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| {{Taxobox | | __NOTOC__ |
| | color = lightgrey
| | {{Mycobacterium abscessus}} |
| | name = ''Mycobacterium abscessus''
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| | regnum = [[Bacterium|Bacteria]]
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| | phylum = [[Actinobacteria]]
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| | ordo = [[Actinomycetales]]
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| | subordo = [[Corynebacterineae]]
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| | familia = [[Mycobacterium|Mycobacteriaceae]]
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| | genus = ''[[Mycobacterium]]''
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| | species = '''''M. abscessus'''''
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| | binomial = ''Mycobacterium abscessus''
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| | binomial_authority = Kusonoki and Ezaki 1992 ATCC 19977
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| }}
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| {{SI}}
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| {{CMG}} | | {{About1|Mycobacterium abscessus causes}} |
| | {{CMG}}; {{AE}} {{Rim}} |
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| {{SK}} M. abcessus, non tuberculous mycobacterium, NTM, rapidly growing mycobacterium, RGM | | {{SK}} M. abcessus, non tuberculous mycobacterium, NTM, rapidly growing mycobacterium, RGM |
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| ==Overview== | | ==[[Mycobacterium abscessus overview|Overview]]== |
| Mycobacterium abscessus is a rapidly growing [[mycobacterium]] (RGM) that is a common water contaminant. Mycobacterium abscessus is a bacterium distantly related to the ones that cause [[tuberculosis]] and [[leprosy]]. It is part of a group known as rapidly growing mycobacteria and is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices. M. abscessus can cause a variety of infections. Healthcare-associated infections due to this bacterium are usually of the skin and the soft tissues under the skin. It is also a cause of serious lung infections in persons with various chronic lung diseases, such as cystic fibrosis, post-traumatic wound infections, and disseminated cutaneous diseases, mostly in patients with suppressed immune systems.
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| ==Historical Perspective== | | ==[[Mycobacterium abscessus historical perspective|Historical Perspective]]== |
| ''Mycobacterium abscessus'' was first isolated in 1953 from gluteal abscesses in a 62-year-old patient who had injured her knee as a child and had a disseminated infection 48 years later.<ref name="pmid13035193">{{cite journal| author=MOORE M, FRERICHS JB| title=An unusual acid-fast infection of the knee with subcutaneous, abscess-like lesions of the gluteal region; report of a case with a study of the organism, Mycobacterium abscessus, n. sp. | journal=J Invest Dermatol | year= 1953 | volume= 20 | issue= 2 | pages= 133-69 | pmid=13035193 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13035193 }} </ref> It was until 1992 that Mycobacterium abscessus is considered a separate organism from [[Mycobacterium chelonae]].
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| | ==[[Mycobacterium abscessus causes|Causes]]== |
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| The species ''M. bolletii'', named after the late microbiologist and taxonomist [[Claude Bollet]], was described in 2006. In current taxonomy, ''M. bolletii'' and ''M. massiliense'' (named for Massilia, the ancient Greek and Roman name for Marseille, where the organism was isolated) have been incorporated into ''M. abscessus'' subsp. ''bolletii''. <ref> Etymologia: Mycobacterium abscessus subsp. bolletii. Emerg Infect Dis [Internet]. 2014 Mar [February 20, 2014]. http://dx.doi.org/10.3201/eid2003.ET2003 </ref>
| | ==[[Mycobacterium abscessus epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Classification== | | ==[[Mycobacterium abscessus risk factors|Risk Factors]]== |
| * M. abscessus sensu stricto
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| * Mycobacterium massiliense<ref name="pmid15583272">{{cite journal| author=Adékambi T, Reynaud-Gaubert M, Greub G, Gevaudan MJ, La Scola B, Raoult D et al.| title=Amoebal coculture of "Mycobacterium massiliense" sp. nov. from the sputum of a patient with hemoptoic pneumonia. | journal=J Clin Microbiol | year= 2004 | volume= 42 | issue= 12 | pages= 5493-501 | pmid=15583272 | doi=10.1128/JCM.42.12.5493-5501.2004 | pmc=PMC535245 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15583272 }} </ref>
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| * Mycobacterium bolletii<ref name="pmid16403878">{{cite journal| author=Adékambi T, Berger P, Raoult D, Drancourt M| title=rpoB gene sequence-based characterization of emerging non-tuberculous mycobacteria with descriptions of Mycobacterium bolletii sp. nov., Mycobacterium phocaicum sp. nov. and Mycobacterium aubagnense sp. nov. | journal=Int J Syst Evol Microbiol | year= 2006 | volume= 56 | issue= Pt 1 | pages= 133-43 | pmid=16403878 | doi=10.1099/ijs.0.63969-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16403878 }} </ref>
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| ==Pathophysiology== | | ==[[Mycobacterium abscessus natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ===Pathogen===
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| Mycobacterium abscessus is a bacterium distantly related to the ones that cause [[tuberculosis]] and [[leprosy]]. It is part of a group known as rapidly growing mycobacteria and is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices.
