Skip to main content

Advertisement

SpringerLink
Log in

Rapidly Growing Mycobacterial Infections of the Skin and Soft Tissues Caused by M. fortuitum and M. chelonae

  • Cutaneous Mycobacterial Diseases of the Skin and Soft Tissues (C Franco-Paredes, Section Editor)
  • Published:
Current Tropical Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Non-tuberculous mycobacteria (NTM) have emerged as pathogens of clinical importance in human health as etiological agents of opportunist infections. Although NTM are known to cause systemic infections in immunocompromised subjects primarily in HIV patients, yet the growing number of immunosuppressed patients with new therapies and even more recently in non-immunocompromised subjects often localized infections of the lungs or skin and soft tissues (S&STI) but with a new clinical spectrums. Our goal is to report distinct patterns of infections according to the clinical and immunological settings and management options.

Recent Findings

Mycobacteria are efficacious pathogens because of their ability to survive and reproduce within the macrophages because of mechanisms of evasion of the host defenses and also because of their capacity to produce biofilms that facilitate their permanence in environmental reservoirs. Thus, both community and healthcare-associated infections have been reported. Also, we emphasize the concept of the new NTM complex of rapid growing Mycobacterium fortuitum-vaccae and Mycobacterium abscessus-chelonae (RGM) based on genetic and molecular characteristics that differentiate members according to the 16S rRNA gene clade and overall genome similarity.

Summary

S&STI by RGM should be considered when response to standard antibiotic therapy is deficient and microbiological work-up is negative. Effective treatment of these RGM pathogens includes surgical treatment with combined antimicrobial therapy; resistance to first-line anti-tuberculous drugs is common so therapy should be based on in vitro susceptibility testing. More clinical studies due to a lack of standard guidelines for the treatment of RGM infections are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Park GYS, Chung MP, Kim H, Jung Kwon O, Lee KS, Lee NY, et al. Clinical significance of Mycobacterium fortuitum isolated from respiratory specimens. Respir Med. 2008;102(3):437–42, ISSN 0954-6111. https://doi.org/10.1016/j.rmed.2007.10.005.

  2. •• Hypolite T, Grant-Kels JM, Chirch LM. Nontuberculous mycobacterial infections: a potential complication of cosmetic procedures. International Journal of Women's Dermatology. 2015;1(1):51–4. https://doi.org/10.1016/j.ijwd.2014.12.007. ISSN 2352–6475, Describes the increase in the incidence of NTM infections related to common cosmetic procedures, methods of identification, and outlines best treatment practices for diagnosis and treatment.

    Article  PubMed  PubMed Central  Google Scholar 

  3. • Tam, P. Y. I., Kline, S., Wagner, J. E., Guspiel, A., Streifel, A., Ward, G., Ferrieri, P. (2014). Rapidly growing mycobacteria among pediatric hematopoietic cell transplant patients traced to the hospital water supply. Pediatric Infectious Disease Journal, 33(10), 1043-1046. https://doi.org/10.1097/INF.0000000000000391. A outbreak of RGM among pediatric hematopoietic cell transplant patients was traced to an environmental source and was successfully controlled through institution of infection control measures.

  4. • Kostakioti M, Hadjifrangiskou M, Hultgren SJ. Bacterial biofilms: development, dispersal, and therapeutic strategies in the dawn of the postantibiotic era. Cold Spring Harb Perspect Med. 2013;3(4): a010306. https://doi.org/10.1101/cshperspect.a010306. Biofilms form both in the environment and in the healthcare setting allowing pathogens to persist as reservoirs that can readily spread to patients since it can subvert innate immune defenses and are associated with long-term persistence.

  5. •• Sabin AP, Ferrieri P, Kline S. Mycobacterium abscessus complex infections in children: a review. Curr Infect Dis Rep. 2017;19:46. https://doi.org/10.1007/s11908-017-0597-2. Describes NTM infections in children, new diagnostic tools utilized to confirm cases and describes the use to verify human-to-human transmission.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tortoli E. Phylogeny of the genus Mycobacterium: many doubts, few certainties. Infect Genet Evol. 2012;12(4):827–31, ISSN 1567-1348. https://doi.org/10.1016/j.meegid.2011.05.025.

