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Mycobacterium xenopi, Mycobacterium fortuitum, Mycobacterium kansasii, and other nontuberculous mycobacteria in an area of endemicity for AIDS.

Between 1981 and 1990, cultures of specimens from 86 patients at State University of New York-Health Sciences Center at Brooklyn were positive for nontuberculous mycobacteria other than Mycobacterium avium/Mycobacterium intracellulare complex or Mycobacterium gordonae. The most common species isolated were Mycobacterium xenopi (33), Mycobacterium fortuitum (28), Mycobacterium kansasii (7), and Mycobacterium chelonae (6). Thirty-five patients (41%) had clinical and/or serological evidence of human immunodeficiency virus (HIV) infection. Patients from whom M. xenopi and M. kansasii were isolated were significantly more likely to be infected with HIV than were the remaining patients in this series. Most of the mycobacterial isolates were cultured from respiratory secretions. However, extrapulmonary infections with M. fortuitum, M. xenopi, M. kansasii, Mycobacterium terrae, and Mycobacterium scrofulaceum did occur among the HIV-infected patients.

Adolescent↗

[Changes in the kidneys in patients with successive findings of Mycobacterium xenopi and Mycobacterium fortuitum in the urine--report of 16 cases]].

INTRODUCTION: Environmental or MOTT (mycobacteria other than tubercle bacilli) mycobacteria are found in both living environment and most of the food we consume. These mycobacteria can induce a disease in humans, although they rarely do. There are a few reports of urogenital infections caused by these bacteria. This is a report of 16 patients with successive findings of Mycobacterium xenopi and Mycobacterium fortuitum in the urine. MATERIAL AND METHODS: In patients suspected for a specific disease of the urogenital tract 7-10 morning urine samples were sent for a bacteriological analysis before initiating any therapy. The samples were treated by 2% NaOH, neutralized by 1% HCl and cultivated on four UIT media with penicillin and acid additives. The cultivated media were incubated at 37C and followed for a potential growth for up to three months. Growth-exhibiting cultures were submitted to a further cultural and biochemical investigation, applying antituberculotic sensitivity tests and a biological probe when needed. The study included 6,468 patients. Finding of mycobacteria was registered in 180 (2.78%) patients. Of them, 164 had Mycobacterium tuberculosis while 16 patients had successive urine culture findings of MOTT bacilli: Mycobacterium xenopi--14 patients or Mycobacterium fortuitum--2 patients. RESULTS: Of 180 patients with positive bacteriologic urine finding, 164 (91.11%) had Mycobacterium tuberculosis and 16 (8.89%) had MOTT bacilli. Of the latter 16 patients, Mycobacterium xenopi was found in 14. They were all females aged 14-64 yrs. MOTT bacilli were secreted in certain time intervals, ranging from a month to nine years. The bacteria were registered successively, at the frequency rate of 6-53 times. Even 5 of 14 patients worked at the Institute for Lung Diseases as either a nurse, laboratory technician, cleaning lady or an officer at the bacteriologic material admission unit. The evidence of patho-anatomic renal changes was obtained from 11 of 14 patients, including a deformed pelvic system of the kidney, a dilated pelvis of the kidney, papillary ulceration, cystic formations, calcification, hydronephrosis and the presence of concrements. Cystic lesions were the most common ones, registered in 7/14 patients. Regarding functional disorders, haematuria, leukocytes in the sediment, proteinuria and renal colics were most frequently registered. Two patients with successive findings of Mycobacterium fortuitum were presented with neither significant patho-anatomic nor functional renal disorders. DISCUSSION: The following conclusions have emerged from the comparative analysis of the findings: the most common source of Mycobacterium tuberculosis is an infected person. The disease is transmitted by a droplet infection. Smear positive patients infect 50-63% of their family members. The renal disease induced by these bacteria is hematogenous in origin and is always associated with a former extrarenal infection. The infection is bilateral, but always manifested in one of the kidneys only. The symptoms of the infection appear in diverse combinations. The most common is a combination of dysuria and albuminuria, while 20% of patients are asymptomatic. The most effective diagnostic procedures are bacteriologic urine test for mycobacteria and intravenous pyelography. A combined antituberculotic 6-9-month treatment is usually effective. Regarding environmental mycobacteria (MOTT), their host is still obscure. The external environment contains them in abundance, but they are not transmitted from one person to another. The MOTT bacteria's habitat can be earth, water, waste waters, garbage, plant material, sphagnum of the swamp vegetation. They colonize the water-pipe systems in towns and are found in the biofilm which coats the water pipes. Water chlorination does not affect their development. They are also found in country yards, animal farms, raw milk and butter, fruit and vegetables. They are also registered in the house dust, in art

Adolescent↗

Evaluation of the bactericidal efficiency of a 2% alkaline glutaraldehyde solution on Mycobacterium xenopi.

