RESUMO
Mycobacterium haemophilum is a slow-growing nontuberculous mycobacterium that can cause disease in both immunocompetent and immunocompromised patients. The most common clinical presentations of infection are the appearance of suppurative and ulcerated skin nodules. For the diagnosis, samples collected from suspected cases must be processed under the appropriate conditions, because M. haemophilum requires lower incubation temperatures and iron supplementation in order to grow in culture. In this case report, we describe the occurrence of skin lesions in a kidney transplant recipient, caused by M. haemophilum, associated with acupuncture treatment. The diagnosis was established by direct smear and culture of material aspirated from cutaneous lesions. Species identification was achieved by characterization of the growth requirements and by partial sequencing of the hsp65 gene. The patient was successfully treated with clarithromycin and ciprofloxacin for 12 months. Considering that the number of patients receiving acupuncture treatment is widely increasing, the implications of this potential complication should be recognized, particularly in immunosuppressed patients.
Assuntos
Terapia por Acupuntura/efeitos adversos , Transplante de Rim/efeitos adversos , Infecções por Mycobacterium/microbiologia , Mycobacterium haemophilum/isolamento & purificação , Dermatopatias Bacterianas/microbiologia , Antibacterianos/uso terapêutico , Ciprofloxacina/uso terapêutico , Claritromicina/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/patologia , Mycobacterium haemophilum/classificação , Mycobacterium haemophilum/genética , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/patologiaRESUMO
Brazil is the largest country in Latin America, with a population of 146 million people. The socioeconomic development and the distribution of population and health services varies widely within the country. There are approximately 1.2 million hospital admissions per month, 80% of them paid by a government healthcare program that follows the diagnosis-related groups (DRGs) model. The Ministry of Health has been trying to establish a nationwide nosocomial infection control program since 1983. Most Brazilian hospitals now have some kind of infection control activity, but only a few of them have complete programs. Infrastructural deficiencies, the scarcity of well-trained healthcare workers, and the widespread occurrence of multiresistant Staphylococcus aureus and gram-negative bacteria are some of the challenges faced by Brazilian hospitals in the control of nosocomial infection.