eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Xenopi

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

Introduction

Background

Researchers first described Mycobacterium xenopi in 1959 after isolating it from skin lesions of the South African toad Xenopus laevis. M xenopi, a slow-growing, nontuberculous mycobacterium, is often considered to be a saprophyte or an environmental contaminant. It grows optimally at 45°C (113°F) and has been found, occasionally in large numbers, in hospital hot water supplies at the outlet valves of water heaters.1,2 M xenopi colonization occurs from ingestion or inhalation of, or cutaneous exposure to, organisms in water, soil, or airborne particles. Colonization of hospital water systems is associated with infection, disease, and nosocomial isolation.

Pathophysiology

M xenopi has low pathogenicity, and host impairment is required to contract disease from the organism. Most M xenopi infections occur in the lungs, usually in patients with preexisting lung disease or with predisposing conditions (eg, extrapulmonary malignancy, alcoholism, diabetes mellitus, HIV infection). Extrapulmonary and disseminated disease may develop in patients with AIDS or other immunodeficiencies.

For pulmonary disease, inhalation of infected airborne particles is the usual route of infection. For skin and soft tissue infections, direct contact through penetrating injuries and surgical procedures provide the route. Person-to-person transmission of nontuberculous mycobacterial disease has never been documented.

Frequency

United States

Surveillance data for M xenopi infection are not available because such infection is not a reportable disease. More than 500 cases have been reported, but only approximately 70 cases seem to document true disease.

International

Prevalence is unknown.

Mortality/Morbidity

Subjects with documented M xenopi infections are divided into the following broad categories:

  • The first group comprises young, severely immunocompromised individuals in whom M xenopi infection occurs as an opportunistic infection that may then become disseminated, conferring a high risk of mortality and morbidity.
    • Persons with CD4+ cell counts of less than 50/µL are susceptible hosts for pathogens such as M xenopi.
    • M xenopi can cause 2 patterns of disease in these patients: localized pulmonary disease that can mimic tuberculosis in persons with early-stage HIV infection and disseminated disease in those with advanced AIDS.
  • The second group comprises immunocompetent adults with chronic lung disease or chronic obstructive pulmonary disease (COPD) in whom M xenopi infection usually follows a long-term, indolent course.

Race

No racial predilection has been identified.

Sex

No predilection for either sex has been demonstrated.

Age

No age predilection has been reported.

Clinical

History

Infection with M xenopi may result in pulmonary infection, usually in older adults with COPD, in patients who are immunocompromised with disseminated disease, or in patients with extrapulmonary disease involving the lymphatic system, skin, bones, or joints. Onset of symptoms is insidious, and the infection may progress slowly or increase and decrease over the course of months or years.

  • Presenting symptoms
    • Chronic productive cough (90%)
    • Dyspnea (80%)
    • Constitutional symptoms such as weakness, malaise, and weight loss (90%)
    • Hemoptysis (20%)
    • Night sweats (20%)
    • Fever (10%)
  • Presenting symptoms of immunocompromised patients with disseminated disease
    • Prolonged febrile illness (95%)
    • Wasting syndrome (95%)
  • Possible presenting symptoms of patients with HIV infection
    • Advanced disease
    • Low CD4+ cell counts (<50/µL)
    • Prior AIDS-defining illness

Physical

Physical findings relate to underlying long-term illness and are not specific for M xenopi infection. More than 95% of patients have abnormal lung findings.

Causes

  • Predisposing factors
    • Preexisting lung disease (eg, COPD, bronchiectasis)
    • Pulmonary or extrapulmonary malignancy
    • Alcoholism
    • Diabetes mellitus
    • Immunocompromised state (eg, HIV infection, AIDS)
    • Exposure via inhalation of aerosolized water infected with M xenopi or contact with infected water droplets
    • Sirolimus therapy inhibits interleukin 12–induced proliferation of activated T lymphocytes and may be a risk factor.

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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  32. Thaunat O, Morelon E, Stern M, et al. Mycobacterium xenopi pulmonary infection in two renal transplant recipients under sirolimus therapy. Transpl Infect Dis. Dec 2004;6(4):179-82. [Medline].

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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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