Humans ; Child ; Nontuberculous Mycobacteria ; Lung Diseases

China/epidemiology* ; Humans ; Mycobacterium Infections, Nontuberculous/microbiology* ; Nontuberculous Mycobacteria/classification* ; Transients and Migrants

Humans ; Nontuberculous Mycobacteria ; Peritoneal Dialysis/adverse effects* ; Peritonitis/etiology*

HIV ; HIV Infections/drug therapy* ; Humans ; Mycobacterium Infections, Nontuberculous ; Nontuberculous Mycobacteria

BACKGROUND: Nontuberculous mycobacteria (NTM) lymphadenitis is an under-recognized entity, and data of the true burden in children are limited. Without a high index of suspicion, diagnosis may be delayed and microbiological detection is challenging. Here, we report a cluster of NTM lymphadenitis experienced in Korean children. METHODS: Subjects under 19 years of age diagnosed with NTM lymphadenitis during November 2016–April 2017 and April 2018 were included. Electronic medical records were reviewed for clinical, laboratory and pathological findings. Information regarding underlying health conditions and environmental exposure factors was obtained through interview and questionnaires. RESULTS: A total of ten subjects were diagnosed during 18 months. All subjects were 8–15 years of age, previously healthy, male and had unilateral, nontender, cervicofacial lymphadenitis for more than 3 weeks with no significant systemic symptoms and no response to empirical antibiotics. Lymph nodes involved were submandibular (n = 8), preauricular (n = 6) and submental (n = 1). Five patients had two infected nodes and violaceous discoloration was seen in seven subjects. Biopsy specimens revealed chronic granulomatous inflammation and acid-fast bacteria culture identified Mycobacterium haemophilum in two cases and NTM polymerase chain reaction was positive in two cases. Survey revealed various common exposure sources. CONCLUSION: NTM lymphadenitis is rare but increasing in detection and it may occur in children and adolescents. Diagnosis requires high index of suspicion and communication between clinicians and the laboratory is essential for identification of NTM.
Adolescent ; Anti-Bacterial Agents ; Bacteria ; Biopsy ; Child ; Diagnosis ; Electronic Health Records ; Environmental Exposure ; Humans ; Inflammation ; Lymph Nodes ; Lymphadenitis ; Male ; Mycobacterium ; Mycobacterium haemophilum ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Tuberculosis, Lymph Node

Mycobacterium abscessus is the second most important pathogen in pulmonary disease caused by nontuberculous mycobacteria (NTM), following Mycobacterium avium. Mycobacterium abscessus is classified into three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Mycobacterium abscessus is the most difficult to treat NTM due to its resistance to many antibiotics. Treatment should include an initial regimen of 2–3 injectable and oral antibiotics for several weeks or months, followed by inhaled amikacin and 1–3 oral antibiotics, depending on the subspecies and drug susceptibility patterns, including macrolide susceptibility. The continuation phase should be continued for a minimum of 12 months after culture conversion. Suitable injectable antibiotics include amikacin, imipenem, cefoxitin, and tigecycline, while oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and moxifloxacin. Surgery can be a useful adjunctive therapy for some patients with refractory disease. However, the overall treatment prognosis is still unsatisfactory. Therefore, novel and more effective interventions are required for the treatment of M. abscessus pulmonary disease.
Amikacin ; Anti-Bacterial Agents ; Cefoxitin ; Clofazimine ; Humans ; Imipenem ; Linezolid ; Lung Diseases ; Macrolides ; Mycobacterium avium ; Mycobacterium ; Nontuberculous Mycobacteria ; Prognosis

Mycobacterium shimoidei is a nontuberculous mycobacterium (NTM), and is rarely reported as a pathogen causing the NTM pulmonary disease. We describe here the case of a 52-year-old male with symptoms such as chronic cough and a history of pulmonary tuberculosis. Radiologic studies revealed a cavitary lesion in the left upper lobe of his lung. Sputum culture was positive for NTM, which was later identified as M. shimoidei using 16S rRNA and hsp65 sequencing. The patient's symptoms, radiologic evidence, and positive culture results together substantiate that this is the first case of M. shimoidei pulmonary disease from Korea.
Cough ; Humans ; Korea ; Lung ; Lung Diseases ; Male ; Middle Aged ; Mycobacterium ; Nontuberculous Mycobacteria ; Sputum ; Tuberculosis, Pulmonary

