes con factores de riesgo, en quienes es más probable la diseminación de la infección.
The increase in infections by environmental or opportunistic mycobacteria (MAO) coincides worldwide with the decline in tuberculosis infection and an increase in infection by the human immunodeficiency virus (HIV). The present work is a retrospective study carried out at the National Reference Laboratory-Tuberculosis/Mycobacterial/Leprosy Research (LNRI-TB / Leprosy / Mycobacteria), of the Pedro Kourí Institute of Tropical Medicine (IPK), La Habana, Cuba, during the period January 2014-December 2018. The objective of our study was to know the variability of isolated species to establish an updated reference on the infections caused by MAO. In this study, 413 strains from symptomatic patients were classified and identified; 162 (39.22%) were isolates from patients with HIV/AIDS treated at our National Hospital of Reference for Attention to HIV/AIDS patients (IPK), and the remaining (n=251 [60.77%]), from immunocompetent patients, including isolates received from the Provincial Centers of Hygiene, Epidemiology, and Microbiology (CPHEM). The samples were analyzed with the established conventional techniques: the lung samples were decontaminated by the modified Petroff method; the extrapulmonary, by the 4% sulfuric acid method; the culture was carried out in modified Löwenstein-Jensen medium. Subsequently, the classification-identification of species was carried out according to the established phenotypic-biochemical scheme. The species with the highest percentage of isolation belonged to Groups III and IV, Mycobacterium avium-intracellulare complex (34.14%), and M. fortuitum complex (20.82%), respectively. These results will allow us to know the prevalence of these species in our country, emphasizing the diagnostic importance of these microorganisms and thus apply a specific treatment, especially in patients with risk factors, in whom the spread of the infection is more likely
Assuntos
Tuberculose , Complexo Mycobacterium avium , Fatores de Risco , Síndrome da Imunodeficiência Adquirida , HIV , Mycobacterium , Mycobacterium aviumRESUMO
ABSTRACT Introduction: Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. Methods: We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). Results: A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p = 0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p = 0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p = 0.27). Conclusions: Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
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INTRODUCTION: Nontuberculous mycobacteria (NTM) comprise several pathogens with a complex profile of virulence, diverse epidemiological and clinical patterns as well as host specificity. Recently, an increase in the number of NTM infections has been observed; therefore, the objective of this study was to evaluate the clinical characteristics and outcomes of these infections. METHODS: We included patients with NTM infections between 2001-2017 and obtained risk factors, clinical features and outcomes; finally, we compared this data between slowly growing (SGM) and rapidly growing mycobacteria (RGM). RESULTS: A total of 230 patients were evaluated, 158 (69%) infected and 72 (31%) colonized/pseudoinfected. The average annual incidence in the first 11 years of the study was 0.5 cases per 1000 admissions and increased to 2.0 cases per 1000 admissions later on. The distribution of NTM infections was as follows: bloodstream and disseminated disease 72 (45%), lung infection 67 (42%), skin and soft tissue infection 19 (12%). Mycobacterium avium complex was the most common isolate within SGM infections, and HIV-infected patients were the most affected. Within RGM infections, M. fortuitum was the most common isolate from patients with underlying conditions such as cancer, type-2 diabetes mellitus, presence of invasive devices, and use of immunosuppressive therapy. We did not find significant differences in deaths and persistent infections between disseminated SGM infection when compared to disseminated RGM infection (42% vs. 24%, p=0.22). However, disseminated SGM infection required a longer duration of therapy than disseminated RGM infection (median, 210 vs. 42 days, p=0.01). NTM lung disease showed no significant differences in outcomes among treated versus non-treated patients (p=0.27). CONCLUSIONS: Our results show a significant increase in the number of Non-tuberculosis-mycobacteria infections in our setting. Patients with slow-growing-mycobacteria infections were mainly persons living with human immunodeficiency virus . Older patients with chronic diseases were common among those with rapidly-growing-mycobacteria infections. For non-tuberculosis-mycobacteria lung infection, antibiotic therapy should be carefully individualized.
