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Mycobacterium Chelonae Treatment & Management

  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 06, 2015
 

Medical Care

Localized cutaneous infection usually resolves with appropriate antibiotics with combined indicated excision or debridement. An optimal drug regimen for Mycobacterium chelonae infection has not been established.

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Surgical Care

Aggressive debridement of infected soft tissue has always been advocated as a modality of therapy. Uncomplicated infections may not require surgical intervention, and it is not unusual for practitioners to try antimicrobial chemotherapy alone before undertaking a surgical procedure. Excision and debridement is currently recommended when infection is extensive, recurrent, or drug resistant. Abscess formation with or without sinus tract formation and bone involvement usually requires formal debridement.[25, 29] In addition, infections in patients intolerant of drug therapy may need surgical excision.

Any infected foreign body or implanted device usually must be removed in combination with antibiotic therapy to optimize the therapeutic outcome.[18, 20, 21, 27, 29]

Ocular infections usually require surgical intervention.[23]

Pulmonary infection only requires surgical intervention when it is extensive, cavitary, or nonresponsive to drug therapy. Surgery usually involves lobectomy or segmentectomy and has been reported to have acceptable morbidity and mortality in most cases with reasonable preserved lung function.[37]

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Consultations

Consultation with the following specialists may be indicated:

  • An infectious diseases specialist for diagnostic and therapeutic guidance
  • A pulmonologist for lung lesions, possible bronchoscopy, and therapeutic guidance
  • A dermatologist for possible biopsy of cutaneous lesions
  • A surgeon for debridement, biopsy or surgical guidance

Consider obtaining expert advice from the following institutions:

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Diet

No specific dietary restrictions are indicated.

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Activity

Patients with M chelonae infections are not contagious and should not be isolated.

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Contributor Information and Disclosures
Author

Alfred Scott Lea, MD Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, University of Texas Medical Branch School of Medicine

Alfred Scott Lea, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Infectious Diseases Society of America, Texas Medical Association, Harris County Medical Society, American College of Certified Wound Specialists

Disclosure: Nothing to disclose.

Coauthor(s)

Jeana L Benwill, MD Assistant Professor, The University of Texas Health Science Center at Tyler

Jeana L Benwill, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chief Administrative Officer, Executive Vice President, Mercy Medical Center, Catholic Health Services of Long Island

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American Association for Physician Leadership, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

References
  1. Brown-Elliott BA, Wallace RJ Jr. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002 Oct. 15(4):716-46. [Medline]. [Full Text].

  2. Kusunoki S, Ezaki T. Proposal of Mycobacterium peregrinum sp. nov., nom. rev., and elevation of Mycobacterium chelonae subsp. abscessus (Kubica et al.) to species status: Mycobacterium abscessus comb. nov. Int J Syst Bacteriol. 1992 Apr. 42(2):240-5. [Medline].

  3. Lévy-Frébault V, Grimont F, Grimont PAD, et al. Deoxyribonucleic acid relatedness study of the Mycobacterium fortuitum-Mycobacterium chelonae complex. Int J System Bacteriol. 1986 Jul. 36:458-60. [Full Text].

  4. Adékambi T, Berger P, Raoult D, Drancourt M. rpoB gene sequence-based characterization of emerging non-tuberculous mycobacteria with descriptions of Mycobacterium bolletii sp. nov., Mycobacterium phocaicum sp. nov. and Mycobacterium aubagnense sp. nov. Int J Syst Evol Microbiol. 2006 Jan. 56(Pt 1):133-43. [Medline].

  5. Adékambi T, Reynaud-Gaubert M, Greub G, Gevaudan MJ, La Scola B, Raoult D, et al. Amoebal coculture of "Mycobacterium massiliense" sp. nov. from the sputum of a patient with hemoptoic pneumonia. J Clin Microbiol. 2004 Dec. 42(12):5493-501. [Medline]. [Full Text].

  6. Nash KA, Brown-Elliott BA, Wallace RJ Jr. A novel gene, erm(41), confers inducible macrolide resistance to clinical isolates of Mycobacterium abscessus but is absent from Mycobacterium chelonae. Antimicrob Agents Chemother. 2009 Apr. 53(4):1367-76. [Medline]. [Full Text].

  7. Ebani VV, Fratini F, Bertelloni F, Cerri D, Tortoli E. Isolation and identification of mycobacteria from captive reptiles. Res Vet Sci. 2012 Dec. 93(3):1136-8. [Medline].

  8. Williams MM, Yakrus MA, Arduino MJ, Cooksey RC, Crane CB, Banerjee SN, et al. Structural analysis of biofilm formation by rapidly and slowly growing nontuberculous mycobacteria. Appl Environ Microbiol. 2009 Apr. 75(7):2091-8. [Medline]. [Full Text].

  9. Hall-Stoodley L, Keevil CW, Lappin-Scott HM. Mycobacterium fortuitum and Mycobacterium chelonae biofilm formation under high and low nutrient conditions. J Appl Microbiol. 1998 Dec. 85 Suppl 1:60S-69S. [Medline].

