RESUMO
Introduction: The Mycobacterium chelonae species and the M. avium and M. abscessus complexes are emerging pathogens that cause mycobacteriosis. Treatment depends on the species and subspecies identified. The drugs of choice are macrolides and aminoglycosides. However, due to the resistance identified to these drugs, determining the microbe's sensitivity profile will allow clinicians to improve the understanding of the prognosis and evolution of these pathologies. Objective: To describe the macrolide and aminoglycoside susceptibility profile of cultures identified by Colombia's Laboratorio Nacional de Referencia de Mycobacteria from 2018 to 2022, as Mycobacterium avium complex, M. abscessus complex, and M. chelonae. Materials and methods. This descriptive study exposes the susceptibility profile to macrolides and aminoglycosides of cultures identified as M. avium complex, M. abscessus complex, and M. chelonae using the GenoType® NTM-DR method. Materials and methods: This descriptive study exposes the susceptibility profile to macrolides and aminoglycosides of cultures identified as M. avium complex, M. abscessus complex, and M. chelonae using the GenoType® NTM-DR method. Results: We identified 159 (47.3 %) cultures as M. avium complex, of which 154 (96.9 %) were sensitive to macrolides, and 5 (3.1 %) were resistant; all were sensitive to aminoglycosides. From the 125 (37.2 %) cultures identified as M. abscessus complex, 68 (54.4 %) were sensitive to macrolides, 57 (45.6 %) were resistant to aminoglycosides, and just one (0.8 %) showed resistance to aminoglycosides. The 52 cultures (15.5 %) identified as M. chelonae were sensitive to macrolides and aminoglycosides. Conclusions: The three studied species of mycobacteria have the least resistance to Amikacin. Subspecies identification and their susceptibility profiles allow the establishment of appropriate treatment schemes, especially against M. abscessus.
Introducción. Mycobacterium chelonae y los complejos Mycobacterium avium y M. abscessus, son agentes patógenos emergentes causantes de micobacteriosis. El tratamiento de esta infección depende de la especie y la subespecie identificadas. Los fármacos de elección son los macrólidos y aminoglucósidos, contra los cuales se ha reportado resistencia; por esta razón, el determinar el perfil de sensibilidad le permite al médico tratante comprender mejor el pronóstico y la evolución de estas infecciones. Objetivo. Describir los perfiles de sensibilidad ante macrólidos y aminoglucósidos, de los cultivos identificados como complejo Mycobacterium avium, complejo M. abscessus o especie M. chelonae, en el Laboratorio Nacional de Referencia de Micobacterias durante los años 2018 a 2022. Materiales y métodos. Se llevó a cabo un estudio descriptivo del perfil de sensibilidad a macrólidos y aminoglucósidos, de los cultivos identificados como complejo M. avium, complejo M. abscessus o M. chelonae, mediante la metodología GenoType® NTM-DR. Resultados. Los cultivos del complejo M. avium fueron 159 (47,3 %), de los cuales, 154 (96,9 %) fueron sensibles y 5 (3,1 %) resistentes a los macrólidos; todos fueron sensibles a los aminoglucósidos. Del complejo M. abscessus se estudiaron 125 (37,2 %) cultivos, 68 (54,4 %) resultaron sensibles y 57 (45,6 %) resistentes a los macrólidos; solo un cultivo (0,8 %) fue resistente a los aminoglucósidos. De M. chelonae se analizaron 52 cultivos (15,5 %), todos sensibles a los macrólidos y aminoglucósidos. Conclusiones. En las tres especies de micobacterias estudiadas, la resistencia contra la amikacina fue la menos frecuente. La identificación de las subespecies y los perfiles de sensibilidad permiten instaurar esquemas de tratamiento adecuados, especialmente en las micobacteriosis causadas por M. abscessus.