Assuntos
Infecções por Mycobacterium não Tuberculosas/epidemiologia , Centros de Atenção Terciária , Humanos , México/epidemiologia , Complexo Mycobacterium avium , Micobactérias não TuberculosasRESUMO
BACKGROUND: Soft tissue or skin infections due to nontuberculous mycobacteria (NTM) have been reported frequently and are mostly associated with trauma or cosmetic interventions like plastic surgery. However, infection with NTM as a result of a dental procedure have rarely been described and the lack of clinical suspicion and a clear clinical manifestation makes diagnosis challenging. CASE PRESENTATION: We report on three patients with a facial cutaneous sinus tract of dental origin, due to an infection with respectively Mycobacterium fortuitum, M. abscessus and M. peregrinum. The infection source was the dental unit waterlines (DUWLs), which were colonized with NTM. CONCLUSIONS: Water of the DUWL can pose a health risk. This report emphasizes the need for quality control and certification of water flowing through DUWLs, including the absence of NTM. Our report also shows the need for a rapid recognition of NTM infections and accurate laboratory diagnosis in order to avoid long-term ineffective antibiotic treatment.
Assuntos
Face/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Adolescente , Criança , DNA Viral/metabolismo , Feminino , Fungos/isolamento & purificação , Humanos , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium fortuitum/genética , Mycobacterium fortuitum/isolamento & purificação , Micobactérias não Tuberculosas/genética , Microbiologia da Água , Adulto JovemRESUMO
To our knowledge, this is the first work on drug susceptibility patterns of rapid growing mycobacteria from Latin America. The susceptibility patterns for 14 antimicrobial agents of the three most important species that cause skin infections in Venezuela were determined as follows: 63 strains belonging to Mycobacterium abscessus group, 66 strains of the Mycobacterium fortuitum group, and 13 Mycobacterium chelonae strains. The M. abscessus group strains were resistant to most antibiotics tested while M. fortuitum strains were relatively susceptible to a large number of antibiotics. We demonstrate the presence of an inducible and truncated erm(41) gene in M. abscessus group, namely M. abscessus subsp. massiliense. We show the variations in susceptibility to antimicrobial agents within and between the mycobacterial species and compare our susceptibility patterns with those reported from other countries. We conclude that the identification of mycobacteria to the species level can guide the antibiotic treatment, but that it is always important to consider drug susceptibility testing when rapidly mycobacteria are isolated.
Assuntos
Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/efeitos dos fármacos , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana , Mutação , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Micobactérias não Tuberculosas/genética , Micobactérias não Tuberculosas/isolamento & purificação , Venezuela/epidemiologiaRESUMO
Resumen Se comunican dos casos clínicos poco frecuentes de micobacteriosis cutáneas; uno adquirido en la comunidad y uno en medio hospitalario, ambos pacientes del género masculino, con dermatosis crónicas constituidas por úlceras, fístulas y placas de aspecto papilomatoso. El diagnóstico fue tardío y la evolución no fue satisfactoria, a pesar de prescribir tratamiento adecuado contra Mycobacterium chelonae. El propósito de este artículo es mostrar la manifestación clínica de las lesiones para sospecha diagnóstica temprana y oportuna de las diferentes disciplinas médicas que participan en la atención de los pacientes con estas infecciones.
Abstract This paper reports the two rare clinical cases of cutaneous mycobacterial infections. One of them acquired the infection within the community while the other was a nosocomial case, both cases were male with chronic ulcers, fistulae and papilloma-like lesions. In both cases diagnosis was late and evolution, despite correct Mycobacterium chelonae treatment, was unsatisfactory. The purpose of this paper is to show the clinical presentation and accurate suspicion of infection of the different medical areas involved in its management.
