Laboratory Studies

Serum electrolyte tests may reveal hyponatremia, most likely due to inappropriate secretion of antidiuretic hormone syndrome.

CBC counts may reveal leukocytosis, leucopenia, anemia, reactive thrombocytosis, or thrombocytopenia, or they may be entirely within reference ranges.

Mycobacterial examination of sputum,^[6]blood, urine, bronchoalveolar lavage fluid, and tissue biopsies may reveal M xenopi.

American Thoracic Society criteria are used for diagnosing nontuberculous mycobacterial lung disease in HIV-seropositive or HIV-seronegative patients. Use the following criteria when diagnosing symptomatic patients who have infiltrative, nodular, or cavitary lung disease and those with high-resolution CT scan findings that reveal multifocal bronchiectasis and/or multiple small nodules:

If 3 sputum/bronchial wash results from the previous 12 months are available: Three positive culture findings with negative acid-fast bacilli (AFB) smear results or 2 positive culture findings and 1 positive smear result.
If only 1 bronchial wash result is available: Positive culture findings with a 2+, 3+, or 4+ AFB smear result or a 2+, 3+, or 4+ growth on solid media
If sputum/bronchial wash results are nondiagnostic or another disease cannot be excluded: Transbronchial or open lung biopsy yielding M xenopi or biopsy showing mycobacterial histopathologic features (granulomatous inflammation^[7]or AFB) and 1 or more sputum or bronchial wash result positive, even in a low number, for M xenopi

Chest radiography

The classic appearance of M xenopi is cavitary apical pulmonary disease. The cavities have thin walls with little surrounding parenchymal infiltration.

Bronchogenic spread of disease is rare and appears as patchy, irregular, alveolar or interstitial opacities.

Adenopathy and pleural effusions are rare and are not isolated findings.

The nonclassic form develops in about 25% of patients and appears as multiple patchy alveolar, interstitial pneumonitis, or interstitial opacities without defined borders (predominantly in the lower lung fields).

M xenopi may occasionally manifest as a solitary pulmonary nodule, usually in asymptomatic individuals who come to medical attention because of possible malignancy. Surgical resection demonstrates changes without evidence of tumor.

Chest CT scanning

This defines the features more precisely by possibly revealing bronchiectasis and 5- to 15-mm nodular opacities.

Carillo et al compared CT scan findings of M xenopi infection with those of Mycobacterium avium-intracellulare infection. In their patient population, they observed a more fibrocavitary and nodular pattern in patients with M xenopi infection compared to classic descriptions of it being more bronchiectatic. They also described findings consistent with ground-glass opacifications and consolidations.^[8]

Positron emission tomography (PET)–CT imaging

This often reveals solitary pulmonary nodules that may mimic carcinoma.

Procedures

See the list below:

Bronchoscopy with bronchoalveolar lavage
Bronchoscopy with endobronchial or transbronchial biopsies
Transbronchial needle aspiration
Video-assisted thoracoscopic biopsy
Open lung biopsy (rarely indicated)

Histologic Findings

Necrotizing or non-necrotizing granulomatous inflammation is observed in lung biopsy samples.

Staging

Similar to other nontuberculous mycobacteria

Presumed colonization
Localized disease (eg, in the lungs)
Disseminated disease or mycobacteremia