Mycobacterium xenopi (M. xenopi) has been implicated in hospital-acquired infections associated with colonization of hospital water systems. M. xenopi is considered to be as resistant as other atypical mycobacteria, which are known to be resistant to many disinfecting treatments. However, the efficacy of disinfectants on this organism has not yet been studied. Therefore we decided to evaluate its susceptibility to 2% alkaline glutaraldehyde solution, which is commonly used in hospitals. Tests were conducted using five strains of M. xenopi: three isolated from human samples, an environmental strain and a collection strain. We used a membrane filtration assay and counted surviving bacteria before and after several exposure times (5, 15, 30 and 60 min) with the disinfecting solution. The log10 reduction factor of organisms achieved within 60 min contact ranged from 2.5 to 7.5. This showed M. xenopi to be more resistant to disinfectants than M. tuberculosis or M. smegmatis and suggested that environmental strains may be more resistant to alkaline glutaraldehyde than those isolated from human samples.

Cross Infection↗

Infection of the knee joint with Mycobacterium xenopi.

Mycobacterium xenopi infection of the knee joint occurred in a 71-year-old man. Owing to the failure to recognize the "contaminant" initially as a possible etiologic agent, the joint was destroyed and eventually treated by arthrodesis.

Aged↗

Clinical review of pulmonary disease caused by Mycobacterium xenopi.

Mycobacterium xenopi comprised 56% of all non-tuberculous mycobacteria isolated in the Brompton Hospital laboratory during six years. M xenopi alone was cultured from the sputum of 23 patients, whose clinical and bacteriological features are reviewed. Pulmonary disease was considered to be due to the organism present in 15 of these patients on the basis of strict criteria for a causal relationship. Radiographs of all these patients were consistent with mycobacterial disease, showing pulmonary cavitation in 11, apical shadowing in three, and upper lobe fibrosis in one. In nine patients the disease was chronic, progressing very slowly with longstanding respiratory symptoms and extensive radiographic abnormalities developing over many years (mean 19 years). In six patients the disease was subacute, being of recent onset with radiographic shadowing of limited extent. M xenopi was isolated as a saprophyte from four patients who had lung disease of known cause and single isolates were obtained from four patients who had no lung disease attributable to this organism. In vitro drug sensitivity tests showed the sputum cultures of 17 of 22 patients to be sensitive to two or more of the drugs rifampicin, isoniazid, and ethambutol. Response to chemotherapy was unpredictable and did not always correlate with the results of sensitivity tests. Of 11 patients treated with at least two drugs to which their organisms were sensitive, two remained sputum positive, one relapsed after 18 months of chemotherapy, and eight have remained sputum negative during a minimum of three years' follow-up.

Adult↗

Radiometric susceptibility testing of Mycobacterium xenopi.

Mycobacterium xenopi is an opportunistic pathogen, frequently isolated in various areas of Europe from pulmonary specimens, which may also cause infections in AIDS patients. We used the Bactec radiometric system (Becton Dickinson, USA) with a procedure expressly adapted to the particular growth characteristics of M. xenopi to determine the susceptibility patterns of 40 clinical isolates to six antimicrobial drugs. The majority of the strains were resistant to ethambutol and susceptible to amikacin, ciprofloxacin, rifampin, rifabutin and streptomycin.

Amikacin↗

Mycobacterium xenopi and Mycobacterium kansasii in a hospital water supply.

A steady rise in the number of isolations of Mycobacterium xenopi from patients in a general hospital led to an examination of water taps. Most patients had been accommodated in a group of wards which had a common water supply. This organism was recovered from 35 of 69 outlets, mostly from hot and mixer taps in those wards. Mycobacterium kansasii was also isolated from 14, mostly cold and mixer taps. Ten strains of Myco. xenopi were recovered from 131 taps sampled at 10 other locations. We conclude that colonization of water supplies by mycobacteria is a likely source of contamination of clinical specimens.