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An adult male Amazonian manatee Trichechus inunguis under human care presented with 3 circular cutaneous lesions on the dorsal aspect of the rostrum and between the nostrils (plenum). Initially these lesions were superficial, hypopigmented, without warmth and non-painful. Microbiological cultures of skin swabs isolated Candida sp. and Pseudomonas aeruginosa, and topical treatment with antiseptic, antifungal, anti-inflammatory and antibiotic medication was instituted. This treatment strategy did not lead to any clinical improvement, and after 6 mo, the lesions progressed to a confluent abscess (5.0 × 3.0 cm) with increased temperature and obvious discomfort on palpation. An impression smear of a cutaneous biopsy was submitted for Ziehl-Neelsen staining and after detection of acid-fast bacilli, the cutaneous biopsy and a swab from the lesion were sent for histopathology, culture and sensitivity testing. After 5 d of incubation and through PCR-restriction analysis of the isolates, Mycobacterium fortuitum and M. abscessus were identified. Sensitivity testing indicated that the isolates were susceptible to ciprofloxacin and clarithromycin, and after draining of the lesion and administration of systemic antibiotic treatment, there was rapid clinical improvement. This report describes non-healing lesions in an aquatic animal and illustrates the importance of evaluating the presence of non-tuberculous mycobacteria, opportunistic pathogens which are ubiquitous in the aquatic environment, in protracted, non-responsive cases. We also highlight the importance of a correct diagnosis and treatment approach, and we review concerns that these bacteria are zoonotic agents and are frequently resistant to conventional antibiotics.
Assuntos
Infecções por Mycobacterium não Tuberculosas/veterinária , Mycobacterium fortuitum/isolamento & purificação , Dermatopatias Bacterianas/veterinária , Trichechus inunguis/microbiologia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Masculino , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Dermatopatias Bacterianas/microbiologiaRESUMO
RESUMEN Los pacientes con VIH son susceptibles a la infección por micobacterias. En el caso de las micobacterias de crecimiento rápido, grupo al que pertenece el Mycobacterium fortuitum (M. fortuitum), se han descrito infecciones en la piel, pulmones, ganglios linfáticos y enfermedad diseminada. Presentamos el caso de un paciente varón de 43 años, con diagnóstico previo de VIH en tratamiento antirretroviral, que acude por fiebre, astenia, pérdida de peso y diarrea crónica. Se realiza tomografía abdominal y se evidencia hepatoesplenomegalia con lesiones nodulares en el bazo. El cultivo esplénico, finalmente, fue positivo para M. fortuitum, con PCR positivo a Mycobacterium tuberculosis. Los protocolos actuales de tratamiento para este tipo de infecciones se basan en la susceptibilidad mostrada en los cultivos realizados. En lo que respecta a coinfecciones entre M. fortuitum y Mycobacterium tuberculosis, en pacientes VIH positivos, la información es aun menor.
ABSTRACT Patients with HIV are susceptible to mycobacterium infection. In the case of fast-growing mycobacteria, the group to which Mycobacterium fortuitum (M. fortuitum) belongs, infections have been described in the skin, lungs, lymph nodes and disseminated disease. We present the case of a 43-year-old male patient with pre-diagnosis of HIV in antiretroviral therapy, which comes as a fever, asthenia, weight loss and chronic diarrhea. Abdominal tomography is performed and hepatosplenomegaly is evidenced with nodular lesions in the spleen. The splenic culture was finally positive for M. Fortuitum, with positive PCR to Mycobacterium tuberculosis. The current treatment protocols for this type of infection are based on the susceptibility shown in the cultures performed. With regard to coinfections between M. Fortuitum and Mycobacterium tuberculosis, in HIV positive patients, there are even less information.
