Autosomal Recessive IL-12p40 Deficiency due to a Mutation in the IL12B Gene: Report of a Brazilian Patient with Lymph Node Mycobacterial Infection.

Background: Autosomal recessive interleukin (IL)-12p40 deficiency is a genetic etiology of Mendelian susceptibility to mycobacterial disease (MSMD). It has been described in ∼50 patients, usually with onset at childhood with Bacille Calmette-Guérin (BCG) and Salmonella infections. Case Presentation: A male patient born to consanguineous parents was diagnosed with presumed lymph node MSMD at the age of 13 years after ocular symptoms. A positive history of inborn error of immunity was present: BCG reaction, skin abscess, and recurrent oral candidiasis. Abnormal measurements of cytokine levels, IL-12p40 and interferon-gamma (IFN-γ), lead to the diagnosis of MSMD. Genetic analysis showed a mutation in exon 7 of the IL12B gene. Currently, the patient is alive under prophylactic antibiotics. Conclusion: We report a rare case of IL-12p40 deficiency in a Latin American patient. Medical history was crucial for immune defect suspicion, as confirmed by precision diagnostic medicine tools.

Avian mycobacteriosis in a naturally infected captive nocturnal curassow (Nothocrax urumutum)

A senile female nocturnal curassow (Nothocrax urumutum) kept under human care was found dead. Grossly, the lungs were congested and had a nodule with 2.0 cm in diameter adhered to the left lung. Histologically, there were multifocal to coalescent areas of necrosis characterized by deposition of amorphous and eosinophilic material with large amount of cellular debris, surrounded by numerous epithelioid macrophages, multinucleated Langhans giant cells, occasional lymphocytes and plasma cells. Ziehl-Neelsen stained sections demonstrated myriad of intralesional alcohol-acid resistant bacilli (BAAR). DNA extracted from lung samples were evaluated by nested polymerase chain reaction resulting in mycobacterial DNA identification. This is the first reported case of mycobacteriosis in a nocturnal curassow.(AU)

Canine Leproid Granuloma (CLG) Caused by Mycobacterial Species Closely Related to Members of Mycobacterium Simiae Complex in a Dog in Brazil.

This report describes the clinical features and molecular diagnosis of a case of canine leproid granuloma (CLG) caused by mycobacterial strains of the Mycobacterium simiae complex in Brazil. A 12-year-old non-neutered male Labrador Retriever dog was presented with a 2-week history of progressive painless cutaneous lesions. Ulcerated nodules with hematic crusts were observed on the dorsal surface of the right and left pinna and on the metacarpal, metatarsal, and digits. Complete blood count, serum biochemistry, aspiration cytology of cutaneous lesions, biopsy for histopathological evaluation, culture for aerobic and anaerobic bacteria, polymerase chain reaction and DNA sequencing to identify mycobacterial species were performed. According to the clinical and histopathological findings, a diagnosis of CLG was established. Despite the negative result of the bacterial culture, mycobacterial identification was made by sequencing the hsp65 gene. Our findings highlight that mycobacterial species closely related to members of the M simiae clade can be causative agents of CLG.

Mycobacteriosis in an appearantly healty atlantic mackerel (Scomber Scombrus, L) and zoonotic potential / Micobacteriose em uma cavala atlântica aparentemente curada (Scomber Scombrus, L) e potencial zoonótico

Mycobacteriosis was detected in seven out of one Atlantic mackerel (Scomber scombrus) that was purchased for human consumption from a fish market. The fish was apparently healthy but during cleaning, several granulomatous foci were noticed in the visceral organs. Histopathological examination of the lesions revealed numerous foci characterized by caseous necrosis in the center of the lesion surrounded by epithelioid giant cells. Ziehl-Neelsen staining revealed the presence of rod-shaped, acid-fast bacteria. Furthermore, immunohistochemical examination revealed the presence of a protein of mycobacterial origin in giant cells and macrophages. Based on gross and microscopic findings, mycobacteriosis was diagnosed. This report showed that due to its zoonotic potential, mycobacteriosis should be considered even in healthy-appearing fishes for human consumption.

