Mycobacterium haemophilum Infection: Background, Pathophysiology, Epidemiology

Sections

Sections Mycobacterium haemophilum Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Overview

Background

Mycobacterium haemophilum is a nontuberculous mycobacterium that causes skin, joint, bone, and pulmonary infections in immunocompromised persons and lymphadenitis in children.^{[1, 2]}

M haemophilum was first isolated from subcutaneous abscesses in a patient with Hodgkin disease. Most recent infections have occurred in patients with AIDS, in transplant recipients, and in patients receiving tumor necrosis factor-alpha inhibitors.^{[3, 4, 5]}M haemophilum skin infection has been associated with permanent eyebrow makeup and tattoos,^[6]as well as acupuncture treatments.^[7]

M haemophilum is a fastidious (requires special growth media) mycobacterium that requires heme-supplemented culture media and low temperatures for growth. Because of these features, it is probably underdiagnosed.

Pathophysiology

The pathophysiology, natural habitat, and mechanism for acquisition of M haemophilum infection are not known. Water reservoirs may be the source of M haemophilum infections. Immunocompromised adults with M haemophilum infection most commonly present with skin lesions. Septic arthritis and osteomyelitis may also occur. Pulmonary infection is much less common and may follow skin disease. M haemophilum infection occasionally causes pulmonary infection initially. Mycobacteremia may occur.

Frequency

United States

More than 40 cases of M haemophilum infection have been reported, including 10 cases in Arizona from 1984-1994. Most cases occurred in immunosuppressed patients. The incidence of disease is unknown.

International

Cases of M haemophilum infection have been reported sporadically from Australia, France, Germany,^[8]Canada, Israel, United Kingdom, and South Africa.

Mortality/Morbidity

In healthy children, localized cervical lymphadenopathy is a benign disease that responds well to excision of the involved lymph nodes.

In immunocompromised patients, the outcome of disease is determined by the degree of underlying immunosuppression. Some patients with AIDS respond to therapy, while others respond initially but relapse later. Fatalities have occurred in bone marrow transplant recipients.

Sex

M haemophilum infection is more common in males than in females. This may be related to the higher incidence of HIV infection in males.

Age

Lymphadenitis occurs in young children.

Most cases in immunocompromised patients occur in adults.

Prognosis

Prognosis for children with localized lymphadenitis is good.

In adults, the outcome is determined by their immune function.

In severely immunosuppressed patients, disease may require long-term therapy. Despite maintenance therapy, infection may persist or recur.

Patient Education

Adherence to medication is of utmost importance to prevent resistance.

Instruct patients to list all medications to avoid drug interactions.

Rifampin and rifabutin may interfere with contraceptives and numerous other medications, especially HIV-related therapy.

