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[Infection due to Mycobacterium malmoense in an immunocompetent patient].
B Camara1, B Borrel, G Panteix
1Service de Pneumologie, Centre Hospitalier Général d'Albi, Albi, France. camara.b@chu-toulouse.fr
Revue Des Maladies Respiratoires
|December 25, 2008
Summary
Mycobacterium malmoense (MM) infections can be challenging to treat. This case highlights poor correlation between in vitro antibiotic sensitivity and patient outcomes in MM pneumonia.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Background:
- Mycobacterium malmoense (MM) is an opportunistic pathogen causing non-specific pulmonary infections, often in compromised lungs.
- Atypical mycobacterial infections require careful diagnostic and therapeutic consideration.
Observation:
- A 52-year-old patient presented with extensive multifocal pneumonia caused by Mycobacterium malmoense.
- Initial empirical treatment included rifampicin, isoniazid, pyrazinamide, and ethambutol.
- Despite documented in vitro sensitivity to multiple antibiotics, including clarithromycin and rifabutin, the patient showed persistent bacilli and clinical deterioration.
Findings:
- A significant discrepancy was observed between in vitro antibiotic sensitivities and in vivo treatment efficacy for Mycobacterium malmoense.
- Isoniazid demonstrated poor in vitro activity against Mycobacterium malmoense.
- Clinical progression was unfavorable despite a broad-spectrum antibiotic regimen.
Implications:
- Current antibiotic treatment guidelines for Mycobacterium malmoense infections may need re-evaluation.
- Further research is needed to understand the in vivo-in vitro correlation for Mycobacterium malmoense.
- This case underscores the complexity of treating opportunistic infections in patients with underlying lung disease.
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