England↗

[Utility of the direct culture examination (Ziehl-Neelsen) using the Bactec system for the presumptive identification of Mycobacterium tuberculosis complex, Mycobacterium avium complex, Mycobacterium xenopi, and Mycobacterium kansasii].

BACKGROUND: The usefulness of the microscopic examination of Bactec 12B and 13A growth medium as a method for the possible identification of M. tuberculosis complex, M. avium complex, M. xenopi, and M. kansasii was performed out to guide the selection of different genetic identification probes and, in the case of M. xenopi, the selection of the temperature of subcultures incubation. METHODS: Upon detection of an index of growth greater than 100 in Bactec tubes, staining was performed by the Ziehl-Neelsen technique. On the basis of the morphology observed, the possible identification was performed by genetic probes. Subcultures were used for definitive identification. RESULTS: Three hundred forty-four positive samples were studied by radiometric technique. A total of 190 strains were identified as M. tuberculosis, 88 strains as M. avium-intracellulare (MAI), 33 strains as M. xenopi, 14 strains as M. kansasii and 19 strains were identified as: M. gordonae (10), unpigmented rapid growth microbacteria (7), and M. simiae (2). Sensitivity, specificity, positive predictive value, and negative predictive value were 97.9%, 95.4%, 96.4%, and 97.3%, respectively for M. tuberculosis complex, 84.0%, 99.2%, 97.3% 94.7% for M. avium complex; 63.6%, 98.3%, 80.7%, 96.2% for M. xenopi; 35.7%, 98.1%, 45.5% 97.2% for M. kansasii. CONCLUSIONS: The morphology of M. tuberculosis complex examined in the radiometric system in useful to differentiate this species from other microbacteria (MOTT), allowing the selection of specific probe used. Within the MOTT, M. avium complex also has morphological characteristics which are useful for its differentiation, the morphology usually described for the remaining species was frequently not observed.

Bacteriological Techniques↗

[Study of the minimal inhibitory concentration of rifabutine (Ansamycin LM 427) for Mycobacterium tuberculosis, Mycobacterium xenopi and Mycobacterium avium-intracellulare].

Ansamycin LM 427 (or rifabutine) is a spiropiperidyl-rifamycin which has been proposed as a treatment for tuberculosis and mycobacterial infections resistant to rifampicin. The minimal inhibitory concentration (MCI) of rifabutine and of rifampicin for 10 strains of M. tuberculosis sensitive to rifampicin, 15 strains of M. tuberculosis resistant to rifampicin, 10 strains of M. xenopi and 15 of M. avium-intracellulare have been measured in a comparative fashion on gel DIFCO 7H11 medium and also on a Loewenstein-Jensen medium. The MCI of rifampicin and of rifabutine inhibiting 90% of the strains (MCI 90) of M. tuberculosis sensitive to rifampicin have been 0.06 mg/l on 7H11 media and 1 mg/l on Loewenstein-Jensen media respectively. For strains of M. tuberculosis resistant to rifampicin they were respectively 256 and 8 mg/l on 7H11 and of 1024 and 128 Loewenstein-Jensen, for the strains of M. xenopi they were 8 and 0.5 on 7H11 and 64 and 4 mg/l on Loewenstein-Jensen respectively, and finally for strains of M. avium-intracellulare they were 64 and 2 mg on 7H11 and 256 and 16 on Loewenstein-Jensen media. With rare exceptions for proven mycobacterial infections there was a link of the order of 20:1 between the values for CMI of rifampicin and rifabutine measured on Loewenstein-Jensen medium and on 7H11; the MCIs were ten times more elevated on the first than on the second and the liaison between the MCI of rifampicin and the MCI of rifabutine tended to show that these two antibiotics have the same mode of action.(ABSTRACT TRUNCATED AT 250 WORDS)

Antitubercular Agents↗

Laboratory and clinical evaluation of Mycobacterium xenopi isolates.