A micobacteriose foi detectada em uma de sete cavalas do Atlântico (Scomber scombrus) que foi comprada para consumo humano em um mercado de peixe. O peixe era aparentemente saudável, mas durante a limpeza, vários focos granulomatosos foram notados nos órgãos viscerais. O exame histopatológico das lesões revelou numerosos focos caracterizados por necrose caseosa no centro da lesão circundada por células gigantes epitelioides. A coloração de Ziehl-Neelsen revelou a presença de bactérias em forma de bastonete, com rápida acidez. Além disso, o exame imunohistoquímico revelou a presença de uma proteína de origem micobacteriana em células gigantes e macrófagos. Com base em achados grosseiros e microscópicos, a micobacteriose foi diagnosticada. Este relatório mostrou que devido a seu potencial zoonótico, a micobacteriose deve ser considerada mesmo em peixes saudáveis para consumo humano.

Tuberculosis in bovine slaughtered in the semi-arid region of Rio Grande do Norte, Brazil / Tuberculose em bovinos abatidos no semiárido do Rio Grande do Norte, Brasil

Between November 2017 and August 2018, in order to determine the occurrence of tuberculosis in cattle slaughtered in the semi-arid region of Rio Grande do Norte, 11,610 bovine carcasses underwent a routine post-mortem inspection. One animal presented suggestive lesions and samples from lung, spleen and heart were submitted to microbiological culture in Stonebrink medium for 90 days and molecular analysis by nested-PCR. For histopathological examination and Ziehl Neelsen staining, the omentum was used. In the cultured samples, two of them (heart and spleen) showed growth, but were not confirmed as M. bovis by conventional PCR. At nested-PCR, the samples showed amplification for the TbD1 region. The presence of numerous granulomas was detected in the histopathological examination characterized by anecrotic center and areas of mineralization, as well as the presence of acid-fast bacilli (AFB) in the Ziehl Neelsen stain. Microbiological culture can show false negative results, despite being considered a gold standard technique, although it takes time. Nested-PCR and histopathology show fast and effective results for the diagnosis of the disease. The presence of positive animals represents a public health risk in the studied region. Therefore, one of the essential systems applied to the control of bovine tuberculosis is the epidemiological surveillance of animals in slaughterhouses.

Entre novembro de 2017 e agosto de 2018, com objetivo de determinar a ocorrência de tuberculose em bovinos abatidos no semiárido do Rio Grande do Norte, 11.610 carcaças de bovinos passaram por inspeção post-mortem de rotina. Um animal apresentou lesões sugestivas e amostras de pulmão, baço e coração foram submetidas ao cultivo microbiológico em meio Stonebrink por 90 dias e análise molecular pela nested-PCR. O omento foi utilizado para exame histopatológico e coloração de Ziehl Neelsen. Nas amostras cultivadas, duas (coração e baço) evidenciaram crescimento, mas M. bovis não foi confirmado na PCR convencional. Já na nested-PCR, as amostras exibiram amplificação para a região TbD1. Foi detectada a presença de inúmeros granulomas no exame histopatológico caracterizados por possuírem um centro necrótico e áreas de mineralização, bem como a presença de bacilos Álcool-ácido resistentes (BAAR)na coloração de Ziehl-Neelsen. A cultura microbiológica pode apresentar resultados falso-negativos, apesar de ser considerada uma técnica padrão-ouro, embora demorada. A nested-PCR e a histopatologia apresentam resultados rápidos e eficazes para o diagnóstico da enfermidade. A presença de animais positivos representa um risco a saúde pública na região estudada. Portanto, um dos sistemas essenciais aplicados ao controle da tuberculose bovina é a vigilância epidemiológica dos animais em abatedouros.