BACKGROUND: Pulmonary infection with nontuberculous mycobacteria (NTM) is increasing in South Korea. Since treatment strategy differs by NTM species, accurate identification is necessary. In this study, using Mycobacterium pulmonary isolates recently recovered from a general hospital in Seoul, the prevalence of NTM isolates was investigated. METHODS: A total of 483 Mycobacterium pulmonary strains isolated between May and November 2018 from an 814-bed general hospital in South Korea were analyzed. Bacterial species were identified based on nucleotide sequences of the 16S–23S rDNA internal transcribed spacer and the rpoB gene. RESULTS: From a total of 1,209 pulmonary specimens from patients suspected to be infected with mycobacteria, 324 deduplicate strains were isolated, comprising 90 Mycobacterium tuberculosis and 229 NTM strains. Among the NTM isolates, 61.5% (n=144) were Mycobacterium avium complex (MAC), including 92 M. avium and 52 Mycobacterium intracellulare, while 8.1% (n=19) represented Mycobacterium abscessus, including 10 M. abscessus subsp. abscessus and 9 M. abscessus subsp. massiliense. In addition, 12 (5.1%) Mycobacterium lentiflavum, 12 (5.1%) Mycobacterium gordonae, 6 (2.6%) Mycobacterium kansasii, and 5 (2.1%) Mycobacterium fortuitum were identified. In addition, Mycobacterium mucogenicum (n=2), Mycobacterium septicum (n=1), Mycobacterium colombiens (n=1), Mycobacterium asiaticum (n=1), and Mycobacterium celatum (n=1) were identified. CONCLUSION: Among the recently recovered Mycobacterium pulmonary strains, more than half were identified as NTM, and MAC was the most prevalent NTM, followed by M. abcessuss.
Base Sequence ; DNA, Ribosomal ; Hospitals, General ; Humans ; Korea ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium fortuitum ; Mycobacterium kansasii ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Prevalence ; Seoul ; Tertiary Care Centers ; Tertiary Healthcare

An inflammatory myofibroblastic tumor (IMT) is a solid tumor of unknown etiology frequently affecting children and young adults and commonly affecting the lung or orbital region. We present a case involving a 41-year-old man who had an IMT combined with Mycobacterium tuberculosis infection in the retroperitoneum. He presented with only pain in the right lower abdomen without accompanying symptoms; a retroperitoneal mass was found on computed tomography. The tumor had invaded the end of the ileum and was attached to the omentum, so mass excision could not be performed. The tumor was completely excised surgically and had histological features diagnostic of an IMT. Histologic findings of the omentum were positive for Ziehl-Nielsen staining for acid-fast bacilli and for a positive polymerase chain reaction for M. tuberculosis. The patient had no apparent immune disorder. These findings made this case exceptional because IMTs, which are mostly due to atypical mycobacteria, have been found mainly in immunocompromised patients.
Abdomen ; Adult ; Child ; Humans ; Ileum ; Immune System Diseases ; Immunocompromised Host ; Inflammation ; Lung ; Mycobacterium tuberculosis ; Myofibroblasts ; Nontuberculous Mycobacteria ; Omentum ; Orbit ; Polymerase Chain Reaction ; Tuberculosis ; Young Adult

A 73-year-old woman presented with a recurrent cystic mass around her left olecranon. She had a history of 8 steroid injections due to elbow pain beginning 3 years ago and twice had undergone aspiration of olecranon bursitis that developed two months prior to presentation. She had been taking medications for hypertension and diabetes with no pertinent past history. On magnetic resonance imaging (MRI), there were multiple nodules in the olecranon bursa, which were isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Our initial diagnosis was synovial chondromatosis. On bursoscopy, masses of gray-white colored nodules were observed in the bursa. Finally, synovial chondromatosis and non-tuberculous mycobacterial infection were concurrently diagnosed. In conclusion, uncalcified synovial chondromatosis and rice bodies can have similar visual and MRI characteristics; therefore, we suggest that clinicians should be aware of the possibility of other infections in cases of this type.
Aged ; Bursitis ; Chondromatosis, Synovial ; Diagnosis ; Elbow ; Female ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Mycobacterium ; Nontuberculous Mycobacteria ; Olecranon Process ; Synovitis ; Tuberculosis