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| Mycobacterium abscessus is relatively resistant to [[chlorine]] and standard desinfectant.<ref name="pmid9891805">{{cite journal| author=Wallace RJ, Brown BA, Griffith DE| title=Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. | journal=Annu Rev Microbiol | year= 1998 | volume= 52 | issue= | pages= 453-90 | pmid=9891805 | doi=10.1146/annurev.micro.52.1.453 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9891805 }} </ref> | |
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| ===Transmission===
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| Infection with M. abscessus is usually caused by injections of substances contaminated with the bacterium or through invasive medical procedures employing contaminated equipment or material. Infection can also occur after accidental injury where the wound is contaminated by soil. There is very little risk of transmission from person to person.
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| ===Microscopy===
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| *Gram-positive, nonmotile and acid-fast rods (1.0-2.5µm x 0.5µm).
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| ===Colony characteristics===
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| *Colonies on Löwenstein-Jensen media may occur as smooth as well as rough, white or greyish and nonphotochromogenic.
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| ===Physiology===
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| *Growth at 28°C and 37°C after 7 days but not at 43°C.
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| *On MacConkey agar at 28°C and even 37°C.
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| *Tolerance to 5% NaCl and 500mg/l hydroxylamine (Ogawa egg medium) and 0.2% picrate (Sauton agar medium).
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| *Positive degradation of p-aminosalicylate.
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| *Production of arylsulfatase but not of nitrate reductase and Tween 80 hydrolase.
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| *Negative iron uptake test. No utilisation of fructose, glucose, oxalate and citrate as sole carbon sources.
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| ===Differential characteristics===
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| *M. abscessus and M. chelonae can be distinguished from M. fortuitum or M. peregrinum by their failure to reduce nitrate and to take up iron.
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| *Tolerance to 5% NaCl in Löwenstein-Jensen media tolerance to 0.2% picrate in Sauton agar and non-utilisation of citrate as a sole carbon source are characteristics that distinguish M. abscessus from M. chelonae.