Tuberculosis in bovine slaughtered in the semi-arid region of Rio Grande do Norte, Brazil / Tuberculose em bovinos abatidos no semiárido do Rio Grande do Norte, Brasil

Between November 2017 and August 2018, in order to determine the occurrence of tuberculosis in cattle slaughtered in the semi-arid region of Rio Grande do Norte, 11,610 bovine carcasses underwent a routine post-mortem inspection. One animal presented suggestive lesions and samples from lung, spleen and heart were submitted to microbiological culture in Stonebrink medium for 90 days and molecular analysis by nested-PCR. For histopathological examination and Ziehl Neelsen staining, the omentum was used. In the cultured samples, two of them (heart and spleen) showed growth, but were not confirmed as M. bovis by conventional PCR. At nested-PCR, the samples showed amplification for the TbD1 region. The presence of numerous granulomas was detected in the histopathological examination characterized by anecrotic center and areas of mineralization, as well as the presence of acid-fast bacilli (AFB) in the Ziehl Neelsen stain. Microbiological culture can show false negative results, despite being considered a gold standard technique, although it takes time. Nested-PCR and histopathology show fast and effective results for the diagnosis of the disease. The presence of positive animals represents a public health risk in the studied region. Therefore, one of the essential systems applied to the control of bovine tuberculosis is the epidemiological surveillance of animals in slaughterhouses.(AU)

Entre novembro de 2017 e agosto de 2018, com objetivo de determinar a ocorrência de tuberculose em bovinos abatidos no semiárido do Rio Grande do Norte, 11.610 carcaças de bovinos passaram por inspeção post-mortem de rotina. Um animal apresentou lesões sugestivas e amostras de pulmão, baço e coração foram submetidas ao cultivo microbiológico em meio Stonebrink por 90 dias e análise molecular pela nested-PCR. O omento foi utilizado para exame histopatológico e coloração de Ziehl Neelsen. Nas amostras cultivadas, duas (coração e baço) evidenciaram crescimento, mas M. bovis não foi confirmado na PCR convencional. Já na nested-PCR, as amostras exibiram amplificação para a região TbD1. Foi detectada a presença de inúmeros granulomas no exame histopatológico caracterizados por possuírem um centro necrótico e áreas de mineralização, bem como a presença de bacilos Álcool-ácido resistentes (BAAR)na coloração de Ziehl-Neelsen. A cultura microbiológica pode apresentar resultados falso-negativos, apesar de ser considerada uma técnica padrão-ouro, embora demorada. A nested-PCR e a histopatologia apresentam resultados rápidos e eficazes para o diagnóstico da enfermidade. A presença de animais positivos representa um risco a saúde pública na região estudada. Portanto, um dos sistemas essenciais aplicados ao controle da tuberculose bovina é a vigilância epidemiológica dos animais em abatedouros.(AU)

Testes comerciais de sondas em linha para detecção do complexo Mycobacterium tuberculosis (MTB), de mutações nas regiões determinantes de resistência a rifampicina e isoniazida (1ª linha) e a fluoroquinolonas e aminoglicosídeos (2ª linha) / Commercial on-line probe tests for detection of Mycobacterium tuberculosis complex (MTB), mutations in rifampicin and isoniazid-resistance-determining regions (1st line) and fluoroquinolones and aminoglycosides (2nd line)

INTRODUÇÃO: Os testes de sonda em linha (LPA) são ensaios qualitativos que utilizam membranas de nitrocelulose com sondas de regiões parciais de genes de resistência. O GenoType MTBDRplus® , a partir de amostras de escarro positivo ou de culturas positivas, identifica o complexo M. tuberculosis e as principais mutações que conferem resistência à rifampicina e isoniazida a partir de sondas das regiões parciais de resistência de determinados genes. O GenoType MTBDRsl® possibilita a identificação de resistência também aos medicamentos injetáveis e de segunda linha, por meio de sondas de genes de resistência conhecidos. A população alvo desse abarca indivíduos com comorbidades ou não, de ambos os sexos, todas as idades, provenientes de qualquer país independentemente da incidência e prevalência regionais da doença, com suspeita de tuberculose pulmonar ou extrapulmonar ou indivíduos diagnosticados com tuberculose, independentemente da baciloscopia, tratados previamente ou não, e suspeita de resistência a drogas de primeira ou segunda linha utilizadas no tratamento das formas resistentes da doença. EQUIPAMENTO: Testes comerciais de sondas em linha para detecção do complexo Mycobacterium tuberculosis (MTB), de mutações nas regiões determinan

