Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 8, Number 11—November 2002
Letter

Mycobacterium haemophilum: Emerging or Underdiagnosed in Brazil?

On This Page
Article Metrics
14
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Mycobacterium haemophilum was first described in 1978 by Sompolinsky et al. (1) as the cause of cutaneous infections in a patient with Hodgkin disease. Since then, fewer than 100 cases have been reported worldwide, mostly among immunocompromised patients (2), although M. haemophilum infection has also been described in immunocompetent patients as the cause of cervical, submandibular, and perihilar lymphadenopathy in children and of pulmonary nodules in an adult (35). Cases have been reported from United States, Australia, Canada, France, Israel, and the United Kingdom, but to date no reports have originated in South America.

The most frequent clinical sign of M. haemophilum infection in adults is a skin or joint lesion. Less common sites for isolation of M. haemophilum include the respiratory tract, blood, bone marrow, bone, and central venous catheters (2,6). M. haemophilum is unique among Mycobacterium species owing to its special growth requirements: it grows best at 30°C and requires an iron supplement (hemin or ferric ammonium citrate).

We report here the characterization of three strains of M. haemophilum isolated from patients living in three states in two distinct regions of Brazil, Rio de Janeiro and São Paulo (southeast region) and Bahia (northeast region). The first strain was detected in Rio de Janeiro in December 2000 from a blood culture of a 67-year-old man who had received a kidney transplant in 1988 at the age of 55 years and was undergoing immunosuppressive treatment with prednisolone and mycophenolate mofetil. The second strain was detected in São Paulo in March 2001 in a 43-year-old HIV-seropositive man from a biopsied specimen of a nasal ulcer. A direct acid-fast stain showed many acid-fast bacilli. At time of diagnosis, the patient’s CD4+ cell count was 8/mm3 and his viral load was 290.000 copies/mL. The third isolate was detected in Bahia in a 30-year-old HIV-seropositive man who had osteomyelitis in an elbow. A direct acid-fast stain showed rare acid-fast bacilli.

The isolate from the Rio de Janeiro patient grew only in Myco/F Lytic media (Becton Dickinson Microbiology Systems, Sparks, MD) plus blood in primary isolation and subculture; it failed to grow on chocolate agar at 30°C after 6 weeks. The isolates from São Paulo and Bahia showed a slight growth in 12B media on primary isolation; this growth was likely supported by the iron provided by the biopsied tissue. Subcultures on chocolate agar showed good growth after 2–3 weeks at 30°C. The isolate did not grow on Middlebrook 7H10 agar without hemin and grew on the same media when supplemented with 60 μM of hemin. Both strains showed a negative catalase reaction.

The species of all isolates was identified through polymerase chain reaction amplification of the gene encoding for the 65-kDa heat shock protein, followed by restriction analysis with the enzymes BstEII and HaeIII as described by Telenti et al. (7), with minor modifications. The three isolates showed the same restriction pattern as that obtained for M. haemophilum American Type Culture Collection 29548 prototype strain. Isolates from Rio de Janeiro and São Paulo were also molecularly characterized as previously described by Roth et al. (8), corroborating M. haemophilum species identification.

To our knowledge, these M. haemophilum isolates are the first to be reported in Brazil. These three patients came from cities 429–962 km apart, demonstrating the dispersion of M. haemophilum infection in Brazil. Given the specific requirements of M. haemophilum for its growth in culture, our findings suggest that its true incidence in Brazil is greatly underestimated. Consequently, we strongly recommend that clinical laboratories in Brazil include an iron-supplemented medium, such as chocolate agar, incubated at 30ºC, for primary isolation of Mycobacterium spp in samples from selected patients.

Top

Jorge Luiz Mello Sampaio*†Comments to Author , Venâncio Avancini Ferreira Alves‡, Sylvia Cardoso Leão†, Vanda Dolabela de Magalhães§, Marinês Dalla Valle Martino§, Caio Marcio Figueiredo Mendes*, Antonio Carlos de Oliveira Misiara¶, Kozue Miyashiro*, Jacyr Pasternak§, Eliana Rodrigues‡, Ronaldo Rozenbaum#, Carlos Alberto Sant´Anna Filho**, Sônia Regina Marques Teixeira*, Adriano Cunha Xavier††, Mauro Silvério Figueiredo*, and José Paulo Gagliardi Leite††‡‡
Author affiliations: *Fleury - Centers for Diagnostic Medicine, São Paulo, Brazil; †Federal University of São Paulo, São Paulo, Brazil; ‡Oswaldo Cruz Hospital, São Paulo, Brazil; §Albert Einstein Hospital, São Paulo, Brazil; ¶Sírio Libanês Hospital, São Paulo, Brazil; #Servidores do Estado Hospital, Rio de Janeiro, Brazil; **Aliança Hospital, Salvador, Bahia, Brazil; ††Lâmina Laboratory, Rio de Janeiro, Brazil; ‡‡Oswaldo Cruz Institute, Rio de Janeiro, Brazil;

Top

References

  1. Sompolinsky  D, Lagziel  A, Naveh  D, Yankilevitz  T. Mycobacterium haemophilum sp. nov., a new pathogen of humans. Int J Syst Bacteriol. 1978;28:6775.
  2. Shah  MK, Sebti  A, Kiehn  E, Massarella  SA, Sepkowitz  KA. Mycobacterium haemophilum in immunocompromised patients. Clin Infect Dis. 2001;33:3307. DOIPubMedGoogle Scholar
  3. Samra  Z, Kaufmann  L, Zeharia  A, Ashkenazi  S, Amir  J, Bahar  J, Optimal detection and identification of Mycobacterium haemophilum in specimens from pediatric patients with cervical lymphadenopathy. J Clin Microbiol. 1999;37:8324.PubMedGoogle Scholar
  4. Armstrong  KL, James  RW, Dawson  DJ, Francis  PW, Masters  B. Mycobacterium haemophilum causing perihilar or cervical lymphadenitis in healthy children. J Pediatr. 1992;121:2025. DOIPubMedGoogle Scholar
  5. White  DA, Kiehn  TE, Bondoc  AY, Massarella  SA. Pulmonary nodule due to Mycobacterium haemophilum in an immunocompetent host. Am J Respir Crit Care Med. 1999;160:13668.PubMedGoogle Scholar
  6. Ward  MS, Lam  KV, Cannell  PK, Herrmann  RP. Mycobacterial central venous catheter tunnel infection: a difficult problem. Bone Marrow Transplant. 1999;24:3259. DOIPubMedGoogle Scholar
  7. Telenti  A, Marchesi  F, Balz  M, Bally  F, Bottger  EC, Bodmer  T. Rapid identification of mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol. 1993;31:1758.PubMedGoogle Scholar
  8. Roth  A, Reischl  U, Streubel  A, Naumann  L, Kroppenstedt  RM, Habicht  M, Novel diagnostic algorithm for identification of mycobacteria using genus-specific amplification of the 16S-23S rRNA gene spacer and restriction endonucleases. J Clin Microbiol. 2000;38:1094104.PubMedGoogle Scholar

Top

Cite This Article

DOI: 10.3201/eid0811.020492

Related Links

Top

Table of Contents – Volume 8, Number 11—November 2002

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Jorge Luiz Mello Sampaio, Fleury–Centers for Diagnostic Medicine, Microbiology Section, Av. General Waldomiro de Lima 508, São Paulo, Brazil 04344-070; fax: 55 11 50147601; .

Send To

10000 character(s) remaining.

Top

Page created: July 19, 2010
Page updated: July 19, 2010
Page reviewed: July 19, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external