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Volume 17, Number 3—March 2011

Research

Mycobacterium lentiflavum in Drinking Water Supplies, Australia

Henry M. MarshallComments to Author , Robyn Carter, Matthew J. Torbey, Sharri Minion, Carla Tolson, Hanna E. Sidjabat, Flavia Huygens, Megan Hargreaves, and Rachel M. Thomson
Author affiliations: Author affiliations: The Prince Charles Hospital, Brisbane, Queensland, Australia (H.M. Marshall); The Royal Brisbane Hospital, Brisbane (R. Carter, M.J. Torbey, S. Minion, C. Tolson); University of Queensland Centre for Clinical Research, Brisbane (H.E. Sidjabat); Queensland University of Technology, Brisbane (F. Huygens, M. Hargreaves); Queensland Tuberculosis Control Centre, Brisbane (R.M. Thomson)

Main Article

Table A1

Summary of published cases of clinically significant Mycobacterium lentiflavum isolates*

Type of infection and reference† Patient age/sex Country Organ/tissue involved Immunocompromised Concurrent conditions Treatment Outcome
Soft tissue/skin
(1) 85 y/F Germany 5-mo history thoracic discitis T9, T10. Biopsy showed granulomata, C+ after 22 d No Diabetes mellitus, congestive heart failure [INH, RMP, PZA] 3 mo, then [INH/RMP] 6 mo Marked symptomatic improvement at 2 mo
(11) 52 y/F Spain Arthritis, skin lesions, synovial fluid was sterile; synovial biopsy found granulomata, ZN+, C+ after 4 wk. Yes, GC, cyclophosphamide Antisynthetase syndrome [INH, RMP, EMB, PZA] then [fusidic acid, LFX, CLR] for 1 wk before death Condition worsened with weight loss, synovitis. Died after 4 mo
(12)
48 y/M
Spain
2 skin ulcers, 2-y history. Biopsy ZN+, C+
Yes
HIV for 15 yr, CD4+ 46, IVDU
[Highly active antiretroviral therapy, INH, EMB, LFX]
Lost to follow-up
Cervical lymphadenitis
(13) 42 mo/M Germany 10-d history, ZN+, C+, granulomata present No No Excision Well at 18 mo
(13) 33 mo/M Germany 14-d history. ZN–, C+, granulomata present No No Excision Well at 18 mo
(14) 4 y/F Italy 15-d history, biopsy scanty ZN+, C+ No No [INH, RMP] duration NS; excision Well at 2 y
(15) 19 mo/M Spain 10-d history, ZN+, C+, granulomata present No Asthma [INH, RMP, PZA] duration NS; then excision Recovered fully
(16) 4 y/M Italy No details No No Excision Well at 1 y
(17) 45 y/F Italy 4-wk history. ZN–, C+ at 10 d, granulomata present No Severe periodontal disease Excision Well at 18 mo
(18) 18 mo/M Italy 4-wk history. ZN+, C+ after 3 wk; recurrent lymphadenopathy at 3 mo in same position showed granulomata No No Excision Recurrent lymphadenopathy after 3 mo treated with excision
Queensland§
20 mo/F
Australia
4-wk history, biopsy ZN–, granulomata present, C+
No
No
Excision
Full recovery
Pulmonary
(14) 58 y/M Italy Left upper lobe pulmonary infiltrates, pleural effusion, low-grade fever, weight loss. Pleural fluid and sputum C–; pleural biopsy showed granulomata, ZN–, C+ after 3 wk Yes(rheumatoid arthritis) Rheumatoid arthritis [INH, RFB, EMB, PZA] Stable at 4 mo. No improvement in computed tomography thorax appearance
(16) 61 y/F Italy Cough, fever, weight loss, right upper lobe nodular pulmonary infiltrates and adenopathy. Sputum ZN+, C+ No Bronchiectasis since age 30 y [RMP, INH, PZA] for “several months,” then
[RFB, EMB, CLR, CIP] 5-y follow-up, sputum intermittently ZN+, C+; no improvement in radiology
(19) 71 y/M Japan Hemoptysis, bilateral pulmonary infiltrates, cavities right upper lobe. Sputum ZN+, C+ after 35 d(multiple specimens) No 2-y treatment for pulmonary TB aged 30 y; smoker [RMP, EMB, INH, PZA] 1 y, CLR also added, duration NS 3-y follow-up, sputum remained ZN+, C+, symptoms continued, CXR slowly progressed
(20)(case 6) 35 y/F Zambia 4-wk history of cough, pleural effusion fluid C+. No No [RMP, INH, PZA, EMB] duration NS Improved. Duration of follow-up NS
(21) 67 y/F Italy Hemoptysis, low-grade fever, weight loss. Sputum ZN+, C+ No Previous pulmonary TB, with fibrosis right upper lobe, chronic obstructive pulmonary disease [INH, PZA, EMB, RMP] 3 mo: no effect: ceased.
2 y later, started CLR monotherapy, improved by 3 mo, but sputum still ZN+ [EMB, RFB, CIP] added for 2 wk 3-y follow-up. Poor compliance with drugs, intermittent hemoptysis, weakness, dyspnoea, sputum remained ZN+, CXR unchanged
