Disseminated mycobacteriosis affecting a prosthetic aortic valve: first case of Mycobacterium peregrinum type III reported
Keywords:
Mycobacterium, Mycobacterium peregrinum infections, aortic valve, endocarditis, Colombia
Abstract
Rapidly growing mycobacteria are non-tuberculous mycobacteria amply present in the environment. Although they are not usually pathogenic for humans, they are opportunistic in that they can cause disease in people with disadvantageous conditions or who are immunocompromised. Mycobacterium peregrinum, an opportunistic, rapidly growing mycobacteria, belongs to the M. fortuitum group and has been reported as responsible for human cases of mycobacteriosis.A case of M. peregrinum type III is herein reported as the first in Colombia. It presented as a disseminated disease involving a prosthetic aortic valve (endocarditis) in a seventeen-year-old girl with a well-established diagnosis of prosthetic aortic valve endocarditis who was referred for a surgical replacement. Due to a congenital heart disease (subaortic stenosis with valve insufficiency), she had two previous aortic valve implantation surgeries. One year after the second implantation, the patient presented with respiratory symptoms and weight lost indicative of lung tuberculosis.
A chest X-ray did not show parenchymal compromise but several Ziehl-Neelsen stains were positive. An echocardiography showed a vegetation on the prosthetic aortic valve. In blood and sputum samples, M. peregrinum type III was identified through culture, biochemical tests and hsp65 gene molecular analysis (PRA). The patient underwent a valve replacement and received a multidrug antimycobacterial treatment. Progressive recovery ensued and further samples from respiratory tract and blood were negative for mycobacteria.
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References
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24. Short WR, Emery C, Bhandary M, O'Donnell JA. Misidentification of Mycobacterium peregrinum, the causal organism of a case of bacteremia and automatic implantable cardioverter defibrillator-associated Infection, due to its unusual acid-fast staining characteristics. J Clin Microbiol. 2005;43:2015-7.
25. Heliot MP, Roussel F, Herve F, Muir JF, Levesque H. Fatal Mycobacterium peregrinum pneumonia in refractary polymiositis treated with infliximab. Reumathology. 2005;44:1202-3.
26. Rivera-Olivero IA, Guevara A, Escalona A, Oliver M, Pérez-Alfonzo R, Piquero J, et al. Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. ¿Cuánto vale la belleza? Enferm Infecc Microbiol Clin. 2006;24:302-6.
27. Sakai T, Kobayashi C, Shinohara M. Mycobacterium peregrinum infection in a patient with AIDS. Intern Med. 2005;44:266-99.
28. DeGroote MA, Huit G. Infections due to rapidly growing Mycobacteria. Clin Infect Dis. 2006;42:1756-63.
2. Heifets L. Mycobacterial infections caused by nontuberculous mycobacteria. Semin Respir Crit Care Med. 2004;25: 283-95.
3. Brown-Elliott BA, Wallace RJ Jr. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002;15:716-46.
4. Raad II, Vartivarian S, Khan A, Bodey GP. Catheter-related infections caused by the Mycobacterium fortuitum complex: 15 cases and review. Rev Infect Dis. 1991;13:1120-5.
5. Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria: analysis of 154 patients. Am Rev Respir Dis. 1993;147:1271-8.
6. Wallace RJ Jr., Musser JM, Hull SI, Silcox VA, Steele LC, Forrester GD, et al. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac bypass surgery. J Infect Dis. 1989;159:708-16.
7. Daley CL, Griffith DE. Pulmonary disease caused by rapidly growing mycobacteria. Clin Chest Med. 2002;23:623-32.
8. Garzón MC, Orjuela D, Naranjo O, Llerena C. Micobacterias no tuberculosas en Colombia 1995-2003. Inf Quinc Epidemiol Nac. 2005;10:168-73.
9. Camargo D, Saad C, Ruiz F, Ramírez ME, Lineros M, Rodríguez G, et al. Iatrogenic outbreak of M. chelonae skin abscesses. Epidemiol Infect. 1996;177:113-9.
10. Ortegón M, Rodríguez G, Camargo D, Orozco LC. Mycobacterium chelonae y Mycobacterium abscessus: patógenos emergentes. Biomédica. 1996;16:217-38.
11. Murcia-Aranguren MI, Gómez-Marín JE, Alvarado FS, Bustillo JG, de Mendivelson E, Gómez B, et al. Frequency of tuberculous and non-tuberculous mycobacteria in HIV infected patients from Bogotá, Colombia. BMC Infect Dis. 2001;1:21.
