Robert C. Good

Mycobacterium avium-intracellulare: A Cause of Disseminated Life-Threatening Infection in Homosexuals and Drug Abusers

Five men developed disseminated infection with Mycobacterium avium-intracellulare. These patients all lived in the New York City area and presented with their illnesses between January 1981 and September 1981; four were homosexual and one was an intravenous drug abuser. Four patients died. All five patients had defects in the cell-mediated immune response. The infections were characterized histopathologically by poor or absent granulomatous tissue reaction. Clinical isolates of M. avium-intracellulare from all five patients agglutinated commonly used antimycobacterial drugs. The spectrum of opportunistic infections among populations of homosexuals and drug abusers should be expanded to include disseminated disease due to M. avium-intracellulare.

Sternal wound infections and endocarditis due to organisms of the Mycobacterium fortuitum complex

Excerpt Sternal wound infections after surgery occur in 0.5% to 6% of all patients requiring sternotomy incisions (1-4). Most infections have been due to staphylococci and aerobic gram-negative org...

A nosocomial pseudo-outbreak of Mycobacterium xenopi due to a contaminated potable water supply: lessons in prevention.

OBJECTIVES To determine risk factors for Mycobacterium xenopi isolation in patients following a pseudo-outbreak of infection with the organism. DESIGN Retrospective cohort analysis of mycobacteriology laboratory specimen records and frequency-matched case-control study of hospital patients. SETTING General community hospital. PATIENTS For the case-control study, 13 case patients and 39 randomly selected controls with mycobacterial cultures negative for M xenopi, frequency matched by specimen source, whose specimens were submitted from June 1990 through June 1991. RESULTS Between June 1990 and June 1991, M xenopi was isolated from 13 clinical specimens processed at a midwestern hospital, including sputum (n = 6), bronchial washings (2), urine (4), and stool (1). None of the patients with M xenopi-positive specimens had apparent mycobacterial disease, although five received antituberculosis drug therapy for a range of one to six months. Specimens collected in a nonsterile manner were more likely to grow the organism than those collected aseptically (3.1% versus 0, relative risk = infinity, P = 0.003). M xenopi isolation was attributed to exposure of clinical specimens to tap water, including rinsing of bronchoscopes with tap water after disinfection, irrigation with tap water during colonoscopy, gargling with tap water before sputum collection, and collecting urine in recently rinsed bedpans. M xenopi was isolated from tap water in 20 of 24 patient rooms tested, the endoscopy suite, and the central hot water mixing tank, but not from water in the microbiology laboratory. The pseudo-outbreak occurred following a decrease in the hot water temperature from 130 degrees F to 120 degrees F in 1989. CONCLUSIONS Maintenance of a higher water temperature and improved specimen collection protocols and instrument disinfection procedures probably would have prevented this pseudo-outbreak.

Mycobacterium malmoense Infections in the United States, January 1993 through June 1995

Mycobacterium malmoense is a nontuberculous mycobacterium rarely encountered in the United States. However, isolations of M. malmoense from 73 patients (11 in 1992, 35 in 1993, and 27 in 1994) were reported to the Centers for Disease Control and Prevention. We contacted state mycobacteriology laboratories and health care providers of patients whose M. malmoense isolations were reported from January 1993 through June 1995. To assign disease status for these patients, we used the criteria of the American Thoracic Society. Of 60 evaluable patients with disease status, only six (10%) had disease due to M. malmoense (five adults with pulmonary disease and one child with cervical lymphadenitis). We conclude that the number of patients with disease due to M. malmoense remains low. Increased isolation of this species may be due to the increased use of more sensitive and specific laboratory methods. For surveillance purposes, multiple M. malmoense isolates and age of younger than 10 years appear to be the best predictors for M. malmoense disease.

Serologic Methods for Diagnosing Tuberculosis

Excerpt The number of new cases of pulmonary tuberculosis in the United States decreased steadily from 1963 through 1985; however, in 1986, the number of cases increased. This reversal may be the r...

Opportunistic Mycobacterial Infections

Infections with nontuberculous Mycobacterium species have been recognized with increasing frequency in recent years, particularly among patient who are immunosuppressed, have prior lung disease, or have undergone invasive procedures and operations. The infections may be self-limited and mild, as in cases of Mycobacterium marinum infection, or disseminated and life-threatening, as in some cases of M. intracellulare infection. Diagnosis of these infections can present a problem, both because the organisms can be difficult to grow in the laboratory and because they are found in the environment. Furthermore, distinguishing infection from colonization is often difficult. Therapy is complicated because many of the isolates are resistant to antituberculosis drugs, and the results of susceptibility testing with other drugs do not necessarily correlate with therapeutic responses. In addition, the epidemiology of such infections is difficult to study because of the lack of definitive markers.

Pneumococcal Vaccine and Isolates for the Centers for Disease Control

Excerpt To the editor: We want to emphasize that the Centers for Disease Control (CDC) continues to welcome isolates ofStreptococcus pneumoniaefrom persons who have previously received the pneumoco...