(22) 49 y/M United States Fever, right upper lobe pulmonary noncavitary nodules, 2×/ sputum C+ at 27 d, bronchoalveolar lavage C– Yes Myelofibrosis on pegylated interferon-α2 [CIP 500 mg 2×/day, azithromycin 500 od, EMB 1 g od] unknown duration Stable disease, lost to follow up; duration of follow-up NS
(22 66 y/M United States Fever, neutropenia, necrotizing pneumonia, single sputum C+ at 28 d Yes Hematopoetic stem cell transplant for chronic lymphocytic leukemia, graft vs. host disease [CLR 500 mg 2×/day, EMB 1 g od] Died after 12 wk, septic shock from Pseudomonas aeruginosa. Uncertain significance of M. lentiflavum
(23 28 y/M Brazil Cough, fever, reticulonodular infiltrate, PCP+, 1× sputum C–. 3 wk later high fever returned – 1× blood C+ Yes Newly diagnosed HIV, PCP [Streptomycin] duration NS(? 1 mo) GC, sulphamethoxazole–trimethoprim, zidovudine, didanosine Died a few mos later, no further clinical details
(23 64 y/F Brazil Pulmonary cavities, treated for ZN+ pulmonary tuberculosis for 6 y Yes Chronic pulmonary tuberculosis Various including CLR, EMB, clofazimine, RMP and doxycycline. No details given. Sputum persistently C+: 12/15 sputum samples grew M. avium complex, 2 grew M. lentiflavum. Died of uterine cancer
(18) 14 y/M Italy Fever, chest pain, pleural effusion, pneumothorax, multiple right upper lobe and right middle lobe nodules. Pleural fluid ZN+, C+ at 4 wk Yes Acute lymphoblastic leukemia, chemotherapy [CLR, amikacin, ceftriaxone] 5 mo Improved, CXR almost returned to normal
(18) 87 y/M Italy Bilateral pleural thickening, left pleural effusion, pulmonary opacities, pleural fluid ZN–, C+ at 3 wk No No [LFX] monotherapy for 3 wk, then
[CLR, LFX, RFB] After 1 mo, pulmonary opacities resolved, effusion remained
(24)(case 2) 23 y/M Greece Pleural effusion, sputum C+ NS NS [INH, RMP, PZA, EMB] duration NS(? 6 mo) Recovered
Queensland§ 85 y/F Australia Cough, pulmonary nodules, mild bronchiectasis, bronchial washings ZN–, C+ No No [EMB 800 mg, RMP 450 mg, CLR 500 mg 2×/day] Stable at 7 mo
Queensland§
49 y/F
Australia
Hemoptysis, bronchiectasis, bronchial washings ZN–, C+
No
No
No specific treatment given
Currently well, stable CXR at 11 y
Disseminated
(25) 49 y/M France Fever, pulmonary infiltrates, 3× blood culture and bronchoalveolar lavage C+ after 4 wk Yes HIV for 7 y [CLR, RFB, EMB] and antiretroviral drugs, at least 4-mo treatment, probably 9 mo Fully recovered, died 3 y later of heart failure
(16 45 y/M Italy Basal pulmonary infiltrate, T4 vertebra involvement, hepatic lesion. Empiric treatment given with clinical improvement. Liver biopsy C+, no other samples reported Yes HIV, non-Hodgkin lymphoma [Antiretrovirals, RFB, CLR], then
[RFB, CIP, EMB, CLR] then [RFB, CLR] Well at 1 y. Hepatic lesion aspirated C+ but continued to grow; was later excised and proven to be non-Hodgkin lymphoma
(20)(case 1) 67 y/F Zambia 8-wk duration hepatosplenomegaly, axillary lymphadenopathy; lymph node biopsy ZN+, C+; 2× Sputum C+ No No No treatment given NS
Queensland§ 43 y/F Australia 4x blood cultures C+ after 15 d, 1x bone marrow ZN–, granulomata present, C+; hepatosplenomegaly, pulmonary nodules Yes HIV, hepatitis C, IVDU, systemic lupus erythematosus [INH 300 mg, EMB 400 mg 2×/day, CLR 500 mg 2×/day] with reducing course of prednisone Compliant with treatment, improving at 12 mo

*C+, culture positive; INH, isoniazid; RMP, rifampicin; PZA, pyrazinamide; ZN+, Ziehl-Neelsen smear stain–positive; GC, glucocorticoids; EMB, ethambutol; LFX, levofloxacin; CLR clarithromycin; IVDU, intravenous drug user; ZN–, Ziehl-Neelsen smear stain–negative; NS information not stated or unknown; RFB, rifabutin; right upper lobe; CIP, ciprofloxacin; TB, tuberculosis; CXR, chest radiograph; C–, culture negative; PCP, Pneumocystis pneumonia.
†Excluded are 2 cases from articles written in Spanish(26,27).
‡Brackets indicate antimicrobial drugs used together as a single regimen.
§Cases reported in this article.
¶Not definite cases of disease.

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