Natural history of Mycobacterium fortuitum pulmonary infection presenting with migratory infiltrates

A case report with microbiological analysis

Satoshi Okamori, Takanori Asakura, Tomoyasu Nishimura, Eiko Tamizu, Makoto Ishii, Mitsunori Yoshida, Hanako Fukano, Yuichiro Hayashi, Masaki Fujita, Yoshihiko Hoshino, Tomoko Betsuyaku, Naoki Hasegawa

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Presence of Mycobacterium fortuitum in respiratory tracts usually indicates mere colonization or transient infection, whereas true pulmonary infection occurs in patients with gastroesophageal disease. However, little is known about the diagnostic indications for true M. fortuitum pulmonary infection and the natural history of the disease. Case presentation: A 59-year-old man was referred to our hospital for treatment against M. fortuitum pulmonary infection. Fifteen years before the referral, he underwent total gastrectomy, after which he experienced esophageal reflux symptoms. After the referral, the patient was closely monitored without antimicrobial therapy because of mild symptoms and no pathological evidence of M. fortuitum pulmonary infection. During the observation, chest imaging showed migratory infiltrates. Two years after the referral, his lung biopsy specimen revealed foamy macrophages and multinucleated giant cells, indicating lipoid pneumonia. However, he was continually monitored without any treatment because there was no evidence of nontuberculous mycobacterial infection. Four years after the referral, he developed refractory pneumonia despite receiving adequate antibiotic therapy. After confirmation of granulomatous lesions, multiple antimicrobial therapy for M. fortuitum resulted in a remarkable improvement with no exacerbation for over 5 years. Random amplified polymorphic DNA polymerase chain reaction analysis revealed identical M. fortuitum strains in seven isolates from six sputum and one intestinal fluid specimens obtained during the course of the disease. Conclusions: We have described a patient with M. fortuitum pulmonary infection who presented with migratory infiltrates. The pathological evidence and microbiological analysis suggested that M. fortuitum pulmonary infection was associated with lipoid pneumonia and chronic exposure to gastrointestinal fluid. Therefore, physicians should carefully monitor patients with M. fortuitum detected from lower respiratory tract specimens and consider antimicrobial therapy for M. fortuitum infection when the patient does not respond to adequate antibiotic therapy against common pneumonia pathogens.

Original languageEnglish
Article number1
JournalBMC Infectious Diseases
Volume18
Issue number1
DOIs
Publication statusPublished - 2018 Jan 2

Fingerprint

Mycobacterium fortuitum
Natural History
Lung
Infection
Pneumonia
Referral and Consultation
Respiratory System
Therapeutics
Anti-Bacterial Agents
Mycobacterium Infections
Giant Cells
DNA-Directed DNA Polymerase
Gastrectomy
Gastroesophageal Reflux
Sputum
Thorax
Macrophages
Observation

Keywords

  • Aspiration
  • Lipoid pneumonia
  • Mycobacterial infection
  • Nontuberculous mycobacteria (NTM)
  • Rapidly growing mycobacteria (RGM)

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Natural history of Mycobacterium fortuitum pulmonary infection presenting with migratory infiltrates : A case report with microbiological analysis. / Okamori, Satoshi; Asakura, Takanori; Nishimura, Tomoyasu; Tamizu, Eiko; Ishii, Makoto; Yoshida, Mitsunori; Fukano, Hanako; Hayashi, Yuichiro; Fujita, Masaki; Hoshino, Yoshihiko; Betsuyaku, Tomoko; Hasegawa, Naoki.

In: BMC Infectious Diseases, Vol. 18, No. 1, 1, 02.01.2018.

Research output: Contribution to journalArticle

Okamori, Satoshi ; Asakura, Takanori ; Nishimura, Tomoyasu ; Tamizu, Eiko ; Ishii, Makoto ; Yoshida, Mitsunori ; Fukano, Hanako ; Hayashi, Yuichiro ; Fujita, Masaki ; Hoshino, Yoshihiko ; Betsuyaku, Tomoko ; Hasegawa, Naoki. / Natural history of Mycobacterium fortuitum pulmonary infection presenting with migratory infiltrates : A case report with microbiological analysis. In: BMC Infectious Diseases. 2018 ; Vol. 18, No. 1.
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abstract = "Background: Presence of Mycobacterium fortuitum in respiratory tracts usually indicates mere colonization or transient infection, whereas true pulmonary infection occurs in patients with gastroesophageal disease. However, little is known about the diagnostic indications for true M. fortuitum pulmonary infection and the natural history of the disease. Case presentation: A 59-year-old man was referred to our hospital for treatment against M. fortuitum pulmonary infection. Fifteen years before the referral, he underwent total gastrectomy, after which he experienced esophageal reflux symptoms. After the referral, the patient was closely monitored without antimicrobial therapy because of mild symptoms and no pathological evidence of M. fortuitum pulmonary infection. During the observation, chest imaging showed migratory infiltrates. Two years after the referral, his lung biopsy specimen revealed foamy macrophages and multinucleated giant cells, indicating lipoid pneumonia. However, he was continually monitored without any treatment because there was no evidence of nontuberculous mycobacterial infection. Four years after the referral, he developed refractory pneumonia despite receiving adequate antibiotic therapy. After confirmation of granulomatous lesions, multiple antimicrobial therapy for M. fortuitum resulted in a remarkable improvement with no exacerbation for over 5 years. Random amplified polymorphic DNA polymerase chain reaction analysis revealed identical M. fortuitum strains in seven isolates from six sputum and one intestinal fluid specimens obtained during the course of the disease. Conclusions: We have described a patient with M. fortuitum pulmonary infection who presented with migratory infiltrates. The pathological evidence and microbiological analysis suggested that M. fortuitum pulmonary infection was associated with lipoid pneumonia and chronic exposure to gastrointestinal fluid. Therefore, physicians should carefully monitor patients with M. fortuitum detected from lower respiratory tract specimens and consider antimicrobial therapy for M. fortuitum infection when the patient does not respond to adequate antibiotic therapy against common pneumonia pathogens.",
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KW - Rapidly growing mycobacteria (RGM)

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