Diagnosis and Treatment of Infections Caused by Rapidly Growing Mycobacteria

ABSTRACT

Rapidly growing mycobacteria (RGM) are ubiquitous environmental organisms capable of causing a wide variety of infections in humans. The prevalence of RGM infections appears to be increasing, although exact incidence rates are unknown. Although some risk factors for pulmonary RGM infection have been determined, the specific host factors predisposing to disease in the majority of cases are not clear. Significant advances in molecular methods of mycobacterial identification have led to isolation of more varieties, changes in taxonomy, and more rapid and accurate diagnosis of RGM from clinical isolates. Despite significant advances in the field, diagnosing and treating RGM pulmonary infections remain complicated. Current guidelines are based on the most commonly encountered NTM. Their applicability to less frequent RGM isolates has not been definitively established. Treatment often requires multiple antimicrobial agents for prolonged periods of time, with varying degrees of success and significant associated morbidity.

KEYWORDS

Rapidly growing mycobacteria (RGM) - nontuberculous mycobacteria (NTM) - diagnosis - treatment

REFERENCES

• 1 Witebsky F G, Conville P S. Rapidly growing mycobacteria. In: Borriello PS, Murray PR, Funke G Topley and Wilson's Microbiology and Microbial Infections: Bacteriology Volume 2. London; Hodder Arnold 2005: 1236-1269
• 2 Tortoli E. The new mycobacteria: an update.  FEMS Immunol Med Microbiol. 2006;  48 169-178
• 3 Euzeby J P. List of prokaryotic names with standing in nomenclature—genus Mycobacterium . Accessed May 16, 2008 at http://www.bacterio.cict.fr/m/mycobacterium.html
• 4 Griffith D E, Aksamit T, Brown-Elliott B A et al.. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases.  Am J Respir Crit Care Med. 2007;  175 367-416
• 5 Herdman A V, Steele Jr J C. The new mycobacterial species: emerging or newly distinguished pathogens.  Clin Lab Med. 2004;  24 651-690
• 6 Falkinham J O. Epidemiology of infection by nontuberculous mycobacteria.  Clin Microbiol Rev. 1996;  9 177-215
• 7 Brown-Elliott B A, Wallace Jr R J. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria.  Clin Microbiol Rev. 2002;  15 716-746
• 8 De Groote M A, Huitt G. Infections due to rapidly growing mycobacteria.  Clin Infect Dis. 2006;  42 1756-1763
• 9 Howard S T, Byrd T F. The rapidly growing mycobacteria: saprophytes and parasites.  Microbes Infect. 2000;  2 1845-1853
• 10 Munayco C V, Grijalva C G, Culqui D R et al.. Outbreak of persistent cutaneous abscesses due to Mycobacterium chelonae after mesotherapy sessions, Lima, Peru.  Rev Saude Publica. 2008;  42 146-149
• 11 Winthrop K L, Abrams M, Yakrus M et al.. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon.  N Engl J Med. 2002;  346 1366-1371
• 12 Wallace Jr R J, Brown B A, Griffith D E. Nosocomial outbreaks/pseudo outbreaks caused by nontuberculous mycobacteria.  Annu Rev Microbiol. 1998;  52 453-490
• 13 Marras T K, Daley C L. Epidemiology of human pulmonary infection with nontuberculous mycobacteria.  Clin Chest Med. 2002;  23 553-567
• 14 Esteban J, Martin-de-Hijas N Z, Fernandez A I et al.. Epidemiology of infections due to nonpigmented rapidly growing mycobacteria diagnosed in an urban area.  Eur J Clin Microbiol Infect Dis. 2008 May 6;  , [Epub ahead of print]
• 15 Martin-Casabona N, Bahrmand A R, Bennedsen J et al.. Non-tuberculous mycobacteria: patterns of isolation: a multi-country retrospective survey.  Int J Tuberc Lung Dis. 2004;  8 1186-1193
