Mycobacterium abscessus Complex-Associated Chronic Meningitis: Time to Think Beyond Tuberculosis

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Neuroscience

Background:

• Mycobacterium abscessus complex (MabC) is an emerging pathogen causing severe human infections, notably meningitis.
• Misidentification of MabC meningitis leads to inappropriate anti-tubercular therapy, resulting in poor patient outcomes.

Approach:

• This study analyzed 12 cases of MabC meningitis from 2011-2021.
• Methods included cerebrospinal fluid analysis, MALDI TOF, hsp65 gene sequencing, and antimicrobial susceptibility testing.
• A literature review of 19 additional cases was conducted for comprehensive analysis.

Key Points:

• M. abscessus subspecies abscessus was the most common cause (11/12 cases), with one pioneer case of M. abscessus subspecies bolletii identified.
• Common predisposing factors included prior tuberculosis, HIV positivity, and head injury.
• All isolates were susceptible to amikacin and tigecycline, though M. abscessus subspecies bolletii exhibited higher MICs.

Conclusions:

• MabC meningitis requires consideration as a differential diagnosis for chronic meningitis.
• Accurate and rapid identification and speciation of MabC are essential for guiding targeted antimicrobial therapy.
• Timely diagnosis and appropriate treatment significantly improve patient prognosis in MabC meningitis.