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Disseminated infection with rapidly growing mycobacteria
C W Ingram1, D C Tanner, D T Durack
1Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Summary
Disseminated infections from rapidly growing mycobacteria like Mycobacterium chelonae and Mycobacterium fortuitum are rare. Patient outcomes significantly depend on immune status, with immunosuppressed individuals facing much higher mortality risks.
Area of Science:
- Infectious Diseases
- Microbiology
- Immunology
Background:
- Disseminated infections caused by rapidly growing mycobacteria (RGM) are infrequent.
- Mycobacterium chelonae and Mycobacterium fortuitum are common RGM species.
- Previous studies on disseminated RGM infections are limited.
Purpose of the Study:
- To characterize disseminated infections caused by Mycobacterium chelonae and Mycobacterium fortuitum.
- To identify risk factors and predict outcomes for patients with disseminated RGM infections.
- To categorize patient groups based on underlying conditions and treatment responses.
Main Methods:
- A retrospective review of cases diagnosed at Duke University Medical Center.
- A comprehensive literature search for cases reported since 1960.
- Categorization of 54 identified cases into three distinct groups based on disease and outcome.
Main Results:
- Group 1 (no immune defect, kidney transplant, collagen vascular disease, or chronic renal failure) had 90% survival, primarily with skin involvement and good response to therapy.
- Group 2 (cell-mediated immune deficiency, lymphoma, or leukemia) had only 10% survival, characterized by widespread, multiorgan involvement and severe illness.
- Group 3 (other underlying diseases) showed intermediate severity and treatment response.
Conclusions:
- Disseminated RGM infections can be stratified into groups based on host immune status and underlying conditions.
- Immunosuppression is a critical factor influencing survival in disseminated RGM infections.
- Understanding these groupings aids in predicting prognosis and guiding therapeutic strategies.