A Case of Mycobacterium Fortuitum Infection in the Left Thigh.

BACKGROUND: In March 2024, our hospital confirmed a case of Mycobacterium fortuitum infection in the left thigh. In January 2024, the patient underwent buttock augmentation surgery at a private plastic surgery hospital. One month after the surgery, the patient sought medical attention at the plastic surgery hospital, due to pain in both legs while sitting. Upon examination, two subcutaneous masses were found in the left thigh, the tumors were painful to pressure, with obvious redness and swelling and elevated skin temperature; therefore, the patient was treated with intravenous infusion (cephalosporin drugs), but after one month of treatment, no significant improvement was observed. In order to seek additional diagnosis and treatment, the patient came to our hospital for treatment. METHODS: Clinical treatment of the left lower limb included wound debridement, abscess incision and drainage, and photodynamic therapy with 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT). During surgery, subcutaneous tough tissue was taken for pathogen examination, including acid fast staining, bacterial culture, and identification. Additional auxiliary examinations: urine routine, blood routine, coagulation function, liver function, kidney function, blood lipids, and blood sugar. RESULTS: Bacterial acid-fast staining: positive. Bacterial Culture and Identification (MALDI-TOF MS): Mycobacterium fortuitum. Clinical treatment plan: clarithromycin 500 mg po bid, moxifloxacin 400 mg po qd, abscess incision and drainage, ALA-PDT. After 24 days of treatment, the patient's condition was good, the surgical incision healed well, there was no bleeding, exudation, or bruising, no redness, swelling, or tenderness, and the skin temperature was normal. The patient improved and was discharged. CONCLUSIONS: This article reports a case of Mycobacterium fortuitum infection in the left thigh. The Mycobacterium fortuitum was quickly and accurately identified by MALDI-TOF MS, and reasonable treatment measures were adopted clinically. The patient improved and was discharged. I hope that in the future, this study can provide assistance for the clinical diagnosis and treatment of Mycobacterium fortuitum infections.

Tuberculosis or Nontuberculosis? A Case of Mycobacterial Skin Infection.

Bacteria other than Mycobacterium tuberculosis and Mycobacterium leprae are known as nontuberculous mycobacteria (NTM), and the frequency of clinically symptomatic forms is increasing day by day. Mycobacterium fortuitum, a rapidly reproducing NTM, causes various clinical signs such as skin soft-tissue infection, surgical site infection, and disseminated infection in immunosuppressed patients. Although progress can be made in terms of diagnosis when growth is detected in culture, it is quite difficult to distinguish between infection and contamination. There is no place for antituberculosis treatment in the treatment of M. fortuitum. Antibiotics such as quinolones, trimethoprim-sulfamethoxazole, linezolid, doxycycline, clarithromycin, azithromycin, imipenem, tigecycline, linezolid, and amikacin are recommended at least in dual combination therapy. In this case presentation, the diagnosis and treatment of a 2-year skin soft-tissue infection with M. fortuitum growth in culture will be discussed.

MYCOLICIBACTERIUM FORTUITUM INFECTION IN EX SITU EMERALD TREE BOA (Corallus batesii).

Emerald tree boas (Corallus batesii) are boids that in situ occurs in forested habitats in the Amazon Basin. The mycobacterial species can infect reptiles but the species Mycolicibacterium fortuitum was identified only in feces samples of ex situ Python regius and was isolated from granulomatous lesions of an ex situ Iguana iguana when was still part of the genus Mycobacterium. This article aims to report a mycobacteria infection case in a female Corallus batesii kept under human care. The animal presented apathy and 2 months of anorexia, being found dead. The necropsy revealed presence of tracheal and pulmonary nodules besides multifocal, bacterial, granulomatous pneumonia. After Fite-Faraco histochemical staining, immunohistochemistry, semi-nested polymerase chain reaction (PCR) and genetic sequencing the Mycolicibacterium fortuitum complex was diagnosed with 99.54% of nucleotide similarity. This mycobacterial species was already pointed out as an important nosocomial pathogen and more studies are necessary to explore their zoonotic potential.

Use of Negative-Pressure Wound Therapy With Instillation and Dwell in Breast Reconstruction.