12. Nagao M, Sanobe M, Bando T, Saito T, Shirano M, Matsushima A, et al. Surgical site infection due to Mycobacterium peregrinum: a case report and literature review. Int J Infect Dis. 2009;13:209-11.
13. Telenti A, Marchesi F, Balz M, Bally F, Bötter EC, Bodmer T. Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol. 1993;31:175-8.
14. Castro C, Puerto G, García L, Orjuela D, Polo C, Garzón M, et al. Identificación molecular de micobacterias no tuberculosas mediante análisis de los patrones de restric-ción, Colombia 1995-2005. Biomédica. 2007;27:439-46.
15. Wallace R Jr., Swenson J, Silcox V, Good RC, Tschen JA, Stone MS. Spectrum of disease due to rapidly growing mycobacteria. Rev Infect Dis. 1983;5:657-79.
16. Hogg GG, Schinsky M, McNeil M, Lasker BA, Silcox VA, Brown J. Central line sepsis in a child due to a previously unidentified Mycobacterium. J Clin Microbiol. 1999;37:1193-6.
17. Chua J, Wilkoff B, Lee I, Juratli N, Longworth D, Gordon S. Diagnosis and management of infections involving implantable electrophysiologic cardiac devices. Ann Intern Med. 2000;133:604-8.
18. Karchmer AW, Longworth DL. Infections of intracardiac devices. Cardiol Clin. 2003;21:523-71.
19. Wallace RJ Jr., Brown BA Jr., Silcox VA, Tsukamura M, Nash DR, Steele LC, et al. Clinical disease, drug susceptibility, and biochemical patterns of the unnamed third biovariant complex of Mycobacterium fortuitum. J Infect Dis. 1991;163:598-603.
20. Kusunki S, Elaki T. Proposal of Mycobacterium peregrinum sp.nov., nom. rev., and elevation of Mycobacterium chelonae subs. abscessus (Kubical et al.) to especies states: Mycobacterium abscessus comb.nov. Int J Syst Bacteriol. 1992;42:240-5.
21. Herdman AV, Steele JC. The new mycobacterial species-emerging or newly distinguished pathogens. Clin Lab Med. 2004;24:651-90.
22. Brown JM, McNeil MM, Desmond EP. Nocardia, Rhodococcus, Gordona, Actinomadura, Streptomyces, and other actinomycetes of medical importance. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology. Seventh edition. Washington, D.C.: American Society for Microbiology; 1999. p. 370-92.
23. Rodríguez-Gancedo MB, Rodríguez-González T, Yague G, Valero-Guillen PL, Segovia-Hernández M. Mycobacterium peregrinum bacteremia in an immunocompromised patient with a Hickman catheter. Eur J Clin Microbiol Infect Dis. 2001;20:589-90.
24. Short WR, Emery C, Bhandary M, O'Donnell JA. Misidentification of Mycobacterium peregrinum, the causal organism of a case of bacteremia and automatic implantable cardioverter defibrillator-associated Infection, due to its unusual acid-fast staining characteristics. J Clin Microbiol. 2005;43:2015-7.
25. Heliot MP, Roussel F, Herve F, Muir JF, Levesque H. Fatal Mycobacterium peregrinum pneumonia in refractary polymiositis treated with infliximab. Reumathology. 2005;44:1202-3.
26. Rivera-Olivero IA, Guevara A, Escalona A, Oliver M, Pérez-Alfonzo R, Piquero J, et al. Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. ¿Cuánto vale la belleza? Enferm Infecc Microbiol Clin. 2006;24:302-6.
27. Sakai T, Kobayashi C, Shinohara M. Mycobacterium peregrinum infection in a patient with AIDS. Intern Med. 2005;44:266-99.
28. DeGroote MA, Huit G. Infections due to rapidly growing Mycobacteria. Clin Infect Dis. 2006;42:1756-63.
How to Cite
1.
Torres-Duque CA, Díaz C, Vargas L, Serpa EM, Mosquera W, Garzón MC, et al. Disseminated mycobacteriosis affecting a prosthetic aortic valve: first case of Mycobacterium peregrinum type III reported. biomedica [Internet]. 2010 Sep. 30 [cited 2024 May 18];30(3):332-7. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/266
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Published
2010-09-30
Issue
Section
Case presentation
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