Assuntos
Aminoglicosídeos , Macrolídeos , Testes de Sensibilidade Microbiana , Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Complexo Mycobacterium avium , Mycobacterium chelonae , Macrolídeos/farmacologia , Mycobacterium abscessus/efeitos dos fármacos , Mycobacterium abscessus/genética , Mycobacterium abscessus/isolamento & purificação , Colômbia/epidemiologia , Mycobacterium chelonae/efeitos dos fármacos , Mycobacterium chelonae/genética , Mycobacterium chelonae/isolamento & purificação , Aminoglicosídeos/farmacologia , Humanos , Complexo Mycobacterium avium/efeitos dos fármacos , Complexo Mycobacterium avium/genética , Complexo Mycobacterium avium/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Prevalência , Farmacorresistência Bacteriana MúltiplaAssuntos
Antibacterianos/uso terapêutico , Linezolida/uso terapêutico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Mycobacterium chelonae/isolamento & purificação , Humanos , Imunocompetência , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Resultado do TratamentoRESUMO
A infecção por Mycobacterium spp. tem sido constatada em diversos vertebrados, ocasionando doenças em humanos e animais. As espécies responsáveis pela ocorrência de micobacteriose em peixes, a saber, Mycobacterium marinum, M. fortuitum e M. chelonae, também são potencialmente infecciosas para os camarões peneídeos. A micobacteriose que afeta crustáceos corresponde a uma enfermidade sistêmica, granulomatosa, possuindo como agente etiológico bacilos Gram positivos ácido-álcool resistentes. Relata-se neste trabalho a ocorrência de micobacteriose em camarões da espécie Litopenaeus vannamei, sendo identificada a bactéria M. marinum nas amostras teciduais analisadas. Durante a manutenção de juvenis da espécie foram observadas lesões enegrecidas no sexto segmento abdominal de 20 espécimes. A partir das técnicas de Fite-Faraco e Fluorescence In Situ Hybridization (FISH) foi identificado o patógeno, representando uma doença bacteriana com potencial zootécnico que ocorre em ambientes aquáticos, acarretando riscos de contaminação tópica em pessoas envolvidas na manipulação de camarões.
The Mycobacterium spp. infection they have been documented in many vertebrates, causing known diseases in man and animals. The species responsible for the occurrence of mycobacteriosis in fish, Mycobacterium marinum, M. fortuitum and M. chelonae, are also potentially infectious for penaeid shrimp. The mycobacterial disease that affects shellfish corresponds to a systemic disease, granulomatous, having as an etiological agent Gram-positive bacilli resistant acid-alcohol. We report the occurrence of mycobacteriosis in shrimps of the species Litopenaeus vannamei, and identified the species M. marinum in tissue samples analyzed. During the maintenance of juvenile of the species, blackish lesions were observed in the sixth abdominal segment in 20 specimens. From techniques Fite-Faraco and hybridization in situ with fluorescence (FISH), has identified the pathogen in the analyzed tissue was observed, representing a bacterial disease of aquatic environments with zoonotic potential, causing risks of topical contamination on people involved in handling shrimp.