SUMMARY: The use of negative-pressure wound therapy (NPWT) has expanded over the last 3 decades, paralleled and documented by an increase in research. This article discusses the evolution and current applications of NPWT in modern breast reconstruction. Negative-pressure wound therapy with instillation and dwell (NPWTi-d) technology can be used to remove infectious material, facilitate salvaging compromised tissue, and stabilize the soft-tissue environment. Published consensus NPWTi-d guidelines can aid in treatment selection and implementation of this new technology. The therapeutic approach of simultaneously removing infectious material and actively improving mastectomy flap perfusion and thickness is a burgeoning concept, and illustrative cases are presented. NPWTi-d preliminary use has led to reconstruction salvage with reproducible early experience and outcomes, and it is hoped that it will raise interest and awareness of this promising application of the technology to improve breast reconstruction outcomes.

Pulmonary infection due to fluoroquinolone-resistant Mycolicibacterium fortuitum: a case report.

BACKGROUND: Mycolicibacterium fortuitum is a species of the rapidly growing mycobacteria that can cause pulmonary infection. It is susceptible to multiple antibiotics both in vitro and in clinical practice, so that any combination of susceptible drugs is effective. However, we encountered a case of infection due to fluoroquinolone-resistant M. fortuitum. In this study, we report the case and describe the mechanism of resistance. CASE PRESENTATION: A 65-year-old man with a history of total gastrectomy and immunosuppressant treatment for rheumatoid arthritis developed a recurrence of pulmonary infection caused by M. fortuitum. He was treated with clarithromycin and levofloxacin as a first-line treatment, based on the favorable susceptibility at that time. After recurrence, a high minimum inhibitory concentration to fluoroquinolones was detected. DNA sequencing of the pathogen showed the substitution of serine for tryptophan at residue 83 in the gyrA gene. He was successfully treated with a combination of other antibiotics. CONCLUSION: This is the first report on the treatment of fluoroquinolone-resistant M. fortuitum and investigation of the mechanism of resistance. We suggest that the susceptibility test remains effective for determining the next line of treatment after a pathogen has acquired resistance, and resistance to fluoroquinolones in M. fortuitum can be attributed to a single change of amino acid.

Mycobacterial Airsacculitis Caused by Mycobacterium fortuitum in a Southern Rockhopper Penguin (Eudyptes chrysocome).

A 21-year-old male southern rockhopper penguin (Eudyptes chrysocome) was presented with a chronic history of intermittently decreased appetite, lethargy, and regurgitation. On the external physical examination, the bird was determined to be in fair-to-thin body condition with the complete blood count and plasma chemistry panel being largely unremarkable. Full-body radiographic images were considered normal, and gastroscopy showed only mild gastritis and duodenitis. The penguin was euthanatized shortly thereafter due to acute onset of respiratory distress. During the gross necropsy examination, the bird had severe airsacculitis with thick, yellow-to-tan, moist granular plaques adhering to the surface of many air sacs, as well as regional contiguous pneumonia. Intralesional acid-fast bacilli were observed in histologic sections of air sac tissue, and polymerase chain reaction of the affected air sacs was positive for Mycobacterium fortuitum. This clinical case study describes mycobacteriosis in a sub-Antarctic penguin and to the best of the authors' knowledge, the first reported isolation of M fortuitum from a penguin.

Choosing the therapy for neurological infection with rapidly growing mycobacteria.

The management of neurological infections due to non-tubercular mycobacteria is extremely challenging because of scarce literature, issues with penetration, lack of easily available susceptibility platforms and adverse effects associated with long term therapy. We report a case of a young girl with neurological infection due to rapidly growing mycobacteria to discuss the factors that should be considered while choosing the therapy for such rare and persistent infections.

Mycobacterium fortuitum Prosthetic Joint Infection After Total Hip Arthroplasty: A Case Report.

CASE: A 57-year-old man presented with a Mycobacterium fortuitum prosthetic joint infection (PJI) after right total hip arthroplasty refractory to the initial revision surgery and cement spacer placement. The patient was subsequently treated with 2-stage total joint arthroplasty revision surgery using an antibiotic-laden spacer customized to include meropenem and delayed reimplantation to allow for prolonged, systemic antimicrobial treatment with multiple antimicrobials, including levofloxacin and linezolid. CONCLUSIONS: There is little evidence to guide practitioners in the diagnosis and treatment of PJI caused by rare, rapidly growing mycobacteria (RGM) such as M. fortuitum. This case demonstrates a successful strategy for the treatment of RGM PJI.

Odontogenic cutaneous sinus tracts due to infection with nontuberculous mycobacteria: a report of three cases.