• 16 Han X Y, De I, Jacobson K L. Rapidly growing mycobacteria: clinical and microbiologic studies of 115 cases.  Am J Clin Pathol. 2007;  128 612-621
• 17 Bodle E E, Cunningham J A, Della-Latta P, Schluger N W, Saiman L. Epidemiology of nontuberculous mycobacteria in patients without HIV infection, New York City.  Emerg Infect Dis. 2008;  14 390-396
• 18 Han X Y. Seasonality of clinical isolation of rapidly growing mycobacteria.  Epidemiol Infect. 2008;  136 1188-1191
• 19 Holland S M. Interferon gamma, IL-12, IL-12R and STAT-1 immunodeficiency diseases: disorders of the interface of innate and adaptive immunity.  Immunol Res. 2007;  38 342-346
• 20 Ebert D L, Olivier K. Nontuberculous mycobacteria in cystic fibrosis.  Infect Dis Clin North Am. 2002;  16 221-233
• 21 Iseman M D, Buchanan D L, Ackerson L M. Pectus excavatum and scoliosis: thoracic anomalies associated with pulmonary disease caused by Mycobacterium avium complex.  Am Rev Respir Dis. 1991;  144 914-916
• 22 Falkinham J O. The changing pattern of nontuberculous mycobacterial disease.  Can J Infect Dis. 2003;  14 281-286
• 23 Somoskovi A, Hotaling J E, Fitzgerald M et al.. Lessons from a proficiency testing event for acid-fast microscopy.  Chest. 2001;  120 250-257
• 24 Somoskovi A, Mester J, Hale Y M, Parsons L M, Salfinger M. Laboratory diagnosis of nontuberculous mycobacteria.  Clin Chest Med. 2002;  23 585-597
• 25 Bange F C, Bottger E C. Improved decontamination method for recovering mycobacteria from patients with cystic fibrosis.  Eur J Clin Microbiol Infect Dis. 2002;  21 546-548
• 26 Daley P, Petrich A, May K et al.. Comparison of in-house and commercial 16S rRNA sequencing with high performance liquid chromatography and genotype AS and CM for identification of nontuberculous mycobacteria.  Diagn Microbiol Infect Dis. 2008;  61 284-293
• 27 Zelazny A M, Calhoun L B, Shea Y R et al.. Identification of Mycobacterium species by secA1 sequences.  J Clin Microbiol. 2005;  43 1051-1058
• 28 Böddinghaus B, Rogall T, Flohr T, Blöcker H, Böttger E C. Detection and identification of mycobacteria by amplification of rRNA.  J Clin Microbiol. 1990;  28 1751-1759
• 29 Telenti A, Marchesi F, Balz M et al.. Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis.  J Clin Microbiol. 1993;  31 175-178
• 30 Plikaytis B B, Plikaytis B D, Yakrus M A et al.. Differentiation of slowly growing Mycobacterium species, including Mycobacterium tuberculosis, by gene amplification and restriction fragment length polymorphism analysis.  J Clin Microbiol. 1992;  30 1815-1822
• 31 Steingrube V A, Gibson J L, Brown B A, Zhang Y, Wilson R A. PCR Amplification and restriction endonuclease analysis of a 65-kilodalton heat shock protein gene sequence for taxonomic separation of rapidly growing mycobacteria.  J Clin Microbiol. 1995;  33 149-153
• 32 Cloud J L, 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
• 33 Ringuet H, Akoua-Koffi C, Honore S. hsp65 sequencing for identification of rapidly growing mycobacteria.  J Clin Microbiol. 1999;  37 852-857
• 34 Roth A, Fischer M, Hamid M E, Michalke S, Ludwig W, Mauch H. Differentiation of phylogenetically related slowly growing mycobacteria based on 16S–23S rRNA gene internal transcribed spacer sequences.  J Clin Microbiol. 1998;  36 139-147
• 35 Kim B, Lee S, Lyu M et al.. Identification of mycobacterial species by comparative sequence analysis of the RNA polymerase gene (rpoB).  J Clin Microbiol. 1999;  37 1714-1720
• 36 Griffith D E, Girard W M, Wallace Jr R J. Clinical features of pulmonary disease caused by rapidly growing mycobacteria: an analysis of 154 patients.  Am Rev Respir Dis. 1993;  147 1271-1278