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| *M. abscessus and M. chelonae sequevar I share an identical sequence in the 54-510 region of 16S rRNA, However, both species can be differentiated by their hsp65 or ITS sequences
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| ===Strains===
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| ATCC 19977 = CCUG 20993 = CIP 104536 = DSM 44196 = JCM 13569 = NCTC 13031
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| ===Genetics===
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| A draft genome sequence of ''M. abscessus'' subsp. ''bolletii'' BD<sup>T</sup> was completed in 2012.<ref>{{cite journal|last=Choi|first=G.-E.|author2=Cho, Y.-J. |author3=Koh, W.-J. |author4=Chun, J. |author5=Cho, S.-N. |author6= Shin, S. J. |title=Draft Genome Sequence of Mycobacterium abscessus subsp. bolletii BDT|journal=Journal of Bacteriology|date=24 April 2012|volume=194|issue=10|pages=2756–2757|doi=10.1128/JB.00354-12}}</ref> More than 25 different strains of this subspecies, including pathogenic isolates, have had their genomes sequenced.<ref>{{cite journal|last=Davidson|first=Rebecca M.|coauthors=Hasan, Nabeeh A.; de Moura, Vinicius Calado Nogueira; Duarte, Rafael Silva; Jackson, Mary; Strong, Michael|title=Phylogenomics of Brazilian epidemic isolates of Mycobacterium abscessus subsp. bolletii reveals relationships of global outbreak strains|journal=Infection, Genetics and Evolution|date=December 2013|volume=20|pages=292–297|doi=10.1016/j.meegid.2013.09.012}}</ref>
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| ===Resistance to Antibiotics===
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| ====Intrinsic Factors====
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| * The permeability barrier of the envelope of the myobacterium<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| * Low affinity of the antibiotics to their target<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| * Drug export systems<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| * Neutralization of the antibiotics by cytoplasmic enzymes<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| ====Acquired Factors====
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| * Mutation of the genes that code the antibiotic targets<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| ==Risk Factors==
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| Mycobacterium abscessus infecttion has been reported in the following cases:
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| ===Skin and Soft Tissue Infection===
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| * Open wounds
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| * Penetrating injury
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| * Surgical tourism<ref name="pmid18174307">{{cite journal| author=Viana-Niero C, Lima KV, Lopes ML, Rabello MC, Marsola LR, Brilhante VC et al.| title=Molecular characterization of Mycobacterium massiliense and Mycobacterium bolletii in isolates collected from outbreaks of infections after laparoscopic surgeries and cosmetic procedures. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 3 | pages= 850-5 | pmid=18174307 | doi=10.1128/JCM.02052-07 | pmc=PMC2268380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18174307 }} </ref>
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| * Laparoscopic surgery<ref name="pmid18174307">{{cite journal| author=Viana-Niero C, Lima KV, Lopes ML, Rabello MC, Marsola LR, Brilhante VC et al.| title=Molecular characterization of Mycobacterium massiliense and Mycobacterium bolletii in isolates collected from outbreaks of infections after laparoscopic surgeries and cosmetic procedures. | journal=J Clin Microbiol | year= 2008 | volume= 46 | issue= 3 | pages= 850-5 | pmid=18174307 | doi=10.1128/JCM.02052-07 | pmc=PMC2268380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18174307 }} </ref>
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| * Cosmetic surgery<ref name="pmid3600710">{{cite journal| author=Safranek TJ, Jarvis WR, Carson LA, Cusick LB, Bland LA, Swenson JM et al.| title=Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skin-marking solution. | journal=N Engl J Med | year= 1987 | volume= 317 | issue= 4 | pages= 197-201 | pmid=3600710 | doi=10.1056/NEJM198707233170403 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3600710 }} </ref>