  10. Svetlíková Z, Skovierová H, Niederweis M, Gaillard JL, McDonnell G, Jackson M. Role of porins in the susceptibility of Mycobacterium smegmatis and Mycobacterium chelonae to aldehyde-based disinfectants and drugs. Antimicrob Agents Chemother. 2009 Sep. 53(9):4015-8. [Medline].

  11. Falkinham JO 3rd. Nontuberculous mycobacteria from household plumbing of patients with nontuberculous mycobacteria disease. Emerg Infect Dis. 2011 Mar. 17(3):419-24. [Medline].

  12. Wallace RJ Jr, Brown BA, Onyi GO. Skin, soft tissue, and bone infections due to Mycobacterium chelonae chelonae: importance of prior corticosteroid therapy, frequency of disseminated infections, and resistance to oral antimicrobials other than clarithromycin. J Infect Dis. 1992 Aug. 166(2):405-12. [Medline].

  13. Kothavade RJ, Dhurat RS, Mishra SN, Kothavade UR. Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis. 2012 Nov 9. [Medline].

  14. Hay RJ. Mycobacterium chelonae--a growing problem in soft tissue infection. Curr Opin Infect Dis. 2009 Apr. 22(2):99-101. [Medline].

  15. Kennedy BS, Bedard B, Younge M, Tuttle D, Ammerman E, Ricci J, et al. Outbreak of Mycobacterium chelonae infection associated with tattoo ink. N Engl J Med. 2012 Sep 13. 367(11):1020-4. [Medline].

  16. Winthrop KL, Chang E, Yamashita S, Iademarco MF, LoBue PA. Nontuberculous mycobacteria infections and anti-tumor necrosis factor-alpha therapy. Emerg Infect Dis. 2009 Oct. 15(10):1556-61. [Medline]. [Full Text].

  17. Uslan DZ, Kowalski TJ, Wengenack NL, Virk A, Wilson JW. Skin and soft tissue infections due to rapidly growing mycobacteria: comparison of clinical features, treatment, and susceptibility. Arch Dermatol. 2006 Oct. 142(10):1287-92. [Medline].

  18. Phillips MS, von Reyn CF. Nosocomial infections due to nontuberculous mycobacteria. Clin Infect Dis. 2001 Oct 15. 33(8):1363-74. [Medline].

  19. Mycobacterium chelonae infections associated with face lifts--New Jersey, 2002-2003. MMWR Morb Mortal Wkly Rep. 2004 Mar 12. 53(9):192-4. [Medline].

  20. Correa NE, Cataño JC, Mejía GI, Realpe T, Orozco B, Estrada S, et al. Outbreak of mesotherapy-associated cutaneous infections caused by Mycobacterium chelonae in Colombia. Jpn J Infect Dis. 2010 Mar. 63(2):143-5. [Medline].

  21. Song Y, Wu J, Yan H, Chen J. Peritoneal dialysis-associated nontuberculous mycobacterium peritonitis: a systematic review of reported cases. Nephrol Dial Transplant. 2012 Apr. 27(4):1639-44. [Medline].

  22. Moorthy RS, Valluri S, Rao NA. Nontuberculous mycobacterial ocular and adnexal infections. Surv Ophthalmol. 2012 May-Jun. 57(3):202-35. [Medline].

  23. Girgis DO, Karp CL, Miller D. Ocular infections caused by non-tuberculous mycobacteria: update on epidemiology and management. Clin Experiment Ophthalmol. 2012 Jul. 40(5):467-75. [Medline].

  24. Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. Am Rev Respir Dis. 1993 May. 147(5):1271-8. [Medline].

  25. [Guideline] Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15. 175(4):367-416. [Medline].

  26. Mateo L, Rufí G, Nolla JM, Alcaide F. Mycobacterium chelonae tenosynovitis of the hand. Semin Arthritis Rheum. 2004 Dec. 34(3):617-22. [Medline].

  27. Eid AJ, Berbari EF, Sia IG, Wengenack NL, Osmon DR, Razonable RR. Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature. Clin Infect Dis. 2007 Sep 15. 45(6):687-94. [Medline].

  28. Suh JD, Ramakrishnan VR, Tajudeen B, Reger C, Kennedy DW, Chiu AG. Identification and treatment of nontuberculous Mycobacterium sinusitis. Am J Rhinol Allergy. 2011 Nov-Dec. 25(6):421-4. [Medline].

  29. Brown-Elliott BA, Nash KA, Wallace RJ Jr. Antimicrobial susceptibility testing, drug resistance mechanisms, and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev. 2012 Jul. 25(3):545-82. [Medline]. [Full Text].

  30. Browne SK, Burbelo PD, Chetchotisakd P, Suputtamongkol Y, Kiertiburanakul S, Shaw PA, et al. Adult-onset immunodeficiency in Thailand and Taiwan. N Engl J Med. 2012 Aug 23. 367(8):725-34. [Medline].