• 37 Chan E D, Kaminska A M, Gill W et al.. Alpha-1-antitrypsin (AAT) anomalies are associated with lung disease due to rapidly growing mycobacteria and AAT inhibits Mycobacterium abscessus infection of macrophages.  Scand J Infect Dis. 2007;  39 690-696
• 38 Daley C L, Griffith D E. Pulmonary disease caused by rapidly growing mycobacteria.  Clin Chest Med. 2002;  23 623-632
• 39 Shelton B G, Flanders W D, Morris G K. Mycobacterium sp. as a possible cause of hypersensitivity pneumonitis in machine workers.  Emerg Infect Dis. 1999;  5 270-273
• 40 Adekambi T, Berger P, Raoult D, Drancourt M. rpoB gene sequence-based characterization of emerging non-tuberculous mycobacteria with descriptions of Mycobacterium bolletii sp. nov. Mycobacterium phocaicum sp. nov and Mycobacterium aubagnense sp nov.  Int J Syst Evol Microbiol. 2006;  56 133-143
• 41 Viana-Niero C, Lima K V, Lopes J L et al.. Molecular characterization of Mycobacterium massiliense and Mycobacterium bolletii in isolates collected from outbreaks of infections after laparascopic surgeries and cosmetic procedures.  J Clin Microbiol. 2008;  46 850-855
• 42 Olivier K N, Weber D J, Wallace Jr R J et al.. Nontuberculous mycobacteria, I: Multicenter prevalence study in cystic fibrosis.  Am J Respir Crit Care Med. 2003;  167 828-834
• 43 Hadjiliadis D, Adlakha A, Prakash U. Rapidly growing mycobacterial lung infection in association with esophageal disorders.  Mayo Clin Proc. 1999;  74 45-51
• 44 Park S, Suh G Y, Chung M P et al.. Clinical significance of Mycobacterium fortuitum isolated from respiratory specimens.  Respir Med. 2008;  102 437-442
• 45 Cullen A R, Cannon C L, Mark E J, Colin A A. Mycobacterium abscessus infection in cystic fibrosis: colonization or infection?.  Am J Respir Crit Care Med. 2000;  161 641-645
• 46 Boxerbaum B. Isolation of rapidly growing mycobacteria in patients with cystic fibrosis.  J Pediatr. 1980;  96 689-691
• 47 Jacobson K, Libshitz H, Whimbey E, Rolston K, Abi-Said D, Raad I. 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
• 48 Han D, Lee K S, Koh W, Yi C A, Kim T A, Kwon O J. Radiographic and CT findings of nontuberculous mycobacterial pulmonary infection caused by Mycobacterium abscessus .  AJR Am J Roentgenol. 2003;  181 513-517
• 49 Hazelton T R, Newell J D, Cook J L et al.. CT finding in 14 patients with Mycobacterium chelonae pulmonary infection.  AJR Am J Roentgenol. 2000;  175 413-416
• 50 Woods G L, Bergmann J S, Witebsky F G et al.. Multisite reproducibility of results obtained by the broth microdilution method for susceptibility testing of Mycobacterium abscessus, Mycobacterium chelonae, and Mycobacterium fortuitum .  J Clin Microbiol. 1999;  37 1676-1682
• 51 Nash K A, Zhang Y, Brown-Elliott B A, Wallace Jr R J. Molecular basis of intrinsic macrolide resistance in clinical isolates of Mycobacterium fortuitum .  J Antimicrob Chemother. 2005;  55 170-177
• 52 Nash K A, Andini N, Zhang Y, Brown-Elliott B A, Wallace Jr R J. Intrinsic macrolide resistance in rapidly growing mycobacteria.  Antimicrob Agents Chemother. 2006;  50 3476-3478
• 53 Wallace Jr R J, Brown-Elliott B A, Crist C J, Mann L, Wilson R W. Comparison of the in vitro activity of the glycylcycline tigecycline (formerly GAR-936) with those of tetracycline, minocycline, and doxycycline against isolates of nontuberculous mycobacteria.  Antimicrob Agents Chemother. 2002;  46 3164-3167
• 54 Wallace Jr R J, Brown-Elliott B A, Ward S C, Crist C J, Mann L B, Wilson R W. Activities of linezolid against rapidly growing mycobacteria.  Antimicrob Agents Chemother. 2001;  45 764-767
