Sections

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

Workup

Laboratory Studies

Evaluate the CBC count, liver enzymes, and serum electrolyte levels, including creatinine.

Acid-fast bacillus smear and culture

M haemophilum is a slow-growing, acid-fast–positive, nontuberculous mycobacterium that requires media supplemented with ferric iron–containing compounds and grows best at 30-32°C. Growth on solid media usually takes 2-3 weeks. The organism typically does not stain with Gram stain.

Aspirate of lesions may reveal acid-fast bacilli.

Perform an acid-fast bacillus (AFB) smear on excised lymph nodes. Culture a specimen at 30-32°C in media supplemented with iron or heme.

In patients with septic arthritis and osteomyelitis, submit synovial fluid specimens and bone biopsy samples for AFB smear and culture. Synovial fluid is usually purulent, and M haemophilum may be isolated from the fluid.

Submit sputum from immunosuppressed patients with pneumonia for AFB smear and culture. M haemophilum can be cultured from the blood of some patients with AIDS using special isolator tubes.

In appropriate clinical settings (eg, skin lesions, lymphadenopathy), informing the mycobacteriology laboratory to culture for M haemophilum may be useful. Iron must be added to grow this organism.

M haemophilum is unlikely to be a saprophyte (an innocent bystander) or a laboratory contaminant in the appropriate clinical setting.

Polymerase chain reaction (PCR)–restriction endonuclease analysis has been used for direct identification of M haemophilum in clinical specimens from immunocompromised patients.^{[32, 33, 34, 35]}

M haemophilum –specific PCR has been used to diagnosis M haemophilum cervicofacial lymphadenitis in children and was superior to culture in one series of patients from the Netherlands.^[36]

Imaging Studies

Radiography of involved joints or bone may demonstrate soft tissue swelling and lytic lesions. Chest radiograph findings are abnormal in patients with pneumonia. Unilateral or bilateral infiltrates may appear.

CT scans of the chest may reveal abnormalities that are not revealed with chest radiography. Regular cuts of 5-7 mm should be sufficient; high-resolution CT scan is rarely necessary.

MRI demonstrates medullary lesions and cortical disruption.

Diagnosis has been made using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scanning.^[37]

Other Tests

In children with lymphadenitis a tuberculin skin test result with purified protein derivative (PPD) of tuberculosis may be positive; however, it is rarely larger than 9 mm.^[38]

Procedures

Aspirate of lesions may reveal AFB.

Histologic Findings

Biopsy specimens of skin lesions show granulomatous panniculitis and caseating or noncaseating granulomas. Patients with AIDS have poorly formed granulomas. A neutrophilic infiltrate with multinucleated giant cells may be observed. AFB smear results are usually positive, revealing large, pleomorphic, or curved AFB.

Lymph node biopsy may reveal granulomas, necrosis, granulating tissue, or multinucleated giant cells, and the specimen may be smear-positive for AFB.

Treatment & Management

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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 Workup

Laboratory Studies

Acid-fast bacillus smear and culture

Imaging Studies

Other Tests

Procedures

Histologic Findings

References

Tables

Contributor Information and Disclosures

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