Huge cutaneous abscess and severe symptomatic hypercalcaemia secondary to Mycobacterium kansasii infection in an immunocompetent patient

2021 ◽  
Vol 14 (9) ◽  
pp. e241662
Author(s):  
Sarocha Vivatvakin ◽  
Kamalas Amnuay ◽  
Chusana Suankratay
Keyword(s):  
Soft Tissue ◽  
Pulmonary Infection ◽  
Immunocompetent Patient ◽  
Surgical Drainage ◽  
Mycobacterium Kansasii ◽  
Adequate Hydration ◽  
Lateral Chest ◽  
Severe Hypercalcaemia ◽  
Human Infections ◽  
Common Infection

Mycobacterium kansasii is among the most common non-tuberculous mycobacteria causing human infections. Apart from pulmonary infection, the most common infection caused by M. kansasii is skin and soft tissue infection, and it is very rare in immunocompetent people. In this report, we present a case of a huge cutaneous abscess caused by M. kansasii. A 63-year-old man living in Bangkok presented with progressive pain at the left lateral chest wall for 3 weeks and altered mentation for a few days. Examination revealed a non-tender fluctuated cutaneous mass 20×10 cm in size. An aspiration of the mass yielded 50 mL pus with many positive acid-fast bacilli. Mycobacterial PCR was positive for M. kansasii with culture confirmation. There was severe hypercalcaemia. The treatment included surgical drainage, and medical treatment consisted of isoniazid, rifampicin, ethambutol and levofloxacin, along with adequate hydration and calcitonin for hypercalcaemia. The patient gradually improved and was discharged 12 days after hospitalisation.

Mycobacterium kansasii arthritis of the elbow in an immunocompetent patient with a suspected soft-tissue tumor

2020 ◽  
Vol 26 (2) ◽  
pp. 261-264
Author(s):  
Hideo Okuno ◽  
Hiroyuki Tanaka ◽  
Hideharu Hagiya ◽  
Hisao Yoshida ◽  
Shigeto Hamaguchi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Tumor ◽  
Immunocompetent Patient ◽  
Mycobacterium Kansasii ◽  
Tissue Tumor

scholarly journals Nodular Subcutaneous Phaeohyphomycosis due to Medicopsis romeroi in an Immunocompetent Patient

2021 ◽  
Author(s):  
Smita Deshkar ◽  
Niranjan Patil ◽  
Ashish Lad ◽  
Shraddha Amberkar ◽  
Swati Sharan
Keyword(s):  
Fungal Infections ◽  
Surgical Excision ◽  
Immunocompetent Patient ◽  
Its Sequencing ◽  
Tropical Regions ◽  
Dematiaceous Fungus ◽  
Dorsum Of Foot ◽  
Subcutaneous Phaeohyphomycosis ◽  
Human Infections ◽  
Organ Tropism

Fungal infections like subcutaneous phaeohyphomycosis are uncommon but are increasing lately, especially in tropical regions like India. Identification of correct aetiologic agent is essential as different species can have different organ tropism. Here, a rare case of nodular subcutaneous phaeohyphomycosis in an immunocompetent 62-year-old male patient who developed nodule over right dorsum of foot is reported. After various diagnostic tests a rare dematiaceous fungus Medicopsis romeroi was identified as a causative agent in the nodular material by Internal Transcribed Spacer (ITS) sequencing. Surgical excision and antifungal therapy of itraconazole proved beneficial with no recurrence during a six months of follow-up. Medicopsis romeroi has been debated for its role in human infections however, it should be considered as one of the aetiologic agents of subcutaneous phaeohyphomycosis.

scholarly journals Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review

2020 ◽  
Vol 14 (02) ◽  
pp. 214-222
Author(s):  
Rushika Saksena ◽  
Dabet Rynga ◽  
Santosh Rajan ◽  
Rajni Gaind ◽  
Reetika Dawar ◽  
...  
Keyword(s):  
Pulmonary Infection ◽  
Species Level ◽  
Shortness Of Breath ◽  
Microbiology Laboratory ◽  
Antimicrobial Susceptibility Pattern ◽  
Improve Treatment ◽  
Amoxicillin Clavulanic Acid ◽  
Biochemical Identification ◽  
Nocardia Otitidiscaviarum ◽  
Human Infections

Introduction: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. Methodology: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). Conclusion: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

