eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Haemophilum

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

Introduction

Background

Mycobacterium haemophilum is a nontuberculous mycobacterium that causes skin, joint, bone, and pulmonary infections in immunocompromised persons and lymphadenitis in children. M haemophilum was first isolated from subcutaneous abscesses in a patient with Hodgkin disease. Most recent infections have occurred in patients with AIDS and in transplant recipients. M haemophilum is a fastidious (requires special growth media) mycobacterium that requires heme-supplemented culture media and low temperatures for growth. Because of these features, it is probably underdiagnosed.

Pathophysiology

The pathophysiology, natural habitat, and mechanism for acquisition of M haemophilum infection are not known. Immunocompromised adults with M haemophilum infection most commonly present with skin lesions. Septic arthritis and osteomyelitis may also occur. Pulmonary infection is much less common and may follow skin disease. M haemophilum infection occasionally causes pulmonary infection initially. Mycobacteremia may occur.

Frequency

United States

More than 40 cases of M haemophilum infection have been reported, including 10 cases in Arizona from 1984-1994. Most cases occurred in immunosuppressed patients. The incidence of disease is unknown.

International

Cases of M haemophilum infection have been reported sporadically from Australia, France, Canada, Israel, United Kingdom, and South Africa.

Mortality/Morbidity

  • In healthy children, localized cervical lymphadenopathy is a benign disease that responds well to excision of the involved lymph nodes.
  • In immunocompromised patients, the outcome of disease is determined by the degree of underlying immunosuppression. Some patients with AIDS respond to therapy, while others respond initially but relapse later. Fatalities have occurred in bone marrow transplant recipients.

Sex

M haemophilum infection is more common in males than in females. This may be related to the higher incidence of HIV infection in males.

Age

  • Lymphadenitis occurs in young children.
  • Most cases in immunocompromised patients occur in adults.

Clinical

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.
  • 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.2
  • 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.
  • 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.3,4,5
  • 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.6
  • Chronic cutaneous granulomata: One case was described in a previously healthy man following a coral injury in Thailand.7

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

Causes

  • Risk factors for M haemophilum infection
    • HIV/AIDS
    • Immunosuppression
    • Steroid use8 : 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.9

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

  1. Lindeboom JA, Kuijper CF, van Furth M. Inguinal lymphadenitis caused by mycobacterium haemophilum in an immunocompetent child. Pediatr Infect Dis J. Jan 2007;26(1):84-6. [Medline].

  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].

  9. Abbott MR, Smith DD. The pathogenic effects of Mycobacterium haemophilum in immunosuppressed albino mice. J Med Microbiol. Nov 1980;13(4):535-40. [Medline].

  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].

  14. Dever LL, Martin JW, Seaworth B, Jorgensen JH. Varied presentations and responses to treatment of infections caused by Mycobacterium haemophilum in patients with AIDS. Clin Infect Dis. Jun 1992;14(6):1195-200. [Medline].

  15. Elsayed S, Read R. Mycobacterium haemophilum osteomyelitis: case report and review of the literature. BMC Infect Dis. 2006;6:70. [Medline].

  16. Holladay KL, Carmichael JK. Mycobacterium haemophilum cellulitis and osteomyelitis in a man with AIDS. J Am Board Fam Pract. Mar-Apr 1996;9(2):122-4. [Medline].

  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].

  18. Lin JH, Chen W, Lee JY, Yan JJ, Huang JJ. Disseminated cutaneous Mycobacterium haemophilum infection with severe hypercalcaemia in a failed renal transplant recipient. Br J Dermatol. Jul 2003;149(1):200-2. [Medline].

  19. Plemmons RM, McAllister CK, Garces MC, Ward RL. Osteomyelitis due to Mycobacterium haemophilum in a cardiac transplant patient: case report and analysis of interactions among clarithromycin, rifampin, and cyclosporine. Clin Infect Dis. May 1997;24(5):995-7. [Medline].

  20. Samra Z, Kaufmann L, Zeharia A, Ashkenazi S, Amir J, Bahar J, et al. Optimal detection and identification of Mycobacterium haemophilum in specimens from pediatric patients with cervical lymphadenopathy. J Clin Microbiol. Mar 1999;37(3):832-4. [Medline].

  21. Saubolle MA, Kiehn TE, White MH, Rudinsky MF, Armstrong D. Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans. Clin Microbiol Rev. Oct 1996;9(4):435-47. [Medline].

  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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