Mycobacterium colombiense and pseudotuberculous lymphadenopathy.
A 25-month-old girl with an unremarkable medical history was hospitalized in the pediatric department of Timone Hospital, Marseille, France, due to development of swelling in a right subclavicular lymph node over a 1-month period. A 5-day course of oxacillin, which was administered orally, had been unsuccessful in alleviating the symptoms. The patient's general condition was excellent, and results of a physical examination were normal, with the exception of a 2-cm hard, immobile, yet painless, noninflammatory, enlarged lymph node. Due to the presence of the enlarged lymph node, a chest radiograph was performed, and results were normal. A hemogram indicated a hemoglobin concentration of 113 g/L, a leukocyte count 8.3 x 109/L consisting of 31% polynuclear neutrophils and 62% lymphocytes, and a normal blood smear. A platelet count indicated a concentration of 389 x 109/L, and the serum lactic dehydrogenase level was 440 UI/L. In addition, no biologic inflammatory syndrome was observed based on the concentration of C-reactive protein (<1 mg/L) and an erythrocyte sedimentation rate of 18 mm/h.
Fine-needle aspiration of the lymph node showed necrosis and mature, activated lymphocytes. These results suggested a possible diagnosis of lymphoma, and a surgical excision biopsy was subsequently performed. Direct microscopic examinations were carried out after results obtained by Gram and Ziehl-Neelsen staining showed that the lymph node was negative for acid-fast bacilli. Histopathologic analysis indicated epithelioid cell granulomas containing giant cells and caseous necrosis without altered leukocytes, all of which are compatible with tuberculosis. Culturing of the biopsy specimen in BACTEC broth (Becton Dickinson, Courtaboeuf, France) at 5% [CO.sub.2] at 37[degrees]C yielded acid-fast bacilli after a 7-day incubation period.
After inactivating the cells and extracting the DNA by using a previously described method, we identified the isolate by PCR sequencing of the rpoB gene (2) and its demonstrated 100% sequence similarity to M. colombiense CIP108962T (1,2). Accordingly, the isolate exhibited positive urease activity, a distinctive characteristic that differentiates M. colombiense from other MAC species (1,2).
Recently, M. colombiense was shown to be responsible for an enlarged lymph node in 1 child from Spain who did not show any evidence of HIV infection (3). In that patient, histopathologic examination showed granulomatous adenitis with necrosis. We report that M. colombiense-infected lymph nodes also yield clinical and histopathologic features evocative of tuberculosis. Indeed, MAC organisms remain the most prevalent agents demonstrated in diseased lymph nodes in children (4).
Because modern molecular tools used for the description of emerging MAC species have not been available in most previous reports, the real prevalence of M. colombiense may have been underestimated. In children, M. hemophilum (5), M. avium subsp. avium (6), M. avium subsp. hominissuis (7), M. lentiflavum (8), M. bohemicum (9), and M. simiae (10) have been demonstrated to be responsible for enlarged cervical lymph nodes (online Appendix Table, available from www.cdc.gov/EID/content/15/4/619-appT.htm). Because management and antimicrobial drug treatment of each of these different infections vary in terms of indication, choice of drugs, and duration, the accurate and rapid identification of the causative Mycobacterium species is absolutely necessary. This identification should use PCR sequencing of selected universal molecular targets, including the 16S rRNA and rpoB genes (2), as illustrated herein.
This work was supported by Unite Mixte de Recherche 6236, Marseille, France.
(1.) Murcia MI, Tortoli E, Menendez MC, Palenque E, Garcia MJ. Mycobacterium colombiense sp. nov., a novel member of the Mycobacterium avium complex and description of MAC-X as a new ITS genetic variant. Int J Syst Evol Microbiol. 2006;56:2049-54. DOI: 10.1099/ ijs.0.64190-0
(2.) Ben Salah I, Adekambi T, Raoult D, Drancourt M. rpoB sequence-based identification of Mycobacterium avium complex species. Microbiology. 2008;154:3715-23. DOI: 10.1099/mic.0.2008/020164-0
(3.) Esparcia O, Navarro F, Quer M, Coll P. Lymphadenopathy caused by Mycobacterium colombiense. J Clin Microbiol. 2008;46:1885-7. DOI: 10.1128/ JCM.01441-07
(4.) Zeharia A, Eidlitz-Markus T, Haimi-Cohen Y, Samra Z, Kaufman L, Amir J. Management of nontuberculous mycobacteria-induced cervical lymphadenitis with observation alone. Pediatr Infect Dis J. 2008;27:920-2. DOI: 10.1097/ INF.0b013e3181734fa3
(5.) Cohen YH, Amir J, Ashkenazi S, Eidlitz-Markus T, Samra Z, Kaufmann L, et al. Mycobacterium haemophilum and lymphadenitis in immunocompetent children, Israel. Emerg Infect Dis. 2008;14:1437-9. DOI: 10.3201/eid1409.070917
(6.) Thegerstrom J, Romanus V, Friman V, Brudin L, Haemig PD, Olsen B. Mycobacterium avium lymphadenopathy among children, Sweden. Emerg Infect Dis. 2008;14:661-3. DOI: 10.3201/ eid1404.060570
(7.) Bruijnesteijn van Coppenraet LE, de Haas PE, Lindeboom JA, Kuijper EJ, van Soolingen D. Lymphadenitis in children is caused by Mycobacterium avium hominissuis and not related to 'bird tuberculosis.' Eur J Clin Microbiol Infect Dis. 2008;27:293-9. DOI: 10.1007/s10096-007-0440-z
(8.) Cabria F, Torres MV, Garcia-Cia JI, Dominguez-Garrido MN, Esteban J, Jimenez MS. Cervical lymphadenitis caused by Mycobacterium lentiflavum. Pediatr Infect Dis J. 2002;21:574-5. DOI: 10.1097/00006454-200206000-00022
(9.) Huber J, Richter E, Binder L, Maass M, Eberl R, Zenz W. Mycobacterium bohemicum and cervical lymphadenitis in children. Emerg Infect Dis. 2008;14:1158-9. DOI: 10.3201/eid1407.080142
(10.) Patel NC, Minifee PK, Dishop MK, Munoz FM. Mycobacterium simiae cervical lymphadenitis. Pediatr Infect Dis J. 2007;26:362-3. DOI: 10.1097/01. inf.0000258614.98241.4e
Katariina Vuorenmaa, Iskandar Ben Salah, Vincent Barlogis, Herve Chambost, and Michel Drancourt
Address for correspondence: Michel Drancourt, Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medecine, 27, Blvd Jean Moulin, Marseille, CEDEX 5, France; email: email@example.com
Author affiliations: Universite de la Mediterranee, Marseille, France (K. Vuorenmaa, I. Ben Salah, M. Drancourt); Assistance Publique des Hopitaux de Marseille-Federation de Microbiologie Clinique Hopital la Timone, Marseille (K. Vuorenmaa, I. Ben Salah, M. Drancourt); and Hopital d'Enfants la Timone, Marseille (V. Barlogis, H. Chambost)
|Printer friendly Cite/link Email Feedback|
|Author:||Vuorenmaa, Katariina; Salah, Iskandar Ben; Barlogis, Vincent; Chambost, Herve; Drancourt, Michel|
|Publication:||Emerging Infectious Diseases|
|Date:||Apr 1, 2009|
|Previous Article:||Mycobacterium avium subsp. hominissuis infection in a pet parrot.|
|Next Article:||Leptospira noguchii and human and animal leptospirosis, southern Brazil.|