Detection of mycobacteria in coalho cheese sold in Northeastern Brazil / Detecção de micobactérias em queijo de coalho comercializado no Nordeste do Brasil

The aim of the present study was to detect and identify Mycobaterium spp. in 50 samples of coalho cheese sold in the Northeast region of Brazil. Of the 50 analyzed samples, 35 were produced by the artisanal process, using raw milk, and 15 originated from industrialized establishments that pasteurize milk. Conventional and real-time nested PCR for the rv2807 gene of the M. tuberculosis complex was performed directly from the 50 analyzed samples. Samples of coalho cheese were grown simultaneously in Stonebrink medium, and conventional PCR was performed from the bacterial isolates with primers that flank differentiation region 4 (DR4), specific to M. bovis, mb400F. Bacterial isolates negative by PCR for RD4 were subjected to PCR for hsp65 of Mycobacterium spp., with subsequent DNA sequencing. The cultures were negative for the M. tuberculosis complex, but two samples (4%) from the artisanal process (with raw milk) exhibited identity with hsp65 of Mycobacterium lehmanii (Sequence ID: KY933786.1, identities: 312/363 [86%]); and Mycobacterium rutilum (sequence ID: LT629971.1, identities: 331/371 [89%]), showing to be indicative environmental contamination. Non-tuberculous mycobacteria are emergent and ubiquitous microorganisms; therefore, they deserve greater attention in the cheese production chain, both in terms of Good Agricultural Practices (GAP)

O presente estudo teve como objetivo detectar e identificar Mycobaterium spp. em 50 amostras de queijo de coalho comercializados na região Nordeste do Brasil. Das 50 amostras analisadas, 35 foram produzidas pelo processo artesanal, com leite cru e 15 provenientes de estabelecimentos industrializados que realizam a pasteurização do leite. Nested-PCR convencional e em tempo real para o gene rv2807 do Complexo M. tuberculosis foi realizada diretamente das cinquenta amostras analisadas. Paralelamente, as amostras de queijo de coalho foram cultivadas em meio de Stonebrink e dos isolados bacterianos foi realizada PCR convencional com iniciadores que flanqueiam a região de diferenciação 4 (RD4), específica de M. bovis, mb400F. Os isolados bacterianos negativos na PCR para RD4 foram submetidos à PCR para hsp65 de Mycobacterium spp., com posterior sequenciamento do DNA. As culturas mostraram-se negativas para o Complexo M. tuberculosis, porém duas amostras oriundas do processo artesanal (com leite cru) (4%) apresentaram identidade com hsp65 de Mycobacterium lehmanii (ID da sequência: KY933786.1, identidades: 312/363 [86%]); e Mycobacterium rutilum (ID da sequência: LT629971.1, identidades: 331/371 [89%]), apontando-se como indicativos de contaminação ambiental. As micobactérias-não-tuberculosas (MNT) são microrganismos emergentes e de natureza ubíqua. Devido a essas características merecem maior atenção na cadeia produtiva de queijos, tanto nas boas práticas agropecuárias (BPAs) quanto nas boas práticas de fabricação de alimentos (BPFs).

Detection of mycobacteria in coalho cheese sold in Northeastern Brazil / Detecção de micobactérias em queijo de coalho comercializado no Nordeste do Brasil

The aim of the present study was to detect and identify Mycobaterium spp. in 50 samples of coalho cheese sold in the Northeast region of Brazil. Of the 50 analyzed samples, 35 were produced by the artisanal process, using raw milk, and 15 originated from industrialized establishments that pasteurize milk. Conventional and real-time nested PCR for the rv2807 gene of the M. tuberculosis complex was performed directly from the 50 analyzed samples. Samples of coalho cheese were grown simultaneously in Stonebrink medium, and conventional PCR was performed from the bacterial isolates with primers that flank differentiation region 4 (DR4), specific to M. bovis, mb400F. Bacterial isolates negative by PCR for RD4 were subjected to PCR for hsp65 of Mycobacterium spp., with subsequent DNA sequencing. The cultures were negative for the M. tuberculosis complex, but two samples (4%) from the artisanal process (with raw milk) exhibited identity with hsp65 of Mycobacterium lehmanii (Sequence ID: KY933786.1, identities: 312/363 [86%]); and Mycobacterium rutilum (sequence ID: LT629971.1, identities: 331/371 [89%]), showing to be indicative environmental contamination. Non-tuberculous mycobacteria are emergent and ubiquitous microorganisms; therefore, they deserve greater attention in the cheese production chain, both in terms of Good Agricultural Practices (GAP)(AU)

