Clinical Characteristics and Treatment Outcomes of Mycobacterium fortuitum Pulmonary Disease.

We evaluated the clinical characteristics and treatment outcomes of 35 patients diagnosed with Mycobacterium fortuitum-pulmonary disease (M. fortuitum-PD). Prior to treatment, all isolates were sensitive to amikacin and 73% and 90% were sensitive to imipenem and moxifloxacin, respectively. Approximately two-thirds of the patients (24 of 35) remained stable without antibiotic treatment. Of 11 patients requiring antibiotic treatment, the majority (81%, 9 of 11) achieved a microbiological cure with susceptible antibiotics. IMPORTANCE Mycobacterium fortuitum (M. fortuitum) is a rapidly growing mycobacterium that causes M. fortuitum-pulmonary disease (PD). It is common among individuals with preexisting lung conditions. Limited data exist regarding treatment and prognosis. Our study examined patients with M. fortuitum-PD. Two-thirds of them remained stable without antibiotics. Among those requiring treatment, 81% achieved a microbiological cure with suitable antibiotics. In many cases, M. fortuitum-PD follows a stable course without antibiotics, and when necessary, a favorable treatment response can be achieved with the appropriate antibiotics.

Repurposing disulfiram to target infections caused by non-tuberculous mycobacteria.

BACKGROUND: Non-tuberculous mycobacteria are emerging pathogens of significant worldwide interest because they have inherent drug resistance to a wide variety of FDA-approved drugs and cause a broad range of serious infections. In order to identify new drugs active against non-tuberculous mycobacteria, we identified disulfiram, utilized for treatment of alcohol dependence, as exhibiting potent growth-inhibitory activity against non-tuberculous mycobacteria. METHODS: Whole-cell growth inhibition assays were used to screen and identify novel inhibitors. The hit compounds were tested against Vero cells to determine the selectivity index, and this was followed by determining time-kill kinetics against Mycobacterium fortuitum and Mycobacterium abscessus. Disulfiram's ability to synergize with several approved drugs utilized for the treatment of M. fortuitum and M. abscessus was determined using fractional inhibitory concentration indexes followed by determining its ability to reduce mycobacterial infections ex vivo. Finally, disulfiram's in vivo potential was determined in a neutropenic murine model mimicking mycobacterial infection. RESULTS: We identified disulfiram as possessing potent antimicrobial activity against non-tuberculous mycobacteria. Disulfiram exhibited concentration- and time-dependent bactericidal activity against M. fortuitum as well as against M. abscessus and synergized with all drugs utilized for their treatment. Additionally, disulfiram reduced bacterial load in macrophages in an intracellular killing assay better than amikacin. When tested in a murine neutropenic M. fortuitum infection model, disulfiram caused significant reduction in bacterial load in kidneys. CONCLUSIONS: Disulfiram exhibits all properties required for it to be repositioned as a novel anti-mycobacterial therapy and possesses a potentially new mechanism of action. Thus, it can be considered as a potent structural lead for the treatment of non-tuberculous mycobacterial infections.

Mycobacterium fortuitum infection after acupuncture treatment.

Actinic keratoses are cutaneous lesions that appear as the result of the proliferation of atypical keratinocytes. These lesions are considered pre-malignant and they can progress to squamous cell carcinoma. Ingenol mebutate has been approved as an effective treatment for AK on the face and trunk. We studied the local skin reactions to this therapy. Data about local skin reactions were collected in a series of 5 patients with photographic documentation, a visual analog scale, and a ranking of satisfaction of the patient. Moderate to severe reactions were reported in most of patients, but only one stopped treatment early. The short duration of treatment contributes to high adherence to the therapy.

Spondylitis with an Epidural Abscess due to Mycobacterium fortuitum: A Case Report / 대한내과학회지

Mycobacterium fortuitum is a rapidly growing mycobacteria that causes skin and soft tissue infection, pulmonary infection, and occasionally disseminated disease in severely immunocompromised patients. While three cases of spondylitis caused by M. fortuitum have been reported, no case has been reported in Korea. We describe the first reported case of M. fortuitum spondylitis and an epidural abscess after lumbar acupuncture, and a surgical procedure to treat spinal stenosis.

Mycobacterium fortuitum skin infections after subcutaneous injections with Vietnamese traditional medicine: a case report.

