eMedicine Specialties > Infectious Diseases > Mycobacterial Infections
Mycobacterium Haemophilum: Treatment & Medication
Updated: Nov 20, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
- Treatment is determined by the degree of immunosuppression. In healthy children with lymphadenitis, surgical excision is the preferred treatment. In immunosuppressed patients, reversal of immunosuppression is the most effective treatment.
- Immunosuppressed patients require combination therapy to prevent development of resistance. Susceptibility testing is not standardized, but M haemophilum is usually susceptible to amikacin, ciprofloxacin, and other quinolones (eg, levofloxacin, clarithromycin, rifabutin, rifampin). M haemophilum is usually resistant to ethambutol, ethionamide, isoniazid, and streptomycin. Although the optimal regimen is not known, combinations have had some clinical success.
- Effective drug combinations include the following:
- Rifampin and ciprofloxacin
- Ciprofloxacin, clarithromycin, and rifampin
- Rifampin and minocycline
- Clarithromycin, minocycline, and rifampin
Surgical Care
- Lymphadenitis in children: Total excision of the involved lymph node or nodes is the treatment of choice.
Consultations
- Infectious disease expert
- Pulmonologist
- Mycobacterium expert
- Health department
Medication
Although no standardized treatment exists, a regimen that includes a combination of at least 2 drugs with low minimum inhibitory concentrations (MICs) against M haemophilum is preferred.
A 3-drug combination of ciprofloxacin, clarithromycin, and rifampin or rifabutin has been used for cutaneous disease in bone marrow transplant recipients. No standard treatment exists; optimal treatment time is unknown.
Antimicrobial agents
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Clarithromycin (Biaxin XL)
Macrolide with activity against various nontuberculous mycobacteria. Binds to bacterial 50S ribosomal subunit and inhibits RNA-dependent protein synthesis.
Adult
500 mg PO q12h
Pediatric
7.5 mg/kg PO q12h; not to exceed 1 g/d
Toxicity increases with coadministration of fluconazole and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmia and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
Documented hypersensitivity; coadministration of pimozide, astemizole (withdrawn from the US market), cisapride, and terfenadine (withdrawn from the US market)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min
Rifampin (Rifadin, Rimactane)
Important drug used in the treatment of infection with M tuberculosis and nontuberculous mycobacterial infections. Inhibits DNA-dependent RNA polymerase activity.
Adult
600 mg PO qd
Pediatric
10-20 mg/kg/d PO qd; not to exceed 600 mg/d
Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; blood pressure may increase with coadministration of enalapril; coadministration with isoniazid may result in a higher rate of hepatotoxicity than with either agent alone (discontinue 1 or both agents if alterations in LFTs occur)
Documented hypersensitivity; patients with HIV who are on antiretroviral therapy
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Obtain CBC counts and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued as soon as purpura occurs; if treatment is continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur; obtain baseline hepatic enzymes, bilirubin, serum creatinine, CBC count, and platelet count and monitor for abnormalities, eg, monthly; adverse reactions have occurred, including flu syndrome, leukopenia, thrombocytopenia, acute hemolytic anemia, hepatitis, renal failure, and anaphylaxis
Ciprofloxacin (Cipro)
Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth. Other quinolones such as levofloxacin, sparfloxacin, and ofloxacin may also be effective.
Adult
500-750 mg PO qd
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase the toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Seizure potential increased; renal impairment and MRSA colonization may occur with therapy
Amikacin (Amikin)
Expected to be a powerful drug for mycobacteremia. Starting amikacin may be beneficial at least as long as the patient is septic.
Adult
15 mg/kg/d IV
Pediatric
Not established
Coadministration with other aminoglycosides, penicillins, cephalosporins, and amphotericin B increases nephrotoxicity; enhances effects of neuromuscular blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission
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
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].
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].
Kiehn TE, White M. Mycobacterium haemophilum: an emerging pathogen. Eur J Clin Microbiol Infect Dis. Nov 1994;13(11):925-31. [Medline].
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].
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].
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].
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].
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].
Abbott MR, Smith DD. The pathogenic effects of Mycobacterium haemophilum in immunosuppressed albino mice. J Med Microbiol. Nov 1980;13(4):535-40. [Medline].
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].
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].
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].
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].
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].
Elsayed S, Read R. Mycobacterium haemophilum osteomyelitis: case report and review of the literature. BMC Infect Dis. 2006;6:70. [Medline].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
Further Reading
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