  31. O'Brien RJ, Geiter LJ, Snider DE Jr. The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis. 1987 May. 135(5):1007-14. [Medline].

  32. Billinger ME, Olivier KN, Viboud C, de Oca RM, Steiner C, Holland SM, et al. Nontuberculous mycobacteria-associated lung disease in hospitalized persons, United States, 1998-2005. Emerg Infect Dis. 2009 Oct. 15(10):1562-9. [Medline]. [Full Text].

  33. Cassidy PM, Hedberg K, Saulson A, McNelly E, Winthrop KL. Nontuberculous mycobacterial disease prevalence and risk factors: a changing epidemiology. Clin Infect Dis. 2009 Dec 15. 49(12):e124-9. [Medline].

  34. Marras TK, Daley CL. Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med. 2002 Sep. 23(3):553-67. [Medline].

  35. Koh WJ, Kwon OJ, Jeon K, Kim TS, Lee KS, Park YK, et al. Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea. Chest. 2006 Feb. 129(2):341-8. [Medline].

  36. Haverkort F. National atypical mycobacteria survey, 2000. Commun Dis Intell. 2003. 27(2):180-9. [Medline].

  37. Yu JA, Weyant MJ, Mitchell JD. Surgical treatment of atypical mycobacterial infections. Thorac Surg Clin. 2012 Aug. 22(3):277-85. [Medline].

  38. Vemulapalli RK, Cantey JR, Steed LL, Knapp TL, Thielman NM. Emergence of resistance to clarithromycin during treatment of disseminated cutaneous Mycobacterium chelonae infection: case report and literature review. J Infect. 2001 Oct. 43(3):163-8. [Medline].

  39. Brown-Elliott BA, Mann LB, Hail D, Whitney C, Wallace RJ Jr. Antimicrobial susceptibility of nontuberculous mycobacteria from eye infections. Cornea. 2012 Aug. 31(8):900-6. [Medline].

  40. Wallace RJ Jr, Swenson JM, Silcox VA, Bullen MG. Treatment of nonpulmonary infections due to Mycobacterium fortuitum and Mycobacterium chelonei on the basis of in vitro susceptibilities. J Infect Dis. 1985 Sep. 152(3):500-14. [Medline].

  41. Wallace RJ Jr, Brown-Elliott BA, Crist CJ, Mann L, Wilson RW. Comparison of the in vitro activity of the glycylcycline tigecycline (formerly GAR-936) with those of tetracycline, minocycline, and doxycycline against isolates of nontuberculous mycobacteria. Antimicrob Agents Chemother. 2002 Oct. 46(10):3164-7. [Medline]. [Full Text].

  42. Peres E, Khaled Y, Krijanovski OI, Mineishi S, Levine JE, Kaul DR, et al. Mycobacterium chelonae necrotizing pneumonia after allogeneic hematopoietic stem cell transplant: report of clinical response to treatment with tigecycline. Transpl Infect Dis. 2009 Feb. 11(1):57-63. [Medline].

  43. Wallace RJ Jr, Brown-Elliott BA, Ward SC, Crist CJ, Mann LB, Wilson RW. Activities of linezolid against rapidly growing mycobacteria. Antimicrob Agents Chemother. 2001 Mar. 45(3):764-7. [Medline]. [Full Text].

  44. Brown-Elliott BA, Wallace RJ Jr, Blinkhorn R, Crist CJ, Mann LB. Successful treatment of disseminated Mycobacterium chelonae infection with linezolid. Clin Infect Dis. 2001 Oct 15. 33(8):1433-4. [Medline].

  45. Kyle SD, Porter WM. Mycobacterium chelonae infection successfully treated with oral clarithromycin and linezolid. Br J Dermatol. 2004 Nov. 151(5):1101. [Medline].

  46. van Ingen J, Totten SE, Helstrom NK, Heifets LB, Boeree MJ, Daley CL. In vitro synergy between clofazimine and amikacin in treatment of nontuberculous mycobacterial disease. Antimicrob Agents Chemother. 2012 Dec. 56(12):6324-7. [Medline]. [Full Text].

  47. Peloquin CA, Berning SE, Nitta AT, Simone PM, Goble M, Huitt GA, et al. Aminoglycoside toxicity: daily versus thrice-weekly dosing for treatment of mycobacterial diseases. Clin Infect Dis. 2004 Jun 1. 38(11):1538-44. [Medline].

  48. Pinto-Gouveia M, Gameiro A, Ramos L, Cardoso JC, Brites MM, Tellechea Ó, et al. Mycobacterium chelonae Is an Ubiquitous Atypical Mycobacterium. Case Rep Dermatol. 2015 May-Aug. 7 (2):207-11. [Medline].

 
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Cutaneous lesions from Mycobacterium abscessus. Courtesy of K. Galil, US Centers for Disease Control and Prevention.
 
 
 
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