Assuntos
Adulto , Humanos , Masculino , Esplenopatias/complicações , Esplenopatias/microbiologia , Tuberculose/complicações , Infecções por HIV/complicações , Mycobacterium fortuitum , Abscesso/complicações , Coinfecção , Infecções por Mycobacterium não Tuberculosas/complicaçõesRESUMO
Mycobacterium fortuitum es agente causante de enfermidad oportunista en humanos y animales. Es un agente biológico modelo para estudios experimentales que sustituy Mycobacterium bovis, que es más patógeno. Este estudio presenta una metodología alternativa para el recuento de unidades formadoras de colonias por mililitro de inóculo para determinar la concentración de Mycobacterium fortuitum usando espectrofotometría. Catorce muestras se utilizaron Mycobacterium fortuitum, cultivadas en Lowesntein-Jensen, ocho de ellos de siete días de cultivo, y la otra entre 8 y 14 días en la cultura. Todas las muestras se colocaron en placas y se incubaron a 37o.C durante 7 días en un invernadero. De cada muestra se hicieron lecturas las variables de absorbancia (Abs) y transmitancia (T%) en un espectrofotómetro, a una longitud de onda de 560 nm y 600 nm. La comparación de los valores de UFC, ABS y T% por análisis de regresión lineal simple, el estadístico SAS versión 8.2 del software, hubo una fuerte evidencia estadística de que el aumento del valor de transmitancia se asocia con la disminución en el valor de UFC chapado, siguiendo el modelo matemático: LOG10 (UFC) = 21,012 - 0,1936 * transmitancia, con p = 0,0025 y una repetibilidad de más de 80%.(AU)
Mycobacterium fortuitum is an opportunistic agent which causes disease in human and animals. It is also a biological model for experimental studies instead of using Mycobacterium bovis, which is more pathogenic. This work presents an alternative methodology using spectrophotometry to count colony forming units (CFU) per milliliter of inoculum, in order to determinate Mycobacterium fortuitum concentration. Fourteen Mycobacterium fortuitum samples were cultivated in Lowenstein-Jensen culture media, considering that eight of them were seven days old cultures and the others were between eight and 14 days old. All samples were seeded and incubated at 37o.C for 7 days in an incubator. For each sample, the variables absorbance (Abs) and transmitance (T%) were read with an spectrophotometer and wave length of 560nm and 600nm. When the values of CFU, Abs and T% were compared through simple linear regression analysis and using the statistic software SAS Version 8.2., it was observed strong statistical evidence that the increase of transmitance value is associated to the decrease of CFU plate values, according to the mathematic model: LOG10 (CFU) = 21.012 - 0.1936*Transmitance, and p value = 0.0025 and a repeatability over 80%.(AU)
O Mycobacterium fortuitum é um agente oportunista causador de doença em humanos e animais. Além disso, é um modelo biológico para estudos experimentais em substituição ao Mycobacterium bovis, que é mais patogênico. Este estudo apresenta metodologia alternativa à contagem de unidades formadoras de colônia por mililitro de inóculo, para determinar a concentração do Mycobacterium fortuitum utilizando espectrofotometria. Utilizaram-se 14 amostras de Mycobacterium fortuitum, cultivadas em meio Lowesntein-Jensen, sendo oito delas com sete dias de cultivo e as demais entre oito e 14 dias de cultivo. Todas as amostras foram semeadas e incubadas a 37o.C por 7 dias em estufa. Fizeram-se, de cada amostra, leituras das variáveis absorbância (Abs) e transmitância (T%) em espectrofotômetro, nos comprimentos de onda de 560nm e 600nm. Comparando-se os valores obtidos de UFC, Abs e T% por meio da análise de regressão linear simples, pelo programa estatístico SAS versão 8.2, observou-se forte evidência estatística que o aumento do valor da transmitância está associado com o decréscimo do valor de UFC em placas, seguindo o modelo matemático: LOG10 (UFC) = 21.012 - 0.1936*Transmitância, com valor de p = 0,0025 e uma repetibilidade de mais de 80%.(AU)
Assuntos
Mycobacterium fortuitum/isolamento & purificação , Espectrofotometria/veterinária , Contagem de Colônia Microbiana/veterináriaRESUMO
Mycobacterium fortuitum es agente causante de enfermidad oportunista en humanos y animales. Es un agente biológico modelo para estudios experimentales que sustituy Mycobacterium bovis, que es más patógeno. Este estudio presenta una metodología alternativa para el recuento de unidades formadoras de colonias por mililitro de inóculo para determinar la concentración de Mycobacterium fortuitum usando espectrofotometría. Catorce muestras se utilizaron Mycobacterium fortuitum, cultivadas en Lowesntein-Jensen, ocho de ellos de siete días de cultivo, y la otra entre 8 y 14 días en la cultura. Todas las muestras se colocaron en placas y se incubaron a 37o.C durante 7 días en un invernadero. De cada muestra se hicieron lecturas las variables de absorbancia (Abs) y transmitancia (T%) en un espectrofotómetro, a una longitud de onda de 560 nm y 600 nm. La comparación de los valores de UFC, ABS y T% por análisis de regresión lineal simple, el estadístico SAS versión 8.2 del software, hubo una fuerte evidencia estadística de que el aumento del valor de transmitancia se asocia con la disminución en el valor de UFC chapado, siguiendo el modelo matemático: LOG10 (UFC) = 21,012 - 0,1936 * transmitancia, con p = 0,0025 y una repetibilidad de más de 80%.