Clinical Presentation

Minani TJ, Saubolle MA, Yu E, Sussland Z. Mycobacterium haemophilum as a novel etiology of cervical lymphadenitis in an otherwise healthy adult patient. J Clin Microbiol. 2010 Jul. 48(7):2636-9. [Medline]. [Full Text].
Bittner MJ, Preheim LC. Other Slow-Growing Nontuberculous Mycobacteria. Microbiol Spectr. 2016 Nov. 4 (6):[Medline].
Collins CS, Terrell C, Mueller P. Disseminated Mycobacterium haemophilum infection in a 72-year-old patient with rheumatoid arthritis on infliximab. BMJ Case Rep. 2013 Mar 15. 2013:[Medline].
Aslam A, Green RL, Motta L, Ghrew M, Griffiths CE, Warren RB. Cutaneous Mycobacterium haemophilum infection in a patient receiving infliximab for psoriasis. Br J Dermatol. 2013 Feb. 168(2):446-7. [Medline].
Swart RM, van Ingen J, van Soolingen D, Slingerland R, Hendriks WD, den Hollander JG. Nontuberculous mycobacteria infection and tumor necrosis factor-alpha antagonists. Emerg Infect Dis. 2009 Oct. 15(10):1700-1. [Medline]. [Full Text].
Giulieri S, Morisod B, Edney T, Odman M, Genné D, Malinverni R, et al. Outbreak of Mycobacterium haemophilum infections after permanent makeup of the eyebrows. Clin Infect Dis. 2011 Feb 15. 52(4):488-91. [Medline].
Castro-Silva AN, Freire AO, Grinbaum RS, Elmor de Araújo MR, Abensur H, Araújo MR, et al. Cutaneous Mycobacterium haemophilum infection in a kidney transplant recipient after acupuncture treatment. Transpl Infect Dis. 2011 Feb. 13(1):33-7. [Medline].
Hamsch C, Hartschuh W, Enk A, Flux K. A Chinese tattoo paint as a vector of atypical mycobacteria-outbreak in 7 patients in Germany. Acta Derm Venereol. 2011 Jan. 91(1):63-4. [Medline].
Lindeboom JA, Kuijper CF, van Furth M. Inguinal lymphadenitis caused by mycobacterium haemophilum in an immunocompetent child. Pediatr Infect Dis J. 2007 Jan. 26(1):84-6. [Medline].
Mycobacterium haemophilum as a novel etiology of cervical lymphadenitis in an otherwise healthy adult patient. J Clin Microbiol. Jul 2010:2636-9. [Full Text].
Atiya N, Sulaiman H, Chong J, Ng KP. First report of cervicofacial lymphadenitis due to Mycobacterium haemophilum in an immunocompromised adult patient. J Infect Dev Ctries. 2015 Mar 15. 9 (3):313-6. [Medline].
Gao W, Chen H, Wang H, Jiang H, Liu W, Hao D, et al. Bilateral Sporotrichoid Cutaneous Infection by Mycobacterium haemophilum in a Chinese Patient with Systemic Lupus Erythematosus. Acta Derm Venereol. 2015 Jun 24. 95 (6):760-1. [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. 2006 Jun. 101(6):774-6. [Medline].
Copeland NK, Arora NS, Ferguson TM. Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient. Case Rep Dermatol Med. 2013. 2013:793127. [Medline].
Ishii K, Ishii N, Nakanaga K, Nakano K, Saito I, Asahina A. Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy. J Dermatol. 2015 May 28. [Medline].
Wollina U. Nodular skin reactions in eyebrow permanent makeup: two case reports and an infection by Mycobacterium haemophilum. J Cosmet Dermatol. 2011 Sep. 10(3):235-9. [Medline].
Kay MK, Perti TR, Duchin JS. Tattoo-associated Mycobacterium haemophilum skin infection in immunocompetent adult, 2009. Emerg Infect Dis. 2011 Sep. 17(9):1734-6. [Medline].
Doherty T, Lynn M, Cavazza A, Sames E, Hughes R. Mycobacterium haemophilum as the Initial Presentation of a B-Cell Lymphoma in a Liver Transplant Patient. Case Rep Rheumatol. 2014. 2014:742978. [Medline].
Izawa K, Kitada S. CLINICAL ANALYSIS OF OSTEOARTICULAR NONTUBERCULOUS MYCOBACTERIAL INFECTION. Kekkaku. 2016 Jan. 91 (1):1-8. [Medline].
Jang EY, Lee SO, Choi SH, Sung H, Kim MN, Kim BJ, et al. Case of pyomyositis due to Mycobacterium haemophilum in a renal transplant recipient. J Clin Microbiol. 2007 Nov. 45(11):3847-9. [Medline].
Kiehn TE, White M. Mycobacterium haemophilum: an emerging pathogen. Eur J Clin Microbiol Infect Dis. 1994 Nov. 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. 1995 Nov 15. 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. 1999 Aug. 24(3):325-9. [Medline].