O presente estudo teve como objetivo detectar e identificar Mycobaterium spp. em 50 amostras de queijo de coalho comercializados na região Nordeste do Brasil. Das 50 amostras analisadas, 35 foram produzidas pelo processo artesanal, com leite cru e 15 provenientes de estabelecimentos industrializados que realizam a pasteurização do leite. Nested-PCR convencional e em tempo real para o gene rv2807 do Complexo M. tuberculosis foi realizada diretamente das cinquenta amostras analisadas. Paralelamente, as amostras de queijo de coalho foram cultivadas em meio de Stonebrink e dos isolados bacterianos foi realizada PCR convencional com iniciadores que flanqueiam a região de diferenciação 4 (RD4), específica de M. bovis, mb400F. Os isolados bacterianos negativos na PCR para RD4 foram submetidos à PCR para hsp65 de Mycobacterium spp., com posterior sequenciamento do DNA. As culturas mostraram-se negativas para o Complexo M. tuberculosis, porém duas amostras oriundas do processo artesanal (com leite cru) (4%) apresentaram identidade com hsp65 de Mycobacterium lehmanii (ID da sequência: KY933786.1, identidades: 312/363 [86%]); e Mycobacterium rutilum (ID da sequência: LT629971.1, identidades: 331/371 [89%]), apontando-se como indicativos de contaminação ambiental. As micobactérias-não-tuberculosas (MNT) são microrganismos emergentes e de natureza ubíqua. Devido a essas características merecem maior atenção na cadeia produtiva de queijos, tanto nas boas práticas agropecuárias (BPAs) quanto nas boas práticas de fabricação de alimentos (BPFs).(AU)

Anal mycobacterial infections / Infecções micobacterianas do ânus

Abstract Background Mycobacterial infections are a serious public health problem worldwide. Involvement of the anal canal and perineum is very rare, but constitute an important differential diagnosis with other equally serious pathologies that may affect the region, such as malignant neoplasms and Crohn's disease. Objectives To conduct a literature review on mycobacterial infections of the perianal region considering the most recent information for diagnostic and therapeutic guidance of this disease. Methods Research was performed on the PUBMED and LILACS databases with the expressions Mycobacterium, Anal, Infection and Tuberculosis. We reviewed articles referring to series of treated cases, clinical reports and literature review published since 2005. Results Information was compiled on the epidemiology of mycobacterial infections; the clinical behavior of affected individuals; diagnostic options and their validity in clinical practice; and, finally, therapeutic options. Conclusions Mycobacterial infections of the anus and perineum are rare. The most common clinical presentations are the presence of ulceration and fistulization. The diagnosis involves more than one procedure for identifying the bacilli and should consider the presence of manifestations in more than one organ. The treatment is based on pharmacological intervention. Surgery is recommended for acute complications or chronic sequelae of the disease.

Resumo Introdução Infecções micobacterianas constituem um grave problema de saúde pública a nível mundial. As manifestações anoperineais são raras, mas constituem um importante diagnóstico diferencial com outras patologias igualmente graves que podem acometer a região, como as neoplasias malignas e a doença de Crohn. Objetivos Realizar um levantamento da literatura sobre infecções micobacterianas da região anoperineal, considerando as informações mais atuais para orientação diagnóstica e terapêutica dessa enfermidade. Métodos Foi realizada pesquisa nos bancos de dados PUBMED e LILACS com as expressões Mycobacterium, Anal, Infection e Tuberculosis. Foram revisados artigos referentes a séries de casos tratados, relatos clínicos e revisão da literatura publicada a partir de 2005. Resultados Foram compiladas informações sobre a epidemiologia das infecções micobacterianas; o comportamento clínico dos indivíduos afetados; opções diagnósticas e sua validade na prática clínica; e, por fim, opções terapêuticas. Conclusões Infecções micobacterianas da região anoperineal são raras. As apresentações clínicas mais comuns são a formação de ulceras e a fistulização. O diagnóstico envolve mais de um procedimento para identificação dos bacilos, e deve considerar a presença de manifestações em mais de um órgão. O tratamento é principalmente medicamentoso, sendo a cirurgia recomendada nas complicações agudas ou sequelas crônicas da doença.