BACKGROUND: Iatrogenic skin and soft tissue infections by rapidly growing mycobacteria are described with increasing frequency, especially among immunocompromised patients. CASE PRESENTATION: Here, we present an immunocompetent patient with extensive Mycobacterium fortuitum skin and soft tissue infections after subcutaneous injections to relieve joint pains by a Vietnamese traditional medicine practitioner. Moreover, we present dilemmas faced in less resourceful settings, influencing patient management. CONCLUSION: This case illustrates the pathogenic potential of rapid growing mycobacteria in medical or non-medical skin penetrating procedures, their world-wide distribution and demonstrates the dilemmas faced in settings with fewer resources.

Mycobacterium fortuitum Complex Skin Infection in a Healthy Adolescent.

Mycobacterium fortuitum complex skin infection is described in a previously healthy adolescent girl in Sydney, Australia. Mycobacterium fortuitum typically causes superficial skin infections following trauma to the skin and in our patient may have been related to prior leg "waxing". This case highlights common causes for a delay in diagnosis: lack of clinician awareness and inadequate microbiological and histopathological investigations of tissue samples. Due to the size and number of lesions, surgical excision was felt to be a less desirable therapeutic option due to the potential risk of poor cosmetic outcome for our patient. The standard chemotherapeutic approach to M. fortuitum infections involves the use of a combination of at least two antimicrobial agents to which the isolate is susceptible. Despite in vitro susceptibility testing that suggested that the isolate from our patient was resistant to most oral anti-microbial agents, our patient was treated successfully with a 10-week course of oral trimethoprim-sulfamethoxazole and moxifloxacin.

Mycobacterium fortuitum Infection after Footbath / 대한피부과학회지

Mycobacterium fortuitum is one of the rapidly-growing atypical mycobacteria, belonging to Runyon group IV. M. fortuitum infection is usually related to trauma, injections and surgical procedures, and is resistant to treatment with anti-tuberculous agents. Herein, we report on a case of M. fortuitum infection after footbath. A 51-year-old male presented with painful, erythematous nodules and plaques with crust and purulent discharge on the lower legs for 3 months. The skin lesion occurred after two herb and aroma footbaths and leg massage. He went to the massage shop again, and received the footbath one more time. The skin lesion aggravated and he visited a hospital, then the skin biopsy was performed but the result was unremarkable. He was treated with antihistamine and antibiotics but there was no improvement. So he visited our hospital, and culture demonstrated atypical mycobacterium, which was identified as M. fortuitum by polymerase chain reaction. He was treated with oral clarythromycin for 5 months, and the skin lesions have improved.

Effects of photodynamic therapy on rapidly growing nontuberculous mycobacteria keratitis.

PURPOSE: The authors investigated the antimicrobial effect of methylene blue (MB)-mediated photodynamic therapy (PDT) on Mycobacterium fortuitum keratitis. METHODS: In the in vitro study, the mycobacterial suspension and colonies were treated with the following: no MB, no light (normal control); MB and no light (dye control); light and no MB (light control); MB and light (PDT). Morphologic characteristics were examined by transmission electron microscopy. The bactericidal effects of combined PDT and antibiotic therapy (ciprofloxacin, moxifloxacin, and amikacin) were determined using the broth microdilution technique. Twenty-one rabbits with Mycobacterium keratitis were randomly divided into three groups (no treatment, topical amikacin treatment, and PDT combined with amikacin treatment). The clinical features of keratitis were scored and graded before treatment and before euthanatization. The diseased corneas were trephined for quantitative bacteriologic analysis to determine the antibacterial efficacy of the treatment. RESULTS: In the in vitro tests, the bacterial count had a 2-log reduction immediately after PDT treatment at 100 J/cm(2) with 10(-3)% MB. After PDT at 100 J/cm(2) with 10(-2)% MB, almost no viable bacteria were detected. PDT had a synergistic antimicrobial effect in combination with antibiotics. The phototoxicity occurred in the cytoplasm first and then disrupted the mycobacterial cell walls by lysis. In the rabbit keratitis model, combined PDT resulted in significantly less bacterial burden (P < 0.01) than in the amikacin group. CONCLUSIONS: This study demonstrated the effectiveness of MB-mediated PDT against Mycobacterium fortuitum. PDT could be a potential alternative treatment for nontuberculous mycobacterial corneal infections.

Soft tissue infection due to Mycobacterium fortuitum following acupuncture: a case report and review of the literature.

