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BMC Ophthalmology Sep 2020Mycobacterium haemophilum is a rare and emerging nontuberculous mycobacteria (NTM). It normally causes localized or disseminated systemic diseases, particularly skin... (Review)
Review
BACKGROUND
Mycobacterium haemophilum is a rare and emerging nontuberculous mycobacteria (NTM). It normally causes localized or disseminated systemic diseases, particularly skin infections and arthritis in severely immunocompromised patients. There have been 5 cases of M. haemophilum ocular infections reported in the literature. Only 1 case presented with scleritis with keratitis. Here, we reported 2 cases of M. haemophilum scleritis. One of them was immunocompetent host and had keratitis with radial keratoneuritis as a presenting sign.
CASE PRESENTATION
Case 1: A 52-year-old Thai female with rheumatoid arthritis presented with scleritis. Conjunctival scraping was carried out and the culture result was positive for M. haemophilum. Despite receiving systemic and topical antibiotics, her clinical symptoms and signs worsened. Surgical debridement was performed. After surgery, the lesion was significantly improved and finally turned to conjunctival scarring. Case 2: A 32-year old healthy Thai male without underlying disease presented with nodular scleritis and keratouveitis with multiple radial keratoneuritis. Surgical debridement of the scleral nodule was performed. Initial microbiological investigations were negative. Herpes ocular infections was suspected. Topical antibiotics, oral acyclovir, low-dose topical steroids and systemic steroids were started. The scleral inflammation subsided but later the keratitis relapsed, requiring corneal biopsy. Histopathology of the specimen revealed acid-fast bacteria and M. haemophilum was identified by polymerase chain reaction (PCR) and sequencing. The diagnosis of Mycobacterial keratitis was made. Although using the combination of systemic and topical antibiotics, his clinical status progressively deteriorated. Multiple therapeutic penetrating keratoplasties were required to eradicate the infection. No recurrence was found during the 1-year follow-up in both cases.
CONCLUSIONS
M. haemophilum can cause scleritis and keratitis, even in immunocompenent host. Radial keraoneuritis is first described in M. haemophilum keratitis. NTM keratitis should be considered in the differential diagnosis of patients with radial keratoneuritis. Increased awareness and early diagnosis using appropriate culture conditions and molecular techniques are important for the proper treatment of this infection. Prompt surgical intervention appears to be vital for successful management of M. haemophilum scleritis and keratitis.
Topics: Adult; Eye Infections, Bacterial; Female; Humans; Keratitis; Male; Middle Aged; Mycobacterium Infections; Mycobacterium haemophilum; Scleritis
PubMed: 32967654
DOI: 10.1186/s12886-020-01649-w -
Emerging Infectious Diseases Sep 2019Mycobacterium haemophilum is a nontuberculous mycobacterium that can infect immunocompromised patients. Because of special conditions required for its culture, this...
Mycobacterium haemophilum is a nontuberculous mycobacterium that can infect immunocompromised patients. Because of special conditions required for its culture, this bacterium is rarely reported and there are scarce data for long-term outcomes. We conducted a retrospective study at Siriraj Hospital, Bangkok, Thailand, during January 2012-September 2017. We studied 21 patients for which HIV infection was the most common concurrent condition. The most common organ involvement was skin and soft tissue (60%). Combination therapy with macrolides and fluoroquinolones resulted in a 60% cure rate for cutaneous infection; adding rifampin as a third drug for more severe cases resulted in modest (66%) cure rate. Efficacy of medical therapy in cutaneous, musculoskeletal, and ocular diseases was 80%, 50%, and 50%, respectively. All patients with central nervous system involvement showed treatment failures. Infections with M. haemophilum in HIV-infected patients were more likely to have central nervous system involvement and tended to have disseminated infections and less favorable outcomes.
