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Volume 15, Number 4—April 2009

Letter

Mycobacterium avium subsp. hominissuis Infection in a Pet Parrot

Suggested citation for this article

To the Editor: Tuberculosis is a chronic wasting disease in domestic birds (especially hens) and free-ranging birds worldwide (1). Most mycobacterial infections in birds are caused by Mycobacterium avium subsp. avium (mainly domestic birds) or by M. genavense (especially pet birds). Nontuberculous (potentially pathogenic) mycobacteria (i.e., M. fortuitum, M. gordonae, and M. nonchromogenicum) occasionally have been isolated from necropsied pet birds (2). Because potentially pathogenic mycobacteria also are increasingly problematic in immunocompromised human patients, they merit special attention. M. avium subsp. hominissuis can infect humans, especially immunocompromised persons. M. avium subsp. hominissuis infections have been documented in pigs and cattle (3) and rarely in dogs (4), birds (5), and other animals.

We report a case of Mycobacterium infection in a female blue-fronted Amazon parrot (Amazona aestiva; pet bird) ≈6 months of age that was brought to a clinic because of inappetence over a 3-day period and polydipsia and yellow coloration of urine. Clinical examination showed slight emaciation, heavy biliverdinuria, ascites, and melena. By coprologic examination, 3 eggs of Ascaridia sp. worms were found in 1 field of view using 40× magnification. A Gram stain of fecal material showed sporadic gram-positive rods. On the basis of these signs, chlamydiosis was suspected. Differential diagnosis suggested liver cirrhosis, neoplasia, and Pacheco disease. Enrofloxacin (Baytril 2.5% injectable; Bayer AG, Frankfurt am Main, Germany) was administered subcutaneously (0.15 mL injected subcutaneously) and albendazole (Aldifal 2.5% suspension; Mevak a.s., Nitra, Slovakia) were administered orally (0.2 mL injected subcutaneously). The bird died 1 day later.

Necropsy showed ascites (clear yellowish fluid), hepatomegaly (stiff liver consistency, yellow-pink), mild splenomegaly, and hemorrhagic enteritis with thickening of the intestinal wall; the finding of hemorrhagic enteritis was unclear because the intestinal mucosa was hyperemic and covered with a thick layer of viscous mucus that contained blood. Twenty worms (Ascaridia sp.) were observed in the intestinal lumen.

Histopathologic examination showed diffused liver fibrosis with cystic dilatation of the bile ducts and focal extramedullary hematopoiesis. The hepatic parenchyma was nearly completely atrophic. Only some clusters of atrophic hepatocytes were observed. The other organs (kidneys, spleen, lungs, brain, and intestines) were free of histopathologic lesions. Hypertrophic cirrhosis (chronic active hepatitis) was diagnosed. Neither granulomatous nor other lesions were observed.

After Ziehl-Neelsen stain of tissue impressions, acid-fast rods (AFRs) were microscopically detected in the liver and intestine. Cultivation according to Matlova et al. (6) grew 6 acid-fast rod–positive isolates from 9 examined tissue specimens. A PCR assay confirmed M. avium spp., and a subsequent PCR assay for M. avium differentiation indicated M. avium subsp. hominissuis (IS1245+ and IS901–); both PCR assays were performed as described (7). The M. avium subsp. hominissuis isolate was classified as serotype 9. Typing of all isolates by IS1245 restriction fragment length polymorphism (RFLP) analysis according to Van Soolingen et al. (8) showed 2 different multibanded IS1245 RFLP types, which varied in only 1 band position (Table).

M. avium subsp. hominissuis is not considered an avian pathogen and rarely has been isolated from tuberculous lesions (5). However, our case study reports the isolation of M. avium subsp. hominissuis from multiple organs of 1 exotic bird that had developmental anomaly and liver fibrosis (Table). In addition to a few nonspecific gross lesions, nontuberculous lesions were observed in the liver, spleen, and intestinal organs.

The etiology of mycobacteriosis, especially in pet birds, is rarely identified. This may be because intravitam and postmortem findings are nonspecific. Infection with M. avium subsp. hominissuis may not lead to tuberculous lesions in birds, particularly when the infection occurs without complications. Susceptibility to mycobacterial infection, including M. avium subsp. hominissuis , depends on the host’s immune and nutritional status, environmental conditions unfavorable for the host, and genetic factors (1,9). Consistent with these reports, in this case, the histologic findings such as fibrosis of the liver associated with cystic dilatation and intestinal ascaris infestation may have aggravated the intensity of the mycobacterial infection.

IS1245 RFLP analysis showed isolates with 2 profiles that differ in the presence of only 1 band. The additional band in the rest of the isolates probably represents the transpositional event. The variability in 1 or 2 bands of 1 strain was also observed previously (10); therefore, we presume the bird was infected by only 1 strain of M. avium subsp. hominissuis . Unfortunately, the source of infection for this bird was not identified.

