eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Haemophilum: Differential Diagnoses & Workup

Author: Natalie C Klein, MD, PhD, Associate Professor, Department of Medicine, Division of Infectious Diseases, SUNY School of Medicine at Stony Brook; Associate Director, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Nov 20, 2007

Differential Diagnoses

Bacillary Angiomatosis
Mycobacterium Kansasii
Blastomycosis
Mycobacterium Marinum
Catscratch Disease
Mycobacterium Xenopi
Kaposi Sarcoma
Sarcoidosis
Mycobacterium Avium-Intracellulare
Sporotrichosis
Mycobacterium Chelonae
Tuberculosis
Mycobacterium Fortuitum
Mycobacterium Gordonae

Other Problems to Be Considered

Lymphadenitis in children

Acute toxoplasmosis
Actinomycosis
Epstein-Barr virus infection
Lymphoma
Tuberculosis (TB) adenitis secondary to Mycobacterium avium complex,
Mycobacterium kansasii, Mycobacterium scrofulaceum, or Mycobacterium tuberculosis infection

Skin lesions

Mycobacterium chelonae infection
Mycobacterium fortuitum infection
Mycobacterium marinum infection
Mycobacterium abscessus infection
Staphylococcal furunculosis
Vasculitis
Disseminated cryptococcal disease
Disseminated aspergillosis
Septic arthritis or osteomyelitis
Lymphoma
Bacillary angiomatosis
Bacterial osteomyelitis

Workup

Laboratory Studies

  • Evaluate the CBC count, liver enzymes, and serum electrolyte levels, including creatinine.
  • Acid-fast bacillus smear and culture
    • M haemophilum is a slow-growing, acid-fast–positive, nontuberculous mycobacterium that requires media supplemented with ferric iron–containing compounds and grows best at 30-32°C. Growth on solid media usually takes 2-3 weeks. The organism typically does not stain with Gram stain.
    • Aspirate of lesions may reveal acid-fast bacilli.
    • Perform an acid-fast bacillus (AFB) smear on excised lymph nodes. Culture a specimen at 30-32°C in media supplemented with iron or heme.
    • In patients with septic arthritis and osteomyelitis, submit synovial fluid specimens and bone biopsy samples for AFB smear and culture. Synovial fluid is usually purulent, and M haemophilum may be isolated from the fluid.
    • Submit sputum from immunosuppressed patients with pneumonia for AFB smear and culture. M haemophilum can be cultured from the blood of some patients with AIDS using special isolator tubes.
    • In appropriate clinical settings (eg, skin lesions, lymphadenopathy), informing the mycobacteriology laboratory to culture for M haemophilum may be useful. Iron must be added to grow this organism.
    • M haemophilum is unlikely to be a saprophyte (an innocent bystander) or a laboratory contaminant in the appropriate clinical setting.
    • Polymerase chain reaction (PCR)–restriction endonuclease analysis has been used for direct identification of M haemophilum in clinical specimens from immunocompromised patients.10
    • M haemophilum –specific PCR has been used to diagnosis M haemophilum cervicofacial lymphadenitis in children and was superior to culture in one series of patients from the Netherlands.11

Imaging Studies

  • Radiography
    • Radiographs of involved joints or bone may demonstrate soft tissue swelling and lytic lesions.
    • Chest radiograph findings are abnormal in patients with pneumonia. Unilateral or bilateral infiltrates may appear.
  • CT scans of the chest may reveal abnormalities that are not revealed with chest radiography. Regular cuts of 5-7 mm should be sufficient; high-resolution CT scan is rarely necessary.
  • MRI demonstrates medullary lesions and cortical disruption.

Other Tests

  • In children with lymphadenitis a tuberculin skin test result with purified protein derivative (PPD) of tuberculosis may be positive; however, it is rarely larger than 9 mm.12

Procedures

  • Aspirate of lesions may reveal AFB.

Histologic Findings

Biopsy specimens of skin lesions show granulomatous panniculitis and caseating or noncaseating granulomas. Patients with AIDS have poorly formed granulomas. A neutrophilic infiltrate with multinucleated giant cells may be observed. AFB smear results are usually positive, revealing large, pleomorphic, or curved AFB.

Lymph node biopsy may reveal granulomas, necrosis, granulating tissue, or multinucleated giant cells, and the specimen may be smear-positive for AFB.

More on Mycobacterium Haemophilum

Overview: Mycobacterium Haemophilum
Differential Diagnoses & Workup: Mycobacterium Haemophilum
Treatment & Medication: Mycobacterium Haemophilum
Follow-up: Mycobacterium Haemophilum
References
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References

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  2. Lindeboom JA, Kuijper EJ, Bruijnesteijn van Coppenraet ES, Prins JM. First case of an oculofacial lesion due to Mycobacterium haemophilum infection in an immunocompetent child. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Jun 2006;101(6):774-6. [Medline].