We report the first case of a post-acupuncture soft tissue infection due to Mycobacterium fortuitum. Two months after finishing an acupuncture treatment session, an immunocompetent 23-year-old woman developed cellulitis at the side of the needle insertions and the acid-fast bacillus was isolated from a closed abscess. The patient was successfully treated with a proper drug combination. We review the literature concerning the infection source and the risks for skin and soft tissue infection due to mycobacteria after acupuncture. The infection source in most cases is unknown but is probably associated with the inadequate sterilization of the needles or the puncture site. We show that these infections are not rare but difficult to diagnose. To avoid delays in the definitive diagnosis, infection with mycobacteria should be considered for skin and soft tissue infections, in particular late-onset infections, which are negative for routine bacterial cultures and without a clinical response to antibiotics used for acute pyogenic infections. Bacterial cultures from this lesion should be maintained for at least six weeks before discharged as negative.

An outbreak of Mycobacterium fortuitum cutaneous infection associated with mesotherapy.

OBJECTIVE: We describe an outbreak of Mycobacterium fortuitum cutaneous infections associated with mesotherapy in La Rioja, Spain. DESIGN: Descriptive epidemiology. SETTING: Private practice. PATIENTS OR OTHER PARTICIPANTS: Case subjects were customers of a single beauty salon who were treated with mesotherapy injections. INTERVENTION(S): Two skin biopsies were taken from each patient. RESULTS: Over the designated period, 138 women received mesotherapy. Of these women, 39, or 28.3%, developed lesions ultimately thought to be caused by Mycobacterium fortuitum infection. The number of lesions per patient varied from 3 to 20 in the most severe case. Most of the lesions were indurated, erythematous or violaceous papules, some progressing to become fluctuant boils with suppuration, fistulization and scarring. The individual lesions varied in diameter from 0.5 to 6 cm. Two patients (5.1%) developed inguinal or axillary adenopathy. Two others presented with fever. One reported muscular pain. In 12 of the 39 cases, M. fortuitum was isolated from the wound cultures. The patients were all successfully treated with clarithromycin and levofloxacin. CONCLUSIONS: We identified a large outbreak of rapidly growing mycobacterial lesions among women who received mesotherapy injections in a single beauty salon.

Cutaneous Infection due to Mycobacterium fortuitum Originated from Soil / 대한피부과학회지

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.

Mesotherapy and cutaneous Mycobacterium fortuitum infection.

BACKGROUND: Cutaneous infections caused by Mycobacterium fortuitum usually are a complication of trauma or postsurgical wounds. CASE REPORT: A 41-year-old woman presented with numerous dusky red nodules, abscesses and sinuses on the right buttock and on the lateral surfaces of both thighs. The lesions developed at the injection sites of mesotherapy treatment. M. fortuitum was cultured from a biopsy specimen and purulent fluid drained from lesions. The lesions had cleared completely with ciprofloxacin 500 mg b.d. for 3 weeks, and then 250 mg b.d. for another 3 weeks. CONCLUSIONS: This case demonstrates the importance of suspecting mycobacterial etiology in patients with nodules and abscesses in the areas of mesotherapy treatment.

Components derived from Pelargonium stimulate macrophage killing of Mycobacterium species.

AIMS: To determine the capacity of extracts of Pelargonium reniforme and Pelargonium sidoides, plants of the Geraniaceae family, to stimulate the uptake and killing of mycobacteria by murine macrophages and to identify the constituents that are responsible. METHODS AND RESULTS: Bioassay-guided fractionation of aqueous P. reniforme extracts yielded five chemically distinct structures with the capacity to increase the rate of intracellular killing by macrophages. These were: gallic acid, methyl gallate, myricetin and quercitin-3-O-beta-d-glucoside, in addition to the previously unrecognized constituent 1-O-(2-(4-methoxyphenyl)ethyl-6-O-galloyl-glucopyranoside. Kinetics of intracellular accumulation of Mycobacterium tuberculosis and Mycobacterium fortuitum by macrophages were indistinguishable; pure preparations of the four previously known plant constituents stimulated macrophage killing, but not uptake, of M. tuberculosis and M. fortuitum equally well. CONCLUSIONS: A number of distinct molecular species are present in the medicinal plant P. reniforme that stimulate the killing of the intracellular pathogen M. tuberculosis. SIGNIFICANCE AND IMPACT OF THE STUDY: These observations support the view that Pelargonium extracts may have utility in the treatment of tuberculosis.

