Mycobacterium abscessus Complex Infections in Humans - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

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Mycobacterium abscessus Complex Infections in Humans - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015

CME ACTIVITY - Synopsis

Mycobacterium abscessus Complex Infections in Humans

On This Page

• Medscape CME Activity
• Search Strategy and Selection Criteria
• Taxonomy and Epidemiology
• Disease Burden
• Clinical Diseases
• Nosocomial Outbreaks and Transmission
• Antimycobacterial Susceptibilities
• Treatment
• Prevention
• Conclusions
• Suggested Citation

Figures

• Figure 1
• Figure 2
• Figure 3
• Figure 4
• Figure 5

Tables

• Table 1
• Table 2

Downloads

• PDF [1.25 MB - 9 pgs]
• RIS [TXT - 2 KB]

Meng-Rui Lee, Wang-Huei Sheng, Chien-Ching Hung, Chong-Jen Yu, Li-Na Lee, and Po-Ren Hsueh 

Author affiliations: National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (M.-R. Lee, W.-H. Sheng, C.-C. Hung, C.-J. Yu, L.-N. Lee, P.-R. Hsueh); National Taiwan University Hospital, Taipei, Taiwan (M.-R. Lee, W.-H. Sheng, C.-C. Hung, C.-J. Yu, L.-N. Lee, P.-R. Hsueh)

Suggested citation for this article

Abstract

Mycobacterium abscessus complex comprises a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria that are responsible for a wide spectrum of skin and soft tissue diseases, central nervous system infections, bacteremia, and ocular and other infections. M. abscessus complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. The 2 major subspecies, M. abscessus subsp. abscessus and M. abscessus subsp.massiliense, have different erm(41) gene patterns. This gene provides intrinsic resistance to macrolides, so the different patterns lead to different treatment outcomes. M. abscessus complex outbreaks associated with cosmetic procedures and nosocomial transmissions are not uncommon. Clarithromycin, amikacin, and cefoxitin are the current antimicrobial drugs of choice for treatment. However, new treatment regimens are urgently needed, as are rapid and inexpensive identification methods and measures to contain nosocomial transmission and outbreaks.

Mycobacteria are divided into 2 major groups for the purpose of diagnosis and treatment: Mycobacterium tuberculosis complex, which comprises M. tuberculosis, and nontuberculous mycobacteria (NTM), which comprise all of the other mycobacteria species that do not cause tuberculosis. NTM can cause pulmonary disease resembling tuberculosis, skin and soft tissue infections (SSTIs), central nervous system infections, bacteremia, and ocular and other infections (1,2). Over the past decade, the number of NTM disease cases worldwide has markedly increased (3,4), and the upsurge cannot be explained solely by increased awareness among physicians and advances in laboratory methods (3).

M. abscessus complex is a group of rapidly growing, multidrug-resistant NTM species that are ubiquitous in soil and water (1). Species comprising M. avium complex (MAC) are the most common NTM species responsible for disease; however, infections caused by M. abscessus complex are more difficult to treat because of antimicrobial drug resistance (5). M. abscessus complex is also resistant to disinfectants and, therefore, can cause postsurgical and postprocedural infections (2,5). Although M. abscessus complex most commonly causes SSTIs and pulmonary infections, the complex can also cause disease in almost all human organs (2,5). To improve our understanding ofM. abscessus complex infections, we reviewed the epidemiology and clinical features of and treatment and prevention measure for diseases caused by the organisms as well as the taxonomy and antimicrobial susceptibilities of these organisms.

Dr. Lee is attending physician at the Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. His primary research interests include emerging infections and epidemiologic and clinical research on diseases caused by nontuberculous mycobacteria.

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Figures

• Figure 1. Serial changes in the nomenclature and taxonomic classification of Mycobacterium abscessus complex, 1992–2013.
• Figure 2. Spectrum of Mycobacterium abscessus subsp. abscessus and M. abscessus subsp. massiliense created by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Biotyper system (Microflex LT; Bruker Daltonik GmbH, Bremen, Germany). The...
• Figure 3. Chest radiograph (A) and computed tomography scan (B) images for a patient with pulmonary disease due to Mycobacterium abscessussubsp. abscessus. A) The arrow indicates a cavity with surrounding...
• Figure 4. Skin lesions caused by Mycobacterium abscessus subsp. abscessus. A) Diffuse erythematous papular eruptions on the face and bilateral cervical lymphadenitis in a middle-aged man. B) A circumscribed subcutaneous nodule...
• Figure 5. Brain computed tomography scan images for a patient with central nervous system infection caused by Mycobacterium abscessus subsp.bolletii. Arrows indicate abnormal nodular pachymeningeal thickening and leptomeningeal and intraparenchymal...

Tables

• Table 1. Summary of recent data on the resistance of Mycobacterium abscessus complex bacteria to different antimicrobial agents
• Table 2. Summary of recommendations from previous studies for the treatment of Mycobacterium abscessus complex infections in humans

Suggested citation for this article: Lee MR, Sheng WH, Hung CC, Yu CJ, Lee LN, Hsueh PR. Mycobacterium abscessus complex infections in humans. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.141634

DOI: 10.3201/eid2109.141634