WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
Sharma et al.
World Journal of Pharmacy and Pharmaceutical Sciences
Volume 3, Issue 4, 1520-1524.
Research Article
ISSN 2278 – 4357
TWO CASES OF MYCOBACTERIUM FORTUITUM REPORTED AT TERTIARY CARE CENTER FROM NAVI MUMBAI, MAHARASHTRA, INDIA. Bhattacharjee Minakshi 1,2, Sharma Revati*1, Kar Harapriya2 1
MGM Central Research Laboratory, MGM Medical College and Hospital, Kamothe, Navi Mumbai 410209.
2
Department of Microbiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai 410209. ABSTRACT
Article Received on 02 March 2014,
Mycobacterium fortuitum has been implicated in surgical site infection,
Revised on 19 March 2014, Accepted on 8 April 2014
implanted device associated infections and injection site abscesses. Two cases of Mycobacterium fortuitum infections one with post operative umbilical hernia abscess and other with inguinal swelling
*Correspondence for Author Dr. Revati Sharma
and abscess are described as per our knowledge for the first time from
MGM Central Research
Navi Mumbai, Maharashtra.
Laboratory, MGM Medical
Key Words:
College and Hospital,
operative, Trauma.
Mycobacterium fortuitum, Real time PCR, Post
Kamothe, Navi Mumbai 410209.
INTRODUCTION Outbreaks and cases of health care associated infections caused by
[email protected]
atypical Mycobacteria have been reported now and then since the first case was described in 1938.
[1]
Atypical Mycobacteria, common environmental inhabitants have been known to
easily contaminate solutions and disinfectants under appropriate circumstances and cause diseases. These saprophytes have increasingly being found to be associated with nosocomial infections establishing themselves as opportunistic and deadly pathogens at times as well.[2] About a one third of the Non-tuberculous mycobacteria species identified are found to be associated with human diseases.
[2]
Surgical site infection, implanted device associated
infections, injection site abscesses are some of the often encountered complications.
[3]
The
current case report addresses two incidences of Mycobacterium fortuitum infections in a tertiary care center of Navi Mumbai, Maharashtra.
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Case1 A 49year old hypertensive male with diabetes type II visited the surgery out patient department of the tertiary care center. He did not undergo surgery in the center but came in for the post operative complications. The healing stitch site was infected with fluid oozing out of it. Aspirated fluid from non healing wound was received in the Central Research Laboratory for TB PCR in June 2013. DNA was extracted using spin columns from Quiagen according to the manufacturers insert. Real time PCR (LC480, Light cycler II) was performed on the extracted DNA by three color hydrolysis probe format. The channels selected were FAM(465-510), VIC/HEX(533-580), Cy5(618-660). Amplification was observed only in Cy5 channel which can be interpreted as Mycobacterium other than Tubercle bacilli (MOTT). The PCR positive (MOTT) sample was further subjected to culture for identification upto the species level. After the growth was observed, Ziehl Neelsen stain of the secondary smear was performed and biochemically identified as Mycobacterium fortuitum. Case2 A 16 years old female came to the out patient department of surgery with painless inguinal swelling. She complained of pain since six months and on and off low grade fever. She had no history of weight loss. An aspirate from the mass was received in the Central Research Laboratory for TB PCR in December 2013. The sample was processed as in case 1. The real Time PCR showed amplification in both FAM and CY5 channels in this case indicating the presence of MOTT. The Lowenstein Jensen media showed growth in two to four days. Smear of the isolate was found to be positive for Acid Fast Bacilli. The isolate which was presumed to be rapidly growing Mycobacterium by its rate of growth was confirmed to be Mycobacterium fortuitum with the help of traditional biochemical methods.
Image1: Ziehl Neelsen Staining of the Colonies. www.wjpps.com
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Image2: Growth after four days on Lowenstein Jensen medium.
Image3: Real Time PCR Amplification Curve for MOTT DISCUSSION Non-tuberculous mycobacteria (NTM) has always been ubiquitously present in the environment, but the incidence of their colonization and causing disease in humans is not yet completely understood.
