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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 -
Clinical Microbiology Reviews Jan 2018Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our... (Review)
Review
Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of infection, (ii) Buruli ulcer caused by and other related slowly growing mycobacteria, (iii) leprosy caused by and , and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. , a mycobacterial species related to , is linked to diffuse lepromatous leprosy of Lucio and Latapí. produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. , a close relative of , is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, , the complex, and may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the group, , and , are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.
Topics: Animals; Dermatitis; Humans; Mycobacterium; Mycobacterium Infections
PubMed: 30429139
DOI: 10.1128/CMR.00069-18 -
The Medical Journal of Australia Oct 2022
Topics: Humans; Mycobacterium haemophilum; Inflammatory Bowel Diseases; Crohn Disease; Mycobacterium Infections
PubMed: 36104022
DOI: 10.5694/mja2.51720 -
The Journal of Rheumatology Sep 2023
Topics: Humans; Mycobacterium haemophilum; Rheumatoid Nodule; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria
PubMed: 36921964
DOI: 10.3899/jrheum.221296 -
Journal of Clinical Tuberculosis and... Aug 2017is an uncommonly encountered acid-fast staining bacillus (AFB) that can cause a broad range of infections. We describe a tertiary care center's experience with... (Review)
Review
is an uncommonly encountered acid-fast staining bacillus (AFB) that can cause a broad range of infections. We describe a tertiary care center's experience with infections identified from 2000 to 2015. Ten adult patients were identified with infections, and most had immunocompromising conditions. presented in one of two syndromes: a peripheral cutaneous infection presenting with skin nodularity and local invasion, and a cervicofacial infection involving regional lymph nodes. Duration of therapy was variable (0-18 months) and was dependent on the underlying syndrome and immunological status of the patient. Treatment responses were favorable in all patients. During therapy, three patients developed culture-negative aseptic cutaneous lesions, consistent with immunologic reconstitution inflammatory syndrome (IRIS); we postulate that such reactions may not be uncommon with select infections.
PubMed: 31723708
DOI: 10.1016/j.jctube.2017.06.002 -
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 -
Veterinary Clinical Pathology Jun 2023A 4-year-old female spayed Australian cattle dog was presented to the Emergency Service at the University of Missouri Veterinary Health Center Small Animal Hospital for...
A 4-year-old female spayed Australian cattle dog was presented to the Emergency Service at the University of Missouri Veterinary Health Center Small Animal Hospital for generalized pain and lethargy. At presentation, the dog showed severe cervical spinal pain and thoracic limb deficits consistent with a multifocal neuroanatomic localization. Magnetic resonance imaging of the cervical spine revealed T2 and T1 postcontrast intense signal extending from the level of the medulla through C5 most marked in the caudal brainstem and cranial cervical spinal cord. The suspected diagnosis was severe meningoencephalomyelitis and secondary edema. Analysis of cerebrospinal fluid (CSF) collected from the cerebellomedullary cistern revealed a marked mixed pleocytosis with intralesional structures morphologically consistent with Mycobacterium sp. Standard DNA PCR assay performed on the CSF yielded the presence of Mycobacterium haemophilum. To the authors' knowledge, this is the first reported case of CNS mycobacteriosis diagnosed on CSF analysis in a dog.
Topics: Female; Cattle; Dogs; Animals; Mycobacterium haemophilum; Australia; Spinal Cord; Magnetic Resonance Imaging; Leukocytosis; Dog Diseases; Cerebrospinal Fluid; Cattle Diseases
PubMed: 36931892
DOI: 10.1111/vcp.13206 -
Clinical Microbiology Reviews Oct 2011Mycobacterium haemophilum is a slowly growing acid-fast bacillus (AFB) belonging to the group of nontuberculous mycobacteria (NTM) frequently found in environmental... (Review)
Review
Mycobacterium haemophilum is a slowly growing acid-fast bacillus (AFB) belonging to the group of nontuberculous mycobacteria (NTM) frequently found in environmental habitats, which can colonize and occasionally infect humans and animals. Several findings suggest that water reservoirs are a likely source of M. haemophilum infections. M. haemophilum causes mainly ulcerating skin infections and arthritis in persons who are severely immunocompromised. Disseminated and pulmonary infections occasionally occur. The second at-risk group is otherwise healthy children, who typically develop cervical and perihilar lymphadenitis. A full diagnostic regimen for the optimal detection of M. haemophilum includes acid-fast staining, culturing at two temperatures with iron-supplemented media, and molecular detection. The most preferable molecular assay is a real-time PCR targeting an M. haemophilum-specific internal transcribed spacer (ITS), but another approach is the application of a generic PCR for a mycobacterium-specific fragment with subsequent sequencing to identify M. haemophilum. No standard treatment guidelines are available, but published literature agrees that immunocompromised patients should be treated with multiple antibiotics, tailored to the disease presentation and underlying degree of immune suppression. The outcome of M. haemophilum cervicofacial lymphadenitis in immunocompetent patients favors surgical intervention rather than antibiotic treatment.
Topics: Animals; Humans; Mycobacterium Infections; Mycobacterium haemophilum
PubMed: 21976605
DOI: 10.1128/CMR.00020-11 -
International Journal of STD & AIDS Nov 2015We report a case of disseminated Mycobacterium haemophilum osteomyelitis in a patient with advanced HIV infection, who later developed recurrent immune reconstitution... (Review)
Review
We report a case of disseminated Mycobacterium haemophilum osteomyelitis in a patient with advanced HIV infection, who later developed recurrent immune reconstitution inflammatory syndrome after commencement of antiretroviral therapy. We review previous reports of M. haemophilum bone and joint infection associated with HIV infection and describe the management of M. haemophilum-associated immune reconstitution inflammatory syndrome, including the role of surgery as an adjunctive treatment modality and the potential drug interactions between antiretroviral and antimycobacterial agents.
Topics: AIDS-Related Opportunistic Infections; Adult; Ankle Joint; Anti-Bacterial Agents; Anti-HIV Agents; Debridement; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Magnetic Resonance Imaging; Male; Middle Aged; Mycobacterium Infections; Mycobacterium haemophilum; Osteomyelitis; Polymerase Chain Reaction; Tenosynovitis
PubMed: 25577597
DOI: 10.1177/0956462414565403 -
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