Assuntos
Animais , Infecções por Mycobacterium/parasitologia , Mycobacterium chelonae/isolamento & purificação , Mycobacterium fortuitum/isolamento & purificação , Mycobacterium marinum/isolamento & purificação , Penaeidae/parasitologia , Hibridização In SituRESUMO
A infecção por Mycobacterium spp. tem sido constatada em diversos vertebrados, ocasionando doenças em humanos e animais. As espécies responsáveis pela ocorrência de micobacteriose em peixes, a saber, Mycobacterium marinum, M. fortuitum e M. chelonae, também são potencialmente infecciosas para os camarões peneídeos. A micobacteriose que afeta crustáceos corresponde a uma enfermidade sistêmica, granulomatosa, possuindo como agente etiológico bacilos Gram positivos ácido-álcool resistentes. Relata-se neste trabalho a ocorrência de micobacteriose em camarões da espécie Litopenaeus vannamei, sendo identificada a bactéria M. marinum nas amostras teciduais analisadas. Durante a manutenção de juvenis da espécie foram observadas lesões enegrecidas no sexto segmento abdominal de 20 espécimes. A partir das técnicas de Fite-Faraco e Fluorescence In Situ Hybridization (FISH) foi identificado o patógeno, representando uma doença bacteriana com potencial zootécnico que ocorre em ambientes aquáticos, acarretando riscos de contaminação tópica em pessoas envolvidas na manipulação de camarões.(AU)
The Mycobacterium spp. infection they have been documented in many vertebrates, causing known diseases in man and animals. The species responsible for the occurrence of mycobacteriosis in fish, Mycobacterium marinum, M. fortuitum and M. chelonae, are also potentially infectious for penaeid shrimp. The mycobacterial disease that affects shellfish corresponds to a systemic disease, granulomatous, having as an etiological agent Gram-positive bacilli resistant acid-alcohol. We report the occurrence of mycobacteriosis in shrimps of the species Litopenaeus vannamei, and identified the species M. marinum in tissue samples analyzed. During the maintenance of juvenile of the species, blackish lesions were observed in the sixth abdominal segment in 20 specimens. From techniques Fite-Faraco and hybridization in situ with fluorescence (FISH), has identified the pathogen in the analyzed tissue was observed, representing a bacterial disease of aquatic environments with zoonotic potential, causing risks of topical contamination on people involved in handling shrimp.(AU)
Assuntos
Animais , Penaeidae/parasitologia , Infecções por Mycobacterium/parasitologia , Mycobacterium fortuitum/isolamento & purificação , Mycobacterium marinum/isolamento & purificação , Mycobacterium chelonae/isolamento & purificação , Hibridização In SituRESUMO
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
Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/imunologia , Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium chelonae/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Feminino , Humanos , Imunocompetência/imunologia , Imunossupressores/efeitos adversos , Doença Mista do Tecido Conjuntivo/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológicoRESUMO
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
In March 2010, a 35 year-old HIV/AIDS female patient was admitted to hospital to start treatment with Highly Active Antiretroviral Therapy (HAART) since during a routine control a dramatic decrease in the CD4(+) levels was detected. At this stage, a nasal swab from each nostril was collected from the patient to include it in the samples for the case study mentioned above. Moreover, it is important to mention that the patient was diagnosed in 2009 with invasive pneumococcal disease, acute cholecystitis, pancreatitis and pulmonary tuberculosis. The collected nasal swabs from both nostrils were positive for Vermamoeba vermiformis species which was identified using morphological and PCR/DNA sequencing approaches. Basic Local Alignment Search Tool (BLAST) homology and phylogenetic analysis confirmed the amoebic strain to belong to V.vermiformis species. Molecular identification of the Mycobacterium strain was carried out using a bacterial universal primer pair for the 16S rDNA gene at the genus level and the rpoB gene was amplified and sequenced as previously described to identify the Mycobacterium species (Shin et al., 2008; Sheen et al., 2013). Homology and phylogenetic analyses of the rpoB gene confirmed the species as Mycobacterium chelonae. In parallel, collected swabs were tested by PCR and were positive for the presence of V.vermiformis and M.chelonae. This work describes the identification of an emerging bacterial pathogen,M.chelonae from a Free-Living Amoebae (FLA) strain belonging to the species V.vermiformis that colonized the nasal cavities of an HIV/AIDS patient, previously diagnosed with TB. Awareness within clinicians and public health professionals should be raised, as pathogenic agents such as M.chelonae may be using FLA to propagate and survive in the environment.
