Mycobacterium chimaera: Difference between revisions
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Mycobacterium chimaera
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==Background== |
==Background== |
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===Microbiology=== |
===Microbiology=== |
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| − | * |
+ | *A member of the [[Mycobacterium avium complex]] |
===Epidemiology=== |
===Epidemiology=== |
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| − | * |
+ | *A global outbreak of ''Mycobacterium chimaera'' infections was associated with point-source contamination of Stöckert 3T-HCD heater-cooler units (HCUs) used in cardiac bypass |
| − | * |
+ | *Higher rates in mainland Europe, followed by UK, followed by North America |
===Pathophysiology=== |
===Pathophysiology=== |
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| − | * |
+ | *The HCUs aerosolized mycobacteria into the surgical field |
==Clinical Manifestations== |
==Clinical Manifestations== |
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| − | * |
+ | *Median incubation period was [[Usual incubation period::14.5 months]] (range [[Incubation period range::6 weeks to 5 years]]), with 80% of patients becoming unwell during the first two years |
| − | * |
+ | *Duration of symptoms median 7 weeks but up to 1 year |
| − | * |
+ | *Most commonly presented with unexplained fever |
| − | * |
+ | *Constitutional symptoms are common |
| − | * |
+ | *Caused prosthetic valve endocarditis, aortic graft infection, surgical site infections, and disseminated disease affecting liver, spleen, bone marrow, spine, skin, and bone |
| − | * |
+ | *Lymphopenia and thrombocytopenia are common, as is elevated ALP |
==Diagnosis== |
==Diagnosis== |
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| − | * |
+ | *Culture in general has sensitivity of 68% but increases to essentially 100% with two cultures |
| − | ** |
+ | **Blood, urine, sputum, tissue, et cetera |
| − | * |
+ | *Two blood cultures are about 76% sensitive |
==Management== |
==Management== |
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| − | * |
+ | *No specific guidelines exist for treatment |
| − | * |
+ | *Typically use a MAC regimen with [[Is treated by::azithromycin]], [[Is treated by::ethambutol]], and [[Is treated by::rifampin]] |
| − | * |
+ | *May need additional aminoglycoside such as [[Is treaed by::amikacin]] for severe disease |
| − | * |
+ | *Duration unclear, but at least several months |
==Prognosis== |
==Prognosis== |
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| − | * |
+ | *Poor prognosis, with median survival of 30 months from initial surgery and 9 months from start of therapy |
==Further Reading== |
==Further Reading== |
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+ | *''Mycobacterium chimaera'' infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. ''Clin Microbiol Infect''. 2018. doi: [https://doi.org/10.1016/j.cmi.2018.04.027 10.1016/j.cmi.2018.04.027] |
{{DISPLAYTITLE:''Mycobacterium chimaera''}} |
{{DISPLAYTITLE:''Mycobacterium chimaera''}} |
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| − | [[Category: |
+ | [[Category:Non-tuberculous mycobacteria]] |
Latest revision as of 20:15, 7 September 2020
Background
Microbiology
- A member of the Mycobacterium avium complex
Epidemiology
- A global outbreak of Mycobacterium chimaera infections was associated with point-source contamination of Stöckert 3T-HCD heater-cooler units (HCUs) used in cardiac bypass
- Higher rates in mainland Europe, followed by UK, followed by North America
Pathophysiology
- The HCUs aerosolized mycobacteria into the surgical field
Clinical Manifestations
- Median incubation period was 14.5 months (range 6 weeks to 5 years), with 80% of patients becoming unwell during the first two years
- Duration of symptoms median 7 weeks but up to 1 year
- Most commonly presented with unexplained fever
- Constitutional symptoms are common
- Caused prosthetic valve endocarditis, aortic graft infection, surgical site infections, and disseminated disease affecting liver, spleen, bone marrow, spine, skin, and bone
- Lymphopenia and thrombocytopenia are common, as is elevated ALP
Diagnosis
- Culture in general has sensitivity of 68% but increases to essentially 100% with two cultures
- Blood, urine, sputum, tissue, et cetera
- Two blood cultures are about 76% sensitive
Management
- No specific guidelines exist for treatment
- Typically use a MAC regimen with azithromycin, ethambutol, and rifampin
- May need additional aminoglycoside such as amikacin for severe disease
- Duration unclear, but at least several months
Prognosis
- Poor prognosis, with median survival of 30 months from initial surgery and 9 months from start of therapy
Further Reading
- Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases. Clin Microbiol Infect. 2018. doi: 10.1016/j.cmi.2018.04.027