Mycobacterium xenopi and Mycobacterium avium complex (MAC) are biochemically similar. To define the laboratory characteristics of M. xenopi that distinguish it from MAC, 53 M. xenopi isolates from different areas in the United States and 47 isolates recovered at one hospital were evaluated by 13 biochemical tests, AccuProbe MAC (Gen-Probe, Inc., San Diego, CA, USA), colony morphology, formation of X-colonies, pigmentation in response to light, growth on MacConkey agar without crystal violet, and relative growth rates at 25 degrees C, 36 degrees C, and 45 degrees C on solid media. Relative growth rates of 10 M. xenopi and 11 MAC isolates were measured at 25 degrees C, 36 degrees C, and 42 degrees C in Middlebrook broth processed using the BACTEC TB System. Ten M. xenopi were tested for p-nitro-alpha-acetylamino-beta-hydroxypropiophenone inhibition at 36 degrees C and 42 degrees C. Reevaluation of 81 isolates previously identified as MAC by biochemical tests alone revealed that two were M. xenopi. The most reliable characteristics distinguishing M. xenopi from MAC were the presence of X-colonies (M. xenopi 97% vs MAC 1%), positive 3-day arylsulfatase (M. xenopi 88% vs MAC 1%), growth at 25 degrees C (M. xenopi 0% vs MAC 100%), and AccuProbe MAC test results (M. xenopi 0% hybridized). Retrospective chart review of 37 patients using American Thoracic Society criteria revealed that six (16%) patients had clinically important isolates. At one of our hospitals M. xenopi was the second most common mycobacterial species isolated for 1990-1992, accounting for 27% of all isolates, whereas at our other hospital it accounted for 1% of isolates.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗

Bronchoscopy-associated Mycobacterium xenopi pseudoinfections.

Mycobacterium xenopi typically accounts for less than 0.3% of all clinical mycobacterial isolates. Over a 37-mo period, 21 (35%) of 60 mycobacterial isolates from a Michigan hospital were identified as M. xenopi. Hospital, laboratory, and bronchoscopy records were reviewed to determine case characteristics, develop a case series, and calculate procedure-specific M. xenopi isolation rates. A case-control study was conducted to elucidate aspects of the bronchoscopy procedure associated with M. xenopi isolation. Bronchoscope cleaning procedures were reviewed, and hospital water systems were cultured. Four isolates were from three patients with disease attributable to M. xenopi. Of the other isolates, specimens obtained by bronchoscopy were more likely to yield M. xenopi than were specimens obtained by other routes (relative risk, 9.7; 95% confidence intervals, 3.2, 29.6). Bronchoscopes were disinfected in a 0.13% glutaraldehyde-phenate and tap-water bath and then were rinsed in tap water. Water from the hot water tank supplying this area yielded M. xenopi. Mycobacteria were cultured from bronchoscopes after disinfection. M. xenopi in the tap water appears to have contaminated the bronchoscopes during cleaning. Adequate disinfection of contaminated bronchoscopes and careful collection of specimens to avoid contamination with contaminated water are essential, both for limiting diagnostic confusion caused by mycobacterial pseudoinfections and for reducing risks of disease transmission.

Adult↗

[Osteoarticular Mycobacterium xenopi infection].

BACKGROUND: Mycobacterium xenopi is a potential pathogen for man and can cause bone and joint infections, particularly spondylodiscitis. Most cases of infection occur in fragilized patients and are found more and more often in AIDS patients. CASE REPORT: A 41-year-old HIV+ woman developed cervical spondylodiscitis due to Mycobacterium xenopi infection. The strain was isolated from a discovertebral biopsy and was resistant to several antibiotics. Outcome was unfavorable. DISCUSSION: Most of the cases reported to date have involved spondylodiscitis of the thoracic or lumbar spine. To our knowledge, this is the first report of cervical spondylodiscitis dut to Mycobacterium xenopi in an HIV+ patient. Antibiotic combinations using fluoroquinolones and new macrolides are usually prescribed. Such protocols may provide cure of these opportunistic infections in immunodeficient patients.

AIDS-Related Opportunistic Infections↗

Rapid differentiation of Mycobacterium xenopi from mycobacteria of the Mycobacterium avium-intracellulare complex by pyrolysis mass spectrometry.

Thirty four cultures of slow growing, Tween-80 negative mycobacteria were analysed by pyrolysis mass spectrometry. The results showed that pyrolysis mass spectrometry could positively distinguish strains of Mycobacterium xenopi from those of the Mycobacterium avium-intracellulare (MAI) complex. Pyrolysis mass spectrometry may be a useful technique for the rapid characterisation of non-tuberculous mycobacteria in such clinical settings as their isolation from immunocompromised patients-for example, those with AIDS.

Hot Temperature↗

Mycobacterium xenopi arthritis.