  3. Kiehn TE, White M. Mycobacterium haemophilum: an emerging pathogen. Eur J Clin Microbiol Infect Dis. Nov 1994;13(11):925-31. [Medline].

  4. Sturenburg EE, Horstkotte MA, Aberle J, Meyer K, Richter E, Laufs R, et al. Disseminated Mycobacterium haemophilum infection as initial manifestation of AIDS. Tuberculosis (Edinb). 2004;84(6):341-5. [Medline].

  5. White MH, Papadopoulos EB, Small TN, Kiehn TE, Armstrong D. Mycobacterium haemophilum infections in bone marrow transplant recipients. Transplantation. Nov 15 1995;60(9):957-60. [Medline].

  6. Ward MS, Lam KV, Cannell PK, Herrmann RP. Mycobacterial central venous catheter tunnel infection: a difficult problem. Bone Marrow Transplant. Aug 1999;24(3):325-9. [Medline].

  7. Smith S, Taylor GD, Fanning EA. Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury. Clin Infect Dis. Oct 1 2003;37(7):e100-1. [Medline].

  8. Shih JY, Hsueh PR, Chang YL, Lin SF, Teng LJ, Luh KT. Pyomyositis due to Mycobacterium haemophilum in a patient with polymyositis and long-term steroid use. Clin Infect Dis. Feb 1998;26(2):505-7. [Medline].

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  10. Wang SX, Sng LH, Leong HN, Tan BH. Direct identification of Mycobacterium haemophilum in skin lesions of immunocompromised patients by PCR-restriction endonuclease analysis. J Clin Microbiol. Jul 2004;42(7):3336-8. [Medline].

  11. Bruijnesteijn van Coppenraet LE, Kuijper EJ, Lindeboom JA, Prins JM, Claas EC. Mycobacterium haemophilum and lymphadenitis in children. Emerg Infect Dis. Jan 2005;11(1):62-8. [Medline].

  12. Lindeboom JA, Kuijper EJ, Prins JM, Bruijnesteijn van Coppenraet ES, Lindeboom R. Tuberculin skin testing is useful in the screening for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clin Infect Dis. Dec 15 2006;43(12):1547-51. [Medline].

  13. Armstrong D, Kiehn T, Boone MW. From the Centers for Disease Control. Mycobacterium haemophilum infections--New York City metropolitan area, 1990-1991. JAMA. Jan 8 1992;267(2):215-6. [Medline].

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  17. Lefkowitz RA, Singson RD. Considering Mycobacterium haemophilum in the differential diagnosis for lytic bone lesions in AIDS patients who present with ulcerating skin lesions. Skeletal Radiol. Jun 1998;27(6):334-6. [Medline].

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  22. Straus WL, Ostroff SM, Jernigan DB, Kiehn TE, Sordillo EM, Armstrong D, et al. Clinical and epidemiologic characteristics of Mycobacterium haemophilum, an emerging pathogen in immunocompromised patients. Ann Intern Med. Jan 15 1994;120(2):118-25. [Medline].

  23. Tan HH, Tan A, Theng C, Ng SK. Cutaneous Mycobacterium haemophilum infections in immunocompromised patients in a dermatology clinic in Singapore. Ann Acad Med Singapore. Jul 2004;33(4):532-6. [Medline].

  24. van Coppenraet LS, Smit VT, Templeton KE, Claas EC, Kuijper EJ. Application of real-time PCR to recognize atypical mycobacteria in archival skin biopsies: high prevalence of Mycobacterium haemophilum. Diagn Mol Pathol. Jun 2007;16(2):81-6. [Medline].

  25. White DA, Kiehn TE, Bondoc AY, Massarella SA. Pulmonary nodule due to Mycobacterium haemophilum in an immunocompetent host. Am J Respir Crit Care Med. Oct 1999;160(4):1366-8. [Medline].

  26. Yarrish RL, Shay W, LaBombardi VJ, Meyerson M, Miller DK, Larone D. Osteomyelitis caused by Mycobacterium haemophilum: successful therapy in two patients with AIDS. AIDS. Jun 1992;6(6):557-61. [Medline].

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Further Reading

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Keywords

M haemophilum, Hodgkin disease, Hodgkin's disease, septic arthritis, osteomyelitis, pulmonary infection, mycobacteremia, Mycobacterium haemophilum infection, M haemophilum infection, cervical lymphadenopathy, lymphadenitis, pneumonia, central venous catheter tunnel infection, chronic cutaneous granulomata

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Contributor Information and Disclosures

Author

Natalie C Klein, MD, PhD, Associate Professor, Department of Medicine, Division of Infectious Diseases, SUNY School of Medicine at Stony Brook; Associate Director, Winthrop-University Hospital
Natalie C Klein, MD, PhD 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.

Medical Editor

Klaus-Dieter Lessnau, MD, FCCP, Clinical Assistant 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 Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; Chief Medical Officer, Departments of Medicine and Infectious Diseases, 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.

CME Editor

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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