Mycobacterium Haemophilum Clinical Presentation

  • Author: Natalie C Klein; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 23, 2012
 

History

  • Lymphadenitis in children
    • The most common symptom is swelling of the neck, which slowly enlarges over several weeks to months. The enlarged nodes may be painful. A course of antimicrobial therapy (eg, 2 wk of oral amoxicillin/clavulanic acid) does not cure the swelling.
    • Inguinal lymphadenitis has also been reported.[1]
    • Systemic symptoms are absent except for low-grade fever.
  • Lymphadenitis in adults - Six cases have occurred in immunocompetent adults.[2]
  • Skin lesions
    • Skin lesions are the most common presenting symptom in immunosuppressed patients.
    • Lesions usually develop on the extremities over joints. They may begin as papules, subcutaneous nodules, scales, or cysts and are initially painless but often become tender and pruritic. Painful ulcerations may occur. Erythema may surround the lesion.
    • Oculofacial lesions have been reported in an immunocompetent child.[3]
    • Nodular skin lesions have occurred after permanent tattooing of eyebrows in 2 women.[4]
    • Tattoo-associated skin lesions have occurred in immunocompetent adults[5]
  • Septic arthritis: Patients present with pain and swelling over a joint, usually the knee or elbow. Often, the patient has a history of cutaneous lesions overlying the joint.
  • Pyomyositis: This has been reported in a renal transplant recipient.[6]
  • Osteomyelitis
    • This is reported in patients with AIDS.
    • Skin lesions are usually present.
    • Septic arthritis is usually present.
  • Pneumonia
    • Symptoms include fever, cough, pleuritic chest pain, and dyspnea.
    • Patients may have a history of treated cutaneous lesions.
    • This is reported in bone marrow transplant recipients and patients with AIDS.[7, 8, 9]
  • Central venous catheter tunnel infection: Two cases in immunosuppressed patients have been reported. The first patient presented with a supraclavicular mass with overlying cellulitis that progressed to ulceration. The second patient had an ulceration and purulent discharge at the former site of a Hickman catheter.[10]
  • Chronic cutaneous granulomata: One case was described in a previously healthy man following a coral injury in Thailand.[11]
  • Endophthalmitis: This has been reported in a cardiac transplant patient.[12]
  • Epididymal abscess: This has been reported in a renal transplant patient.[13]
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Physical

  • Lymphadenitis
    • The submandibular and cervical nodes are most frequently involved. Perihilar nodes are involved less frequently. Enlarged nodes are usually unilateral and may be tender and fluctuant. Overlying skin may be erythematous.
    • Low-grade fever may be present.
  • Skin lesions
    • Lesions include the following:
      • Papules
      • Subcutaneous abscesses
      • Nodules
      • Cysts
      • Scaly plaques
      • Ulcers
    • Initially, they are painless but may become painful or pruritic.
    • They may be localized on extremities over joints, or they may be diffuse.
  • Septic arthritis: The major finding is a swollen fluctuant knee.
  • Osteomyelitis: Septic arthritis is also present.
  • Pneumonia: Fever is present.
  • Central venous catheter tunnel infection: Ulcerations develop at the exit site and along the catheter track.
  • Lymphadenopathy
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Causes

  • Risk factors for M haemophilum infection
    • HIV/AIDS
    • Immunosuppression[14, 15, 16, 17, 18]
    • Steroid use[19] - In 30 steroid-treated mice injected with M haemophilum, 12 developed ear lesions similar to the skin lesions observed in humans; no legions developed in mice that were not treated with steroids.[20]
    • Tattooing and eyebrow permanent makeup
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Contributor Information and Disclosures
Author

Natalie C Klein  MD, PhD, Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, 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, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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