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Published on: December 8, 2017
Mycobacterium haemophilum: an emerging pathogen
1Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Abstract:
Mycobacterium haemophilum is emerging as a pathogen of immunocompromised patients particularly those with AIDS and organ transplants. Infection has also occurred in healthy children. Adults usually present with cutaneous manifestations, septic arthritis or occasionally pneumonia. Children have perihilar, cervical or submandibular adenitis. The organism grows on mycobacterial media supplemented with ferric ammonium citrate or hemin, incubated at 30 degrees C to 32 degrees C, two to three weeks after inoculation. The most active antimicrobial agents in vitro are amikacin, ciprofloxacin, clarithromycin, rifabutin and rifampin. Development of resistance to the rifamycins has been demonstrated after patients were treated for several months with several antimycobacterial agents, including the rifamycins. Treatment for several months with at least two agents demonstrated to have low MICs for the organism has been shown to be effective.
Insights
Mycobacterium haemophilum infections are increasing in immunocompromised individuals and children. Effective treatment involves long-term use of at least two antimicrobials with low minimum inhibitory concentrations (MICs).
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Mycobacterium haemophilum is an emerging opportunistic pathogen.
- Infections occur in immunocompromised patients (AIDS, organ transplant recipients) and healthy children.
- Clinical presentations vary by age: adults typically show cutaneous or joint involvement, while children often have adenitis.
Purpose of the Study:
- To summarize the clinical features, diagnostic methods, and treatment strategies for Mycobacterium haemophilum infections.
- To highlight the challenges in treating this emerging pathogen, including antimicrobial resistance.
Main Methods:
- Review of clinical cases and in vitro antimicrobial susceptibility testing.
- Identification of Mycobacterium haemophilum based on specific growth requirements (ferric ammonium citrate/hemin, 30-32°C incubation).
Main Results:
- In vitro susceptibility testing identified amikacin, ciprofloxacin, clarithromycin, rifabutin, and rifampin as active agents.
- Development of resistance to rifamycins was observed with prolonged treatment.
- Successful treatment was achieved with multi-drug regimens (at least two agents) with low MICs over several months.
Conclusions:
- Mycobacterium haemophilum requires specific culture conditions for isolation.
- Antimicrobial resistance is a concern, necessitating careful drug selection and monitoring.
- Prolonged combination therapy with agents demonstrating low MICs is crucial for effective treatment.
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