Title : Rapid growing mycobacteria infection: An entity in diagnosis?
Abstract:
Nontuberculous mycobacteria includes rapid growing (RGM) and slow growing mycobacteria. RGMs like M. abscessus and M. fortuitum- chelonae complex can produce natural chronic infections and the infections of implants. They are usually present in soil and water and get introduced to human body by invasive procedures and by natural means. This presentation describes four cases of M. fortuitum and one case of M. abscessus. Three patients (age group 50-60 yrs) who underwent inguinal hernia repair with mesh had complaints of oozing from wound for several weeks, and one patient for three years. Initially they were investigated for wound infections by culturing the superficial samples for which they had undergone treatment for colonisations like pseudomonas. As the symptoms were persisting, eventually wound explorations were done to grow M. fortuitum and thus they were treated with macrolides and fluoroquinolones.
A 50-year-old male with a history of stent implant in coronary artery presented with pyrexia of unknown origin (PUO) of six months duration. Despite the patient had undergone various antibiotic treatments, his PUO was not relieved. Three blood samples were collected at different time for a detailed evaluation and M. fortuitum was identified. The colonization was possibly associated with stent. Despite a long period of treatment, the patient finally succumbed to disease.
A 3-year-old child was brought with abscess on the front of right ear. Ultrasonogram features were suggestive of tuberculosis. Histopathologiacal examination revealed granulomatous change and there were acid fast bacilli in the drained out pus. The infection was provisionally diagnosed as tuberulosis. But cartridge based nucleic acid amplification test failed to detect M. tuberculosis. Culture of pus on Lowenstein Jensen medium grew M. abscessus which was later identified genotypically as subspecies massiliense. Patient was successfully treated with macrolides and fluoroquinolones. Proper identification prevents the physician from prescribing unnecessary antibiotics and thus reduces the morbidity. This signifies the importance of microbiological diagnosis of situations of menace in infection which could help in all the above cases.
