2269. Disseminated Mycobacterium genavense in the immunocompromised: a case series at Mayo Clinic Rochester
Session: Poster Abstract Session: Non-Tuberculous Mycobacteria - Epidemiology and Management
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • ID wk M gen.pdf (601.4 kB)
  • Background: Mycobacterium genavense can cause serious disease in the immunocompromised. We report our experience with this uncommon infection.

    Methods: Retrospective review of M. genavense infection at Mayo Clinic (2010-2017).

    Results: Three patients were diagnosed with M. genavense from 2010-2017 (table 1). Lymph node biopsy noted non-necrotizing granulomatous inflammation with AFB in 2 patients. Delayed growth in culture was noted after at least 6 weeks incubation. All patients were started on mycobacterial therapy; no isolate grew sufficiently for drug susceptibility testing.

    Age

    Gender

    Risk factor

    Presentation

    Microbiology

    Antimicrobials

    Management

    Outcome

    51

    M

    Renal transplant  

     Prednisone

     Azathioprine

    2 months right TKA pain

    Positive right knee operative culture at 12 wk

    Ciprofloxacin

    Ethambutol Rifampin

    Clarithromycin

    TKA resection + arthrodesis

    24 mo antimicrobials

    9 y – no relapse

    66

    F

    Idiopathic CD4 lymphopenia

    Abdominal pain, fever, weight loss

    Intra-abdominal lymphadenopathy (figure 1 & 2)

    Positive mesenteric lymph node culture at 8 wk, blood cultures at 6 wk

    Clarithromycin

    Moxifloxacin

    Rifabutin

    Symptoms resolved

    Expired from stroke - 7 mo

    36

    F

    AIDS

    Abdominal pain

    Intra-abdominal lymphadenopathy

    Positive mesenteric lymph node culture at 11 wk

    Clarithromycin Rifabutin Ethambutol

    Symptoms improved at 1 mo

    Lost to followup

    Conclusion: M. genavense is an environmental mycobacteria, it rarely causes infection in non-HIV hosts. Our cases involved advanced HIV, solid organ transplant and idiopathic CD4 lymphopenia. Presentation with GI and systemic symptoms is common, pulmonary and cutaneous less so. Growth in culture requires prolonged incubation (8–12 weeks) in broth media with Mycobactin J supplementation. Positive pathological examination for AFB organisms, negative probes for MTB or MAC combined with persistently negative cultures, should raise the suspicion for this organism in the right clinical setting. It is generally susceptible to rifamycins, fluoroquinolones and macrolides; resistant to isoniazid and sometimes pyrazinamide. Immunosuppression should be reduced if possible to speed recovery. Duration of therapy is usually at least 12 months for disseminated disease, depending on response and immunosuppression.

    Maryam Mahmood, MD, Saira Ajmal, MD, Jasmine R. Marcelin, MD and Omar Abu Saleh, MD, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

    Disclosures:

    M. Mahmood, None

    S. Ajmal, None

    J. R. Marcelin, None

    O. Abu Saleh, None

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