Topics: Adult; Aged; Anti-Bacterial Agents; Cohort Studies; Female; HIV Infections; Humans; Immunocompromised Host; Male; Middle Aged; Mycobacterium Infections; Mycobacterium haemophilum; Retrospective Studies; Thailand; Treatment Outcome
PubMed: 31441427
DOI: 10.3201/eid2509.190430 -
Journal Der Deutschen Dermatologischen... Nov 2023Mycobacterium haemophilum (MH) is a slow-growing, non-tuberculous Mycobacterium that most commonly causes infections in immunocompromised patients. The skin is the most... (Review)
Review
Mycobacterium haemophilum (MH) is a slow-growing, non-tuberculous Mycobacterium that most commonly causes infections in immunocompromised patients. The skin is the most prevalent site of infection and can be an isolated presentation or part of a disseminated disease. Herein, we reported a case of isolated MH infection of the hand and a case of disseminated MH infection with multiple skin lesions. In addition, other MH cases with cutaneous involvement over the last 10 years, from 2011-2022, were reviewed and analyzed. Among the 79 included cases, the common skin findings in MH infections included nodules, ulcers, abscesses, swelling, and pustules. Middle-aged patients with iatrogenic immunosuppression from glucocorticoids, mycophenolate mofetil, cyclosporine, and cyclophosphamide are the most susceptible to MH infection, with a higher risk of dissemination to internal organs. Disseminated MH infections commonly present as tenosynovitis, arthritis/arthralgia, or osteomyelitis. There is a lack of strong evidence for treatment; however, triple therapy of quinolone, macrolides, and rifampicin is most often used in clinical practice. The overall prognosis is good. The presence of iatrogenic immunocompromised diseases, lesions involving the proximal limbs, and dissemination of MH infections are associated with worse clinical outcomes.
Topics: Middle Aged; Humans; Mycobacterium haemophilum; Mycobacterium Infections, Nontuberculous; Cellulitis; Skin; Iatrogenic Disease
PubMed: 37679966
DOI: 10.1111/ddg.15163 -
The Journal of Rheumatology Sep 2023
Topics: Humans; Mycobacterium haemophilum; Rheumatoid Nodule; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria
PubMed: 36921964
DOI: 10.3899/jrheum.221296 -
The Journal of Dermatology May 2024
PubMed: 38801177
DOI: 10.1111/1346-8138.17273 -
International Journal of Dermatology Feb 2024Mycobacterium haemophilum has been increasingly found in severely immunocompromised patients but is scarcely reported in immunocompetent adults. (Review)
Review
BACKGROUND
Mycobacterium haemophilum has been increasingly found in severely immunocompromised patients but is scarcely reported in immunocompetent adults.
METHODS
We systematically reviewed previous literature to identify studies on infection in immunocompetent adults. Articles reporting at least one case of M. haemophilum infection were included. We excluded articles involving patients who had immunosuppression-related diseases and routinely used glucocorticoids or immunosuppressants. We also reported a case of a young immunocompetent woman infected by M. haemophilum along the eyebrows, which was probably due to the use of an eyebrow pencil retrieved from a sink drain.
RESULTS
Twelve qualifying articles reporting M. haemophilum infection in immunocompetent adults were identified. Among them, most cases report skin lesions along the eyebrows, and the remaining had cervicofacial lymphadenitis, lesions on the arm or fingers, inflammation in the eyeballs, or ulceration in the perineal region. Most cases were caused by tattoos, make-up, injury, or surgical operation. For diagnosis, specialized tissue culture sensitivity was roughly 75%, and polymerase chain reaction (PCR) test sensitivity was approximately 89%. Triple antibiotic therapy for 3 to 24 months, or surgical excision was effective in controlling infection.
CONCLUSION
M. haemophilum infection should be considered if routine antibacterial and glucocorticoid treatments are ineffective against the disease, even in healthy adults. To definitively diagnose this infection, conditioned tissue culture or PCR testing is required. Treatment usually involves a combination of multiple antibiotics and, if necessary, surgical removal of infected tissue.
Topics: Adult; Female; Humans; Mycobacterium haemophilum; Anti-Bacterial Agents; Lymphadenitis; Mycobacterium Infections; Inflammation
PubMed: 38058233
DOI: 10.1111/ijd.16874 -
BMC Infectious Diseases Jan 2021Ruxolitinib is a novel oral Janus kinase inhibitor that is used for treatment of myeloproliferative diseases. It exhibits potent anti-inflammatory and immunosuppressive... (Review)
Review
BACKGROUND
Ruxolitinib is a novel oral Janus kinase inhibitor that is used for treatment of myeloproliferative diseases. It exhibits potent anti-inflammatory and immunosuppressive effects, and may increase the risk of opportunistic infections. Here, we report a rare case of Cryptococcus neoformans and Mycobacterium haemophilum coinfection in a myelofibrosis patient who was receiving ruxolitinib.
