Volume 17, Number 3—March 2011
Research
Mycobacterium lentiflavum in Drinking Water Supplies, Australia
Henry M. Marshall
, Robyn Carter, Matthew J. Torbey, Sharri Minion, Carla Tolson, Hanna E. Sidjabat, Flavia Huygens, Megan Hargreaves, and Rachel M. Thomson
, Robyn Carter, Matthew J. Torbey, Sharri Minion, Carla Tolson, Hanna E. Sidjabat, Flavia Huygens, Megan Hargreaves, and Rachel M. ThomsonTable 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.
