From American Journal of Clinical Pathology

Rapidly Growing Mycobacteria: Clinical and Microbiologic Studies of 115 Cases

Xiang Y. Han, MD, PhD;1 Indra DE9, MD, PhD;1 Kalen L. Jacobson, MD2

Published: 10/16/2007

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Abstract and Introduction

Abstract

We analyzed clinical and microbiologic features of 115 cases involving rapidly growing mycobacteria (RGM) isolated at the University of Texas M.D. Anderson Cancer Center, Houston (2000-2005) and identified by 16S ribosomal RNA gene sequencing analysis. At least 15 RGM species were included: Mycobacterium abscessus (43 strains [37.4%]), Mycobacterium fortuitum complex (33 strains [28.7%]), and Mycobacterium mucogenicum (28 strains [24.3%]) most common, accounting for 90.4%. Most M abscessus (32/43) were isolated from respiratory sources, whereas most M mucogenicum (24/28) were from blood cultures. Antimicrobial susceptibility tests showed that M abscessus was the most resistant species; M mucogenicum was most susceptible. From blood and catheter sources, 46 strains (40.0%) were isolated; 44 represented bacteremia or catheter-related infections. These infections typically manifested high fever (mean temperature, 38.9B0C), with a high number of RGM colonies cultured. All infections resolved with catheter removal and antibiotic therapy. Six strains (M abscessus and M fortuitum only) were from skin, soft tissue, and wound infections. There were 59 strains from respiratory sources, and 28 of these represented definitive to probable infections. Prior lung injuries and coisolation of other pathogenic organisms were common. Overall, 78 RGM strains (67.8%) caused true to probable infections without direct deaths.

Introduction

Mycobacterium is probably the best-studied bacterial genus and currently contains more than 100 species.[1,2] Several reasons account for this: Mycobacterium tuberculosis is one of the oldest and most common causes of infection and death worldwide; Mycobacterium avium frequently causes bloodstream infection in patients with AIDS[3]; the spectrum of pathogenicity varies widely across the species, from strict pathogens to essentially nonpathogens[4]; the niches and reservoir are diverse, from human to animal to environmental[5-7]; all species are characteristically stained as acid-fast bacilli (AFB); and all disease-causing species elicit granulomatous tissue reactions.

Rapidly growing mycobacteria (RGM) are the Runyon group IV organisms that usually form colonies within 7 days of incubation as opposed to slow-growing mycobacteria, ie, Runyon groups I, II, and III and the M tuberculosis complex group, that require longer incubation. RGM have emerged as significant human pathogens, causing various infections in healthy and immunocompromised hosts. Although the general recognition of RGM can be made with confidence, further species identification has been difficult, particularly by biochemical methods, as with many nontuberculous slow growers.

As a result of the widespread use of 16S ribosomal RNA (rRNA) gene sequencing, more than 50 new Mycobacterium species have been described since 1990.[1,2,8] Many clinical and reference laboratories worldwide, including ours, have adopted the 16S sequencing method to routinely identify various mycobacteria[9-15] to improve turnaround time and accuracy. In this study, we analyzed the microbiologic and clinical features of 115 RGM strains.