Treatment & Management

Sebakova H, Kozisek F, Mudra R, Kaustova J, Fiedorova M, Hanslikova D, et al. Incidence of nontuberculous mycobacteria in four hot water systems using various types of disinfection. Can J Microbiol. 2008 Nov. 54(11):891-8. [QxMD MEDLINE Link].
Hussein Z, Landt O, Wirths B, Wellinghausen N. Detection of non-tuberculous mycobacteria in hospital water by culture and molecular methods. Int J Med Microbiol. 2009 Apr. 299(4):281-90. [QxMD MEDLINE Link].
Salmon JH, Direz G, Ziza JM, Desplaces N, Brochot P, Eschard JP. Discitis and sacroiliitis diagnosed 15years after iatrogenic Mycobacterium xenopi inoculation. Joint Bone Spine. 2012 Mar 9. [QxMD MEDLINE Link].
Portillo ME, Sánchez F, Vicente E, Salvadó M. [Trochanteric bursitis due to Mycobacterium xenopi in a patient with pharmacological immunosuppression]. Enferm Infecc Microbiol Clin. 2011 May. 29(5):399-401. [QxMD MEDLINE Link].
Varghese B1, Memish Z, Abuljadayel N, Al-Hakeem R, Alrabiah F, Al-Hajoj SA. Emergence of clinically relevant Non-Tuberculous Mycobacterial infections in Saudi Arabia. PLoS Negl Trop Dis. May 2013. 7:2234. [QxMD MEDLINE Link].
Alvarez-Uria G, Falcó V, Martín-Casabona N, Crespo M, Villar Del Saz S, Curran A, et al. Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization?. Int J STD AIDS. 2009 Mar. 20(3):193-5. [QxMD MEDLINE Link].
De Lorenzi D, Solano-Gallego L. Tracheal granuloma because of infection with a novel mycobacterial species in an old FIV-positive cat. J Small Anim Pract. 2009 Mar. 50(3):143-6. [QxMD MEDLINE Link].
Carrillo MC1, Patsios D, Wagnetz U, Jamieson F, Marras TK. Comparison of the Spectrum of Radiologic and Clinical Manifestations of Pulmonary Disease Caused by Mycobacterium avium Complex and Mycobacterium xenopi. Can Assoc Radiol J. December 2013. 47-48. [QxMD MEDLINE Link].
Al Jarad N, Demertzis P, Jones DJ, et al. Comparison of characteristics of patients and treatment outcome for pulmonary non-tuberculous mycobacterial infection and pulmonary tuberculosis. Thorax. 1996 Feb. 51(2):137-9. [QxMD MEDLINE Link].
American Thoracic Society. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. 1997 Aug. 156(2 Pt 2):S1-25. [QxMD MEDLINE Link].
Andrejak C, Lescure FX, Pukenyte E, et al. Mycobacterium xenopi pulmonary infections: a multicentric retrospective study of 136 cases in north-east France. Thorax. 2009 Apr. 64(4):291-6. [QxMD MEDLINE Link].
Andréjak C, Lescure FX, Pukenyte E, Douadi Y, Yazdanpanah Y, Laurans G, et al. Mycobacterium xenopi pulmonary infections: a multicentric retrospective study of 136 cases in north-east France. Thorax. 2009 Apr. 64(4):291-6. [QxMD MEDLINE Link].
Ausina V, Barrio J, Luquin M, et al. Mycobacterium xenopi infections in the acquired immunodeficiency syndrome. Ann Intern Med. 1988 Dec 1. 109(11):927-8. [QxMD MEDLINE Link].
Banks J, Hunter AM, Campbell IA, et al. Pulmonary infection with mycobacterium xenopi: review of treatment and response. Thorax. 1984 May. 39(5):376-82. [QxMD MEDLINE Link].
Bennett SN, Peterson DE, Johnson DR, et al. Bronchoscopy-associated Mycobacterium xenopi pseudoinfections. Am J Respir Crit Care Med. 1994 Jul. 150(1):245-50. [QxMD MEDLINE Link].
Bishburg E, Zucker MJ, Baran DA, Arroyo LH. Mycobacterium xenopi infection after heart transplantation: an unreported pathogen. Transplant Proc. 2004 Nov. 36(9):2834-6. [QxMD MEDLINE Link].
Chen F, Sethi G, Goldin R, et al. Concurrent granulomatous Pneumocystis carinii and Mycobacterium xenopi pneumonia: an unusual manifestation of HIV immune reconstitution disease. Thorax. 2004 Nov. 59(11):997-9. [QxMD MEDLINE Link].
Costrini AM, Mahler DA, Gross WM, et al. Clinical and roentgenographic features of nosocomial pulmonary disease due to Mycobacterium xenopi. Am Rev Respir Dis. 1981 Jan. 123(1):104-9. [QxMD MEDLINE Link].
David E. Griffith, Timothy Aksamit, Barbara A. Brown-Elliott, Antonino Catanzaro, Charles Daley, Fred Gordin, et al. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. [Full Text].
el-Helou P, Rachlis A, Fong I, et al. Mycobacterium xenopi infection in patients with human immunodeficiency virus infection. Clin Infect Dis. 1997 Aug. 25(2):206-10. [QxMD MEDLINE Link].
