Unusual Presentation for Unusual Infection: Disseminated Mycobacterium Avium-Intracellulare complex (MAC) in Patient with Sickle Cell Anemia Mimicking Blood Transfusion Reaction

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4980-4980
Author(s):  
Nayf Edrees ◽  
Thomas H. Howard
Keyword(s):  
Blood Culture ◽  
Sickle Cell ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Conflicts Of Interest ◽  
Venous Catheter ◽  
Whole Body ◽  
Transfusion Reaction ◽  
Mycobacterium Avium Intracellulare ◽  
Slow Grower

Abstract Nontuberculous mycobacteria (NTM) are ubiquitous free living soil and water– borne organisms that cause numerous clinical syndromes including lymphadenitis, skin, soft tissue and pulmonary infections, however disseminated infection is almost exclusively in patient with severe immunocompromise (i.e:HIV, Hematological malignancy, and bone marrow transplant). Mycobacterium avium complex (MAC) is hard to diagnose as it is considered slow grower NTM. We describe a case of disseminated Mycobacterium avium-intracellulare complex infection in teenager with sickle hemoglobinopathy with unique presentation mimicking pRBCs transfusion reaction. Patient presented on three different occasions with tachycardia, hypotension and fever within 2-24 hours following pRBCs pheresis, all three episodes were investigated and were negative for transfusion reactions. Patient had central venous catheter (CVC), frequent admissions for vaso-occlusive painful episode, on hydrocortisone for adrenal insufficiency and off Hydroxyurea for two months. Diagnosis of mycobacterium avium complex bacteremia was confirmed by two positive blood cultures, whole body CT scan showed liver nodules, spleen nodules and lung nodules. Pulmonary dissemination was confirmed by Biopsy and culture, Lymphocyte markers showed severe lymphopenia with absolute CD4 count of 64. Patient underwent treatment with three month of four antibiotics followed by 9 months of three antibiotics with removal of the central line, follow up scan showed decrease size and numbers of nodules, patient started tolerating pheresis within one month of the antibiotics initiation. NTM infection should be added to the list of pathogens in sickle cell patients with CVCs and fever and should be considered in frequent pRBC transfusion like reaction with negative workup. Routine blood culture can identify rapid growing NTM but specific mycobacterial blood culture is required in case of other NTM species (slow grower). As dissemination almost always occurs in those with impaired cellular immunity, HIV testing and lymphocyte markers should be performed Removal of involved CVCs is essential for the treatment as well as appropriate antimicrobial medications. Disclosures No relevant conflicts of interest to declare.

Treatment and prophylaxis of Mycobacterium avium complex

1996 ◽  
Vol 7 (1_suppl) ◽  
pp. 23-27 ◽  
Author(s):  
L S Young
Keyword(s):  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Antimicrobial Agents ◽  
Careful Study ◽  
Double Blind ◽  
Acquired Immunodeficiency ◽  
Mycobacterium Avium Intracellulare ◽  
Immunodeficiency Syndrome ◽  
Emergence Of Resistance ◽  
Cytochrome P 450

The most common pathogens involved in disseminated bacterial infection in people with acquired immunodeficiency syndrome (AIDS) are organisms of the Mycobacterium avium-intracellulare complex (MAC). Azithromycin and clarithromycin, a new azalide and macrolide, respectively, are among the most potent monotherapies for MAC bacteraemia, although many bloodstream isolates demonstrate increased minimum inhibitory concentrations after 4 months of treatment. Current recommended prophylaxis, based on the results of two randomized, double-blind, prospective studies, is rifabutin 300 mg daily for people with AIDS with <100 CD4 lymphocytes/mm3. In the beige mouse model, we have shown that both azithromycin and clarithromycin prevent MAC bacteraemia following repetitive oral challenge. Clinical trials are now underway to confirm these effects in man; comparative treatments include placebo, rifabutin and an azalide/macrolide plus rifabutin. While combinations might be more effective and reduce the emergence of resistance, the spectre of cytochrome P-450 drug interactions necessitates careful study before combination prophylactic approaches are accepted. Such interactions are associated with rifabutin and some macrolides, although azithromycin may be less problematic in this respect as it appears to have little potential to interact with other antimicrobial agents.

scholarly journals Mycobacterium avium Complex-Associated Hemophagocytic Lymphohistiocytosis in a Sickle Cell Patient: An Unusual Fatal Association

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mohammed A. R. Chamsi-Pasha ◽  
M. Chadi Alraies ◽  
Abdul Hamid Alraiyes ◽  
Eric D. Hsi
Keyword(s):  
Sickle Cell ◽  
Mycobacterium Avium ◽  
Sickle Cell Anemia ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Mycobacterium Avium Complex ◽  
Sickle Cell Anemia Patient ◽  
Anemia Patient

Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory syndrome, characterized clinically by fever, splenomegaly, cytopenia, and high ferritin. Infectious causes have been associated with secondary HLH, with viruses being the most common. We report a case ofMycobacterium avium complex-associated HLH in a sickle cell anemia patient. To the best of our knowledge, this association has never been reported in sickle cell anemia.

