Volume 17, Number 3—March 2011
Research
Mycobacterium lentiflavum in Drinking Water Supplies, Australia
Table A1
Type of infection and reference† | Patient age/sex | Country | Organ/tissue involved | Immunocompromised | Concurrent conditions | Treatment | Outcome |
---|---|---|---|---|---|---|---|
Soft tissue/skin | |||||||
(1) | 85 y/F | Germany | 5-mo history thoracic discitis T9, T10. Biopsy showed granulomata, C+ after 22 d | No | Diabetes mellitus, congestive heart failure | [INH, RMP, PZA] 3 mo, then [INH/RMP] 6 mo | Marked symptomatic improvement at 2 mo |
(11) | 52 y/F | Spain | Arthritis, skin lesions, synovial fluid was sterile; synovial biopsy found granulomata, ZN+, C+ after 4 wk. | Yes, GC, cyclophosphamide | Antisynthetase syndrome | [INH, RMP, EMB, PZA] then [fusidic acid, LFX, CLR] for 1 wk before death | Condition worsened with weight loss, synovitis. Died after 4 mo |
(12) |
48 y/M |
Spain |
2 skin ulcers, 2-y history. Biopsy ZN+, C+ |
Yes |
HIV for 15 yr, CD4+ 46, IVDU |
[Highly active antiretroviral therapy, INH, EMB, LFX] |
Lost to follow-up |
Cervical lymphadenitis | |||||||
(13) | 42 mo/M | Germany | 10-d history, ZN+, C+, granulomata present | No | No | Excision | Well at 18 mo |
(13) | 33 mo/M | Germany | 14-d history. ZN–, C+, granulomata present | No | No | Excision | Well at 18 mo |
(14) | 4 y/F | Italy | 15-d history, biopsy scanty ZN+, C+ | No | No | [INH, RMP] duration NS; excision | Well at 2 y |
(15) | 19 mo/M | Spain | 10-d history, ZN+, C+, granulomata present | No | Asthma | [INH, RMP, PZA] duration NS; then excision | Recovered fully |
(16) | 4 y/M | Italy | No details | No | No | Excision | Well at 1 y |
(17) | 45 y/F | Italy | 4-wk history. ZN–, C+ at 10 d, granulomata present | No | Severe periodontal disease | Excision | Well at 18 mo |
(18) | 18 mo/M | Italy | 4-wk history. ZN+, C+ after 3 wk; recurrent lymphadenopathy at 3 mo in same position showed granulomata | No | No | Excision | Recurrent lymphadenopathy after 3 mo treated with excision |
Queensland§ |
20 mo/F |
Australia |
4-wk history, biopsy ZN–, granulomata present, C+ |
No |
No |
Excision |
Full recovery |
Pulmonary | |||||||
(14) | 58 y/M | Italy | Left upper lobe pulmonary infiltrates, pleural effusion, low-grade fever, weight loss. Pleural fluid and sputum C–; pleural biopsy showed granulomata, ZN–, C+ after 3 wk | Yes(rheumatoid arthritis) | Rheumatoid arthritis | [INH, RFB, EMB, PZA] | Stable at 4 mo. No improvement in computed tomography thorax appearance |
(16) | 61 y/F | Italy | Cough, fever, weight loss, right upper lobe nodular pulmonary infiltrates and adenopathy. Sputum ZN+, C+ | No | Bronchiectasis since age 30 y | [RMP, INH, PZA] for “several months,” then [RFB, EMB, CLR, CIP] | 5-y follow-up, sputum intermittently ZN+, C+; no improvement in radiology |
(19) | 71 y/M | Japan | Hemoptysis, bilateral pulmonary infiltrates, cavities right upper lobe. Sputum ZN+, C+ after 35 d(multiple specimens) | No | 2-y treatment for pulmonary TB aged 30 y; smoker | [RMP, EMB, INH, PZA] 1 y, CLR also added, duration NS | 3-y follow-up, sputum remained ZN+, C+, symptoms continued, CXR slowly progressed |
(20)(case 6) | 35 y/F | Zambia | 4-wk history of cough, pleural effusion fluid C+. | No | No | [RMP, INH, PZA, EMB] duration NS | Improved. Duration of follow-up NS |
(21) | 67 y/F | Italy | Hemoptysis, low-grade fever, weight loss. Sputum ZN+, C+ | No | Previous pulmonary TB, with fibrosis right upper lobe, chronic obstructive pulmonary disease | [INH, PZA, EMB, RMP] 3 mo: no effect: ceased. 2 y later, started CLR monotherapy, improved by 3 mo, but sputum still ZN+ [EMB, RFB, CIP] added for 2 wk | 3-y follow-up. Poor compliance with drugs, intermittent hemoptysis, weakness, dyspnoea, sputum remained ZN+, CXR unchanged |
(22) | 49 y/M | United States | Fever, right upper lobe pulmonary noncavitary nodules, 2×/ sputum C+ at 27 d, bronchoalveolar lavage C– | Yes | Myelofibrosis on pegylated interferon-α2 | [CIP 500 mg 2×/day, azithromycin 500 od, EMB 1 g od] unknown duration | Stable disease, lost to follow up; duration of follow-up NS |