BACKGROUND: Soft tissue or skin infections due to nontuberculous mycobacteria (NTM) have been reported frequently and are mostly associated with trauma or cosmetic interventions like plastic surgery. However, infection with NTM as a result of a dental procedure have rarely been described and the lack of clinical suspicion and a clear clinical manifestation makes diagnosis challenging. CASE PRESENTATION: We report on three patients with a facial cutaneous sinus tract of dental origin, due to an infection with respectively Mycobacterium fortuitum, M. abscessus and M. peregrinum. The infection source was the dental unit waterlines (DUWLs), which were colonized with NTM. CONCLUSIONS: Water of the DUWL can pose a health risk. This report emphasizes the need for quality control and certification of water flowing through DUWLs, including the absence of NTM. Our report also shows the need for a rapid recognition of NTM infections and accurate laboratory diagnosis in order to avoid long-term ineffective antibiotic treatment.

Diagnosis and management of postlaparotomy wound infection caused by Mycobacterium fortuitum.

Mycobacterium fortuitum is ubiquitous in nature and can cause a wide variety of lesions in humans with immunocompromised or antecedent chronic illness. Clinical diagnosis is difficult and relapses are seen. This is due to the fact that they are not critically investigated and are not responded to traditional antitubercular treatment and other antibiotics. Herewith, we report a case of M. fortuitum causing laparotomy port infection-causing repeated multiple abscess on the anterior abdominal wall and treated with amikacin and clarithromycin. The wound healed completely and the patient recovered after administering a combination of amikacin and clarithromycin. We conclude that strict standard operating procedures should be followed to prevent mycobacteria other than tuberculosis (MOTT) infections during and after surgical procedures. Any postoperative, chronic infection which is not responding to conventional antibiotics should be highly suspected for such MOTT infections. Antibiotic susceptibility testing should be performed so as to identify the required antibiotic combination and treated accordingly to prevent further complications and to reduce the cost of treatment.

Historical evolution of the diseases caused by non-pigmented rapidly growing mycobacteria in a University Hospital.

OBJECTIVE: Non-pigmented rapidly growing mycobacteria (NPRGM) are a group of organisms of increasing interest due to the growing number of potential patients and the difficulties for a proper treatment in many of them. However, the evolution of these diseases in a long period of time and its evolutionary changes has been described only in a scanty number of reports. METHODS: We performed a retrospective study between January 1st 2004 and December 31st 2017 in order to evaluate the clinical significance and types of diseases caused by NPRGM. Patients with isolates of NPRGM during this period were selected for the study, and clinical charts were reviewed using a predefined protocol. RESULTS: During this period we identified 59 patients (76 clinical samples) with isolates of NPRGM, with 12 cases of clinical disease and one patient with doubtful significance (including 6 respiratory tract infections, 2 catheter infections, 1 skin and soft tissue infection, 1 disseminated infection, 1 conjunctivitis, 1 prosthetic joint infection and 1 mastitis). Fifty percent of M. chelonae isolates, 37.5% of M. abscessus isolates and 23.33% of M. fortuitum isolates were clinically significant. None of the isolates of other species were significant. CONCLUSIONS: Most isolates in respiratory samples were contaminants/colonizations. M. abscessus was the main etiological agent in respiratory syndromes, whereas M. chelonae and M. fortuitum were more frequently associated with other infections, especially clinical devices and skin and soft tissue infections.

Mycobacterium fortuitum as a cause of acute CNS infection in an immune-competent girl undergoing repeated VP shunt surgeries.

We present the case of a 14-year-old immune-competent girl with ventriculoperitoneal shunt who was repeatedly hospitalised with meningeal signs despite repeated shunt revision surgeries. Eventually Mycobacterium fortuitum was isolated and the patient improved after specific treatment. M. fortuitum is a rapidly growing, non-tuberculous mycobacterium (NTM). NTMs are associated with postsurgical, post-trauma and device-related infections. Most of the present-day surgical equipment, catheters, prostheses and indwelling devices comprised silicone, stainless steel, polyvinyl chloride and polycarbonate, on which NTMs have the tendency to form biofilms. Central nervous system infection caused by NTM carries a high mortality rate (ranging from 35% to 70%), especially in immune-compromised patients. Indwelling device removal along with prolonged treatment with a combination regimen is recommended in such cases.

Cardiac resynchronization therapy-defibrillator pocket infection caused by Mycobacterium fortuitum: a case report and review of the literature.

