Mycobacterium Chelonae Clinical Presentation

Updated: Nov 14, 2017
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Presentation

History

Patients with Mycobacterium chelonae skin involvement may have a chronic, nonhealing cellulitis or skin ulcer that is slow to spread. Areas of cellulitis associated with the infection are frequently hyperpigmented. Skin nodules, sinus tract, and abscess formation may be present. Sinus tracts and abscesses may drain and appear to resolve, only to recur days to weeks later during the first months of treatment.

Patients with M chelonae lung disease may have a chronic cough, sputum production, or progressive dyspnea.

Easy fatigability, fever, night sweats, and weight loss occur with pulmonary or disseminated disease, although less commonly than with tuberculosis.

Infections associated with surgical procedures may present as wound infections, draining fistulae/sinus tracts, or inflamed and/or dysfunctional prosthetic devices. [17, 18]

Bacteremia is associated fever, with or without chills, in immunocompromised patients with intravascular catheters, hemodialysis catheters, peritoneal dialysis catheters, biliary stents, and prosthetic heart valves. [18]

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Physical

No physical examination findings are pathognomonic for M chelonae infection. Findings, as follows, depend on infection site and the cause:

  • Skin: Ulcerative lesions and/or subcutaneous nodules may be present. Deep infection may lead to abscess formation and draining sinus tracts. In contrast to Mycobacterium fortuitum infection, the skin lesions caused by M chelonae infection tend to be multiple and tend to occur in older patients or individuals receiving immunosuppressive drugs. [12] The sinus tracts may drain thick purulence, which may appear and disappear over time. Skin involvement is often associated with hyperpigmentation. Lesions are indolent and not particularly warm to the touch. See the image below.
  • Eye: Conjunctivitis, episcleritis, canniculitis, corneal ulcers, dacryocystitis, or keratitis may be present.
  • Lungs: Rales or rhonchi may be present.
  • Heart: Valvular murmur with endocarditis may be present.
  • Abdomen: Diffuse tenderness with peritonitis may be associated with peritoneal dialysis.

Overlying cellulitis, cold abscess formation, late-onset incisional drainage, and/or joint pain/dysfunction suggests prosthetic infection of all types.

Fever, with or without chills, in the presence of intravascular catheters, dialysis catheters, or prosthetic heart valves raises the possibility of bacteremia, particularly in an immunocompromised patient.

Cutaneous lesions from Mycobacterium abscessus. Co Cutaneous lesions from Mycobacterium abscessus. Courtesy of K. Galil, US Centers for Disease Control and Prevention.
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Causes

Causes of M chelonae infection are as follows:

  • Trauma or injection - Accidental or surgical trauma, particularly puncture wounds (eg, tattoos, acupuncture, injection sites)
  • Disseminated disease - Immunosuppression, immune defects, and cytotoxic chemotherapy [25, 30]
  • Tattoo ink and contaminated skin marking solutions [15, 19]
  • Indwelling catheters, dialysis catheters, prosthetic valves, orthopedic prostheses, biliary stents, scleral buckles, and breast implants [1]
  • Associated surgical procedures include bronchoscopy, laparoscopy, liposuction, and mammoplasty, as well as all types of cardiac, otolaryngologic, orthopaedic, plastic/reconstructive, and ophthalmologic surgery [1]
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Complications

Complications of M chelonae infections may include the following:

  • Severe lung disease or disseminated disease may cause death.
  • Skin lesions and subsequent debridement may be disfiguring.
  • Loss of surgically implanted prosthetic devices may occur.
  • Antimycobacterial monotherapy may lead to drug resistance.
  • Antimycobacterial chemotherapy of all types may be associated with adverse drug reactions, organ failure, and death.
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