Assuntos
Amebíase/complicações , Infecções por HIV/complicações , Hartmannella/microbiologia , Infecções por Mycobacterium não Tuberculosas/complicações , Mycobacterium chelonae/isolamento & purificação , Simbiose , Adulto , DNA Bacteriano/isolamento & purificação , DNA de Protozoário/isolamento & purificação , Reservatórios de Doenças , Feminino , Infecções por HIV/microbiologia , Infecções por HIV/parasitologia , Hartmannella/genética , Hartmannella/isolamento & purificação , Humanos , Dados de Sequência Molecular , Infecções por Mycobacterium não Tuberculosas/transmissão , Mycobacterium chelonae/genética , Mycobacterium chelonae/fisiologia , Mucosa Nasal/microbiologia , Mucosa Nasal/parasitologia , PeruRESUMO
Mycobacterium chelonae es una micobacteria atípica, de rápido crecimiento, ampliamente distribuida en la naturaleza. Germen oportunista del humano y causante de infecciones de diversa gravedad. Suele ser resistente a los métodos habituales de desinfección y esterilización. Es fundamentalpara su diagnóstico y tratamiento el aislamiento del mismo y la obtención del antibiograma, ya que presenta resistencia a diferentes antibióticos. Se presentan dos casos clínicos de infección cutánea por Mycobacterium chelonae. El primero, un paciente inmunocompetente, con aislamiento de la micobacteria por punción-aspiración de las lesiones; tratado con antibióticos según antibiograma, con curación de las mismas. El segundo, una paciente inmunocomprometida no HIV, quien fue tratada con múltiples esquemas antibióticos, criocirugía, termoterapia y resección quirúrgica de las lesiones, con respuesta parcial. El presente artículo intenta actualizar conceptos sobre esta micobacteria y sus diferentes manifestaciones clínicas según el estado inmune del paciente que infecta.
Assuntos
Humanos , Masculino , Adulto , Feminino , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium chelonae/isolamento & purificação , Mycobacterium chelonae/patogenicidade , Pele/microbiologia , Pele/patologia , Fatores de RiscoAssuntos
Surtos de Doenças , Doença Iatrogênica/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Mycobacterium chelonae/isolamento & purificação , Dermatopatias Bacterianas/epidemiologia , Adolescente , Adulto , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , Colômbia/epidemiologia , Impressões Digitais de DNA , Feminino , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Técnica de Amplificação ao Acaso de DNA Polimórfico , Dermatopatias Bacterianas/microbiologia , Adulto JovemRESUMO
OBJECTIVES: A rapid-growing mycobacteria biological prosthetic valve (BPV) endocarditis related to prosthetic manufacturing process is described in Brazil. METHODS: From 1999 to 2008, thirty-nine patients underwent BPV replacement due to culture-negative suspected endocarditis. All these cases had histological sections stained by Ziehl-Neelsen method. Clinical and microbiological data were reviewed in all acid-fast bacilli (AFB) positive cases. The 16S-23S internal transcribed sequence (ITS) was amplified using DNA extracted from paraffin-embedded samples, digested with restrictions enzymes and/or sequenced. RESULTS: Eighteen AFB positive BPV (18/39)(46%) were implanted in 13 patients and were from the same manufacturer. Four of them were implanted in other hospitals. Thirteen BPV were histologically proven endocarditis and five showed a colonization pattern. The examination of six non-implanted "sterile" BPV from this manufacturer resulted in 5 AFB positive. Mycobacterium chelonae was the AFB identified by ITS restriction analysis and sequencing. CONCLUSIONS: Rapid-growing mycobacteria infections must be suspected and Ziehl-Neelsen stain always performed on histology of either early or late BPV endocarditis, particularly when blood cultures are negative.