    Article  PubMed  Google Scholar 

  7. •• Tortoli E. Microbiological features and clinical relevance of new species of the genus Mycobacterium. Clin Microbiol Rev. 2014;27(4):727–52. https://doi.org/10.1128/CMR.00035-14. published 2 October 2014; Describes 50 new species of NTM and their role in human infections as opportunistic pathogens.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Joao I, Cristovao P, Antunes L, Nunes B, Jordao L. Identification of nontuberculous mycobacteria by partial gene sequencing and public databases. Int J Mycobacteriol. 2014;3(2):144–51, ISSN 2212-5531. https://doi.org/10.1016/j.ijmyco.2014.04.001.

    Article  PubMed  Google Scholar 

  9. Freidlin PJ. A new paradigm for genus Mycobacterium population structure. J Bacteriol Parasitol. 2013;4:169. https://doi.org/10.4172/2155-9597.1000169.

    Article  CAS  Google Scholar 

  10. • Beye M, Fahsi N, Raoult D, Fournier P-E. Careful use of 16S rRNA gene sequence similarity values for the identification of Mycobacterium species. New Microbes New Infect. 2018;22:24–9. https://doi.org/10.1016/j.nmni.2017.12.009. Evaluate the suitability of the interpretation of interspecies 16S rRNA identity values should be made to cautiously classify a new mycobacterial isolate at the species level.

  11. •• Gupta RS, Lo B, Son J. Phylogenomics and comparative genomic studies robustly support division of the genus Mycobacterium into an emended genus Mycobacterium and four novel genera. Front Microbiol. 2018;9:67. https://doi.org/10.3389/fmicb.2018.00067. Describes unique genetic and molecular characteristics that differentiate members of the mycobacterial species into these five distinct NTM groups giving origin “ Fortuitum-vaccae ” and “ abscessus-chelonae” clades.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Svetlíková Z, Skovierová H, Niederweis M, Gaillard JL, McDonnell G, Jackson M. Role of porins in the susceptibility of Mycobacterium smegmatis and Mycobacterium chelonae to aldehyde-based disinfectants and drugs. Antimicrob Agents Chemother. 2009;53(9):4015–8. https://doi.org/10.1128/AAC.00590-09.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Bryers JD. Medical biofilms. Biotechnol Bioeng. 2008;100(1):1–18. https://doi.org/10.1002/bit.21838.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. • Griffith D, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2017;175(4):367–416. https://doi.org/10.1164/rccm.200604-571ST. The diagnostic criteria and management of nontuberculous mycobacterial infection by the ATSA/IDSA.

  15. Bark CM, Traboulsi RS, Honda K, Starnes AM, Jacobs MR, Rodriguez B. Disseminated Mycobacterium chelonae infection in a patient receiving an epidermal growth factor receptor inhibitor for advanced head and neck cancer. J Clin Microbiol. 2012;50(1):194–5. https://doi.org/10.1128/JCM.05399-11.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shah KK, et al. Histopathologic review of granulomatous inflammation. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. 2017;7:1–12. https://doi.org/10.1016/j.jctube.2017.02.001.

    Article  Google Scholar 

  17. •• Fowler J, Mahlen SD. Cutaneous rapidly growing mycobacteria infection. Arch Pathol Lab Med. 2014;138:1106–9. https://doi.org/10.5858/arpa.2012-0203-RS. Describes histologic features of RGM infections, methods of laboratory identification, recommended treatment and clinical prognosis.

    Article  PubMed  Google Scholar 

  18. Cook JL. Nontuberculous mycobacteria: opportunistic environmental pathogens for predisposed hosts. Br Med Bull. 2010;96(1):45–59. https://doi.org/10.1093/bmb/ldq035.

    Article  PubMed  Google Scholar 

  19. O’Brien et al. The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis. 1987 May;135(5):1007–14.

    Google Scholar 

  20. Maureen Cassidy P, Hedberg K, Saulson A, McNelly E, Winthrop KL. Nontuberculous mycobacterial disease prevalence and risk factors: a changing epidemiology. Clin Infect Dis. 2009;49(12):e124–9. https://doi.org/10.1086/648443.