CASE PRESENTATION
A 70-year-old Thai man who was diagnosed with JAK2V617F-mutation-positive primary myelofibrosis had been treated with ruxolitinib for 4 years. He presented with cellulitis at his left leg for 1 week. Physical examination revealed fever, dyspnea, desaturation, and sign of inflammation on the left leg and ulcers on the right foot. Blood cultures showed positive for C. neoformans. He was prescribed intravenous amphotericin B deoxycholate with a subsequent switch to liposomal amphotericin B due to the development of acute kidney injury. He developed new onset of fever after 1 month of antifungal treatment, and the lesion on his left leg had worsened. Biopsy of that skin lesion was sent for mycobacterial culture, and the result showed M. haemophilum. He was treated with levofloxacin, ethambutol, and rifampicin; however, the patient eventually developed septic shock and expired.
CONCLUSIONS
This is the first case of C. neoformans and M. haemophilum coinfection in a patient receiving ruxolitinib treatment. Although uncommon, clinicians should be aware of the potential for multiple opportunistic infections that may be caused by atypical pathogens in patients receiving ruxolitinib.
Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antifungal Agents; Cellulitis; Coinfection; Cryptococcosis; Cryptococcus neoformans; Deoxycholic Acid; Drug Combinations; Fungemia; Humans; Male; Mycobacterium Infections; Mycobacterium haemophilum; Nitriles; Opportunistic Infections; Primary Myelofibrosis; Pyrazoles; Pyrimidines
PubMed: 33413168
DOI: 10.1186/s12879-020-05703-2 -
Infectious Diseases (London, England) Jul 2023is a nontuberculous mycobacterium with fastidious growth requirements and an increasingly reported cause of extrapulmonary disease. Timely diagnosis and management of...
BACKGROUND
is a nontuberculous mycobacterium with fastidious growth requirements and an increasingly reported cause of extrapulmonary disease. Timely diagnosis and management of infections and the immune reconstitution inflammatory syndromes (IRIS) observed in a subset of patients during treatment remain challenging.
METHODS
We conducted a retrospective chart review between January 1, 2010, and January 1, 2022 and identified 26 patients diagnosed with infection at our institution. We describe their clinical presentation, diagnostic results, management, and outcomes.
RESULTS
The majority of patients in our cohort had upper and/or lower extremity skin involvement, were immunosuppressed, and had generally favourable treatment outcomes. All tested isolates were susceptible to clarithromycin and trimethoprim-sulfamethoxazole. Moreover, high rates of susceptibility were noted for ciprofloxacin (95%), linezolid (90%), and rifampin (85%). IRIS was identified in 31% of cases and should be considered in patients who develop worsening skin lesions or systemic symptoms following the initiation of effective antimicrobial therapy. Visualisation of acid-fast bacilli on initial tissue stains, a positive mycobacterial blood culture, and rapid de-escalation of tumour necrosis factor-α inhibitors and/or corticosteroids were more frequently encountered among patients in our cohort who developed IRIS.
CONCLUSION
infection should be considered among patients receiving immunomodulatory therapy who develop discoloured or nodular skin lesions involving the extremities, worsening focal arthritis, tenosynovitis, or isolated adenopathy. A heightened awareness of this pathogen's clinical and laboratory characteristics can lead to a timely diagnosis and favourable outcome.
Topics: Humans; Immune Reconstitution Inflammatory Syndrome; Mycobacterium haemophilum; Mycobacterium Infections; Retrospective Studies; Treatment Outcome
PubMed: 37151046
DOI: 10.1080/23744235.2023.2208210 -
Microbiology Spectrum Jun 2022Leprosy is caused by Mycobacterium leprae and Mycobacterium . We report construction and analyses of the complete genome sequence of FJ924. The genome contained...