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| * Intramuscular injections<ref name="pmid17626174">{{cite journal| author=Kim HY, Yun YJ, Park CG, Lee DH, Cho YK, Park BJ et al.| title=Outbreak of Mycobacterium massiliense infection associated with intramuscular injections. | journal=J Clin Microbiol | year= 2007 | volume= 45 | issue= 9 | pages= 3127-30 | pmid=17626174 | doi=10.1128/JCM.00608-07 | pmc=PMC2045247 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17626174 }} </ref><ref name="pmid4683319">{{cite journal| author=Borghans JG, Stanford JL| title=Mycobacterium chelonei in abscesses after injection of diphtheria-pertussis-tetanus-polio vaccine. | journal=Am Rev Respir Dis | year= 1973 | volume= 107 | issue= 1 | pages= 1-8 | pmid=4683319 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4683319 }} </ref><ref name="pmid5797954">{{cite journal| author=Inman PM, Beck A, Brown AE, Stanford JL| title=Outbreak of injection abscesses due to Mycobacterium abscessus. | journal=Arch Dermatol | year= 1969 | volume= 100 | issue= 2 | pages= 141-7 | pmid=5797954 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5797954 }} </ref><ref name="pmid9195073">{{cite journal| author=Villanueva A, Calderon RV, Vargas BA, Ruiz F, Aguero S, Zhang Y et al.| title=Report on an outbreak of postinjection abscesses due to Mycobacterium abscessus, including management with surgery and clarithromycin therapy and comparison of strains by random amplified polymorphic DNA polymerase chain reaction. | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 6 | pages= 1147-53 | pmid=9195073 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9195073 }} </ref>
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| ** Inappropriate skin disinfection
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| ** Inappropriate sterilization of the equipment<ref name="pmid2362334">{{cite journal| author=Wenger JD, Spika JS, Smithwick RW, Pryor V, Dodson DW, Carden GA et al.| title=Outbreak of Mycobacterium chelonae infection associated with use of jet injectors. | journal=JAMA | year= 1990 | volume= 264 | issue= 3 | pages= 373-6 | pmid=2362334 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2362334 }} </ref>
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| ** Contaminated solutions
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| * Contaminated municipal or water supply<ref name="pmid9891805">{{cite journal| author=Wallace RJ, Brown BA, Griffith DE| title=Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. | journal=Annu Rev Microbiol | year= 1998 | volume= 52 | issue= | pages= 453-90 | pmid=9891805 | doi=10.1146/annurev.micro.52.1.453 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9891805 }} </ref>
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| * Acupuncture (contaminated solution used to clean the physical therapy device)<ref name="pmid19694761">{{cite journal| author=Koh SJ, Song T, Kang YA, Choi JW, Chang KJ, Chu CS et al.| title=An outbreak of skin and soft tissue infection caused by Mycobacterium abscessus following acupuncture. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 7 | pages= 895-901 | pmid=19694761 | doi=10.1111/j.1469-0691.2009.03026.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19694761 }} </ref>
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| * [[Dialysis]]<ref name="pmid4045242">{{cite journal| author=Bolan G, Reingold AL, Carson LA, Silcox VA, Woodley CL, Hayes PS et al.| title=Infections with Mycobacterium chelonei in patients receiving dialysis and using processed hemodialyzers. | journal=J Infect Dis | year= 1985 | volume= 152 | issue= 5 | pages= 1013-9 | pmid=4045242 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4045242 }} </ref><ref name="pmid2295862">{{cite journal| author=Lowry PW, Beck-Sague CM, Bland LA, Aguero SM, Arduino MJ, Minuth AN et al.| title=Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California. | journal=J Infect Dis | year= 1990 | volume= 161 | issue= 1 | pages= 85-90 | pmid=2295862 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2295862 }} </ref>
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| * [[Bronchoscopy]]<ref name="pmid9891805">{{cite journal| author=Wallace RJ, Brown BA, Griffith DE| title=Nosocomial outbreaks/pseudo-outbreaks caused by nontuberculous mycobacteria. | journal=Annu Rev Microbiol | year= 1998 | volume= 52 | issue= | pages= 453-90 | pmid=9891805 | doi=10.1146/annurev.micro.52.1.453 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9891805 }} </ref>
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| ** Inadequate desinfection of the [[bronchoscope]]
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| ** Contaminated local anesthesia solution
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| ** Contaminated tap water
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| ** Contaminated antimicrobial solution
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| ===Bronchopulmonary Infection===