    Article  PubMed  Google Scholar 

  21. Umrao J, Singh D, Zia A, Saxena S, Sarsaiya S, Singh S, et al. Dhole, prevalence and species spectrum of both pulmonary and extrapulmonary nontuberculous mycobacteria isolates at a tertiary care center. Int J Mycobacteriol. 2016;5(3):288–93, ISSN 2212-5531. https://doi.org/10.1016/j.ijmyco.2016.06.008.

  22. Maurya AK, Nag VL, Kant S, et al. Prevalence of nontuberculous mycobacteria among extrapulmonary tuberculosis cases in tertiary care centers in northern India. BioMed Res Int. 2015;2015:465403, 5 pages. https://doi.org/10.1155/2015/465403.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Yu X, et al. The prevalence of non-tuberculous mycobacterial infections in mainland China: systematic review and meta-analysis. J Infect. 2016;73(6):558–67.

    Article  PubMed  Google Scholar 

  24. Chong SG, et al. Pulmonary non-tuberculous mycobacteria in a general respiratory population. IMJ. 2014;107(7)

  25. •• van Dissel JT, Kuijper EJ. Rapidly growing mycobacteria: emerging pathogens in cosmetic procedures of the skin. Clin Infect Dis. 2009;49(9):1365–8. https://doi.org/10.1086/606051. Describes the emerging cases of S & ST RGM infections linked to mesotherapy.

    Article  PubMed  Google Scholar 

  26. Tortoli E. Clinical manifestations of nontuberculous mycobacteria infections. Clin Microbiol Infect. 2009;15(10):906–10, ISSN 1198-743X. https://doi.org/10.1111/j.1469-0691.2009.03014.x.

    Article  PubMed  CAS  Google Scholar 

  27. Torres-Duque CA, Díaz C, Vargas L, Serpa EM, Mosquera W, Garzón MC, et al. Disseminated mycobacteriosis affecting a prosthetic aortic valve: first case of Mycobacterium peregrinum type III reported in Colombia. Biomédica. 2010;30(3):332–7. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-41572010000300005&lng=en&tlng=en

  28. Enweluzo C, Sharma A, Lenfest S, Aziz F. Non-tuberculous Mycobacterium: a rare cause of granulomatous hepatitis. Gastroenterol Res. 2013;6(2):71–3. https://doi.org/10.4021/gr538w.

    Article  Google Scholar 

  29. Smith MB, et al. Clinical and pathologic features of Mycobacterium fortuitum infections an emerging pathogen in patients with AIDS. Am J Clin Pathol. 2001;116:225–32. https://academic.oup.com/ajcp/article-abstract/116/2/225/1758083

    Article  PubMed  CAS  Google Scholar 

  30. Suh JD, Ramakrishnan VR, Tajudeen B, Reger C, Kennedy DW, Chiu AG. Identification and treatment of nontuberculous Mycobacterium sinusitis. Am J Rhinol Allergy. 2011;25(6):421–4. https://doi.org/10.2500/ajra.2011.25.3677.

    Article  PubMed  Google Scholar 

  31. Serra C, Loi G, Saddi B, Pautasso M, Manzin A. Unusual clinical presentation of Mycobacterium fortuitum infection in an immunocompetent woman. J Clin Microbiol. 2007;45(5):1663–5. https://doi.org/10.1128/JCM.00119-07.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lee M-R, Sheng W-H, Hung C-C, Yu C-J, Lee L-N, Hsueh P-R. Mycobacterium abscessus complex infections in humans. Emerg Infect Dis. 2015;21(9):1638–46. https://doi.org/10.3201/2109.141634.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Lage R, Biccigo DGZ, Santos FBC, Chimara E, Pereira ESP, da Costa A. Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease. An Bras Dermatol. 2015;90(1):104–7. https://doi.org/10.1590/abd1806-4841.20152276.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jung S-Y, et al. An outbreak of joint and cutaneous infections caused by non-tuberculous mycobacteria after corticosteroid injection. Int J Infect Dis. 2015;36:62–9. https://doi.org/10.1016/j.ijid.2015.05.018.

    Article  PubMed  Google Scholar 

  35. Sarma S, Thakur R. Cutaneous infection with Mycobacterium fortuitum: an unusual presentation. Indian J Med Microbiol. 2008;26:388–90.