Leprosy is caused by Mycobacterium leprae and Mycobacterium . We report construction and analyses of the complete genome sequence of FJ924. The genome contained 3,271,694 nucleotides to encode 1,789 functional genes and 1,564 pseudogenes. It shared 1,420 genes and 885 pseudogenes (71.4%) with M. leprae but differed in 1,281 genes and pseudogenes (28.6%). In phylogeny, the leprosy bacilli started from a most recent common ancestor (MRCA) that diverged ~30 million years ago (Mya) from environmental organism Mycobacterium haemophilum. The MRCA then underwent reductive evolution with pseudogenization, gene loss, and chromosomal rearrangements. Analysis of the shared pseudogenes estimated the pseudogenization event ~14 Mya, shortly before species bifurcation. Afterwards, genomic changes occurred to lesser extent in each species. Like M. leprae, four major types of highly repetitive sequences were detected in , contributing to chromosomal rearrangements within and after MRCA. Variations in genes and copy numbers were noted, such as three copies of the gene encoding bifunctional diguanylate cyclase/phosphodiesterase in , but single copy in M. leprae; 6 genes encoding the TetR family transcriptional regulators in , but 11 such genes in M. leprae; presence of gene in , but absence in M. leprae; and others. These variations likely aid unique pathogenesis, such as diffuse lepromatous leprosy associated with , while the shared genomic features should explain the common pathogenesis of dermatitis and neuritis in leprosy. Together, these findings and the genomic data of may facilitate future research and care for leprosy. Leprosy is a dreaded infection that still affects millions of people worldwide. Mycobacterium is a recently recognized cause in addition to the well-known Mycobacterium leprae. is likely specific for diffuse lepromatous leprosy, a severe form of the infection and endemic in Mexico. This study constructed and annotated the complete genome sequence of FJ924 and performed comparative genomic analyses with related mycobacteria. The results afford new and refined insights into the genome size, gene repertoire, pseudogenes, phylogenomic relationship, genome organization and plasticity, process and timing of reductive evolution, and genetic and proteomic basis for pathogenesis. The availability of the complete genome may prove to be useful for future research and care for the infection.
Topics: Humans; Leprosy; Leprosy, Lepromatous; Mycobacterium; Mycobacterium leprae; Proteomics
PubMed: 35467405
DOI: 10.1128/spectrum.01692-21 -
BMC Infectious Diseases Mar 2023Mycobacterium haemophilum is a slow-growing non-chromogenic nontuberculous Mycobacterium species that can cause skin infection or arthritis in an immunocompromised...
BACKGROUND
Mycobacterium haemophilum is a slow-growing non-chromogenic nontuberculous Mycobacterium species that can cause skin infection or arthritis in an immunocompromised population or in children. Primary infection of the healthy adult cornea is rare. The special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical manifestation and treatment process of corneal infection and notify the awareness of M. Haemophilus keratitis among clinicians. This is the first case report of primary M. haemophilum infection in the cornea of healthy adults reported in the literature.
CASE PRESENTATION
A 53-year-old healthy goldminer presented with left eye redness and a history of vision loss for four months. The patient was misdiagnosed with herpes simplex keratitis until M. haemophilum was detected using high-throughput sequencing. Penetrating keratoplasty was performed, and a large number of mycobacteria were detected by Ziehl-Neelsen staining of the infected tissue. Three months later, the patient developed conjunctival and eyelid skin infections that manifested as caseous necrosis of the conjunctiva and skin nodules. After excision and debridement of the conjunctival lesions and systemic antituberculosis drug treatment for 10 months, the patient was cured.
CONCLUSION
M. haemophilum could cause primary corneal infection in healthy adults, which is an infrequent or rare infection. Owing to the need for special bacterial culture conditions, conventional culture methods do not provide positive results. High-throughput sequencing can rapidly identify the presence of bacteria, which aids in early diagnosis and timely treatment. Prompt surgical intervention is an effective treatment option for severe keratitis. Long-term systemic antimicrobial therapy is crucial.
Topics: Adult; Child; Humans; Middle Aged; Mycobacterium haemophilum; Cornea; Eye Infections; Nontuberculous Mycobacteria; Skin
PubMed: 36882753
DOI: 10.1186/s12879-023-08094-2