Smith S, Taylor GD, Fanning EA. Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury. Clin Infect Dis. 2003 Oct 1. 37(7):e100-1. [Medline].
Modi D, Pyatetsky D, Edward DP, Ulanski LJ, Pursell KJ, Tessler HH, et al. Mycobacterium haemophilum: a rare cause of endophthalmitis. Retina. 2007 Oct. 27(8):1148-51. [Medline].
Keller M, Mak A, Thibert L, Rene P, Klein MB. Mycobacterium haemophilum epididymal abscess in a renal transplant patient. J Clin Microbiol. 2008 Jul. 46(7):2459-60. [Medline]. [Full Text].
Buppajarntham A, Apisarnthanarak A, Rutjanawech S, Khawcharoenporn T. Central nervous system infection due to Mycobacterium haemophilum in a patient with acquired immunodeficiency syndrome. Int J STD AIDS. 2015 Mar. 26 (4):288-90. [Medline].
Merkler AE, Parlitsis G, Patel S, Oliveira C, Lavi E, Schuetz A, et al. Infection of the optic apparatus and hypothalamus by Mycobacterium haemophilum. Neurology. 2014 Aug 12. 83 (7):659-60. [Medline].
Rajpara A, Sri J, Driscoll M. Mycobacterium haemophilum: Cutanoeus nodules in a renal transplant patient. Dermatol Online J. 2010. 16(7):3. [Medline].
Kelley CF, Armstrong WS, Eaton ME. Disseminated Mycobacterium haemophilum infection. Lancet Infect Dis. 2011 Jul. 11(7):571-8. [Medline].
Bekou V, Büchau A, Flaig MJ, Ruzicka T, Hogardt M. Cutaneous infection by Mycobacterium haemophilum and kansasii in an IgA-deficient man. BMC Dermatol. 2011. 11:3. [Medline].
Clement CG, Loeffelholz MJ, Eltorky MA, Tang YW, Williams-Bouyer N. Mycobacterium haemophilum and Histoplasma capsulatum coinfection in a renal transplant patient. J Clin Microbiol. 2011 Sep. 49(9):3425-8. [Medline].
Takeo N, Hatano Y, Okamoto O, Saruwatari K, Nakanaga K, Ishii N. Case of Mycobacterium haemophilum infection in a Japanese renal transplant patient and a review of Japanese cases. J Dermatol. 2012 Mar 14. [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. 1998 Feb. 26(2):505-7. [Medline].
Abbott MR, Smith DD. The pathogenic effects of Mycobacterium haemophilum in immunosuppressed albino mice. J Med Microbiol. 1980 Nov. 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. 2004 Jul. 42(7):3336-8. [Medline].
Lau SK, Curreem SO, Ngan AH, Yeung CK, Yuen KY, Woo PC. First report of disseminated Mycobacterium skin infections in two liver transplant recipients and rapid diagnosis by hsp65 gene sequencing. J Clin Microbiol. 2011 Nov. 49(11):3733-8. [Medline].
Lindeboom JA, Bruijnesteijn van Coppenraet LE, van Soolingen D, Prins JM, Kuijper EJ. Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev. 2011 Oct. 24(4):701-17. [Medline].
Lindeboom JA. Facial Skin Lesions in Children Caused by Nontuberculous Mycobacteria. Pediatr Dermatol. 2016 Mar-Apr. 33 (2):196-9. [Medline].
Bruijnesteijn van Coppenraet LE, Kuijper EJ, Lindeboom JA, Prins JM, Claas EC. Mycobacterium haemophilum and lymphadenitis in children. Emerg Infect Dis. 2005 Jan. 11(1):62-8. [Medline].
Münster S, Zustin J, Derlin T. Atypical mycobacteriosis caused by Mycobacterium haemophilum in an immunocompromised patient: diagnosis by (18)F-FDG PET/CT. Clin Nucl Med. 2013 Apr. 38(4):e194-5. [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. 2006 Dec 15. 43(12):1547-51. [Medline].
Lindeboom JA. Surgical treatment for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children. J Oral Maxillofac Surg. 2012 Feb. 70(2):345-8. [Medline].
Touma Z, Haddad A, Gladman DD, Uleryk EM, Urowitz MB. Skin nontuberculous mycobacterial infection in systemic lupus erythematosus: an unusual skin infection mimicking lupus vasculitis. Semin Arthritis Rheum. 2013 Apr. 42(5):498-506. [Medline].
Armstrong D, Kiehn T, Boone MW. From the Centers for Disease Control. Mycobacterium haemophilum infections--New York City metropolitan area, 1990-1991. JAMA. 1992 Jan 8. 267(2):215-6. [Medline].