(22)¶ | 66 y/M | United States | Fever, neutropenia, necrotizing pneumonia, single sputum C+ at 28 d | Yes | Hematopoetic stem cell transplant for chronic lymphocytic leukemia, graft vs. host disease | [CLR 500 mg 2×/day, EMB 1 g od] | Died after 12 wk, septic shock from Pseudomonas aeruginosa. Uncertain significance of M. lentiflavum |
(23)¶ | 28 y/M | Brazil | Cough, fever, reticulonodular infiltrate, PCP+, 1× sputum C–. 3 wk later high fever returned – 1× blood C+ | Yes | Newly diagnosed HIV, PCP | [Streptomycin] duration NS(? 1 mo) GC, sulphamethoxazole–trimethoprim, zidovudine, didanosine | Died a few mos later, no further clinical details |
(23)¶ | 64 y/F | Brazil | Pulmonary cavities, treated for ZN+ pulmonary tuberculosis for 6 y | Yes | Chronic pulmonary tuberculosis | Various including CLR, EMB, clofazimine, RMP and doxycycline. No details given. | Sputum persistently C+: 12/15 sputum samples grew M. avium complex, 2 grew M. lentiflavum. Died of uterine cancer |
(18) | 14 y/M | Italy | Fever, chest pain, pleural effusion, pneumothorax, multiple right upper lobe and right middle lobe nodules. Pleural fluid ZN+, C+ at 4 wk | Yes | Acute lymphoblastic leukemia, chemotherapy | [CLR, amikacin, ceftriaxone] 5 mo | Improved, CXR almost returned to normal |
(18) | 87 y/M | Italy | Bilateral pleural thickening, left pleural effusion, pulmonary opacities, pleural fluid ZN–, C+ at 3 wk | No | No | [LFX] monotherapy for 3 wk, then [CLR, LFX, RFB] | After 1 mo, pulmonary opacities resolved, effusion remained |
(24)(case 2) | 23 y/M | Greece | Pleural effusion, sputum C+ | NS | NS | [INH, RMP, PZA, EMB] duration NS(? 6 mo) | Recovered |
Queensland§ | 85 y/F | Australia | Cough, pulmonary nodules, mild bronchiectasis, bronchial washings ZN–, C+ | No | No | [EMB 800 mg, RMP 450 mg, CLR 500 mg 2×/day] | Stable at 7 mo |
Queensland§ |
49 y/F |
Australia |
Hemoptysis, bronchiectasis, bronchial washings ZN–, C+ |
No |
No |
No specific treatment given |
Currently well, stable CXR at 11 y |
Disseminated | |||||||
(25) | 49 y/M | France | Fever, pulmonary infiltrates, 3× blood culture and bronchoalveolar lavage C+ after 4 wk | Yes | HIV for 7 y | [CLR, RFB, EMB] and antiretroviral drugs, at least 4-mo treatment, probably 9 mo | Fully recovered, died 3 y later of heart failure |
(16)¶ | 45 y/M | Italy | Basal pulmonary infiltrate, T4 vertebra involvement, hepatic lesion. Empiric treatment given with clinical improvement. Liver biopsy C+, no other samples reported | Yes | HIV, non-Hodgkin lymphoma | [Antiretrovirals, RFB, CLR], then [RFB, CIP, EMB, CLR] then [RFB, CLR] | Well at 1 y. Hepatic lesion aspirated C+ but continued to grow; was later excised and proven to be non-Hodgkin lymphoma |
(20)(case 1) | 67 y/F | Zambia | 8-wk duration hepatosplenomegaly, axillary lymphadenopathy; lymph node biopsy ZN+, C+; 2× Sputum C+ | No | No | No treatment given | NS |
Queensland§ | 43 y/F | Australia | 4x blood cultures C+ after 15 d, 1x bone marrow ZN–, granulomata present, C+; hepatosplenomegaly, pulmonary nodules | Yes | HIV, hepatitis C, IVDU, systemic lupus erythematosus | [INH 300 mg, EMB 400 mg 2×/day, CLR 500 mg 2×/day] with reducing course of prednisone | Compliant with treatment, improving at 12 mo |
*C+, culture positive; INH, isoniazid; RMP, rifampicin; PZA, pyrazinamide; ZN+, Ziehl-Neelsen smear stain–positive; GC, glucocorticoids; EMB, ethambutol; LFX, levofloxacin; CLR clarithromycin; IVDU, intravenous drug user; ZN–, Ziehl-Neelsen smear stain–negative; NS information not stated or unknown; RFB, rifabutin; right upper lobe; CIP, ciprofloxacin; TB, tuberculosis; CXR, chest radiograph; C–, culture negative; PCP, Pneumocystis pneumonia.
†Excluded are 2 cases from articles written in Spanish(26,27).
‡Brackets indicate antimicrobial drugs used together as a single regimen.
§Cases reported in this article.
¶Not definite cases of disease.
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