Mycobacterium arupense, Mycobacterium heraklionense, and a Newly Proposed Species, “Mycobacterium virginiense” sp. nov., but Not Mycobacterium nonchromogenicum, as Species of the Mycobacterium terrae Complex Causing Tenosynovitis and Osteomyelitis
Mycobacterium terraecomplex has been recognized as a cause of tenosynovitis, withM. terraeandMycobacterium nonchromogenicumreported as the primary etiologic pathogens. The molecular taxonomy of theM. terraecomplex causing tenosynovitis has not been established despite approximately 50 previously reported cases. We evaluated 26 isolates of theM. terraecomplex associated with tenosynovitis or osteomyelitis recovered between 1984 and 2014 from 13 states, including 5 isolates reported in 1991 asM. nonchromogenicumby nonmolecular methods. The isolates belonged to three validated species, one new proposed species, and two novel related strains. The majority of isolates (20/26, or 77%) belonged to two recently described species:Mycobacterium arupense(10 isolates, or 38%) andMycobacterium heraklionense(10 isolates, or 38%). Three isolates (12%) had 100% sequence identity to each other by 16S rRNA and 99.3 to 100% identity byrpoBgene region V sequencing and represent a previously undescribed species within theM. terraecomplex. There were no isolates ofM. terraeorM. nonchromogenicum, including among the five isolates reported in 1991. The 26 isolates were susceptible to clarithromycin (100%), rifabutin (100%), ethambutol (92%), and sulfamethoxazole or trimethoprim-sulfamethoxazole (70%). The current study suggests thatM. arupense,M. heraklionense, and a newly proposed species (“M. virginiense” sp. nov.; proposed type strain MO-233 [DSM 100883, CIP 110918]) within theM. terraecomplex are the major causes of tenosynovitis and osteomyelitis in the United States, with little change over 20 years. Species identification within this complex requires sequencing methods.