A Case of Mycobacterium fortuitum Infection at the Site of Acupuncture / 대한피부과학회지

Mycobacterial infections that are transmitted by acupuncture are an emerging problem. M. fortuitum is one of the rapid-growing atypical mycobacteria and this infection usually follows a puncture wound or a surgical procedure. We report here on a case of M. fortuitum infection following an acupuncture procedure. A 37-year-old woman presented with indurations and ulcerations of both popliteal fossae after undergoing acupuncture. The skin biopsy specimen showed suppurative inflammation with a lymphocytic infiltration, and the Ziehl-Neelsen stain for AFB was negative. Bacterial culture of the tissue fluid was negative. The culture of the tissue specimen and polymerase chain reaction revealed M. fortuitum. The infection responded to 10 weeks of treatment with isoniazid, rifampin and ethambutol, and four months of treatment with rifampin. Despite of the increasing popularity of acupuncture, the importance of infection control has not been adequately emphasized in oriental medicine. Education for proper infection control, including aseptic practice, is necessary for oriental medical doctors and practitioners.

Bilateral sporotrichoid lymphocutaneous dermatosis in a drug abuser: case report and review of the literature.

Bilateral sporotrichoid mycobacterial cutaneous infection is unusual and has been reported in only three cases involving different species and with an unknown route of infection in the literature.We report a case of bilateral sporotrichoid dermatosis in an immunocompetent patient with a history of intravenous heroin injection before development of the skin lesions. Both special stain and culture of biopsy specimen were negative. Finally, Mycobacterium fortuitum was identified by a polymerase chain reaction-based method. The patient responded well to clarithromycin and ciprofloxacin therapy. This case represents an unusual primary cutaneous M. fortuitum infection manifested as bilateral sporotrichoid lesions of the limbs. Review of previous reported cases of bilateral sporotrichoid mycobacterial infection shows different isolated organisms and routes of infection to that found in our case.

[Treatment of cutaneous infections due to Mycobacterium fortuitum: two cases]. / Traitement des infections cutanées àMycobacterium fortuitum : deux cas.

INTRODUCTION: Cutaneous infections due to Mycobacterium fortuitum, a rapidly growing environmental mycobacteria, are often iatrogenic, resulting from surgery or injection. We report two cases following plastic surgery and describe the outcome after surgery and antibiotics. CASE REPORTS: Two immunocompetent women underwent abdominal plastic surgery and liposuction, which were complicated with recurrent abscesses one and 13 months later respectively. Cultures of bacteriologic samples isolated M. fortuitum in the two patients. The two strains exhibited different antibiotic sensibility profiles. The initial antibiotic therapy consisted of combined amikacin and moxifloxacin in both patients plus imipenem in one, followed by oral doxycycline and clarithromycin in one and moxifloxacin in the other for a total duration of nine and five months, respectively. In both cases, surgical treatment was also given before, during and after antibiotic therapy. No new lesions had appeared six months after the end of antibiotic therapy. DISCUSSION: Cutaneous infections due to M. fortuitum are rare and secondary to iatrogenic skin wounds. The clinical appearance is not specific, accounting for delayed diagnosis. Treatment is difficult and there is no consensus. According to our experience, surgical treatment is essential whereas the efficacy of antibiotics, even involving multiple agents, seems more doubtful.

Purified compounds and extracts from Euclea species with antimycobacterial activity against Mycobacterium bovis and fast-growing mycobacteria.

Naphthoquinones and other compounds with antimycobacterial activity against Mycobacterium tuberculosis have previously been isolated from Euclea species. In this study, several constituents of Euclea natalensis and E. undulata, as well as organic extracts of the leaves, were assessed for efficacy against the zoonotic pathogen, Mycobacterium bovis. Also included in the battery of test organisms were M. bovis BCG and the fast-growing species M. smegmatis and M. fortuitum. The acetone extract of E. natalensis had potent activity against M. bovis (MIC=26 microg/ml). The naphthoquinone 7-methyljuglone was the most active compound, with an MIC as low as 1.55 microg/ml against pathogenic M. bovis. M. bovis BCG was not as susceptible to the test compounds as the pathogenic strain, but similar patterns of activity were observed between all the strains tested. M. smegmatis appeared to be a better predictor of antimycobacterial activity against pathogenic M. bovis (and M. tuberculosis), while MIC values obtained using M. fortuitum correlated well with those of M. bovis BCG.