Cohen YH, Amir J, Ashkenazi S, Eidlitz-Markus T, Samra Z, Kaufmann L, et al. Mycobacterium haemophilum and lymphadenitis in immunocompetent children, Israel. Emerg Infect Dis. 2008 Sep. 14(9):1437-9. [Medline]. [Full Text].
Da Mata O, Pérez Alfonzo R, Natera I, Sucre Rdel C, Bello T, de Waard JH. The diagnosis of two cases of cutaneous ulcer caused by infection with Mycobacterium haemophilum: direct identification in a clinical sample by polymerase chain reaction-restriction endonuclease analysis. Int J Dermatol. 2008 Aug. 47(8):820-3. [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. 1992 Jun. 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. 1996 Mar-Apr. 9(2):122-4. [Medline].
Kamboj M, Louie E, Kiehn T, Papanicolaou G, Glickman M, Sepkowitz K. Mycobacterium haemophilum infection after alemtuzumab treatment. Emerg Infect Dis. 2008 Nov. 14(11):1821-3. [Medline]. [Full Text].
Lee WJ, Kang SM, Sung H, Won CH, Chang SE, Lee MW, et al. Non-tuberculous mycobacterial infections of the skin: a retrospective study of 29 cases. J Dermatol. 2010 Nov. 37(11):965-72. [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. 1998 Jun. 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. 2003 Jul. 149(1):200-2. [Medline].
Lott JP, Werth VP, Kovarik CL. Cutaneous Mycobacterium haemophilum infection in iatrogenically immunocompromised patients without transplantation. J Am Acad Dermatol. 2008 Jul. 59(1):139-42. [Medline].
Phowthongkum P, Puengchitprapai A, Udomsantisook N, Tumwasorn S, Suankratay C. Spindle cell pseudotumor of the brain associated with Mycobacterium haemophilum and Mycobacterium simiae mixed infection in a patient with AIDS: the first case report. Int J Infect Dis. 2008 Jul. 12(4):421-4. [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. 1997 May. 24(5):995-7. [Medline].
Sagi L, Leshem E, Barzilai A, Baum S, Har-Zahav Y, Rahav G. Mycobacterium haemophilum infection presenting as bilateral cellulitis and annular lesion in a heart transplant recipient. Isr Med Assoc J. 2010 Jan. 12(1):57-8. [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. 1999 Mar. 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. 1996 Oct. 9(4):435-47. [Medline].
Seitz CS, Trautemann A, Bröcker EB, Abele-Horn M, Goebeler M. Skin nodules in rheumatoid arthritis due to infection with Mycobacterium haemophilum. Acta Derm Venereol. 2008. 88(4):428-9. [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. 1994 Jan 15. 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. 2004 Jul. 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. 2007 Jun. 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. 1999 Oct. 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. 1992 Jun. 6(6):557-61. [Medline].

Media Gallery

of 0

Author

Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, South Nassau Communities Hospital

Aaron Glatt, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, 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, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein, MD, PhD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, New York County Medical Society, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Former 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 Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Sections Mycobacterium haemophilum Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Mycobacterium haemophilum Infection

Background

Pathophysiology

Epidemiology

Frequency

Mortality/Morbidity

Sex

Age

Prognosis

Patient Education

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Mycobacterium haemophilum Infection

Background

Pathophysiology

Epidemiology

Frequency

Mortality/Morbidity

Sex

Age

Prognosis

Patient Education

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions

What to Read Next on Medscape

Related Conditions and Diseases

Medscape Consult

News & Perspective

Tools

Slideshow

Most Popular Articles

Recommended