Mycobacterium Avium Complex Presenting as Pulmonary Nodules in a Child With Sickle Cell Disease

2019 ◽  
Vol 41 (6) ◽  
pp. e409-e412 ◽  
Author(s):  
Thu Anh Pham ◽  
Linh Thuy Samuel ◽  
Cassandra Lefevre ◽  
Lea H. Mallett ◽  
Malvika Sagar
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Pulmonary Nodules ◽  
Cell Disease

Neutrophil Aging, Regulated By Microbiota-Derived Signals, Promotes Sickle Cell Vaso-Occlusion

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 324-324
Author(s):  
Dachuan Zhang ◽  
Yuya Kunisaki ◽  
Paul S. Frenette
Keyword(s):  
Sickle Cell ◽  
Aging Process ◽  
Conflicts Of Interest ◽  
Binding Capacity ◽  
Whole Body ◽  
Small Subset ◽  
Surgical Trauma ◽  
Wild Type ◽  
Dramatic Decrease

Vaso-occlusion is one of the most common complications in sickle cell disease (SCD). Our previous studies have shown that neutrophils play an important role in promoting sickle cell vaso-occlusion by capturing sickle red blood cells (sRBC) through activated αMβ2 integrin (Mac-1). However, high Mac-1 activity was only observed in a small subset of adherent neutrophils (Nat. Med. 2009;15:384). Recent studies have shown that a CD62Llow CXCR4high subset of neutrophils represents the cells that have truly aged in vivo (Cell. 2013;153:1025). Since aged neutrophils may have experienced activation signals when they survey the whole body, we hypothesized that they are over-active cells that promote sickle cell vaso-occlusion. To test this possibility, we first analyzed the correlation between CD62L expression and Mac-1 activity of adherent neutrophils using multichannel fluorescence intravital microscopy and albumin-coated fluosphere beads that specifically bind activated Mac-1. We found a strong inverse correlation where neutrophils with lower CD62L expression showed greater bead binding capacity (P < 0.001). Mice deficient in P-selectin (Selp-/-), an adhesion molecule required for neutrophil clearance from the circulation, showed a dramatic increase in the percentages of CD62Llow CXCR4high aged neutrophils (wild-type / Selp-/-: 9.0 ± 1.0% / 74.7 ± 2.1%, P < 0.01). When purified neutrophils from Selp-/- mice were transferred into wild-type recipients, these aged neutrophils exhibited significantly higher Mac-1 activity compared to those purified from wild-type animals (wild-type / Selp-/-: 0.26 ± 0.06 / 1.52 ± 0.35 beads per adherent neutrophil, P < 0.05). Since microbial products derived from the microbiota could translocate into the system and modulate the innate immunity (Nat. Rev. Microbiol. 2011;9:233), we hypothesized that microbiota-derived signals could regulate the neutrophil aging process. To test this idea, we depleted the microbiota by treating mice with ampicillin, neomycin, metronidazole and vancomycin for 4 weeks. In these mice, the numbers of CD62Llow CXCR4high aged neutrophils were significantly decreased, and this reduction was reversible by intragastric gavage of Lipopolysaccharide (LPS; Control / Antibiotics-treated (ABX) / ABX + LPS: 87.2 ± 20.3 / 12.9 ± 2.0 / 83.9 ± 60.0 cells / μL blood, P < 0.05 between first two groups). To analyze the kinetics of neutrophil aging in vivo, we transferred blood from CD45.1+ mice into CD45.2+ control or antibiotics-treated mice, and monitored the percentages of CD62Llow CXCR4high population in CD45.1+ donor neutrophils. Strikingly, the aging process of donor neutrophils was significantly slower in antibiotics-treated recipients (Control / ABX: 78.2 ± 3.4% / 45.7 ± 7.7%, 5h after transfer, P < 0.01; 95.5 ± 0.7 / 67.1 ± 7.8%, 9h after transfer, P < 0.05). Since MyD88 mediates the signaling of most toll-like receptors (TLRs), we analyzed the neutrophil aging phenotypes in LysM-Cre/MyD88-flox mice, in which MyD88 is specifically deleted in the myeloid lineage. Similarly, we observed a dramatic decrease in the numbers of aged neutrophils in these mice (wild-type / LysM-Cre/MyD88-flox: 70.1 ± 22.2 / 23.8 ± 3.7 cells / μL blood, P = 0.08), and also a significantly slower aging process when we transferred blood from LysM-Cre/MyD88-flox mice into wild-type recipients (wild-type / LysM-Cre/MyD88-flox: 15.0 ± 3.1% / 5.0 ± 1.0%, 10min after transfer, P=0.09; 49.7 ± 5.2% / 12.0 ± 1.5%, 5h after transfer, P < 0.05; 59.6 ± 2.0% / 19.5 ± 3.2%, 9h after transfer, P < 0.01). To test whether neutrophil aging was relevant in SCD, we depleted the microbiota in a humanized SCD mouse model (“Berkeley” mice). Five weeks after depletion, we observed a dramatic decrease in the numbers of aged neutrophils (Control SCD / ABX SCD: 4392 ± 574 / 819 ± 358 cells/ μL blood, P < 0.01), and a significant improvement of splenomegaly (Control SCD / ABX SCD: 691.7 ± 46.4 / 453.5 ± 28.5 mg, P<0.05). Further, preliminary data indicate that microbiota depletion could protect against vaso-occlusive crisis induced by TNF-α and surgical trauma, leading to prolonged survival. Taken together, these data suggest that aged neutrophils, modulated by microbiota-derived signals, represent an over-active subset of neutrophils that promotes sickle cell vaso-occlusion. Gaining understanding of neutrophil aging may lead to novel ways to control the manifestations of the disease and its complications. Disclosures: No relevant conflicts of interest to declare.