Assuntos
Bioprótese/microbiologia , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium chelonae/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Adulto , Animais , Contaminação de Equipamentos , Feminino , Histocitoquímica , Humanos , Masculino , Pessoa de Meia-Idade , SuínosRESUMO
An outbreak of postsurgical infections caused by rapidly growing mycobacteria has been ongoing in Brazil since 2004. The degrees of similarity of the rpoB and hsp65 sequences from the clinical isolates and the corresponding sequences from both the Mycobacterium massiliense and the M. bolletii type strains were above the accepted limit for interspecies variability, leading to conflicting identification results. Therefore, an extensive characterization of members of the M. chelonae-M. abscessus group was carried out. The M. abscessus, M. chelonae, M. immunogenum, M. massiliense, and M. bolletii type strains and a subset of clinical isolates were analyzed by biochemical tests, high-performance liquid chromatography, drug susceptibility testing, PCR-restriction enzyme analysis of hsp65 (PRA-hsp65), rpoB, and hsp65 gene sequencing and analysis of phylogenetic trees, DNA-DNA hybridization (DDH), and restriction fragment length polymorphism (RFLP) analysis of the 16S rRNA gene (RFLP-16S rRNA). The clinical isolates and the M. abscessus, M. massiliense, and M. bolletii type strains could not be separated by phenotypic tests and were grouped in the phylogenetic trees obtained. The results of DDH also confirmed the >70% relatedness of the clinical isolates and the M. abscessus, M. massiliense, and M. bolletii type strains; and indistinguishable RFLP-16S rRNA patterns were obtained. On the contrary, the separation of clinical isolates and the M. abscessus, M. massiliense, and M. bolletii type strains from M. chelonae and M. immunogenum was supported by the results of PRA-hsp65, DDH, and RFLP-16S rRNA and by the rpoB and hsp65 phylogenetic trees. Taken together, these results led to the proposition that M. abscessus, M. massiliense, and M. bolletii represent a single species, that of M. abscessus. Two subspecies are also proposed, M. abscessus subsp. abscessus and M. abscessus subsp. massiliense, and these two subspecies can be distinguished by two different PRA-hsp65 patterns, which differ by a single HaeIII band, and by differences in their rpoB (3.4%) and hsp65 (1.3%) sequences.
Assuntos
Surtos de Doenças , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , Cromatografia Líquida de Alta Pressão , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium/química , Mycobacterium/genética , Mycobacterium chelonae/classificação , Mycobacterium chelonae/isolamento & purificação , Ácidos Micólicos/análise , Filogenia , Polimorfismo de Fragmento de Restrição , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Homologia de SequênciaRESUMO
Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.
Assuntos
Discite/microbiologia , Abscesso Epidural/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium chelonae/isolamento & purificação , Esclerite/microbiologia , Idoso , Humanos , Hospedeiro Imunocomprometido , MasculinoRESUMO
Mycobacteria other than tuberculosis (MOTT) have a low incidence as pathogens in human pathology. The most frequent clinical expression is the disseminated disease in subjects with compromised cellular immunity. Bacteriological characteristics in culture can generate confusion with other pathogens, which delays the appropriate diagnosis and treatment. We present a case of a disseminated infection due to Mycobacterium chelonae with scleritis, spondylodiscitis and spinal epidural abscess in a man with a medical background of cellular immunity deficit induced by therapeutic drugs. The antibiotic scheme of twenty-one weeks, during the follow-up period, controlled the infection, however, the optimum duration of treatment has not been established.
Assuntos
Idoso , Humanos , Masculino , Discite/microbiologia , Abscesso Epidural/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium chelonae/isolamento & purificação , Esclerite/microbiologia , Hospedeiro ImunocomprometidoRESUMO
Outbreaks of rapidly growing mycobacteria have been occasionally described. The article reports an outbreak of cutaneous abscesses due to Mycobacterium chelonae following mesotherapy in Lima, Peru. From December 2004 through January 2005, 35 subjects who had participated in mesotherapy training sessions presented with persistent cutaneous abscesses. Thirteen (37%) of these suspected cases consented to undergo clinical examination. Skin punch-biopsies were collected from suspicious lesions and substances injected during mesotherapy were analyzed. Suspected cases were mainly young women and lesions included subcutaneous nodules, abscesses and ulcers. Mycobacterium chelonae was isolated from four patients and from a procaine vial. In conclusion, it is important to consider mesotherapy as a potential source of rapidly growing mycobacteria infections.