    Article  PubMed  CAS  Google Scholar 

  36. Moriuchi R, Arita K, Ujiie H, Kodama K, Shimizu T, Shimizu H. Large subcutaneous abscesses caused by Mycobacterium fortuitum infection. Acta Derm Venereol. 2008;88(3):313–4. https://doi.org/10.2340/00015555-0426.

    Article  PubMed  Google Scholar 

  37. Pai R, Parampalli U, Hettiarachchi G, Ahmed I. Mycobacterium fortuitum skin infection as a complication of anabolic steroids: a rare case report. Ann R Coll Surg Engl. 2013;95(1):e12–3. https://doi.org/10.1308/003588413X13511609955175.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. • Phillips MS, Fordham von Reyn C. Nosocomial infections due to nontuberculous mycobacteria. Clin Infect Dis. 2001;33(8):1363–74. https://doi.org/10.1086/323126. Descibes that NTM should be considered in all cases of nosocomial infection, and careful surveillance must be used to identify potential outbreaks. Recommends that control measures should be based the NTM species, type of outbreak, and potential patient groups at increased risk of infection.

  39. Tsai S-C, Chen L-H, Liao H-H, Chiang C-Y, Lin W-L, Chen S-C, et al. Complicated skin and soft tissue infection with Mycobacterium fortuitum following excision of a sebaceous cyst in Taiwan. J Infect Dev Ctries. 2016;10:1357–61. https://doi.org/10.3855/jidc.7356.

  40. Jaubert J, et al. A case of postoperative breast infection by Mycobacterium fortuitum associated with the hospital water supply. Am J Infect Control. 2015;43(4):406–8. https://doi.org/10.1016/j.ajic.2014.12.023.

    Article  PubMed  Google Scholar 

  41. Pastor E, et al. Mycobacterium fortuitum: a rare cause of pacemaker infection. Enferm Infecc Microbiol Clin. 2006;24:136–7. https://doi.org/10.1157/13085023.

    Article  PubMed  Google Scholar 

  42. Moorthy RS, et al. Nontuberculous mycobacterial ocular and adnexal infections. Surv Ophthalmol. 2012;57(3):202–35. https://doi.org/10.1016/j.survophthal.2011.10.006.

    Article  PubMed  Google Scholar 

  43. Song Y, Wu J, Yan H, Chen J. Peritoneal dialysis-associated nontuberculous Mycobacterium peritonitis: a systematic review of reported cases. Nephrol Dial Transplant. 2012;27(4):1639–44. https://doi.org/10.1093/ndt/gfr504.

    Article  PubMed  Google Scholar 

  44. Goldman J, Caron F, de Quatrebarbes J, et al. Infections from tattooing: outbreak of Mycobacterium chelonae in France. BMJ. 2010;341:c5483. https://doi.org/10.1136/bmj.c5483.

    Article  PubMed  Google Scholar 

  45. Bechara C, Macheras E, Heym B, Pages A, Auffret N. Mycobacterium abscessus skin infection after tattooing: first case report and review of the literature. Dermatology. 2010;221:1–4. https://doi.org/10.1159/000313974.

    Article  PubMed  Google Scholar 

  46. Kennedy BS, et al. Outbreak of Mycobacterium chelonae infection associated with tattoo ink. N Engl J Med. 2012;367:1020–4. https://doi.org/10.1056/NEJMoa12051.

    Article  PubMed  CAS  Google Scholar 

  47. Han B, Choi MW, Han TY, Lee J-C, Son S-J. A case of mycobacterium chelonae infection at the site of acupuncture. Korean J Dermatol. 2017;55:717–20.

    Google Scholar 

  48. Ara M, De Santamaría CS, Zaballos P, Yus C, Lezcano MA. Mycobacterium chelonaeinfection with multiple cutaneous lesions after treatment with acupuncture. Int J Dermatol. 2003;42:642–4. https://doi.org/10.1046/j.1365-4362.2003.01639_3.x.

    Article  PubMed  Google Scholar 

  49. Cho SY, Peck KR, Kim J, Ha YE, Kang C-I, Chung DR, et al. Mycobacterium chelonae infections associated with bee venom acupuncture. Clin Infect Dis. 2014;58(5):e110–3. https://doi.org/10.1093/cid/cit753.

  50. Ivan M, Dancer C, Koehler AP, Hobby M, Lease C. Mycobacterium chelonae abscesses associated with biomesotherapy, Australia, 2008. Emerg Infect Dis. 2013;19(9):1493–5. https://doi.org/10.3201/eid1909.120898.