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| * Chronic lung disease (for example, [[cystic fibrosis]])<ref name="pmid14720400">{{cite journal| author=Sermet-Gaudelus I, Le Bourgeois M, Pierre-Audigier C, Offredo C, Guillemot D, Halley S et al.| title=Mycobacterium abscessus and children with cystic fibrosis. | journal=Emerg Infect Dis | year= 2003 | volume= 9 | issue= 12 | pages= 1587-91 | pmid=14720400 | doi=10.3201/eid0912.020774 | pmc=PMC3034322 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14720400 }} </ref><ref name="pmid19830845">{{cite journal| author=Radhakrishnan DK, Yau Y, Corey M, Richardson S, Chedore P, Jamieson F et al.| title=Non-tuberculous mycobacteria in children with cystic fibrosis: isolation, prevalence, and predictors. | journal=Pediatr Pulmonol | year= 2009 | volume= 44 | issue= 11 | pages= 1100-6 | pmid=19830845 | doi=10.1002/ppul.21106 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19830845 }} </ref>
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| * Previously untreated mycobacterial infection
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| * Co-existent mycobacterium avium complex infection
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| * Chronic vomiting
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| * AIDS/HIV (not a common infection in this population)<ref name="pmid20375687">{{cite journal| author=Benwill J, Babineaux M, Sarria JC| title=Pulmonary Mycobacterium abscessus in an AIDS patient. | journal=Am J Med Sci | year= 2010 | volume= 339 | issue= 5 | pages= 495-6 | pmid=20375687 | doi=10.1097/MAJ.0b013e3181d96ad7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20375687 }} </ref>
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| ===Disseminated Infection===
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| * Immune suppression<ref name="pmid22554363">{{cite journal| author=Babalık A, Kuyucu T, Ordu EN, Ernam D, Partal M, Köksalan K| title=Non-tuberculous mycobacteria infection: 75 cases. | journal=Tuberk Toraks | year= 2012 | volume= 60 | issue= 1 | pages= 20-31 | pmid=22554363 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22554363 }} </ref><ref name="pmid21552751">{{cite journal| author=Lambertucci JR, Borges AH, Voieta I| title=Disseminated Mycobacterium abscessus infection in an AIDS patient. | journal=Rev Soc Bras Med Trop | year= 2011 | volume= 44 | issue= 2 | pages= 265 | pmid=21552751 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21552751 }} </ref>
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| ==Natural History, Complications and Prognosis==
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| Infection with Mycobacterium abscessus can lead to:
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| * Skin and soft tissue infection
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| * Open wound infection
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| ** Sternal wound infection<ref name="pmid7240799">{{cite journal| author=Hoffman PC, Fraser DW, Robicsek F, O'Bar PR, Mauney CU| title=Two outbreaks of sternal wound infection due to organisms of the Mycobacterium fortuitum complex. | journal=J Infect Dis | year= 1981 | volume= 143 | issue= 4 | pages= 533-42 | pmid=7240799 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7240799 }} </ref>
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| * Bronchopulmonary infection<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| * Disseminated infection in non AIDS immunocompromised patients<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| * Other rare infections
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| ** Vertebral [[osteomyelitis]]<ref name="pmid23925676">{{cite journal| author=Garcia DC, Sandoval-Sus J, Razzaq K, Young L| title=Vertebral osteomyelitis caused by Mycobacterium abscessus. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue= | pages= | pmid=23925676 | doi=10.1136/bcr-2013-009597 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23925676 }} </ref>
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| ** Abdominal infection<ref name="pmid16638646">{{cite journal| author=Ding LW, Lai CC, Lee LN, Hsueh PR| title=Abdominal nontuberculous mycobacterial infection in a university hospital in Taiwan from 1997 to 2003. | journal=J Formos Med Assoc | year= 2006 | volume= 105 | issue= 5 | pages= 370-6 | pmid=16638646 | doi=10.1016/S0929-6646(09)60132-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16638646 }} </ref>
| |
| ** [[Lymphadenitis]]<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
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| Mycobacterium abscessus is reported in many health-care associated infections. A history of Mycobacterium abscessus infection is a contraindication for lung transplantation.<ref name="pmid22290346">{{cite journal| author=Nessar R, Cambau E, Reyrat JM, Murray A, Gicquel B| title=Mycobacterium abscessus: a new antibiotic nightmare. | journal=J Antimicrob Chemother | year= 2012 | volume= 67 | issue= 4 | pages= 810-8 | pmid=22290346 | doi=10.1093/jac/dkr578 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22290346 }} </ref>