Assuntos
Abscesso/epidemiologia , Surtos de Doenças , Contaminação de Medicamentos , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Mycobacterium chelonae/isolamento & purificação , Dermatopatias Bacterianas/epidemiologia , Abscesso/microbiologia , Adulto , Terapias Complementares/efeitos adversos , Técnicas Cosméticas , Feminino , Humanos , Injeções/efeitos adversos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/etiologia , Peru/epidemiologia , Dermatopatias Bacterianas/etiologiaRESUMO
La infección de micobacterias atípicas de rápido crecimiento ha sido asociada a diversos procedimientos invasivos como mamoplastia, acupuntura, microcirugía de Mohs y lipoaspiración. Reportamos el caso de una paciente que presentó una infección por Mycobacterium chelonae, un mes después de haber sido sometida a una lipoaspiración en muslos. Fue tratada con claritromicina durante seis meses con remisión completa de las lesiones y sin evidencia de recidiva luego de trece meses de seguimiento.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Mycobacterium chelonae/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Lipectomia/efeitos adversos , Pele/patologiaRESUMO
BACKGROUND: Mesotherapy is an increasingly used technique which is currently causing several mycobacterial infections owing to contaminated substances being injected, and also to poor aseptic measures being held by nonprofessional practitioners. PATIENTS AND METHODS: We collected 15 cases of nontuberculous mycobacteria (NTM) infection after mesotherapy in a 6-month period. RESULTS: All patients were female with ages ranging from 19 to 52 years; the main substances injected were procaine and lecithin, and the time between mesotherapy and the appearance of the lesions varied between 1 and 12 weeks. Clinical lesions were mostly nodules and abscesses, which were localized in the abdomen and buttocks in the majority of cases. The main patient complaint was local pain but some presented with systemic symptoms such as fever and malaise. Biopsies reported granulomatous chronic inflammation in the majority of cases. Skin cultures were positive for NTM and Mycobacterium chelonae. DISCUSSION AND CONCLUSIONS: Mesotherapy not performed with quality controlled substances can be a predisposing factor for NTM infection.
Assuntos
Contaminação de Medicamentos , Injeções/efeitos adversos , Infecções por Mycobacterium não Tuberculosas/etiologia , Micobactérias não Tuberculosas/isolamento & purificação , Dermatopatias Bacterianas/etiologia , Adulto , Colômbia , Técnicas Cosméticas/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium chelonae/isolamento & purificação , Dermatopatias Bacterianas/patologiaRESUMO
Super-infection of an exogenous lipoid pneumonia by nontuberculous mycobacteria has been described in the literature. It produces a distinctive histologic picture with suppurative, noncaseating granulomas surrounding lipid vacuoles containing acid-fast bacilli. Mainly isolated cases have been found, but seldom in children. We describe a series of 9 children with similar histological findings. All our patients were under 1 year of age, malnourished, and with chronic respiratory symptoms. The diagnosis, based on the characteristic histology with acid-fast rods, was established at autopsy in 4 cases, on lobectomy specimens in 4 and by open lung biopsy in 1. Mycobacterium fortuitum-chelonei was cultured in 1 case. Gastro-esophageal reflux was documented in all 4 cases in which it was explored. Aspiration of lipid gastric contents or of oil given as medication can result in exogenous lipoid pneumonia, which in turn becomes super-infected with mycobacteria. Recognition of the distinctive histology permits the diagnosis of this complication.
Assuntos
Infecções por Mycobacterium não Tuberculosas/complicações , Mycobacterium chelonae/isolamento & purificação , Mycobacterium fortuitum/isolamento & purificação , Pneumonia Lipoide/microbiologia , Superinfecção , Evolução Fatal , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/patologia , Humanos , Lactente , Pulmão/patologia , Masculino , Infecções por Mycobacterium não Tuberculosas/patologia , Mycobacterium chelonae/fisiologia , Mycobacterium fortuitum/fisiologia , Pneumonia Lipoide/patologiaRESUMO
INTRODUCTION: Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy. METHODS: Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene. RESULTS: Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively. CONCLUSIONS: Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment.