BACKGROUND: With the rising utilization of cardiovascular implantable electronic devices (CIEDs), infections secondary to device implantation are increasingly encountered. Staphylococcus aureus and coagulase-negative staphylococci are usually the predominant causative organisms. A CIED infection due to non-tuberculous mycobacteria (NTM) is extremely rare. CASE PRESENTATION: A 68-year-old man was admitted to our hospital with a history of pain and swelling at his cardiac resynchronization therapy-defibrillator (CRT-D) pocket site, for 4 days. The CRT-D had been implanted 2 weeks prior. The exudate smear was positive for acid-fast bacilli and culture results revealed rapidly growing nontuberculous mycobacteria (RGM). After an urgent removal of the device followed by 1 year of antibiotic treatment, the patient was completely cured. A new device was finally implanted, 3 years later. CONCLUSIONS: Infections caused by nontuberculous mycobacteria following the implantation of cardiac devices are very rare. The typical manifestations of post-implantation CIED infections caused by RGMs include an early onset, with local redness, swelling, and spontaneous drainage. Systemic symptoms such as fever, chills, and fatigue are absent. Mycobacterium fortuitum is the most common species of RGM implicated in CIED infections, the manifestations of which usually appear within several weeks of the implantation procedure. An urgent removal of the device and appropriate antibiotic therapy are essential therapeutic measures. This is the first such reported case, in which the patient has been re-implanted with another device at the same site, after achieving a complete cure. We followed-up the patient for an additional 3 years and observed that the patient remained free of infection. Our case report shows that though an RGM infection is rare and difficult to treat, it can be completely cured. In addition, we demonstrated that it is subsequently possible to safely re-implant a CIED for the patient, at the same site.

Efficacy of copper and silver as residual disinfectants in drinking water.

Contamination events and biofilms can decrease the amount of free chlorine available in drinking water systems. The efficacy of 100 µg/L silver and 400 µg/L copper, individually and combined, were evaluated as secondary, longer-lasting residual disinfectants against Salmonella enterica serovar Typhimurium, Escherichia coli, Listeria monocytogenes, and Mycobacterium fortuitum at 24 °C and 4 °C. A >5.0-log10 reduction was observed in E. coli and L. monocytogenes after three hours and S. Typhimurium following seven hours of exposure to silver. M. fortuitum was the most resistant species to silver (1.11-log10 after seven hours). Copper did not significantly reduce S. Typhimurium and E. coli at 24 °C; ≥2.80-log10 reductions were observed in the Gram-positive L. monocytogenes and M. fortuitum. Longer exposure times were required at 4 °C to achieve significant reductions in all species. A synergistic effect was observed when silver and copper were combined at 24 °C. In addition, silver was not affected by the presence of organic matter at concentrations that completely inhibited 0.2 mg/L chlorine. The results of this study suggest that combinations of silver and copper show promise as secondary residual disinfectants. They may also be used in conjunction with low chlorine levels or other disinfectants to provide additional, long-lasting residuals in distribution systems.

Mycobacterium fortuitum infection associated with achalasia.

The association achalasia and non tuberculous Mycobacteria lung infection is described in the literature. Most of the time Mycobacterium Fortuitum is responsible of aspiration pneumonia that didn't respond to usual antibiotic therapy. We report a new case about a 15 year-old woman with Allgrove's syndrome history. The chest imaging showed a right pulmonary condensation and the diagnosis was bacteriological. Mycobacterium Fortuitum resistant to Rifampicin, isoniazid, Pyrazinamide and ethamabutol was isolated. She was treated by cotrimoxazole, ciprofloxacin and clarithromycin for 12 months, with a good clinical, radiological and bacteriological evolution. With the purpose to prevent the relapse the patient was treated by cardiomyotomy.

Mycobacterium Fortuitum infection associated with achalasia.

The association between achalasia and no tuberculosis mycobacterial   lung infection is well described in the literature. MycobactériumFortuitum is often responsible, and the clinical's presentation   is an aspiration pneumonia resistant to usual antibiotic therapy. We report the case of a 15 year-old patient with the history of Allgrove syndrome. The chest imaging showed right lung congestion; the diagnosis was bacteriological and MycobactériumFortuitum resistant to rifampicin, isoniazid, pyrazinamide and ethambutol was isolated. The patient was treated by the association cotrimoxazole, ciprofloxacin and clarithromycin for 12 months and the clinical, radiological and bacteriological outcomes were favorable. To prevent the recurrence the patient benefited from a cardiomyotomy.