Mycobacterium fortuitum is an opportunistic agent which causes disease in human and animals. It is also a biological model for experimental studies instead of using Mycobacterium bovis, which is more pathogenic. This work presents an alternative methodology using spectrophotometry to count colony forming units (CFU) per milliliter of inoculum, in order to determinate Mycobacterium fortuitum concentration. Fourteen Mycobacterium fortuitum samples were cultivated in Lowenstein-Jensen culture media, considering that eight of them were seven days old cultures and the others were between eight and 14 days old. All samples were seeded and incubated at 37o.C for 7 days in an incubator. For each sample, the variables absorbance (Abs) and transmitance (T%) were read with an spectrophotometer and wave length of 560nm and 600nm. When the values of CFU, Abs and T% were compared through simple linear regression analysis and using the statistic software SAS Version 8.2., it was observed strong statistical evidence that the increase of transmitance value is associated to the decrease of CFU plate values, according to the mathematic model: LOG10 (CFU) = 21.012 - 0.1936*Transmitance, and p value = 0.0025 and a repeatability over 80%.
O Mycobacterium fortuitum é um agente oportunista causador de doença em humanos e animais. Além disso, é um modelo biológico para estudos experimentais em substituição ao Mycobacterium bovis, que é mais patogênico. Este estudo apresenta metodologia alternativa à contagem de unidades formadoras de colônia por mililitro de inóculo, para determinar a concentração do Mycobacterium fortuitum utilizando espectrofotometria. Utilizaram-se 14 amostras de Mycobacterium fortuitum, cultivadas em meio Lowesntein-Jensen, sendo oito delas com sete dias de cultivo e as demais entre oito e 14 dias de cultivo. Todas as amostras foram semeadas e incubadas a 37o.C por 7 dias em estufa. Fizeram-se, de cada amostra, leituras das variáveis absorbância (Abs) e transmitância (T%) em espectrofotômetro, nos comprimentos de onda de 560nm e 600nm. Comparando-se os valores obtidos de UFC, Abs e T% por meio da análise de regressão linear simples, pelo programa estatístico SAS versão 8.2, observou-se forte evidência estatística que o aumento do valor da transmitância está associado com o decréscimo do valor de UFC em placas, seguindo o modelo matemático: LOG10 (UFC) = 21.012 - 0.1936*Transmitância, com valor de p = 0,0025 e uma repetibilidade de mais de 80%.
Assuntos
Espectrofotometria/veterinária , Mycobacterium fortuitum/isolamento & purificação , Contagem de Colônia Microbiana/veterináriaRESUMO
During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.