[2,4]
Reports of NTM causing infection after trauma or undergoing
surgery, liposuction, silicon injection, pedicures and subcutaneous injections has been seen over the last few years. [5,6,7,8,9,10,11] NTM in health care facilities are seen more, probably due to inadequate temperature of sterilization or concentration of sterilization agents. They can make their way into the wound site through water, dressing matter, hospital instruments, or any other like source harboring them. [12] In almost all cases of nosocomial infections caused by NTM, poor sterilization process of solutions, surgical instruments and medical devices were found to be the causative factors. [12] Mycobacterium fortuitum-chelonei complex categorized as Rapid Growers, group IV of Runyon’s classification, though commonly associated with cutaneous diseases, disseminated infections are seen as well. [13] www.wjpps.com
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Few cases of Mycobacterium fortuitum infection are reported from India due to lack of suspicion of its presence among clinicians and microbiologists. [5,13,14,15] Any non healing or delayed healing wound not responding to antibiotics for acute pyogenic infection should consider of NTM, both from diagnostic and therapeutic point of views. Timely and efficient management of patients could be sought by high index of clinical suspicion followed by microbiological evaluation. REFERENCES 1. Da Costa Cruz JC. Mycobacterium fortuitum. um novo bacilo acidoresistente pathogenic para o homem. Acta.Med (Rio de Janeiro) 1938; 1:298-301. 2. Katoch VM. Infections due to non-tuberculous mycobacteria (NTM). Indian J Med Res Oct 2004;120(4):290-304. 3. Lahiri KK, Jena J, Pannicker KK. Mycobacterium fortuitum Infections in Surgical Wounds. MJAFI 2009;65:91-92. 4. Sethi NK, Aggarwal PK, Duggal L, Sachar VP.Mycobacterium chelonae infection following laparoscopic inguinal herniorrhaphy. JAPI 2003;51 :81-82. 5. Kalita JB, Rahman H, Baruah KC. Delayed post-operative wound infections due to nontuberculous Mycobacterium. Indian J Med Res 2005;535-9. 6. Rodrigues C, Mehta A, Jha U, Bharucha M, Dastur FD, Udwadia TE. Nosocomial M chelonae infection in laproscopic surgery. Infect Control Hosp Epidemol 2001;22:474-5. 7. Rajini M, Prasad SR, Reddy RR, Bhat RV, Vimala KR. Postoperative infection of laparoscopic surgery wound infection due to Mycobacterium chelonae . Indian J Med Microbiol 2007;25:163-5. 8. Behroozan DS, Christian MM, Moy RL. Mycobacterium fortuitum infection following neck liposuction: A case report. Dermatol Surg 2000;26:588-90. 9. Fox LP, Geyer AS, Husain S, Della-Latta P, Grossman ME. Mycobacterium abscessus cellulites and multifocal abscesses of the breasts in a transsexual from illicit intramammary injection of silicon. J Am Acad Dermatol 2004;50:450-54. 10. Winthrop KL, Albridge K, South D, Albrecht M, Abrams M, Samuel MC, et al . The clinical management and outcome of nail salon-acquired Mycobacterium fortuitum skin infection . Clin Infect Dis 2004;38:38-44. 11. Devi DR, Indumathi VA, Indira S, Babu PR, Sridharan D, Belwadi MR. Injection site abscess due to Mycobacterium fortuitum : A case report. Indian J Med Microbiol 2003;21:133-4.
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12. Michael SP, Fordham C. Nosocomial Infection due to Nontuberculous Mycobacteria. Clinical Infectious Diseases 2001;33:1363-74. 13. Gayathri Devi DR, Sridaran D, Indumathi VA, Babu PRS, Belwadi SM, Swamy ACV. Isolation of Mycobacterium chelonae from wound infection following laparoscopy: A case report. Indian J Tuberc 2004; 51:149-51. 14. Unni M, Jesudason MV, Rao S, George B.Mycobacterium fortuitum bacteraemia in an immunocompromised patient. Indian J Med Microbiol 2005;23:137-8. 15. Muthuswami JC, Vyas FL, Mukundan U, Jesudasan MV, Govil S, Jesudasan. Mycobacterium fortuitum:an iatrogenic cause of soft tissue infection in surgery.ANZ J Surg 2004;74-6.
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