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      The first case of cutaneous infection with Mycobacterium parascrofulaceum

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          Abstract

          The authors present the first, to the best of their knowledge, reported case of cutaneous infection caused by Mycobacterium parascrofulaceum. A 42-year-old woman presented with asymptomatic reddish papules, nodules, plaques, and patches on the right side of her face and on her forehead that had persisted for 5 years, with the lesions gradually increasing in size over that time. No previous intervening medical treatment had been applied. No history or evidence of immunosuppression was found. A skin biopsy was performed for routine histological examination. Samples of lesioned skin were inoculated on Löwenstein–Jensen medium to determine the presence of acid-fast bacilli. Ziehl–Neelsen staining was used to confirm the presence of the organism. In vitro drug susceptibility testing was conducted using the microtiter plate method. Mycobacterium was identified by polymerase chain reaction–restriction fragment length polymorphism analysis and sequencing of the hsp65 and 16S rDNA genes. Cultures for aerobic and anaerobic bacteria, as well as fungus, were also conducted. Routine histopathology revealed granulomatous changes without caseation. Ziehl–Neelsen staining showed that the organisms in both the lesions and the cultures were acid-fast bacilli. The cultured colonies were grown in Löwenstein–Jensen medium and incubated at two different temperatures (32°C and 37°C) for 2–3 weeks, developing pigmentation both in the dark and in the light. In vitro drug susceptibility tests showed that the organism was sensitive to clarithromycin and moxifloxacin. Polymerase chain reaction–restriction fragment length polymorphism analysis and sequencing of the hsp65 and 16S rDNA genes confirmed that the isolated organisms were M. parascrofulaceum. Fungal and other standard bacterial cultures were negative. In conclusion, identification and diagnosis of nontuberculous mycobacteria should be performed promptly to obtain better prognoses. Empirical treatments may be feasible, and drug susceptibility tests are important.

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          Most cited references 16

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          The new mycobacteria: an update.

          The continuous evolution of mycobacterial taxonomy may represent a source of confusion for laboratories and clinicians. Apart from the obvious pathogenic strains of the Mycobacterium tuberculosis complex, Mycobacterium leprae and Mycobacterium ulcerans, the role of other mycobacteria may be associated with varying conditions ranging from contamination to specific disease processes. Of the more than 120 mycobacterial species recognized currently, very few have not been reported as pathogenic in humans or animals. Although the attempt to keep pace with the steadily increasing number of mycobacterial species seems hopeless, a careful review of the recent literature relevant to the newly described species may be advantageous. The aim of this present update is to provide epidemiological and clinical information along with major phenotypic and genotypic characteristics of the species described in the last 3 years.
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            Nontuberculous mycobacteria: opportunistic environmental pathogens for predisposed hosts.

             L. Cook (2009)
            Nontuberculous mycobacterial (NTM) infections are caused by environmental mycobacteria. Patients with pulmonary NTM disease usually have predisposing lung abnormalities. Diagnostic methods are evolving. Treatment is largely empiric. Data were extracted from peer reviewed publications, guidelines, and case series. Progressive NTM lung disease should be treated. Multidrug regimens are mostly macrolide based and are occasionally complemented by lung resection. Disease persistence and relapse are not uncommon and are a greater problem with so-called rapid-grower NTM infections. Some of the issues considered in this review are: the role of antibiotic susceptibility testing in predicting treatment effectiveness, optimal drug combinations, daily vs. intermittent dosing intervals for different NTM infections and disease severity, when the goal of cure should be replaced with observation or palliation, and patient selection for surgery. Future needs for development and research include improved epidemiology, definition of genetic and other risk factors, definition of predictors of treatment outcome, multicenter treatment studies, new drug discovery and animal models of disease and treatment.
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              PCR assay based on DNA coding for 16S rRNA for detection and identification of mycobacteria in clinical samples.

               A Kolk,  L Kox,  S Knijper (1995)
              A PCR and a reverse cross blot hybridization assay were developed for the detection and identification of mycobacteria in clinical samples. The PCR amplifies a part of the DNA coding for 16S rRNA with a set of primers that is specific for the genus Mycobacterium and that flanks species-specific sequences within the genes coding for 16S rRNA. The PCR product is analyzed in a reverse cross blot hybridization assay with probes specific for M. tuberculosis complex (pTub1), M. avium (pAvi3), M. intracellulare (pInt5 and pInt7), M. kansasii complex-M. scrofulaceum complex (pKan1), M. xenopi (pXen1), M. fortuitum (pFor1), M. smegmatis (pSme1), and Mycobacterium spp. (pMyc5a). The PCR assay can detect 10 fg of DNA, the equivalent of two mycobacteria. The specificities of the probes were tested with 108 mycobacterial strains (33 species) and 31 nonmycobacterial strains (of 17 genera). The probes pAvi3, pInt5, pInt7, pKan1, pXen1, and pMyc5a were specific. With probes pTub1, pFor1, and pSme1, slight cross hybridization occurred. However, the mycobacterial strains from which the cross-hybridizing PCR products were derived belonged to nonpathogenic or nonopportunistic species which do not occur in clinical samples. The test was used on 31 different clinical specimens obtained from patients suspected of having mycobacterial disease, including a patient with a double mycobacterial infection. The samples included sputum, bronchoalveolar lavage, tissue biopsy samples, cerebrospinal fluid, pus, peritoneal fluid, pleural fluid, and blood. The results of the PCR assay agreed with those of conventional identification methods or with clinical data, showing that the test can be used for the direct and rapid detection and identification of mycobacteria in clinical samples.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2012
                2012
                15 August 2012
                : 8
                : 353-358
                Affiliations
                Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for STD and Leprosy Control, Chinese Center for Disease Control and Prevention, Nanjing, People’s Republic of China
                Author notes
                Correspondence: Hongsheng Wang, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for STD and Leprosy Control, Chinese Center for Disease Control and Prevention, 12 Jiangwangmiao Street, Nanjing 210042, People’s Republic of China, Tel +86 25 8547 8953, Fax +86 25 8541 4477, Email wanghs@ 123456ncstdlc.org , whs33@ 123456vip.sina.com
                [*]

                These authors contributed equally to this work

                Article
                tcrm-8-353
                10.2147/CLEP.S34346
                3425344
                22930638
                © 2012 Zong et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Case Report

                Medicine

                therapy, laboratory diagnosis, pcr-rflp, skin infection, nontuberculous mycobacteria

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