 
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References

  1. Tortoli E. Impact of genotypic studies on mycobacterial taxonomy: the new mycobacteria of the 1990s. Clin Microbiol Rev. 2003;16:319-354.
  2. Schinsky MF, Morey RE, Steigerwalt AG, et al. Taxonomic variation in the Mycobacterium fortuitum third biovariant complex: description of Mycobacterium boenickei sp nov, Mycobacterium houstonense sp nov, Mycobacterium neworleansense sp nov and Mycobacterium brisbanense sp nov and recognition of Mycobacterium porcinum from human clinical isolates. Int J Syst Evol Microbiol. 2004;54:1653-1667.
  3. Inderlied CB, Kemper CA, Bermudez LM. The Mycobacterium avium complex. Clin Microbiol Rev. 1993;6:266-310.
  4. Metchock BG, Nolte FS, Wallace RJ Jr. Mycobacterium. In: Murray PR, Baron EJ, Pfaller MA, et al, eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: ASM Press; 1997:399-437.
  5. Covert TC, Rodgers MR, Reyes AL, et al. Occurrence of nontuberculous mycobacteria in environmental samples. Appl Environ Microbiol. 1999;65:2492-2496.
  6. Falkinham JO III, Norton CD, LeChevallier MW. Factors influencing numbers of Mycobacterium avium, Mycobacterium intracellulare, and other mycobacteria in drinking water distribution systems. Appl Environ Microbiol. 2001;67:1225-1231.
  7. Wallace RJ, Steele LC, Labidi A, et al. Heterogeneity among isolates of rapidly growing mycobacteria responsible for infections following augmentation mammaplasty despite case clustering in Texas and other southern coastal states. J Infect Dis. 1989;160:281-288.
  8. Hale YM, Pfyffer GE, Salfinger M. Laboratory diagnosis of mycobacterial infections: new tools and lessons learned. Clin Infect Dis. 2001;33:834-846.
  9. Cloud JL, Neal H, Rosenberry R, et al. Identification of Mycobacterium spp by using a commercial 16S ribosomal DNA sequencing kit and additional sequencing libraries. J Clin Microbiol. 2002;40:400-406.
  10. Han XY, Pham AS, Tarrand JJ, et al. Rapid and accurate identification of mycobacteria by sequencing hypervariable regions of the 16S ribosomal RNA gene. Am J Clin Pathol. 2002;118:796-801.
  11. Holberg-Petersen M, Steinbakk M, Figenschau KJ, et al. Identification of clinical isolates of Mycobacterium spp by sequence analysis of the 16S ribosomal RNA gene: experience from a clinical laboratory. APMIS. 1999;107:231-239.
  12. Patel JB, Leonard DG, Pan X, et al. Sequence-based identification of Mycobacterium species using the Microseq 500 16S rDNA bacterial identification system. J Clin Microbiol. 2000;38:246-251.
  13. Rogall T, Flohr T, Bottger EC. Differentiation of Mycobacterium species by direct sequencing of amplified DNA. J Gen Microbiol. 1990;136:1915-1920.
  14. Tortoli E, Bartoloni A, BF6ttger EC, et al. Burden of unidentifiable mycobacteria in a reference laboratory. J Clin Microbiol. 2001;39:4058-4065.
  15. Turenne CY, Tschetter L, Wolfe J, et al. Necessity of quality-controlled 16S rRNA gene sequence databases: identifying nontuberculous Mycobacterium species. J Clin Microbiol. 2001;39:3637-3648.
  16. Tarrand JJ, Guillot C, Wenglar M, et al. Clinical comparison of the resin-containing Bactec 26 plus and the Isolator 10 blood culturing systems. J Clin Microbiol. 1991;29:2245-2249.
  17. Altschul SF, Gish W, Miller W, et al. Basic local alignment search tool. J Mol Biol. 1990;215:403-410.
  18. National Committee for Clinical Laboratory Standards. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard. M24-A. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003.
  19. American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med. 1997;156(2 pt 2):S1-S25.
  20. Han XY, Tarrand JJ, Infante R, et al. Clinical significance and epidemiologic analyses of Mycobacterium avium and Mycobacterium intracellulare in patients without AIDS. J Clin Microbiol. 2005;43:4407-4412.
  21. Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter related infections. Clin Infect Dis. 2001;32:1249-1272.
  22. Demenech P, Jimenez MS, Menendez MC, et al. Mycobacterium mageritense sp nov. Int J Syst Bacteriol. 1997;47:535-540.
  23. Brown-Elliott BA, Wallace RJ Jr. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002;15:716-746.
  24. Wallace RJ Jr, Swenson JM, Silcox VA, et al. Spectrum of disease due to rapidly growing mycobacteria. Rev Infect Dis. 1983;5:657-679.
  25. Jacobson K, Garcia R, Libshitz H, et al. Clinical and radiological features of pulmonary disease caused by rapidly growing mycobacteria in cancer patients. Eur J Clin Microbiol Infect Dis. 1998;17:615-621.
  26. Raad II, Vartivarian S, Khan A, et al. Catheter-related infections caused by the Mycobacterium fortuitum complex: 15 cases and review. Rev Infect Dis. 1991;13:1120-1125.
  27. Rolston KV, Jones PG, Fainstein V, et al. Pulmonary disease caused by rapidly growing mycobacteria in patients with cancer. Chest. 1985;87:503-506.
  28. Wallace RJ. The clinical presentation, diagnosis, and therapy of cutaneous and pulmonary infections due to the rapidly growing mycobacteria, M fortuitum and M chelonae. Clin Chest Med. 1989;10:419-429.