A multibanded IS1245 RFLP profile was described in a M. avium isolate from a parrot (4), but no details about this case were given. Our findings suggest that owners of pet birds and their family members may be at risk from this pathogenic causal agent. Hence, immunocompromised persons, children, and others involved in the breeding of exotic birds should avoid contact with birds with clinically suspected M. avium subsp. hominissuis .

Edmealem Jembere Shitaye, Veronika Grymova, Martin Grym, Roman Halouzka, Alica Horvathova, Monika Moravkova, Vladimir Beran, Jana Svobodova, Lenka Dvorska-Bartosova, and Ivo PavlikComments to Author 
Author affiliations: Veterinary Research Institute, Brno, Czech Republic (E.J. Shitaye, A. Horvathova, M. Moravkova, V. Beran, L. Dvorska-Bartosova, I. Pavlik); University of Veterinary and Pharmaceutical Sciences, Brno (E.J. Shitaye, R. Halouzka); Veterinary Clinic AvetuM, Brno (V. Grymova, M. Grym); Regional Institute of Public Health, Brno (J. Svobodova)

Acknowledgments

We thank Eva Slezakova for technical assistance. We also thank Ludmila Faldikova and Neysan Donnelly for their critical grammatical corrections.

This study was supported by grant nos. MZE0002716201 and NPV 1B53009 from the Ministry of Agriculture of the Czech Republic and PathogenCombat (no. FOOD-CT-2005-007081, Brussels, EC).

References

  1. Tell LA, Woods L, Cromie RL. Mycobacteriosis in birds. Rev Sci Tech. 2001;20:180203.PubMed
  2. Hoop RK, Böttger EC, Pfyffer GE. Etiological agents of mycobacteriosis in pet birds between 1986 and 1995. J Clin Microbiol. 1996;34:9912.PubMed
  3. Pavlik I, Svastova P, Bartl J, Dvorska L, Rychlik I. Relationship between IS901 in the Mycobacterium avium complex strains isolated from birds, animals, humans and environment and virulence for poultry. Clin Diagn Lab Immunol. 2000;7:2127. DOIPubMed
  4. Haist V, Seehusen F, Moser I, Hotzel H, Deschl U, Baumgärtner W, Mycobacterium avium subsp. hominissuis infection in 2 pet dogs, Germany. Emerg Infect Dis. 2008;14:98890. DOIPubMed
  5. Dvorska L, Matlova L, Ayele WY, Fischer OA, Amemori T, Weston RT, Avian tuberculosis in naturally infected captive water birds of the Ardeideae and Threskiornithidae families studied by serotyping, IS901 RFLP typing, and virulence for poultry. Vet Microbiol. 2007;119:36674. DOIPubMed
  6. Matlova L, Dvorska L, Ayele WY, Bartos M, Amemori T, Pavlik I. Distribution of Mycobacterium avium complex isolates in tissue samples of pigs fed peat naturally contaminated with mycobacteria as a supplement. J Clin Microbiol. 2005;43:12618. DOIPubMed
  7. Moravkova M, Hlozek P, Beran V, Pavlik I, Preziuso S, Cuteri V, Strategy for the detection and differentiation of Mycobacterium avium species in isolates and heavily infected tissues. Res Vet Sci. 2008;85:25764. DOIPubMed
  8. Van Soolingen D, Bauer J, Leao S, Pavlik I, Vincent V, Rastogi N, IS1245 Restriction fragment length polymorphism typing of Mycobacterium avium isolates: proposal for standardization. J Clin Microbiol. 1998;36:30514.PubMed
  9. Cromie RL, Brown MJ, Ash NJ, Stanford JL. Avian immune responses to Mycobacterium avium: the wildfowl example. Dev Comp Immunol. 2000;24:16985. DOIPubMed
  10. Picardeau M, Varnerot A, Lecompte T, Brel F, May T, Vincent V. Use of different molecular typing techniques for bacteriological follow-up in a clinical trial with AIDS patients with Mycobacterium avium bacteremia. J Clin Microbiol. 1997;35:250310.PubMed

Table

Suggested citation for this article: Shitaye EJ, Grymova V, Grym M, Halouzka R, Horvathova A, Moravkova M, et al. Mycobacterium avium subsp. hominissuis infection in a pet parrot [letter]. Emerg Infect Dis [serial on the Internet]. 2009 Apr [date cited]. Available from http://wwwnc.cdc.gov/eid/article/15/4/08-1003.htm

DOI: 10.3201/eid1504.081003

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Table of Contents – Volume 15, Number 4—April 2009

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Ivo Pavlik, Veterinary Research Institute, Hudcova 70, 621 00 Brno, Czech Republic





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