    Article  PubMed Central  Google Scholar 

  51. Wolf R, Wolf D. A tattooed butterfly as a vector of atypical mycobacteria. J Am Acad Dermatol. 2003;48:S73–S74 14. https://doi.org/10.1067/mjd.2003.166.

    Article  PubMed  Google Scholar 

  52. Winthrop KL, Albridge K, South D, Albrecht P, Abrams M, Samuel MC, et al. The clinical management and outcome of nail salon—acquired Mycobacterium fortuitum skin infection. Clin Infect Dis. 2004;38(1):38–44. https://doi.org/10.1086/380459.

  53. Lamy B, Marchandin H, Hamitouche K, Laurent F. Mycobacterium setense sp nov., a Mycobacterium fortuitum-group organism isolated from a patient with soft tissue infection and osteitis. Int J Syst Evol Microbiol. 2008;58:486–90. https://doi.org/10.1099/ijs.0.65222-0.

    Article  PubMed  CAS  Google Scholar 

  54. Adékambi T, Stein A, Carvajal J, Raoult D, Drancourt M. Description of Mycobacterium conceptionense sp. nov., a Mycobacterium fortuitum group organism isolated from a posttraumatic osteitis inflammation. J Clin Microbiol. 2006;44(4):1268–73. https://doi.org/10.1128/JCM.44.4.1268-1273.2006.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  55. Yung Y-B, Li P-H, Lee Q-J, Wong Y-C, Wai Y-L. Treatment of Mycobacterium fortuitum infection of total knee arthroplasty: a case report. Journal of Orthopaedics, Trauma and Rehabilitation. 2012;16(2):82–5, ISSN 2210-4917. https://doi.org/10.1016/j.jotr.2012.09.010.

    Article  Google Scholar 

  56. Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother. 2009;53(4):1367–76.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. Sethi S, Arora S, Gupta V, Kumar S. Cutaneous Mycobacterium fortuitum infection: successfully treated with amikacin and ofloxacin combination. Indian J Dermatol. 2014;59(4):383–4. https://doi.org/10.4103/0019-5154.135491.

    Article  PubMed  PubMed Central  Google Scholar 

  58. •• Parize P, Hamelin A, Veziris N, Morand P, Guillemain R, Lortholary O, et al. Induction therapy with linezolid/clarithromycin combination for Mycobacterium chelonae skin infections in immunocompromised hosts. J Eur Acad Dermatol Venereol. 2016;30:101–5. https://doi.org/10.1111/jdv.12965. Reports their considerations of initial therapeutic strategy for M. chelonae skin infections in immunocompromised patients.

  59. • Wallace RJ, Brown-Elliott BA, Ward SC, Crist CJ, Mann LB, Wilson RW. Activities of linezolid against rapidly growing mycobacteria. Antimicrob Agents Chemother. 2001;45(3):764–7. https://doi.org/10.1128/AAC.45.3.764-767.2001. The study demonstrate the excellent potential of linezolid for therapy of 10 reference strians of rapidly growing mycobacteria.

Download references

Author information

Authors and Affiliations

  1. Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara, Mexico

    Esteban Gonzalez-Diaz, Rayo Morfin-Otero, Hector Raul Perez-Gomez, Sergio Esparza-Ahumada & Eduardo Rodriguez-Noriega

  2. Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico

    Esteban Gonzalez-Diaz, Rayo Morfin-Otero, Hector Raul Perez-Gomez & Eduardo Rodriguez-Noriega

Authors
  1. Esteban Gonzalez-Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rayo Morfin-Otero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hector Raul Perez-Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sergio Esparza-Ahumada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eduardo Rodriguez-Noriega
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Esteban Gonzalez-Diaz.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Cutaneous Mycobacterial Diseases of the Skin and Soft Tissues

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gonzalez-Diaz, E., Morfin-Otero, R., Perez-Gomez, H.R. et al. Rapidly Growing Mycobacterial Infections of the Skin and Soft Tissues Caused by M. fortuitum and M. chelonae. Curr Trop Med Rep 5, 162–169 (2018). https://doi.org/10.1007/s40475-018-0150-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40475-018-0150-x

Keywords

Search

Navigation