  29. Han XY. Seasonality of clinical activity of rapidly growing mycobacteria. Epidemiol Infect. In press.
  30. Cooksey RC, de Waard JH, Yakrus MA, et al. Mycobacterium cosmeticum sp nov, a novel rapidly growing species isolated from a cosmetic infection and from a nail salon. Int J Syst Evol Microbiol. 2004;54:2385-2391.
  31. Yakrus MA, Hernandez SM, Floyd MM, et al. Comparison of methods for identification of Mycobacterium abscessus and M chelonae isolates. J Clin Microbiol. 2001;39:4103-4110.
  32. Swenson JM, Wallace RJ Jr, Silcox VA, et al. Antimicrobial susceptibility of five subgroups of Mycobacterium fortuitum and Mycobacterium chelonae. Antimicrob Agents Chemother. 1985;28:807-811.
  33. Wallace RJ Jr, Tanner D, Brennan PJ, et al. Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med. 1993;119:482-486.
  34. Nash KA, Andini N, Zhang Y, et al. Intrinsic macrolide resistance in rapidly growing mycobacteria. Antimicrob Agents Chemother. 2006;50:3476-3478.
  35. Wallace RJ Jr, Brown-Elliott BA, Hall L, et al. Clinical and laboratory features of Mycobacterium mageritense. J Clin Microbiol. 2002;40:2930-2935.
  36. Brown-Elliott BA, Wallace RJ Jr, Crist CJ, et al. Comparison of in vitro activities of gatifloxacin and ciprofloxacin against four taxa of rapidly growing mycobacteria. Antimicrob Agents Chemother. 2002;46:3283-3285.
  37. Wallace RJ, Brown BA, Onyi GO. Susceptibility of Mycobacterium fortuitum biovar fortuitum and the two subgroups of Mycobacterium chelonae to imipenem, cefmetazole, cefoxitin, and amoxicillin-clavulanic acid. Antimicrob Agents Chemother. 1991;35:773-775.
  38. Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria: an analysis of 154 patients. Am Rev Respir Dis. 1993;147:1271-1278.
  39. Kusunoki S, Ezaki T. Proposal of Mycobacterium peregrinum sp nov, nom rev, and elevation of Mycobacterium chelonae subsp abscessus (Kubica et al) to species status: Mycobacterium abscessus comb nov. Int J Syst Bacteriol. 1992;42:240-245.
  40. Wallace RJ Jr, Silcox VA, Tsukamura M, et al. Clinical significance, biochemical features, and susceptibility patterns of sporadic isolates of the Mycobacterium chelonae–like organism. J Clin Microbiol. 1993;31:3231-3239.
  41. Springer B, Bottger EC, Kirschner P, et al. Phylogeny of the Mycobacterium chelonae–like organism based on partial sequencing of the 16S rRNA gene and proposal of Mycobacterium mucogenicum sp nov. Int J Syst Bacteriol. 1995;45:262-267.
  42. Kline S, Cameron S, Streifel A, et al. An outbreak of bacteremias associated with Mycobacterium mucogenicum in a hospital water supply. Infect Control Hosp Epidemiol. 2004;25:1042-1049.
  43. Adekambi T, Foucault C, La Scola B, et al. Report of two fatal cases of Mycobacterium mucogenicum central nervous system infection in immunocompetent patients. J Clin Microbiol. 2006;44:837-840.
  44. Schinsky MF, McNeil MM, Whitney AM, et al. Mycobacterium septicum sp nov, a new rapidly growing species associated with catheter-related bacteraemia. Int J Syst Evol Microbiol. 2000;50:575-581.
  45. Tsukamura M, Nemeto H, Yugi H. Mycobacterium porcinum sp nov, a porcine pathogen. Int J Syst Bacteriol. 1983;33:162-165.
  46. Wallace RJ Jr, Brown-Elliott BA, Wilson RW, et al. Clinical and laboratory features of Mycobacterium porcinum. J Clin Microbiol. 2004;42:5689-5697.
  47. Woo PCY, Tsoi HW, Leung KW, et al. Identification of Mycobacterium neoaurum isolated from a neutropenic patient with catheter-related bacteremia by 16S rDNA sequencing. J Clin Microbiol. 2000;38:3515-3517.
  48. Heckman GA, Hawkins C, Morris A, et al. Rapidly progressive dementia due to Mycobacterium neoaurum meningoencephalitis. Emerg Infect Dis. 2004;10:924-927.
  49. Han XY. Mycobacterium neoaurum contamination [letter]. Emerg Infect Dis. 2005;11:1316-1317.
  50. Kiska DL, Turenne CY, Dubansky AS, et al. First case report of catheter-related bacteremia due to "Mycobacterium lacticola." J Clin Microbiol. 2004;42:2855-2857.
  51. Luquin M, Ausina V, Vincent-Levey-Frebault V, et al. Mycobacterium brumae sp nov, a rapidly growing, nonphotochromogenic mycobacterium. Int J Syst Bacteriol. 1993;43:405-413.
  52. Lee SA, Raad II, Adachi JA, et al. Catheter-related bloodstream infection caused by Mycobacterium brumae. J Clin Microbiol. 2004;42:5429-5431.
  53. Jimenez MS, Campos-Herrero MI, Garcia D, et al. Mycobacterium canariasense sp nov. Int J Syst Evol Microbiol. 2004;54:1729-1734.
  54. Brown BA, Springer B, Steingrube VA, et al. Mycobacterium wolinskyi sp nov and Mycobacterium goodii sp nov, two new rapidly growing species related to Mycobacterium smegmatis and associated with human wound infections: a cooperative study from the International Working Group on Mycobacterial Taxonomy. Int J Syst Bacteriol. 1999;49:1493-1511.
  55. Ferguson DD, Gershman K, Jensen B, et al. Mycobacterium goodii infections associated with surgical implants at Colorado hospital. Emerg Infect Dis. 2004;10:1868-1871.
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Table 1. Species Identification and Isolation Sources of 115 Rapidly Growing Mycobacteria