Cutaneous Mycobacterial Infections.

Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of Mycobacterium tuberculosis infection, (ii) Buruli ulcer caused by Mycobacterium ulcerans and other related slowly growing mycobacteria, (iii) leprosy caused by Mycobacterium leprae and Mycobacterium lepromatosis, and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Mycobacterium ulcerans produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.

Growth characteristics of liquid cultures increase the reliability of presumptive identification of Mycobacterium tuberculosis complex.

We evaluated the microscopic and macroscopic characteristics of mycobacteria growth indicator tube (MGIT) cultures for the presumptive identification of the Mycobacterium tuberculosis complex (MTBC) and assessed the reliability of this strategy for correctly directing isolates to drug susceptibility testing (DST) or species identification. A total of 1526 isolates of mycobacteria received at the Instituto Adolfo Lutz were prospectively subjected to presumptive identification by the observation of growth characteristics along with cord formation detection via microscopy. The presumptive identification showed a sensitivity, specificity and accuracy of 98.8, 92.5 and 97.9 %, respectively. Macroscopic analysis of MTBC isolates that would have been erroneously classified as non-tuberculous mycobacteria based solely on microscopic morphology enabled us to direct them rapidly to DST, representing a substantial gain to patients. In conclusion, the growth characteristics of mycobacteria in MGIT, when considered along with cord formation, increased the reliability of the presumptive identification, which has a great impact on the laboratory budget and turnaround times.

Detection of Mycobacterium chelonae, Mycobacterium abscessus Group, and Mycobacterium fortuitum Complex by a Multiplex Real-Time PCR Directly from Clinical Samples Using the BD MAX System.

A new multiplex PCR test was designed to detect Mycobacterium chelonae, Mycobacterium abscessus group, and Mycobacterium fortuitum complex on the BD MAX System. A total of 197 clinical samples previously submitted for mycobacterial culture were tested using the new protocol. Samples were first treated with proteinase K, and then each sample was inoculated into the BD MAX Sample Buffer Tube. Extraction and multiplex PCR were performed by the BD MAX System, using the BD MAX ExK TNA-3 extraction kit and BD TNA Master Mix, along with specific in-house designed primers and probes for each target. The limit of detection of each target, as well as specificity, was evaluated. Of 197 clinical samples included in this study, 133 were positive and 60 were negative for mycobacteria by culture, and another 4 negative samples were spiked with M. chelonae ATCC 35752. The new multiplex PCR on the BD MAX had 97% concordant results with culture for M. abscessus group detection, 99% for M. chelonae, and 100% for M. fortuitum complex. The new multiplex PCR test performed on the BD MAX System proved to be a sensitive and specific test to detect M. chelonae, M. abscessus group, and M. fortuitum complex by real-time PCR on an automated sample-in results-out platform.

Verrucous tumor mimicking squamous cell carcinoma in immunocompetent patient.

Mycobacteria cause a range of diseases in both immunocompetent and immunosuppressed individuals. An increase in non-tuberculous mycobacterial (NTM) infections targeting skin has been described. Many hypotheses have been developed in order to explain it: the increasing burden of immunocompromised individuals, immigration from endemic countries, improved laboratory identification techniques, and changes inhuman behavior that expose individuals to this NTM. Mycobacterium mucogenicum group comprises M. mucogenicum, Mycobacterium aubagnense, and Mycobacterium phocaicum. This group of organisms was first named Mycobacterium chelonae-like organism in 1982. Most clinically significant cases of those organisms involved catheter-related infections. Nevertheless, we report an interesting patient with a cutaneous infection produced by M. mucogenicum mimicking a squamous cell carcinoma; an excellent response to combined therapy with rifampicin and clarythromicin was observed.