RESUMO
We describe an outbreak of severe subcutaneous infections due to nontuberculous mycobacteria following mesotherapy. Epidemiological studies and molecular comparisons of Mycobacterium chelonae strains from different patients and the environment suggested that contamination may be associated with inappropriate cleaning of the multiple-injection device with tap water.
Assuntos
Surtos de Doenças , Injeções/efeitos adversos , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/epidemiologia , Mycobacterium chelonae/isolamento & purificação , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/epidemiologia , Adulto , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , Impressões Digitais de DNA , Eletroforese em Gel de Campo Pulsado , Microbiologia Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Infecções por Mycobacterium/microbiologia , Mycobacterium chelonae/classificação , Mycobacterium chelonae/genética , Dermatopatias Bacterianas/microbiologia , Adulto JovemRESUMO
Results of in vitro susceptibility studies and one clinical trial have led to recommendations of clarithromycin monotherapy for the treatment of disseminated cutaneous Mycobacterium chelonae infections. We describe the case of a 65-year-old woman, immunocompromised by the use of chronic steroid therapy, who developed disseminated cutaneous infection with M. chelonae and failed clarithromycin monotherapy due to the development of drug resistance. In the relapse isolate we document the presence of a single point mutation at position 2058 in the gene coding for 23S rRNA peptidyltransferase regions, a mutation previously implicated in the development of resistance to clarithromycin. Two susceptible control isolates lacked the mutation. Three additional reports in the literature of patients developing recurrent skin lesions with clarithromycin-resistant M. chelonae following initial response to monotherapy are summarized. We demonstrate that clarithromycin monotherapy in patients with disseminated cutaneous infections can lead to clarithromycin resistance and therapeutic failure associated with a single point mutation at position 2058 of 23S rRNA.