Tattoo-Associated Cutaneous Mycobacterium mageritense Infection: A Case Report and Brief Review of the Literature

There have been increasing reports of tattoo-associated mycobacterial infections in recent years, with a number of outbreaks documented worldwide. This has therefore become a public health concern. Nontuberculous mycobacteria (NTM) are capable of producing skin and soft tissue infections typically via inoculation during surgery, trauma, and cosmetic procedures. We present a case of tattoo-associated cutaneous infection caused by <i>Mycobacterium mageritense</i>, a rare species of rapidly growing NTM. A 25-year-old man developed a rash on his left lower leg 4 weeks after he underwent professional tattooing. A skin swab identified <i>M</i>. <i>mageritense</i> complex. Based on susceptibility testing, a course of oral ciprofloxacin and trimethoprim/sulfamethoxazole was initiated, with significant improvement observed after 5 weeks. We speculate that the mechanism of inoculation was a result of either the artist using nonsterile water to dilute black ink to gray or from use of contaminated prediluted gray ink. The Therapeutic Goods Administration does not have regulatory authority over the sterility of tattoo inks or practices in Australia. Instead, tattoo practices are regulated by local government jurisdictions. Because of the variability seen in clinical presentation and challenges associated with organism identification, a high index of suspicion is required to diagnose mycobacterial infections. Infection caused by NTM should be considered in the differential diagnosis of tattoo-associated dermatological complications, particularly in patients who have chronic lesions, negative bacterial cultures, and fail to respond to standard antibiotic therapy. Mandatory regulations for safe tattoo practices should be considered to prevent outbreaks and ensure public safety.

Myrtus Communis Leaf Extract - A Source of Secondary Metabolites Exhibiting Anticancer and Antimycobacterial Activities

Background: Plant-derived products or extracts are widely used in folk/traditional medicine to treat several, infections, ailments, or disorders. A notable therapeutic herb Myrtus communis, worldwide utilized in the traditional medication for centuries, is an evergreen aromatic and medicinal plant of the Mediterranean region. Materials and methods: The SulphoRhodamine-B assay and DNA flow cytometry were used to investigate the proliferation and subsequent distribution of cells among different phases of the cell cycle. Annexin V-FITC/PI staining coupled with flow cytometry was used to analyze apoptosis and necrosis of the cancer cells. Western blotting detected the expression of pro- and anti-apoptotic proteins. Zone of inhibition and MIC were determined by well diffusion method and microplate alamar blue assay, respectively. Biofilm formation was studied by crystal violet method. For statistical analysis, a two-tailed Student’s t-test of GraphPad Prism 6.0 was used.Results: In this study, the secondary metabolites of M. communis leaves extracted in ethanol showed the highest cytotoxicity and thus the greatest anticancer effects against diverse cancer cell lines of the breast (MCF-7), liver (HepG2), cervix (HeLa), and colon (HCT116) (IC50; ranging from 33 to 83 mg/ml). The cancer cells arrested in the G1 phase of the cell cycle undergo apoptosis. The induction of the latter is mediated by activation of the intrinsic mitochondrial pathway. Furthermore, the extract showed a strong growth inhibitory effect (zone of inhibition; 20.3±1.1 - 26.3±2.5 mm, MIC; 4.88 - 312.5 µg/ml, and MBC; 39.07 - 1250 μg/ml) against several rapid and slow-growing mycobacterial strains that cause tuberculosis and several other mycobacterial infections. The biofilm formation in BSL2 microorganisms, M. smegmatis and S. aureus, is strongly inhibited by the extract. Conclusion: These results suggest that M. communis leaf extract is a potential source of secondary metabolites, which could be developed further as potential anti-cancer and anti-mycobacterial agents to treat diverse types of cancers and mycobacterial infections.

Structure of Mycobacterium tuberculosis cytochrome bcc in complex with Q203 and TB47, two anti-TB drug candidates

Pathogenic mycobacteria pose a sustained threat to global human health. Recently, cytochrome bcc complexes have gained interest as targets for antibiotic drug development. However, there is currently no structural information for the cytochrome bcc complex from these pathogenic mycobacteria. Here, we report the structures of Mycobacterium tuberculosis cytochrome bcc alone (2.68 Å resolution) and in complex with clinical drug candidates Q203 (2.67 Å resolution) and TB47 (2.93 Å resolution) determined by single-particle cryo-electron microscopy. M. tuberculosis cytochrome bcc forms a dimeric assembly with endogenous menaquinone/menaquinol bound at the quinone/quinol-binding pockets. We observe Q203 and TB47 bound at the quinol-binding site and stabilized by hydrogen bonds with the side chains of QcrBThr313 and QcrBGlu314, residues that are conserved across pathogenic mycobacteria. These high-resolution images provide a basis for the design of new mycobacterial cytochrome bcc inhibitors that could be developed into broad-spectrum drugs to treat mycobacterial infections.

Application of Bacteriophages for Mycobacterial Infections, from Diagnosis to Treatment

Mycobacterium tuberculosis and other non-tuberculous mycobacteria are responsible for a variety of different infections affecting millions of patients worldwide. Their diagnosis is often problematic and delayed until late in the course of disease, requiring a high index of suspicion and the combined efforts of clinical and laboratory colleagues. Molecular methods, such as PCR platforms, are available, but expensive, and with limited sensitivity in the case of paucibacillary disease. Treatment of mycobacterial infections is also challenging, typically requiring months of multiple and combined antibiotics, with associated side effects and toxicities. The presence of innate and acquired drug resistance further complicates the picture, with dramatic cases without effective treatment options. Bacteriophages (viruses that infect bacteria) have been used for decades in Eastern Europe for the treatment of common bacterial infections, but there is limited clinical experience of their use in mycobacterial infections. More recently, bacteriophages’ clinical utility has been re-visited and their use has been successfully demonstrated both as diagnostic and treatment options. This review will focus specifically on how mycobacteriophages have been used recently in the diagnosis and treatment of different mycobacterial infections, as potential emerging technologies, and as an alternative treatment option.

Coinfection of Mycobacterial diseases

Although both mycobacterial infections are endemic in developing countries, the coinfection has hardly been reported in the last decade. The combined National TB & Leprosy Control Programme of Bangladesh came into effect in 1994. Though the Elimination of Leprosy (<1 case / 10,000 population) was achieved nationally in 1998, Bangladesh is still endemic for Tuberculosis. A 10 years cohort study was conducted in six districts of the Northern part of Bangladesh, covered by the Damien Foundation. This cohort consisted of a total of 4,788 leprosy cases registered from 2007 to 2016. Reviewing the records of all these cases, 25 (0.52%) patients were identified as having coinfection with Tuberculosis & Leprosy. All cases were coinfected with smear positive pulmonary TB. This study concludes that duel infection with mycobacteria is uncommon. Early diagnosis is very important for better outcomes of both diseases. CBMJ 2020 July: Vol. 09 No. 02 P: 39-41