Osteoarticular Mycobacterium xenopi infections are very rare. We describe a patient with dermatomyositis and isolated shoulder arthritis due to M. xenopi. The diagnosis was delayed for 7 months; only 2 of 5 interval joint aspirates grew M. xenopi. The infection responded well to triple antituberculous therapy.

Adult↗

[Four cases of Mycobacterium xenopi pulmonary disease].

Mycobacterium xenopi is very rare pathogen in Japan. We reported herein four cases of M. xenopi pulmonary disease. These patients were all male and their ages ranged from 53 to 72. They all had past history of pulmonary tuberculosis, including two cases who had been also treated for Mycobacterium kansasii pulmonary disease later. The bacilli could be cultured in Mycobacteria Growth Indicator Tube (MGIT) system from 10 sputum samples, but they could not be cultured on Ogawa egg media except for two samples. All four cases fulfilled the criteria for the diagnosis of nontuberculous mycobacteria pulmonary disease proposed by the Japanese Society for Tuberculosis. Combination chemotherapy including isoniazid, rifampicin, and ethambutol was started in all four cases when mycobacteria were detected under tentative diagnosis of the relapse of tuberculosis or Mycobacterium kansasii disease. Sputum converted to culture negative by the chemotherapy in two cases. In one case, the chemotherapeutic regimen was changed to rifampicin, ethambutol, and clarithromycin after the bacteriological identification of M. xenopi, and the new regimen was found to be effective. In the final case, both of the regimens were finally ineffective.

Aged↗

Development of a species-specific probe for Mycobacterium xenopi.

In Europe, Mycobacterium xenopi is a frequently isolated species among opportunist mycobacteria, and represents one of the main agents of pulmonary infection due to non-tuberculous mycobacteria. Conventional identification of mycobacteria is a time-consuming and laborious process. In this study, we propose a rapid and simple method for the identification of M. xenopi using polymerase chain reaction. The amplified product consists of a specific probe, present in all 38 M. xenopi strains tested, which could not be amplified and did not present cross-hybridization with a set of 110 strains belonging to 23 other mycobacterial species. The probe was cloned and sequenced. Comparison with data bases revealed no significant homologies with previously described sequences.

Base Sequence↗

[Acquired immunodeficiency syndrome and pulmonary Mycobacterium xenopi infection. Role of computerized tomography].

INTRODUCTION: Mycobacterium xenopi is one of the most common agents responsible for nontubercular mycobacterial pulmonary disease on AIDS patients. These lesions have been studied with conventional radiography, while CT has been used in patients with aspecific mycobacterioses or non-AIDS pulmonary conditions from Mycobacterium xenopi. PURPOSE: We investigated the yield of CT in the study of lung lesions from Mycobacterium xenopi in AIDS patients. MATERIAL AND METHODS: We examined 12 AIDS patients with pulmonary lesions from Mycobacterium xenopi, patients age ranged 30 to 46 years. All patients had CD4 blood levels lower than 250 cells/mL and Mycobacterium xenopi in the sputum. All patients underwent a standard chest radiograph and a CT examination. CT images were evaluated by three radiologists independently and the definitive diagnosis was made in the presence of a fourth radiologist. RESULTS: Chest CT showed parenchymal consolidation in 66% of cases, associated with bilateral basal bands in 16% of cases. Consolidation was unilateral in 41% of cases and most frequently involved the right lower lobe. Bilateral reticular interstitial involvement was seen in the patients (41%). Micronodules in 1 patient (8%) and mediastinal adenopathy in 33% of cases. Two patients had pre-xisting emphysema and 1 had bronchiectasis. DISCUSSION AND CONCLUSIONS: The frequency of lung disease from Mycobacoerium xenopi has increased because of the spreading of the HIV infection. Such lung lesions in AIDS patients are aspecific in appearance and localization, which the clinical radiologist needs to consider to address treatment planning. The frequent finding of parenchymal consolidation and the absence of cavitary lesions may be referred to the poor capability of AIDS to produce an adequate inflammatory response. The lung lesions tend to distribute in the lower lobes unilaterally. Adenopathy was also a frequent finding. CT plays a fundamental role in studying the chest of these patients because it permits to locate lung lesions with higher accuracy than conventional radiography and to detect adenopathies, micronodules reticular interstitial involvement and bronchiectases.

Acquired Immunodeficiency Syndrome↗