El-Solh AA, Nopper J, Abdul-Khoudoud MR, et al. Clinical and radiographic manifestations of uncommon pulmonary nontuberculous mycobacterial disease in AIDS patients. Chest. 1998 Jul. 114(1):138-45. [QxMD MEDLINE Link].
Eng RH, Forrester C, Smith SM, Sobel H. Mycobacterium xenopi infection in a patient with acquired immunodeficiency syndrome. Chest. 1984 Jul. 86(1):145-7. [QxMD MEDLINE Link].
First randomised trial of treatments for pulmonary disease caused by M avium intracellulare, M malmoense, and M xenopi in HIV negative patients: rifampicin, ethambutol and isoniazid versus rifampicin and ethambutol. Thorax. 2001 Mar. 56(3):167-72. [QxMD MEDLINE Link].
Griffith DE, Girard WM, Wallace RJ Jr. Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. Am Rev Respir Dis. 1993 May. 147(5):1271-8. [QxMD MEDLINE Link].
Hadjiliadis D, Adlakha A, Prakash UB. Rapidly growing mycobacterial lung infection in association with esophageal disorders. Mayo Clin Proc. 1999 Jan. 74(1):45-51. [QxMD MEDLINE Link].
Ibarra MR, Algarabel PA, Marquina C, Arnaudas JI, del Moral A, Pareti L. Magnetic phase diagram and anisotropy of pseudoternary (ErxDy1-x)2Fe14B compounds. Phys Rev B Condens Matter. 1989 Apr 1. 39(10):7081-7088. [QxMD MEDLINE Link].
Jiva TM, Jacoby HM, Weymouth LA, et al. Mycobacterium xenopi: innocent bystander or emerging pathogen?. Clin Infect Dis. 1997 Feb. 24(2):226-32. [QxMD MEDLINE Link].
Koizumi JH, Sommers HM. Mycobacterium xenopi and pulmonary disease. Am J Clin Pathol. 1980 Jun. 73(6):826-30. [QxMD MEDLINE Link].
Kotloff RM. Infection caused by nontuberculous mycobacteria: clinical aspects. Semin Roentgenol. 1993 Apr. 28(2):131-8. [QxMD MEDLINE Link].
Lavy A, Rusu R, Mates A. Mycobacterium xenopi, a potential human pathogen. Isr J Med Sci. 1992 Nov. 28(11):772-5. [QxMD MEDLINE Link].
Maimon N, Brunton J, Chan AK, Marras TK. Fatal pulmonary Mycobacterium xenopi in a patient with rheumatoid arthritis receiving etanercept. Thorax. 2007 Aug. 62(8):739-40. [QxMD MEDLINE Link].
Majoor CJ, Schreurs AJ, Weers-Pothoff G. Mycobacterium xenopi infection in an immunosuppressed patient with Crohn's disease. Thorax. 2004 Jul. 59(7):631-2. [QxMD MEDLINE Link].
Martin-Penagos L, Rodrigo E, Ruiz JC, et al. Lung cavitation due to Mycobacterium xenopi in a renal transplant recipient. Transpl Infect Dis. 2009 Jun. 11(3):249-52. [QxMD MEDLINE Link].
Massachusetts General Hospital. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-1989. A 58-year-old man with cavitary lung disease. N Engl J Med. 1989 Apr 27. 320(17):1130-9. [QxMD MEDLINE Link].
Matsui Y, Tamura A, Nagayama N, Akashi S, Araki K, Kimura H, et al. [Review of pulmonary Mycobacterium xenopi infection cases: 11 cases of our own and 18 other cases reported in Japan]. Kekkaku. 2010 Aug. 85(8):647-53. [QxMD MEDLINE Link].
Meybeck A, Fortin C, Abgrall S, et al. Spondylitis due to Mycobacterium xenopi in a human immunodeficiency virus type 1-infected patient: case report and review of the literature. J Clin Microbiol. 2005 Mar. 43(3):1465-6. [QxMD MEDLINE Link].
Miller WC, Perkins MD, Richardson WJ, Sexton DJ. Pott's disease caused by Mycobacterium xenopi: case report and review. Clin Infect Dis. 1994 Dec. 19(6):1024-8. [QxMD MEDLINE Link].
Miller WT, Miller WT. Pulmonary infections with atypical mycobacteria in the normal host. Semin Roentgenol. 1993 Apr. 28(2):139-49. [QxMD MEDLINE Link].
O'Brien RJ, Geiter LJ, Snider DE Jr. The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis. 1987 May. 135(5):1007-14. [QxMD MEDLINE Link].
Olivier KN, Weber DJ, Lee JH, Handler A, Tudor G, Molina PL, et al. Nontuberculous mycobacteria. II: nested-cohort study of impact on cystic fibrosis lung disease. Am J Respir Crit Care Med. 2003 Mar 15. 167(6):835-40. [QxMD MEDLINE Link].
Olivier KN, Weber DJ, Wallace RJ Jr, Faiz AR, Lee JH, Zhang Y. Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med. 2003 Mar 15. 167(6):828-34. [QxMD MEDLINE Link].
Portaels F. Epidemiology of mycobacterial diseases. Clin Dermatol. 1995 May-Jun. 13(3):207-22. [QxMD MEDLINE Link].