Assuntos
Turismo Médico , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium abscessus , Adolescente , Adulto , Surtos de Doenças , República Dominicana/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/economia , Cirurgia Plástica/efeitos adversos , Infecção da Ferida Cirúrgica , Estados Unidos/epidemiologia , Adulto JovemRESUMO
This paper addresses a sensitive method for the detection of mycobacteria in hemodialysis water samples based on a magneto-actuated immunoassay with optical readout. In this approach, micro (2.8µm) sized magnetic particles were modified with an antibody against the lipoarabinomannan (LAM) located in the mycobacterial cell wall. The system relies on the immunocapturing of the mycobacteria with the tailored antiLAM magnetic particles to pre-concentrate the bacteria from the hemodialysis samples throughout an immunological reaction. The performance of the immunomagnetic separation on the magnetic carrier was evaluated using confocal microscopy to study the binding pattern, as well as a magneto-actuated immunoassay with optical readout for the rapid detection of the bacteria in spiked hemodialysis samples. In this approach, the antiLAM polyclonal antibody was labeled with fluorescein isothiocyanate. The optical readout was achieved by the incubation with a secondary anti-fluorescein antibody labeled with peroxidase as optical reporter. The magneto-actuated immunoassay was able to detect mycobacteria contamination in hemodialysis water at a limit of detection of 13CFUmL(-1) in a total assay time of 3h without any previous culturing pre-enrichment step.
Assuntos
Mycobacterium fortuitum , Imunoensaio , Separação Imunomagnética , Magnetismo , Diálise Renal , ÁguaRESUMO
We aim to communicate the experience gathered during the management of infections by atypical mycobacteria in immunocompetent patients in a general practice. Between 2008 and 2013, 5 patients with non-tuberculous mycobacterial infections were identified: 2 with cutaneous involvement and 3 with lung infection. None of them had evidence of immunosuppression. A patient with elbow bursitis by M. chelonae presented with a high mononuclear count in fluid analysis with mycobacterial growth at the fifth day of culture. He evolved satisfactorily with clarithromycin. A case with M. fortuitum skin infection had a delayed initial diagnosis with progression to local draining lymph nodes; the culture when requested was positive after 13 days of incubation. Patients with pulmonary infection presented with prolonged cough and sputum and had in common to be postmenopausal women displaying small nodules and bronchiectases at lung images, a classical pattern. Time elapsed between respiratory sampling and a definitive inform ranged from 40 to 89 days. Non-tuberculous mycobacterial infections in non-immunosuppresed patients can generate diagnostic and therapeutic challenges. Delay in identification contributes to this problem.
El objetivo de este trabajo es reportar la experiencia acumulada sobre infecciones por micobacterias atípicas en pacientes sin inmunosupresión. Entre el año 2008 y 2013 se observaron cinco pacientes con infección por micobacterias atípicas: dos con infección cutánea y tres con infección pulmonar. Ninguno de estos pacientes tenía evidencias de inmunosupresión. Un paciente con bursitis de codo por M. chelonae tuvo un estudio citoquímico con aumento de celularidad de predominio mononuclear y desarrollo de bacterias al quinto día; respondió favorablemente a claritromicina. Un caso con infección cutánea por M. fortuitum evolucionó en forma prolongada con supuración ganglionar antes del diagnóstico y el cultivo solicitado a los 13 días fue positivo. Los tres pacientes con aislados pulmonares presentaron tos y expectoración y tenían en común ser mujeres en edad post-menopáusica y presentar pequeños infiltrados nodulares asociados a bronquiectasias en el estudio de imágenes pulmonares, un patrón descrito en la literatura científica. En estos tres casos, la latencia entre la toma de muestra y el informe definitivo tuvo un rango de 40 a 89 días. El aislamiento de micobacterias atípicas en muestras de expectoración en pacientes sin inmunosupresión se da en un contexto típico pero plantea dificultades diagnósticas y terapéuticas. El lento crecimiento de estos microorganismos en el laboratorio contribuye a este problema.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Bronquiectasia/diagnóstico , Diagnóstico Tardio , Doenças Linfáticas/patologia , Nódulos Pulmonares Múltiplos/diagnóstico , Infecções por Mycobacterium não Tuberculosas/microbiologiaRESUMO
Around 50 mycobacteria species cause human disease. Immunosuppressive states predispose to non-tuberculous mycobaterium infection, such as Mycobacterium chelonae: AFB, non-tuberculous, fast growth of low virulence and uncommon as a human pathogen. It may compromise the skin and soft tissues, lungs, lymph nodes and there is also a disseminated presentation. The diagnosis involves AFB identification and culture on Agar and Lowenstein-Jensen medium base. A 41-year-old female with MCTD (LES predominance) is reported, presenting painless nodules in the right forearm. She denied local trauma. Immunosuppressed with prednisone and cyclophosphamide for 24 months. Lesion biopsy has demonstrated positive bacilloscopy (Ziehl-Neelsen stain) and M.chelonae in culture (Lowenstein-Jensen medium base), therefore clarithromycin treatment has been started (best therapy choice in the literature).