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| Mycobacterium abscessus is the most common non tuberculosis mycobacterial infection in [[cystic fibrosis]].<ref name="pmid14720400">{{cite journal| author=Sermet-Gaudelus I, Le Bourgeois M, Pierre-Audigier C, Offredo C, Guillemot D, Halley S et al.| title=Mycobacterium abscessus and children with cystic fibrosis. | journal=Emerg Infect Dis | year= 2003 | volume= 9 | issue= 12 | pages= 1587-91 | pmid=14720400 | doi=10.3201/eid0912.020774 | pmc=PMC3034322 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14720400 }} </ref> Chronic infection with Mycobacterium abscessus is associated with a decline in lung function among patients with [[cystic fibrosis]].<ref name="pmid20071249">{{cite journal| author=Esther CR, Esserman DA, Gilligan P, Kerr A, Noone PG| title=Chronic Mycobacterium abscessus infection and lung function decline in cystic fibrosis. | journal=J Cyst Fibros | year= 2010 | volume= 9 | issue= 2 | pages= 117-23 | pmid=20071249 | doi=10.1016/j.jcf.2009.12.001 | pmc=PMC3837580 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20071249 }} </ref> The most commonly reported symptom is [[cough]]. Constitutional symptoms increase as the disease progresses. The only effective long-term therapy for Mycobacterium abscessus was reported to be surgical resection of the localized disease.<ref name="pmid8484642">{{cite journal| author=Griffith DE, Girard WM, Wallace RJ| title=Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. | journal=Am Rev Respir Dis | year= 1993 | volume= 147 | issue= 5 | pages= 1271-8 | pmid=8484642 | doi=10.1164/ajrccm/147.5.1271 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8484642 }} </ref> Death may occur in these patients (mortality in ~14% of patients) due to respiratory failure secondary to the progressive lung disease.<ref name="pmid8484642">{{cite journal| author=Griffith DE, Girard WM, Wallace RJ| title=Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. | journal=Am Rev Respir Dis | year= 1993 | volume= 147 | issue= 5 | pages= 1271-8 | pmid=8484642 | doi=10.1164/ajrccm/147.5.1271 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8484642 }} </ref>
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| ==Diagnosis== | | ==Diagnosis== |
| ===History===
| | [[Mycobacterium abscessus diagnostic criteria|Diagnostic Criteria]] | [[Mycobacterium abscessus history and symptoms|History and Symptoms]] | [[Mycobacterium abscessus physical examination|Physical Examination]] | [[Mycobacterium abscessus laboratory findings|Laboratory Findings]] | [[Mycobacterium abscessus chest X ray|Chest X Ray]] | [[Mycobacterium abscessus other imaging findings|Other Imaging Findings]] |
| The patient should be asked about any recent history of procedures, such as surgery or injections.
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| | |
| ===Symptoms===
| |
| ====Symptoms of Skin and Soft Tissue Infection====
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| * Red, warm, tender to the touch, swollen, and/or painful [[skin]]
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| * [[Boil]]s
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| * Pus-filled [[vesicle]]s
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| | |
| ====Symptoms of Pulmonary Infection====
| |
| * Cough<ref name="pmid8484642">{{cite journal| author=Griffith DE, Girard WM, Wallace RJ| title=Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. | journal=Am Rev Respir Dis | year= 1993 | volume= 147 | issue= 5 | pages= 1271-8 | pmid=8484642 | doi=10.1164/ajrccm/147.5.1271 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8484642 }} </ref>
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| | |
| ====Constitutional Symptoms====
| |
| *[[Fever]]
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| *[[Chills]]
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| *[[Muscle aches]]
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| *[[Malaise]]
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| | |
| ===Physical Examination===
| |
| ===Skin===
| |
| *Skin infected with M. abscessus is usually red, warm, tender to the touch, swollen, and/or painful.
| |
| *Infected areas can also develop [[boils]] or pus-filled [[vesicles]].
| |
| | |
| ===Laboratory Studies===
| |
| To reach a definitive diagnosis, the organism has to be cultured from the infection site or, in severe cases, from a blood culture. The diagnosis is made by growing this bacterium in the laboratory from a sample of the pus or biopsy of the infected area.