Mycobacterium avium Complex (MAC)

2010 ◽  
pp. 703-715
Author(s):  
Edward C. Rosenow
Keyword(s):  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Mycobacterium Avium Intracellulare

• M avium and M intracellulare are genetically so similar that they are considered the same organism (ie, MAC [M avium complex, formerly Mycobacterium avium-intracellulare, or MAIC]) • MAC is most common mycobacterial organism cultured and one of most common of all organisms cultured •...

scholarly journals Disseminated Mycobacterium Avium Complex infection in Acquired Immunedeficiency Syndrome patient

2017 ◽  
Vol 4 (2) ◽  
pp. 42
Author(s):  
Pradeep Kumar Kumar Mada ◽  
Smitha Maruvada ◽  
Andrew Stevenson Joel Chandranesan
Keyword(s):  
Mycobacterium Avium ◽  
Highly Active Antiretroviral Therapy ◽  
Mycobacterium Avium Complex ◽  
The United States ◽  
Mycobacterium Abscessus ◽  
Highly Active ◽  
Compliant Patient ◽  
Immunodeficiency Virus ◽  
Mycobacterium Avium Intracellulare ◽  
One Year

In the United States, the most common non-tuberculous species causing human diseases are slowly growing species; Mycobacterium avium complex (MAC) and Mycobacterium kansasii and rapidly growing species; Mycobacterium abscessus. With the advent of highly active antiretroviral therapy and MAC prophylaxis, disseminated MAC disease is seen infrequently. We report a case of 33-Year-old HIV (Human Immunodeficiency Virus), non-compliant patient presented with disseminated MAC disease. Sputum AFB smear, culture, and Bone marrow biopsy revealed Mycobacterium Avium Intracellulare by DNA (Deoxyribonucleic acid) probe. Following confirmation, he was initiated on Clarithromycin, Ethambutol and Rifabutin for one year of duration with follow up as outpatient.

scholarly journals Mycobacterium Avium Complex Genitourinary Infections: Case Report and Literature Review

2021 ◽  
Vol 13 (2) ◽  
pp. 454-464
Author(s):  
Sanu Rajendraprasad ◽  
Christopher Destache ◽  
David Quimby
Keyword(s):  
Case Report ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Treatment Guidelines ◽  
Controlled Trials ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Randomized Controlled ◽  
Mycobacterium Avium Intracellulare ◽  
Genitourinary Infections

Nontuberculous mycobacterial (NTM) genitourinary (GU) infections are relatively rare, and there is frequently a delay in diagnosis. Mycobacterium avium-intracellulare complex (MAC) cases seem to be less frequent than other NTM as a cause of these infections. In addition, there are no set treatment guidelines for these organisms in the GU tract. Given the limitations of data this review summarizes a case presentation of this infection and the literature available on the topic. Many different antimicrobial regimens and durations have been used in the published literature. While the infrequency of these infections suggests that there will not be randomized controlled trials to determine optimal therapy, our case suggests that a brief course of amikacin may play a useful role in those who cannot tolerate other antibiotics.

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