Assuntos
Técnicas Cosméticas/efeitos adversos , Surtos de Doenças , Injeções Subcutâneas/efeitos adversos , Infecções por Mycobacterium não Tuberculosas/etiologia , Micobactérias não Tuberculosas/isolamento & purificação , Infecções dos Tecidos Moles/etiologia , Soluções/efeitos adversos , Tuberculose Cutânea/etiologia , Abscesso/etiologia , Abscesso/microbiologia , Adulto , Técnicas Cosméticas/normas , Contaminação de Medicamentos , Dermatoses Faciais/etiologia , Dermatoses Faciais/microbiologia , Feminino , Humanos , Licenciamento , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium chelonae/isolamento & purificação , Mycobacterium fortuitum/isolamento & purificação , Micobactérias não Tuberculosas/classificação , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia , Especificidade da Espécie , Tuberculose Cutânea/epidemiologia , Tuberculose Cutânea/microbiologia , Venezuela/epidemiologiaRESUMO
We report a patient with complete interleukin-12 receptor beta-1 deficiency associated with cutaneous leukocytoclastic vasculitis. The patient experienced Bacille Calmette Guérin, Mycobacterium chelonae, and Salmonella enteritidis infection. Vasculitis affecting both small arteries and postcapillary venules due to deposition of immune complexes was probably caused by S. enteritidis and/or M. chelonae infection.
Assuntos
Receptores de Interleucina/deficiência , Vasculite Leucocitoclástica Cutânea/microbiologia , Animais , Bovinos , Criança , Consanguinidade , Feminino , Humanos , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Mycobacterium bovis/isolamento & purificação , Mycobacterium chelonae/isolamento & purificação , Abscesso do Psoas/microbiologia , Receptores de Interleucina-12 , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Salmonella enteritidis/isolamento & purificação , Esplenomegalia/cirurgia , Tuberculose Bovina/diagnóstico , Tuberculose Bovina/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/tratamento farmacológicoRESUMO
PURPOSE: To evaluate the in vitro activity of fluoroquinolones against Mycobacterium abscessus and Mycobacterium chelonae isolated from outbreaks of infectious keratitis in Brazil. MATERIAL AND METHODS: Micobacterial isolates were recovered from infectious keratitis cases related outbreaks that occurred in Brazil after LASIK for myopia. Two outbreaks occurred in Rio de Janeiro in 1998 and 1999, and 3 in São Paulo between 2000 and 2003. All laboratorial analysis, including molecular identification and antibiotic susceptibility testing with determination of the minimum inhibitory concentration (MIC) levels for ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin, were performed at Universidade Federal de São Paulo in Brazil. RESULTS: Fifteen samples were identified as M. chelonae, and 3 were identified as M. abscessus. The outbreaks studied were designated SP-1 in 2000; SP-2 in 2000-2001; and SP-3 in 2003, R1 in 1988 and R2 in 1999. All but 1 of the M. chelonae were resistant to all fluoroquinolones with an MIC90 greater than 32 microg/mL. The only susceptible isolate had MIC levels for ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin of 0.38 microg/mL, 0.032 microg/mL, 0.047 microg/mL, and 0.19 microg/mL, respectively. MIC levels for all 3 M. abscessus isolates tested were greater then 32 microg/mL for all fluoroquinolones tested. CONCLUSIONS: Fluoroquinolone MICs for 17 M. abscessus and M. chelonae isolates recovered from infectious keratitis cases in Brazil indicate that they are not susceptible to these drugs in vitro. Further studies to investigate the in vivo effectiveness of fluoroquinolones against mycobacteria are required because in vitro tests do not support their use in the treatment of micobacterial keratitis in this particular geographic area.