Subject(s)
Immunocompromised Host , Mycobacterium Infections/diagnosis , Mycobacterium haemophilum/isolation & purification , Skin Diseases, Bacterial/diagnosis , Female , Humans , Immunocompromised Host/immunology , Middle Aged , Mycobacterium Infections/immunology , Mycobacterium haemophilum/immunology , Skin Diseases, Bacterial/immunologyABSTRACT
Mycobacterium haemophilum is a slow-growing organism first identified in 1978. Since that time, it has emerged as an unusual pathogen, but one that is identified increasingly, mainly affecting immunocompromised patients and healthy children. The range of disease caused by this organism includes skin and soft-tissue infections, pulmonary infections, lymphadenitis, and frequently, bone and joint infections. Laboratory identification of M haemophilum needs special culture techniques and media and can be difficult in a setting at which these methods are not routinely used. We describe a case of chronic, disseminated M haemophilum infection in a patient with AIDS, and we review published work.
Subject(s)
Acquired Immunodeficiency Syndrome/virology , Anti-Bacterial Agents/administration & dosage , Anti-HIV Agents/administration & dosage , Cellulitis/microbiology , HIV/immunology , Mycobacterium Infections/virology , Mycobacterium haemophilum/immunology , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/immunology , Cellulitis/drug therapy , Cellulitis/immunology , Clarithromycin/administration & dosage , Humans , Immunocompromised Host , Male , Middle Aged , Mycobacterium Infections/drug therapy , Mycobacterium Infections/immunology , Ofloxacin/administration & dosage , Rifabutin/administration & dosageABSTRACT
Reports of the association of Mycobacterium haemophilum with disease in humans have greatly increased. At least 64 cases have now been reported, with symptoms ranging from focal lesions to widespread, systemic disease. The organism is now known to cause primarily cutaneous and subcutaneous infection, septic arthritis, osteomyelitis, and pneumonitis in patients who are immunologically compromised and lymphadenitis in apparently immunocompetent children. Underlying conditions in the compromised patients have included AIDS; renal, bone marrow, and cardiac transplantation; lymphoma; rheumatoid arthritis; marrow hypoplasia; and Crohn's disease. Reports have originated from diverse geographic areas worldwide. The epidemiology of M. haemophilum remains poorly defined; there appears to be a genetic diversity between strains isolated from different regions. The organism is probably present in the environment, but recovery by sampling has not been successful. M. haemophilum has several unique traits, including predilection for lower temperatures (30 to 32 degrees C) and requirement for iron supplementation (ferric ammonium citrate or hemin). These may in the past have compromised recovery in the laboratory. Therapy has not been well elucidated, and the outcome appears to be influenced by the patient's underlying immunosuppression. The organisms are most susceptible to ciprofloxacin, clarithromycin, rifabutin, and rifampin. Timely diagnosis and therapy require communication between clinician and the laboratory.