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      Drugs & Diseases > Infectious Diseases

      Mycobacterium haemophilum Infection Clinical Presentation

      Updated: Jun 11, 2020
      • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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      Presentation

      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. [3]

      Systemic symptoms are absent except for low-grade fever.

      Lymphadenitis in adults

      Six cases have occurred in immunocompetent adults. [4]

      Cervicofacial lymphadenitis has been reported in immunocompromised adults. [5]

      Skin lesions

      Skin lesions are the most common presenting symptom in immunosuppressed patients.

      Lesions usually develop on the upper and lower 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.

      Nodular lesions involving the peripheral extremities is among the most common presentation.

      Lesions may resemble sporotrichosis. [6]

      Oculofacial lesions have been reported in an immunocompetent child. [7]

      Erythematous plaques and subcutaneous nodules of the face mimicking leprosy have been reported. [8, 9]

      Nodular skin lesions have occurred after permanent tattooing of eyebrows in 2 women. [10]

      Tattoo-associated skin lesions have occurred in immunocompetent adults. [11]

      Skin lesions have been reported prior to onset of B cell lymphoma in a liver transplant recipient. [12]

      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. [13]

      Pyomyositis

      This has been reported in a renal transplant recipient. [14]

      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. [15, 16, 17]

      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. [18]

      Chronic cutaneous granulomata

      One case was described in a previously healthy man following a coral injury in Thailand. [19]

      Endophthalmitis

      This has been reported in a cardiac transplant patient. [20]

      Epididymal abscess

      This has been reported in a renal transplant patient. [21]

      Central nervous system infection

      This has been reported in patients with AIDS. [22, 23]

      Next:

      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

      Lymphadenopathy may occur.

      Bacteremia

      While uncommon, M haemophilum bloodstream infections have been described in individuals with immunologically advanced HIV infection and in persons with significant non-HIV immunosuppressive conditions. [1]

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      Next:

      Causes

      Risk factors for M haemophilum infection include the following:

      • HIV/AIDS

      • Immunosuppression [24, 25, 26, 27, 28]

      • Patients receiving biological agents such as anti-TNF-α agents [29]

      • Steroid use [30] - 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. [31]

      • Tattooing and eyebrow permanent makeup

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