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Table 1. Species Identification and Isolation Sources of 115 Rapidly Growing Mycobacteria

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Table 2. Antimicrobial Susceptibility of 105 Rapidly Growing Mycobacteria

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Table 3. Rapidly Growing Mycobacteria Species Causing Catheter-Related Infections (n = 44)*

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Table 3. Rapidly Growing Mycobacteria Species Causing Catheter-Related Infections (n = 44)*

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Table 4. Clinical Features of 44 Catheter-Related Rapidly Growing Mycobacteria Infections

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Table 3. Rapidly Growing Mycobacteria Species Causing Catheter-Related Infections (n = 44)*

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Table 4. Clinical Features of 44 Catheter-Related Rapidly Growing Mycobacteria Infections

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Table 5. Features of Skin, Soft Tissue, and Wound Rapidly Growing Mycobacteria Infections

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Table 6. Clinical Significance of Infection in 59 Patients With Rapidly Growing Mycobacteria From Respiratory Sources

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Table 2. Antimicrobial Susceptibility of 105 Rapidly Growing Mycobacteria

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Table 2. Antimicrobial Susceptibility of 105 Rapidly Growing Mycobacteria

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Table 1. Species Identification and Isolation Sources of 115 Rapidly Growing Mycobacteria

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Table 3. Rapidly Growing Mycobacteria Species Causing Catheter-Related Infections (n = 44)*

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Table 1. Species Identification and Isolation Sources of 115 Rapidly Growing Mycobacteria

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Table 2. Antimicrobial Susceptibility of 105 Rapidly Growing Mycobacteria

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Table 3. Rapidly Growing Mycobacteria Species Causing Catheter-Related Infections (n = 44)*

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Table 6. Clinical Significance of Infection in 59 Patients With Rapidly Growing Mycobacteria From Respiratory Sources

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Table 3. Rapidly Growing Mycobacteria Species Causing Catheter-Related Infections (n = 44)*

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Authors and Disclosures

Xiang Y. Han, MD, PhD,1 Indra DE9, MD, PhD,1 and Kalen L. Jacobson, MD2

[1]Clinical Microbiology
[2]Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston.

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American Journal of Clinical Pathology. 2007;128(4):612-621. © 2007 American Society for Clinical Pathology

 
 
 
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