Primm TP, Lucero CA, Falkinham JO 3rd. Health impacts of environmental mycobacteria. Clin Microbiol Rev. 2004 Jan. 17(1):98-106. [QxMD MEDLINE Link]. [Full Text].
Schmitt H, Schnitzler N, Riehl J, et al. Successful treatment of pulmonary Mycobacterium xenopi infection in a natural killer cell-deficient patient with clarithromycin, rifabutin, and sparfloxacin. Clin Infect Dis. 1999 Jul. 29(1):120-4. [QxMD MEDLINE Link].
Schwabacher H. A strain of Mycobacterium isolated from skin lesions of a cold-blooded animal, Xenopus laevis, and its relation to atypical acid-fast bacilli occurring in man. J Hyg (Lond). 1959 Mar. 57(1):57-67. [QxMD MEDLINE Link].
Shafer RW, Sierra MF. Mycobacterium xenopi, Mycobacterium fortuitum, Mycobacterium kansasii, and other nontuberculous mycobacteria in an area of endemicity for AIDS. Clin Infect Dis. 1992 Jul. 15(1):161-2. [QxMD MEDLINE Link].
Simor AE, Salit IE, Vellend H. The role of Mycobacterium xenopi in human disease. Am Rev Respir Dis. 1984 Mar. 129(3):435-8. [QxMD MEDLINE Link].
Smith MJ, Citron KM. Clinical review of pulmonary disease caused by Mycobacterium xenopi. Thorax. 1983 May. 38(5):373-7. [QxMD MEDLINE Link].
Sniadack DH, Ostroff SM, Karlix MA, et al. A nosocomial pseudo-outbreak of Mycobacterium xenopi due to a contaminated potable water supply: lessons in prevention. Infect Control Hosp Epidemiol. 1993 Nov. 14(11):636-41. [QxMD MEDLINE Link].
Thaunat O, Morelon E, Stern M, et al. Mycobacterium xenopi pulmonary infection in two renal transplant recipients under sirolimus therapy. Transpl Infect Dis. 2004 Dec. 6(4):179-82. [QxMD MEDLINE Link].
Torkko P, Suomalainen S, Iivanainen E, Suutari M, Tortoli E, Paulin L. Mycobacterium xenopi and related organisms isolated from stream waters in Finland and description of Mycobacterium botniense sp. nov. Int J Syst Evol Microbiol. 2000 Jan. 50 Pt 1:283-9. [QxMD MEDLINE Link].
van Ingen J, Boeree MJ, de Lange WC, Hoefsloot W, Bendien SA, Magis-Escurra C. Mycobacterium xenopi clinical relevance and determinants, the Netherlands. Emerg Infect Dis. 2008 Mar. 14(3):385-9. [QxMD MEDLINE Link].
Varadi RG, Marras TK. Pulmonary Mycobacterium xenopi infection in non-HIV-infected patients: a systematic review. Int J Tuberc Lung Dis. 2009 Oct. 13(10):1210-8. [QxMD MEDLINE Link].
Wang HX, Yue J, Han M, Yang JH, Gao RL, Jing LJ. Nontuberculous mycobacteria: susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008. Chin Med J (Engl). 2010 Jan 20. 123(2):184-7. [QxMD MEDLINE Link].
Witty LA, Tapson VF, Piantadosi CA. Isolation of mycobacteria in patients with pulmonary alveolar proteinosis. Medicine (Baltimore). 1994 Mar. 73(2):103-9. [QxMD MEDLINE Link].
Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis. 1992 Jul. 15(1):1-10. [QxMD MEDLINE Link].
Zurawski CA, Cage GD, Rimland D, Blumberg HM. Pneumonia and bacteremia due to Mycobacterium celatum masquerading as Mycobacterium xenopi in patients with AIDS: an underdiagnosed problem?. Clin Infect Dis. 1997 Feb. 24(2):140-3. [QxMD MEDLINE Link].
Alexander DC, Marras TK, Ma JH, Mirza S, Liu D, Kus JV, et al. Multilocus sequence typing of Mycobacterium xenopi. J Clin Microbiol. 2014 Nov. 52 (11):3973-7. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Mansoor Arif, MD Hospitalist, Department of Medicine, Mount Auburn Hospital; Instructor, Department of Medicine, Harvard Medical School

Mansoor Arif, MD is a member of the following medical societies: American College of Physicians, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Syed Faisal Mahmood, MBBS Associate Professor of Infectious Diseases, Program Director, Infectious Diseases Fellowship Program, Department of Medicine, Aga Khan University Hospital, Pakistan

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 E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai

Aaron E Glatt, MD, MACP, FIDSA, FSHEA 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

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Acknowledgements

Martin Backer, MD Fellow in Combined Adult and Pediatric Infectious Diseases, State University of New York Health Sciences Center