eMedicine Specialties > Infectious Diseases > Mycobacterial Infections
Mycobacterium gordonae
Updated: Aug 15, 2007
Introduction
Background
Advanced laboratory diagnostic techniques have improved the isolation and identification of nontuberculous mycobacteria. Mycobacterium gordonae, a commonly found species of mycobacteria, is named after its discoverer, the American bacteriologist Ruth E. Gordon. It is classified in Runyon group 2 as a scotochromogenic organism. Cultures grow slowly, are smooth, and are pigmented yellow. M gordonae is referred to as the tap water bacillus because it is a frequent isolate in tap water.
M gordonae is ubiquitous and may be found in soil, water (eg, ground, tap, bottled), whirlpools, unpasteurized milk, mucous membranes of healthy persons, urine, and gastric fluid. It is the most commonly encountered nontuberculous mycobacterium in water, with concentrations as high as 1000 colony-forming units per liter.
New cases of M gordonae disease should always be published to increase the knowledge of this disease. Many isolates represent contamination of the specimen or colonization, but not true disease. Discussing positive culture findings with microbiology laboratory personnel is useful. The authors are willing to discuss any possibly new case of M gordonae infection and are willing to offer support to write up cases of actual disease.
Pathophysiology
M gordonae is one of the least pathogenic of the mycobacteria. It is usually a contaminant or colonizer in patients who are not infected with HIV. However, in patients who are infected with HIV and have severe immunosuppression (count of <100 CD4+ cells/µL), M gordonae may infect the lungs, blood, bone marrow, and other organs. In the few published case reports of M gordonae disease, pathogenicity was not always established because of the presence of single isolates, the lack of confirmation by a reference laboratory, or the rapid improvement of pulmonary infiltrates, which are not characteristic features of infections from other mycobacterial species.
Frequency
United States
M gordonae disease is rare. While more than 100 cases have been reported, most documentation supports contamination or colonization rather than pathogenicity. Nosocomial pseudo-outbreaks have been described from tap water, ice machines, antimicrobial and laboratory solutions, instrumentation, fiberoptic bronchoscopes and colonoscopes (especially if the working channel is not adequately exposed to disinfectant), aerosol devices, and (possibly) continuous ambulatory peritoneal dialysis fluid.
International
Worldwide distribution is probable. Additional studies with adequate documentation are warranted to investigate the pathogenicity of M gordonae.
Mortality/Morbidity
The mortality rate is less than 0.1%. M gordonae may be a marker of severe immunosuppression in patients infected with HIV. One death was reported in a patient who was HIV positive and had severe immunosuppression, acute respiratory distress syndrome, and multiple isolates of M gordonae.
Race
No racial predilection is recognized.
Sex
No sexual predilection is known.
Age
No age predilection has been determined.
Clinical
History
- Fever (eg, >2 wk)
Physical
- Patients without HIV
- Possible skin granuloma or nodule following injuries involving soil exposure (eg, gardeners)
- Keratitis of the cornea (associated with previous trauma)
- Lung infiltrates and/or nodules, small and thin-walled cavities in lungs
- Possible hepatic or peritoneal infiltration or infection
- Possible infection in urine
- Possible prosthetic aortic valve or ventriculoatrial shunt infection
- Patients with HIV
- Respiratory specimens with repeatedly high colony counts
- Pulmonary infiltrates
- Adult respiratory distress syndrome
- Evidence of dissemination and disease (eg, cornea, peritoneal cavity, synovial fluid, urine)
- Blood sepsis or dissemination
Causes
Positive HIV status with severe immunosuppression (<50 CD4+ cells/µL) is a risk factor.
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References
American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. Aug 1997;156(2 Pt 2):S1-25. [Medline].
Konishi M, Uno K, Kasahara K, Mori K, Yoshimoto E, Maeda K, et al. [A case of pulmonary Mycobacterium gordonae infection progressed for no therapy]. Nihon Kokyuki Gakkai Zasshi. May 2007;45(5):436-40. [Medline].
Lalande V, Barbut F, Varnerot A, Febvre M, Nesa D, Wadel S, et al. Pseudo-outbreak of Mycobacterium gordonae associated with water from refrigerated fountains. J Hosp Infect. May 2001;48(1):76-9. [Medline].
Lessnau KD, Milanese S, Talavera W. Mycobacterium gordonae: a treatable disease in HIV-positive patients. Chest. Dec 1993;104(6):1779-85. [Medline].
Sneath PH, Mair NS, Sharpe ME, eds. The Mycobacteria. Genus Mycobacterium. In: Bergey's Manual of Systematic Bacteriology. Vol 2. 2nd ed. Baltimore, Md: Williams & Wilkins; 1986:1447.
Weinberger M, Berg SL, Feuerstein IM, Pizzo PA, Witebsky FG. Disseminated infection with Mycobacterium gordonae: report of a case and critical review of the literature. Clin Infect Dis. Jun 1992;14(6):1229-39. [Medline].
Further Reading
Keywords
Mycobacterium gordonae, M gordonae, Mycobacterium aquae, M aquae, tap water bacillus, tap water isolate, tap water bacteremia, nontuberculous mycobacteria, mycobacteria, non-tuberculous mycobacteria, bacteremia, HIV infection, human immunodeficiency virus