Assuntos
Adulto , Feminino , Humanos , Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/imunologia , Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium chelonae/isolamento & purificação , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Imunocompetência/imunologia , Imunossupressores/efeitos adversos , Doença Mista do Tecido Conjuntivo/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológicoRESUMO
Lymphadenitis caused by non-tuberculous mycobacteria is an uncommon manifestation in immunocompetent individuals. Here, we report a case of Mycobacterium fortuitum infection in a previously healthy 9-year-old patient who developed cervical lymphadenitis evolving to a suppurative ulcer associated with a varicella-zoster virus infection. We discuss the relationship between the varicella-zoster virus and the immune response of the host as an explanation for the unusual progression of the case.
Assuntos
Criança , Feminino , Humanos , Herpes Zoster/complicações , Linfadenite/microbiologia , Mycobacterium fortuitum , Infecções por Mycobacterium não Tuberculosas/complicações , Dermatopatias Bacterianas/complicações , /isolamento & purificação , Hospedeiro Imunocomprometido , Linfadenite/complicações , Mycobacterium fortuitum/isolamento & purificação , Dermatopatias Bacterianas/microbiologiaRESUMO
In recent decades there has been an increase in the number of breast implants for reconstruction and cosmetic purposes. Infection is a severe complication mostly caused by Staphylococcus aureus or coagulase-negative staphylococci. Mycobacteria are an infrequent cause of infection in this type of surgery. We describe a case of Mycobacterium fortuitum infection in a patient with lupus, subjected to a prosthetic replacement. These patients are more prone to unusual opportunistic infections. Treatment always requires both removal of prosthetic material and antibiotic therapy.
En las últimas décadas se ha producido un incremento en el número de colocaciones de implantes mamarios para reconstrucciones y fines estéticos. La infección es una complicación seria y en su mayoría es producida por Staphylococcus aureus o Staphylococcus coagulasa-negativa. Las micobacterias son una causa infrecuente de infección en este tipo de cirugías. Describimos el caso de una infección de un implante mamario por Mycobacterium fortuitum en una paciente lúpica sometida a un recambio protésico. Este tipo de pacientes es más propenso a padecer infecciones oportunistas. El tratamiento siempre requiere retiro del material asociado a antibioterapia.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Implantes de Mama/microbiologia , Lúpus Eritematoso Sistêmico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium fortuitum/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologiaRESUMO
Mycobacterium fortuitum is a rapidly growing nontuberculous Mycobacterium that can cause a range of diseases in humans. Complications from M. fortuitum infection have been associated with numerous surgical procedures. A protective immune response against pathogenic mycobacterial infections is dependent on the granuloma formation. Within the granuloma, the macrophage effector response can inhibit bacterial replication and mediate the intracellular killing of bacteria. The granulomatous responses of BALB/c mice to rapidly and slowly growing mycobacteria were assessed in vivo and the bacterial loads in spleens and livers from M. fortuitum and Mycobacterium intracellulare-infected mice, as well as the number and size of granulomas in liver sections, were quantified. Bacterial loads were found to be approximately two times lower in M. fortuitum-infected mice than in M. intracellulare-infected mice and M. fortuitum-infected mice presented fewer granulomas compared to M. intracellulare-infected mice. These granulomas were characterized by the presence of Mac-1+ and CD4+ cells. Additionally, IFN-γmRNA expression was higher in the livers of M. fortuitum-infected mice than in those of M. intracellulare-infected mice. These data clearly show that mice are more capable of controlling an infection with M. fortuitum than M. intracellulare. This capacity is likely related to distinct granuloma formations in mice infected with M. fortuitum but not with M. intracellulare.