Mycobacterium Fortuitum

Mycobacterium Fortuitum

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Mycobacterium fortuitum is a nontuberculous mycobacterium (NTM), a grouping that encompasses all mycobacteria outside of the Mycobacterium tuberculosis complex. M fortuitum is classified in the Runyon group IV, rapidly growing mycobacteria. [1] It has been found in natural and processed water sources, as well as in sewage and dirt. Distribution is probably worldwide. 

M fortuitum infection can cause various clinical syndromes. It is an uncommon cause of NTM lung disease. Local cutaneous disease, osteomyelitis, joint infections, and ocular disease (eg, keratitis, corneal ulcers) may occur after trauma. M fortuitum infection is a rare cause of isolated lymphadenitis. Disseminated disease, usually with disseminated skin lesions and soft tissue lesions, occurs almost exclusively in the setting of severe immunosuppression, especially AIDS. Endocarditis has been documented.

Surgical-site infections due to M fortuitum infection are well-documented, especially in association with cardiothoracic surgery. The source is frequently contamination of the wound, directly or indirectly, with colonized tap water. Other nosocomial infections with this organism include infections of implanted devices (eg, catheters) and injection-site abscesses. Pseudo-outbreaks have been associated with contaminated endoscopes. Recent outbreaks have also been described in immunocompetent hosts after use of contaminated whirlpool footbaths in nail salons. [2]

United States

NTM infections are not required to be reported; therefore, exact estimates of disease prevalence and incidence are impossible to determine. The most recent estimates come from voluntary reports tracked by the Centers for Disease Control and Prevention (CDC). From 1993-1996, 4.65-5.99 cases per million persons were reported to the CDC. [3] Sputum was the most frequently reported site, but this may represent a bias in the sites most likely to be cultured for mycobacteria.

Most cases are reported from the southeast United States, including Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia, and the south-central United States, including Arkansas, Kansas, Louisiana, Missouri, Oklahoma, and Texas. Because all cases were likely not reported and some positive culture results may not represent disease, which is perhaps especially true of positive sputum culture results, these numbers may significantly overestimate or underestimate true disease incidence. However, they suggest the general order of magnitude of the situation. An increased appreciation of these organisms as true pathogens may be the reason NTM infection rates are perceived to be increasing, even excluding Mycobacterium avium complex (MAC) infections in persons with AIDS.

International

The World Health Organization does not track NTM infections. Incidence and prevalence undoubtedly vary greatly by locale.

Mortality due to localized M fortuitum infection is rare. Death may result from extensive pulmonary or disseminated disease in patients who are immunocompromised.

Morbidity depends largely on the site of the infection. Localized skin lesions may eventually heal without therapy or surgical intervention. At other sites, chronic infection is the rule.

No clear racial predilection exists.

No sexual predominance is known; however, from 1993-1996, more cases reported to the CDC were involved men than did women. [3] Whether this represents a true sex-based preference or reflects a bias in testing and reporting is unclear.

In general, no known age predominance exists. Lung disease in a younger patient (< 50 y) strongly suggests a primary underlying lung disorder. Isolated lymphadenitis primarily occurs in children.

With debridement and antibiotic therapy, prognosis is very good for most sites of infection.

Lung disease may be difficult or impossible to eradicate. Chronic suppression of the infection and slowing of the progression of lung disease may be the only achievable goal in this setting.

Cure of infected implants that cannot be removed may be impossible.

Educate patients about the importance of compliance with multiple drug regimens to avoid development of antibiotic resistance.

Patients may confuse the disease with tuberculosis and need to be reassured that they are not contagious to others.

For excellent patient education resources, see eMedicineHealth’s patient education article Bronchoscopy.

Ho YS, Adroub SA, Aleisa F, Mahmood H, Othoum G, Rashid F, et al. Complete Genome Sequence of Mycobacterium fortuitum subsp. fortuitum Type Strain DSM46621. J Bacteriol. 2012 Nov. 194(22):6337-8. [Medline]. [Full Text].

Winthrop KL, Abrams M, Yakrus M, Schwartz I, Ely J, Gillies D, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. 2002 May 2. 346(18):1366-71. [Medline].

CDC. Nontuberculous mycobacteria reported to the Public Health Laboratory Information System by State Public Health Laboratories United States, 1993-1996. [Full Text].

