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
Mycobacterium haemophilum has been described as a pathogen that causes cutaneous lesions in immunocompromised patients. A specimen from a skin ulcer on the leg of a Japanese patient with acquired immunodeficiency syndrome yielded acid-fast bacilli on blood agar plates after 4 weeks of incubation at 30 degrees C, but the organism was not found on Ogawa egg slants. The organism was identified as M. haemophilum, on the basis of 16S rRNA gene sequence analysis. Prolonged culture in an optimal environment that includes an iron supplement, and growth temperatures at 28 degrees to 33 degrees C are necessary to grow M. haemophilum. Genotypic characterization of 16S rRNA is useful for a rapid diagnosis of this slowly growing mycobacterium.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Úlcera da Perna/microbiologia , Infecções por Mycobacterium/microbiologia , Mycobacterium haemophilum/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Sequência de Bases , DNA Bacteriano , Humanos , Japão , Úlcera da Perna/tratamento farmacológico , Úlcera da Perna/patologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/patologia , Mycobacterium haemophilum/classificação , Mycobacterium haemophilum/genética , Mycobacterium haemophilum/crescimento & desenvolvimento , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Homologia de Sequência do Ácido Nucleico , Resultado do TratamentoRESUMO
Acid-fast bacilli from pediatric patients with lymphadenopathy were detected in the BACTEC radiometric system and in MB Redox broth, but not on Löwenstein Jensen medium. PCR amplification identified the isolates as Mycobacterium haemophilum, which has special nutrition requirements (iron supplements) for growth. Suitable culture medium ensures optimal recovery of this microorganism, avoiding underdiagnosis.