Hypercalcaemia in Mycobacterium kansasii pulmonary infection

2021 ◽  
Vol 14 (11) ◽  
pp. e245800
Author(s):  
Robert Costigan Flowers ◽  
Javier Ocampo ◽  
Justin Krautbauer ◽  
Warren L Kupin
Keyword(s):  
Pulmonary Infection ◽  
Case Reports ◽  
Kidney Injury ◽  
Disease Status ◽  
Altered Mental Status ◽  
Mycobacterium Kansasii ◽  
End Stage Kidney Disease ◽  
Granulomatous Diseases ◽  
End Stage ◽  
Work Up

A gentleman in his 60s with end-stage kidney disease status post kidney transplantation on prednisone and tacrolimus presented with generalised weakness for 7 days, associated with altered mental status. Investigations revealed pancytopenia, acute kidney injury, hypercalcaemia, decreased parathyroid hormone (PTH) and normal calcitriol levels. CT of the chest showed multifocal lung opacities suspicious for malignancy. Bronchoscopy with biopsy yielded no malignant cells, and bronchoalveolar lavage specimens grew Mycobacterium kansasii. The patient was treated with bisphosphonates, calcitonin and antibiotics for non-tuberculous mycobacteria pulmonary infection, with improvement in serum calcium levels, and was discharged after 5 weeks of hospitalisation.The work-up for hypercalcaemia begins with PTH measurement, and low PTH levels are consistent with malignancy, immobilisation and granulomatous diseases. Hypercalcaemia in the lattermost is classically caused by overproduction of calcitriol by activated macrophages. However, there are case reports of mycobacterial infections with hypercalcaemia despite normal calcitriol levels, supporting the existence of an additional mechanism of hypercalcaemia in granulomatous infections.

Pathologic Features of Mycobacterium kansasii Infection in Patients With Acquired Immunodeficiency Syndrome

2003 ◽  
Vol 127 (5) ◽  
pp. 554-560 ◽  
Author(s):  
Michael B. Smith ◽  
Claudia P. Molina ◽  
Vicki J. Schnadig ◽  
Michael C. Boyars ◽  
Judith F. Aronson
Keyword(s):  
Lymph Node ◽  
Acquired Immunodeficiency Syndrome ◽  
Pulmonary Infection ◽  
Mycobacterium Kansasii ◽  
Abdominal Lymph Node ◽  
Inflammatory Reactions ◽  
Pathologic Features ◽  
Wide Range ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Abstract Context.—Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium that may infect patients with human immunodeficiency virus (HIV) late in the course of acquired immunodeficiency syndrome (AIDS). The clinical features of pulmonary and extrapulmonary infections have been described in the literature; however, the pathology of infection has not been adequately addressed. Objective.—This report describes the pathologic features of 12 cases of M kansasii infection in patients with AIDS. Design.—The medical records, autopsy protocols, cytologic material, and histologic material from patients with AIDS and concomitant M kansasii infection at a tertiary-care medical center during 1990–2001 were reviewed. Results.—Twelve cases were identified, 6 by autopsy, 5 of which were diagnosed postmortem. Four of the 12 cases had cytologic material and 4 cases had histologic biopsies available for review. Pulmonary infection was most common (9/12), and all patients in whom thoracic lymph nodes were assessed showed involvement (7/7). Abdominal infection was less frequent, with only 1 of 6, 2 of 6, and 2 of 6, demonstrating liver, spleen, and abdominal lymph node infection, respectively. Isolated infections without documented pulmonary infection included brain abscess (n = 1), ulnar osteomyelitis (n = 1), and paratracheal mass (n = 1). Cytologic and histologic material showed a wide range of inflammatory reactions, including granulomas with and without necrosis, neutrophilic abscesses, spindle-cell proliferations, and foci of granular eosinophilic necrosis. The M kansasii bacillus was characteristically long, coarsely beaded, and frequently showed folded, bent, or curved ends. Intracellular bacilli were randomly or haphazardly distributed within histiocytes. Conclusion.—Mycobacterium kansasii infection produces predominately pulmonary infection in late-stage AIDS with a high incidence of thoracic lymph node involvement and a much lower incidence of dissemination to other sites. Infection is manifest as a wide variety of inflammatory reactions on cytology and histology; however, the characteristic appearance of the bacillus on acid-fast bacilli stain and its intracellular arrangement in histiocytes can allow a presumptive identification.

scholarly journals Primary Cutaneous Chrysosporium Infection following Ear Piercing: A Case Report