Jiang SH, Roberts DM, Dawson AH, Jardine M. Mycobacterium fortuitum as a cause of peritoneal dialysis-associated peritonitis: case report and review of the literature. BMC Nephrol. 2012 Jun 8. 13:35. [Medline]. [Full Text].

Sparks R, Khatami A. Mycobacterium Fortuitum Complex Skin Infection in a Healthy Adolescent. Infect Disord Drug Targets. 2014 Jul 13. [Medline].

Philips RC, Hunter-Ellul LA, Martin JE, Wilkerson MG. Mycobacterium fortuitum infection arising in a new tattoo. Dermatol Online J. 2014 Jun 15. 20(6):[Medline].

ATS. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. 1997 Aug. 156(2 Pt 2):S1-25. [Medline].

Rocchetti TT, Silbert S, Gostnell A, Kubasek C, Campos Pignatari AC, Widen R. Detection of Mycobacterium chelonae, Mycobacterium abscessus Group, and Mycobacterium fortuitum Complex by a Multiplex Real-Time PCR Directly from Clinical Samples Using the BD MAX System. J Mol Diagn. 2017 Mar. 19 (2):295-302. [Medline].

Cruz AT, Antekeier SB. Chronic multifocal Mycobacterium fortuitum osteomyelitis following penetrating plantar trauma. Am J Orthop (Belle Mead NJ). 2012 Aug. 41(8):E109-11. [Medline].

Wallace RJ, Swenson JM, Silcox VA, Bullen MG. Treatment of nonpulmonary infections due to Mycobacterium fortuitum and Mycobacterium chelonei on the basis of in vitro susceptibilities. J Infect Dis. 1985 Sep. 152(3):500-14. [Medline].

Heifets LB. Antimycobacterial drugs. Semin Respir Infect. 1994 Jun. 9(2):84-103. [Medline].

Brown-Elliott BA, Wallace RJ, Crist CJ. Comparison of in vitro activities of gatifloxacin and ciprofloxacin against four taxa of rapidly growing mycobacteria. Antimicrob Agents Chemother. 2002 Oct. 46(10):3283-5. [Medline].

Zheng HW, Pang Y, He GX, Song YY, Zhao YL. Antimicrobial Susceptibility Testing and Molecular Characterization of Mycobacterium fortuitum Isolates in China. Biomed Environ Sci. 2017 May. 30 (5):376-379. [Medline].

Wallace RJ, Brown-Elliott BA, Crist CJ. Comparison of the in vitro activity of the glycylcycline tigecycline (formerly GAR-936) with those of tetracycline, minocycline, and doxycycline against isolates of nontuberculous mycobacteria. Antimicrob Agents Chemother. 2002 Oct. 46(10):3164-7. [Medline].

Esteban J, Ortiz-Pérez A. Current treatment of atypical mycobacteriosis. Expert Opin Pharmacother. 2009 Dec. 10(17):2787-99. [Medline].

Sethi S, Arora S, Gupta V, Kumar S. Cutaneous Mycobacterium fortuitum Infection: Successfully Treated with Amikacin and Ofloxacin Combination. Indian J Dermatol. 2014 Jul. 59(4):383-4. [Medline]. [Full Text].

ATS/IDSA: Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. Am J Respir Crit Care Med. February 2007. 175:367-416. [Medline].

Bhambri S, Bhambri A, Del Rosso JQ. Atypical mycobacterial cutaneous infections. Dermatol Clin. 2009 Jan. 27(1):63-73. [Medline].

Griffith DE, Wallace RJ. New developments in the treatment of nontuberculous mycobacterial (NTM) disease. Semin Respir Infect. 1996 Dec. 11(4):301-10. [Medline].

Kyle SD, Porter WM. Mycobacterium chelonae infection successfully treated with oral clarithromycin and linezolid. Br J Dermatol. 2004 Nov. 151(5):1101. [Medline].

Porat MD, Austin MS. Bilateral knee periprosthetic infection with Mycobacterium fortuitum. J Arthroplasty. 2008 Aug. 23(5):787-9. [Medline].

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Joseph M Fritz, MD Fellow, Division of Infectious Diseases, Washington University School of Medicine, Barnes Jewish Hospital

Joseph M Fritz, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, South Nassau Communities Hospital

Aaron Glatt, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Keith F Woeltje, MD, PhD Professor, Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine

Keith F Woeltje, MD, PhD is a member of the following medical societies: American College of Physicians, American Medical Informatics Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Mycobacterium Fortuitum

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