| |
| | |
| ===Chest X-Ray===
| |
| Patients with pulmonary Mycobacterium abscessus infection might have the following on [[chest X-ray]]:<ref name="pmid8484642">{{cite journal| author=Griffith DE, Girard WM, Wallace RJ| title=Clinical features of pulmonary disease caused by rapidly growing mycobacteria. An analysis of 154 patients. | journal=Am Rev Respir Dis | year= 1993 | volume= 147 | issue= 5 | pages= 1271-8 | pmid=8484642 | doi=10.1164/ajrccm/147.5.1271 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8484642 }} </ref>
| |
| * Upper lobe infiltrates
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| * Bilateral involvement of the lungs
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| * Cavitation
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| | |
| ==Diagnostic Criteria for Pulmonary Mycobacterium Abscessus==
| |
| The diagnosis of pulmoanry mycobacterium abscessus infection requires the presence of clinical and microbiological criteria.<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| ===Clinical Diagnostic Criteria===
| |
| * Pulmonary symptoms, ''OR''
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| * Cavitation or nodular opacities on [[chest X-ray]], ''OR''
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| * Multifocal [[bronchiectasis]] with multiple small nodules on HRCT scan
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| ''AND''
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| * Other diagnoses, such as [[tuberculosis]], are ruled out<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
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| | |
| ===Microbiological Diagnostic Criteria===
| |
| * Positive culture from ≥2 different expectorated sputum samples
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| ''OR''
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| * Positive culture from ≥1 bronchial wash or bronchial lavage
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| ''OR''
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| * Histopathologic features of mycobacterial infection in transbronchial or lung biopsy ''AND'' positive culture for mycobacterium abscessus
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| ''OR''
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| * Histopathologic features of mycobacterial infection in transbronchial or lung biopsy ''AND'' positive culture of ≥1 expectorated sputum or bronchial wash samples<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
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|
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| ==Treatment== | | ==Treatment== |
| ===Skin and Soft Tissue Infections===
| | [[Mycobacterium abscessus medical therapy|Medical Therapy]] | [[Mycobacterium abscessus surgery|Surgery]] | [[Mycobacterium abscessus primary prevention|Primary Prevention]] |
| * Draining collections of pus
| |
| * Surgical debridement<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| * Administration of combination of antibiotics for a prolonged period of time: [[macrolide]] based regimen<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| ** Infection with this bacterium usually does not improve with the usual antibiotics used to treat skin infections. Testing the bacteria against different antibiotics is helpful in guiding doctors to the most appropriate treatment for each patient.
| |
| | |
| ===Pulmonary Infection===
| |
| * Administration of combination of antibiotics for a prolonged period of time: [[clarithromycin]] 1,000 mg/day based regimen<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| ** A combination of antibiotics is indicated for the treatment of pulmonary infection with mycobacterium abscessus; however, there is no evidence on the optimal multidrug regimen.
| |
| * Surgical resection of the localized disease<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| ** Surgical resection and multidrug antibiotic therapy is associated with a higher chance of a successful treatment.
| |
| | |
| ==Primary Prevention==
| |
| * There should not be exposure to '''tap water or tap water ice''' of any of the following:<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| ** Surgical [[wound]]s
| |
| ** Intravenous catheters
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| ** Injection sites
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| *** Avoid chloride based disinfectant
| |
| *** Avoid multidose vials
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| ** [[Endoscope]]
| |
| *** Automated [[endoscope|endoscopic]] washing machines
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| *** Manual Cleaning
| |
| * Tap water or tap water ice should not be used in the operating rooms, particularly in cardiac surgeries or [[mammoplasty]].<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
| |
| * Tap water or tap water ice should not be used in the outpatient plastic surgery procedures, such as [[mammoplasty]] and [[liposuction]].<ref name="pmid17277290">{{cite journal| author=Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F et al.| title=An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. | journal=Am J Respir Crit Care Med | year= 2007 | volume= 175 | issue= 4 | pages= 367-416 | pmid=17277290 | doi=10.1164/rccm.200604-571ST | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17277290 }} </ref>
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| *Anyone who touches or cares for the infected site should wash their hands carefully with soap and water.
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| *Patients should follow all instructions given by their healthcare provider following any surgery or medical procedure.
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| *Subjects should avoid receiving procedures or injections by unlicensed persons.
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| ==References==
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| {{Reflist|2}}
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| [[Category:Acid fast bacilli]] | | [[Category:Acid fast bacilli]] |
| [[Category:Corynebacterineae]]
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| [[Category:Nontuberculous mycobacteria]] | | [[Category:Nontuberculous mycobacteria]] |
| [[Category:Infectious disease]]
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