2015 ◽  
Vol 7 (2) ◽  
pp. 136-140 ◽  
Author(s):  
Poonkiat Suchonwanit ◽  
Chayada Chaiyabutr ◽  
Vasanop Vachiramon
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Transplant Patient ◽  
Immunocompetent Patient ◽  
Immunocompromised Patients ◽  
Heart Transplant Patient ◽  
Cutaneous Injury ◽  
Ear Piercing ◽  
Large Genus ◽  
Slow Onset

Chrysosporium is a large genus of saprophytic fungi that is commonly found in the soil. Infection caused by this organism is rare in humans and typically occurs in immunocompromised patients. Primary cutaneous Chrysosporium infection is relatively rare and has been reported in a heart transplant patient. The prognosis is usually favorable, but very poor in the setting of persistent profound immunosuppression. We herein report a case of primary cutaneous Chrysosporium infection following ear piercing in an immunocompetent patient. It is important for clinicians to consider this condition in patients with slow-onset skin and soft tissue infection following cutaneous injury, even in an immunocompetent setting.

scholarly journals Pulmonary Cryptococcosis in the Immunocompetent Patient—Many Questions, Some Answers

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
John F. Fisher ◽  
Paula A. Valencia-Rey ◽  
William B. Davis
Keyword(s):  
Pulmonary Infection ◽  
Case Reports ◽  
Severe Disease ◽  
Case Series ◽  
Immunocompetent Patient ◽  
Pulmonary Cryptococcosis ◽  
Polysaccharide Antigen ◽  
Prospective Data ◽  
Radiographic Findings ◽  
Oral Fluconazole

Abstract Background.  There are no prospective data regarding the management of pulmonary cryptococcosis in the immunocompetent patient. Clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe disease. It is unclear whether patients who have histological evidence of Cryptococcus neoformans but negative cultures will even respond to drug treatment. We evaluated and managed a patient whose presentation and course raised important questions regarding the significance of negative cultures, antifungal choices, duration of therapy, and resolution of clinical, serologic, and radiographic findings. Methods.  In addition to our experience, to answer these questions we reviewed available case reports and case series regarding immunocompetent patients with pulmonary cryptococcosis for the last 55 years using the following definitions: Definite - Clinical and/or radiographic findings of pulmonary infection and respiratory tract isolation of C. neoformans without other suspected etiologies; Probable - Clinical and radiographic findings of pulmonary infection, histopathologic evidence of C. neoformans, and negative fungal cultures with or without a positive cryptococcal polysaccharide antigen. Results.  Pulmonary cryptococcosis resolves in most patients with or without specific antifungal therapy. Clinical, radiographic, and serologic resolution is slow and may take years. Conclusions.  Persistently positive antigen titers are most common in untreated patients and may remain strongly positive despite complete or partial resolution of disease. Respiratory fungal cultures are often negative and may indicate nonviable organisms.

scholarly journals Necrotizing Fasciitis by Two Anaerobic Bacteria in an Immunocompetent Patient after Minor Trauma: A Case Report

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Marco Sciarra ◽  
Andrea Schimmenti ◽  
Tommaso Manciulli ◽  
Cristina Sarda ◽  
Marco Mussa ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Rare Case ◽  
Subcutaneous Tissue ◽  
Anaerobic Bacteria ◽  
Immunocompetent Patient ◽  
Minor Trauma ◽  
Group A Streptococci ◽  
Group A

Necrotizing fasciitis (NF) is a soft tissue infection affecting subcutaneous tissue and the muscular fascia without involvement of the muscle and can be either monomicrobial or polymicrobial. Monomicrobial infections are usually caused by group A streptococci, while infections caused by anaerobic germs usually affect immunodepressed patients. We report a rare case of NF caused by two anaerobic bacteria in an immunocompetent patient.

scholarly journals Cryptococcal Meningitis in an Immunocompetent Patient with a Ventriculo-Pleural Shunt

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Raynieri Fernandez ◽  
Jose Henao ◽  
Catherine Creticos
Keyword(s):  
Cryptococcal Meningitis ◽  
Pulmonary Infection ◽  
Organ Transplant ◽  
Immunocompetent Patient ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cerebrospinal Fluid Analysis ◽  
Fluid Analysis ◽  
Cell Immunity ◽  
Solid Organ Transplant Recipients

Cryptococcal meningitis is the most common form of infection caused by Cryptococcus yeast species, followed by pulmonary infection. It is an opportunistic infection seen in patients with impaired cell immunity, most frequently in HIV patients and solid organ transplant recipients; however, it can occur in patients with no apparent immunodeficiency. We describe the case of Cryptococcus neoformans meningitis in an immunocompetent patient with aseptic cerebrospinal fluid analysis which highlights the heterogeneity of this disease.

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