• 55 Wallace Jr R J, Meir A, Brown B A et al.. Genetic basis for clarithromycin resistance among isolates of Mycobacterium chelonae and Mycobacterium abscessus .  Antimicrob Agents Chemother. 1996;  40 1676-1681
• 56 Davis K K, Kao P N, Jacobs S S, Ruoss S J. Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series.  BMC Pulm Med. 2007;  7 2
• 57 Stein G E, Craig W A. Tigecycline: a critical analysis.  Clin Infect Dis. 2006;  43 518-524
• 58 Smith M B, Hardin W D, Dressel D A et al.. Predicting outcomes following pulmonary resection in cystic fibrosis patients.  J Pediatr Surg. 1991;  26 655-659
• 59 Taylor J L, Palmer S M. Mycobacterium abscessus chest wall and pulmonary infection in a cystic fibrosis lung transplant recipient.  J Heart Lung Transplant. 2006;  25 985-988
• 60 Fairhurst R M, Kubak B M, Shpiner R B, Levine M S, Pegues D A, Ardehali A. Mycobacterium abscessus empyema in a lung transplant recipient.  J Heart Lung Transplant. 2002;  21 391-394
• 61 Sanguinetti M, Ardito F, Fiscarelli E et al.. Fatal pulmonary infection due to multidrug-resistant Mycobacterium abscessus in a patient with cystic fibrosis.  J Clin Microbiol. 2001;  39 816-819
• 62 Chernenko S M, Humar A, Hutcheon M et al.. Mycobacterium abscessus infections in lung transplant recipients: the international experience 2006.  J Heart Lung Transplant. 2006;  25 1447-1455
• 63 Lamy B, Marchandin H, Hamitouche K, Laurent F. Mycobacterium setense sp. nov., a Mycobacterium fortuitum-group organism isolated from a patient with soft tissue infection and osteitis.  Int J Syst Evol Microbiol. 2008;  58 486-490
• 64 Talati N J, Rouphael N, Kuppalli K, Franco-Paredes C. Spectrum of CNS disease caused by rapidly growing mycobacteria.  Lancet Infect Dis. 2008;  8 390-398
• 65 Uslan D Z, Kowalski T J, Wenenack N L, Virk A, Wilson J W. Skin and soft tissue infections due to rapidly growing mycobacteria: comparison of clinical features, treatment, and susceptibility.  Arch Dermatol. 2006;  142 1287-1292
• 66 Galil K, Miller L A, Yakrus M A et al.. Abscesses due to Mycobacterium abscessus linked to injection of unapproved alternative medication.  Emerg Infect Dis. 1999;  5 681-687
• 67 Wallace Jr R J, Musser J M, Hull S I et al.. Diversity and sources of rapidly growing mycobacteria associated with infections following cardiac surgery.  J Infect Dis. 1989;  159 708-716
• 68 John T, Velotta E. Nontuberculous (atypical) mycobacterial keratitis after LASIK: current status and clinical implications.  Cornea. 2005;  24 245-255
• 69 Hawkins C, Qi C, Warren J, Stosor V. Catheter related bloodstream infections caused by rapidly growing nontuberculous mycobacteria: a case series including rare species.  Diagn Microbiol Infect Dis. 2008;  61 187-191
• 70 Chetchotisakd P, Mootsikapun P, Anunnatsiri S et al.. Disseminated infection due to rapidly growing mycobacteria in immunocompetent hosts presenting with chronic lymphadenopathy: a previously unrecognized clinical entity.  Clin Infect Dis. 2000;  30 29-34
• 71 Holland S M, Eisenstein E M, Kuhns D B et al.. Treatment of refractory disseminated nontuberculous mycobacterial infection with interferon gamma: a preliminary report.  N Engl J Med. 1994;  330 1348-1355
• 72 Daines B S, Vroman D T, Sandoval H P, Steed L L, Solomon K D. Rapid diagnosis and treatment of mycobacterial keratitis after laser in situ keromileusis.  J Cataract Refract Surg. 2003;  29 1014-1018
• 73 Rodriguez B, Holzinger K A, Le L H, Winkle R K, Allen R D. Mycobacterium chelonae keratitis after laser-assisted subepithelial keratectomy.  J Cataract Refract Surg. 2006;  32 1059-1061