eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Xenopi: Differential Diagnoses & Workup

Author: Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Coauthor(s): Martin Backer, MD, Fellow in Combined Adult and Pediatric Infectious Diseases, State University of New York Health Sciences Center; Sailaja Kolli, MD, Fellow, Department of Internal Medicine, Division of Pulmonary and Critical Care, The Brooklyn Hospital Center; 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
Contributor Information and Disclosures

Updated: May 12, 2009

Differential Diagnoses

Bronchiectasis
Mycobacterium Haemophilum
Bronchitis
Mycobacterium Kansasii
Mycobacterium Avium-Intracellulare
Mycobacterium Marinum
Mycobacterium Chelonae
Tuberculosis
Mycobacterium Fortuitum
Mycobacterium Gordonae

Other Problems to Be Considered

AIDS-related complex
Colonization
Contamination

Workup

Laboratory Studies

  • Serum electrolyte tests may reveal hyponatremia, most likely due to inappropriate secretion of antidiuretic hormone syndrome.
  • CBC counts may reveal leukocytosis, leucopenia, anemia, reactive thrombocytosis, or thrombocytopenia, or they may be entirely within reference ranges.
  • Mycobacterial examination of sputum,3 blood, urine, bronchoalveolar lavage fluid, and tissue biopsies may reveal M xenopi.
  • American Thoracic Society criteria are used for diagnosing nontuberculous mycobacterial lung disease in HIV-seropositive or HIV-seronegative patients. Use the following criteria when diagnosing symptomatic patients who have infiltrative, nodular, or cavitary lung disease and those with high-resolution CT scan findings that reveal multifocal bronchiectasis and/or multiple small nodules:
    • If 3 sputum/bronchial wash results from the previous 12 months are available: Three positive culture findings with negative acid-fast bacilli (AFB) smear results or 2 positive culture findings and 1 positive smear result.
    • If only 1 bronchial wash result is available: Positive culture findings with a 2+, 3+, or 4+ AFB smear result or a 2+, 3+, or 4+ growth on solid media
    • If sputum/bronchial wash results are nondiagnostic or another disease cannot be excluded: Transbronchial or open lung biopsy yielding M xenopi or biopsy showing mycobacterial histopathologic features (granulomatous inflammation4 or AFB) and 1 or more sputum or bronchial wash result positive, even in a low number, for M xenopi

Imaging Studies

  • Chest radiograph
    • The classic appearance of M xenopi is cavitary apical pulmonary disease. The cavities have thin walls with little surrounding parenchymal infiltration.
    • Bronchogenic spread of disease is rare and appears as patchy, irregular, alveolar or interstitial opacities.
    • Adenopathy and pleural effusions are rare and are not isolated findings.
    • The nonclassic form develops in about 25% of patients and appears as multiple patchy alveolar, interstitial pneumonitis, or interstitial opacities without defined borders (predominantly in the lower lung fields).
    • M xenopi may occasionally manifest as a solitary pulmonary nodule, usually in asymptomatic individuals who come to medical attention because of possible malignancy. Surgical resection demonstrates changes without evidence of tumor.
  • Chest CT scan: This defines the features more precisely by possibly revealing bronchiectasis and 5- to 15-mm nodular opacities.
  • Positron emission tomography (PET)–CT imaging: This often reveals solitary pulmonary nodules that may mimic carcinoma.

Procedures

  • Bronchoscopy with bronchoalveolar lavage
  • Bronchoscopy with endobronchial or transbronchial biopsies
  • Transbronchial needle aspiration
  • Video-assisted thoracoscopic biopsy
  • Open lung biopsy (rarely indicated)

Histologic Findings

Necrotizing or non-necrotizing granulomatous inflammation is observed in lung biopsy samples.

Staging

Similar to other nontuberculous mycobacteria

  • Presumed colonization
  • Localized disease (eg, in the lungs)
  • Disseminated disease or mycobacteremia

More on Mycobacterium Xenopi

Overview: Mycobacterium Xenopi
Differential Diagnoses & Workup: Mycobacterium Xenopi
Treatment & Medication: Mycobacterium Xenopi
Follow-up: Mycobacterium Xenopi
References
Further Reading
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References

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Keywords

Mycobacterium xenopi, M xenopi, South African toad, Xenopus laevis, X laevis, nontuberculous mycobacterium, nontuberculous mycobacteria, mycobacteremia, leukocytosis, leucopenia, leukopenia, anemia, reactive thrombocytosis, thrombocytopenia, nontuberculous mycobacterial lung disease, pulmonary disease, cavitary apical pulmonary disease, multifocal bronchiectasis, granulomatous inflammation, acid-fast bacilli

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Contributor Information and Disclosures

Author

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Martin Backer, MD, Fellow in Combined Adult and Pediatric Infectious Diseases, State University of New York Health Sciences Center
Martin Backer, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Sailaja Kolli, MD, Fellow, Department of Internal Medicine, Division of Pulmonary and Critical Care, The Brooklyn Hospital Center
Sailaja Kolli, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

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 Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: sepracor Ownership interest None

Medical Editor

Wesley W Emmons, MD, FACP, Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE
Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
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; President and CEO, Former 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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