Rapidly Growing Mycobacteria Infection in Patients with Cancer

Infectious Disease Service, Dept of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 08/2010; 51(4):422-34. DOI: 10.1086/655140
Source: PubMed

ABSTRACT Rapidly growing mycobacteria (RGM) have been associated with various clinical syndromes in immunocompetent and immunocompromised hosts. The risk factors and outcomes of RGM infection in patients with cancer have not been clearly defined.
Data were derived from 2 distinct sources. Demographic and clinical data were collected for all patients with cancer at Memorial Sloan-Kettering Cancer Center with a culture positive for RGM from January 1999 through December 2008. We also reviewed the literature for studies describing RGM infection in patients with cancer.
During the 10-year period, 28 patients with cancer at Memorial Sloan-Kettering Cancer Center had cultures positive for RGM. Most cases occurred in patients with solid tumors and were confined to the lung. A review of the literature identified 313 additional patients with cancer and RGM infection. Combining our series data with cases from the literature, we defined 3 distinct syndromes: pulmonary disease, which occurred in 158 patients (47%); bloodstream infection, occurring in 151 patients (45%); and disseminated infection involving at least 1 end organ, affecting 26 persons (8%). The syndromes differed by age of onset, underlying cancer, main RGM species, and outcome. Persons with bloodstream infection typically were young and had an excellent outcome; those with disseminated infection were older, had pronounced immunosuppression, and had a very poor prognosis.
RGM infections in patients with cancer comprise 3 distinct disorders with different risk factors, predominant mycobacterial species, and prognoses. In turn, the approach to management, including number and duration of antimycobacterial drugs, may be fundamentally different for various patients with cancer who receive a diagnosis of RGM infection.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: There is limited knowledge about the predominant malignancy associated with rapidly growing Mycobacterium (RGM) infections. This study identifies the most common malignancies, body site, treatment, and outcome associated with RGM infections. Methods: A retrospective chart review was conducted at Moffitt Cancer Center in Tampa, Florida. The computerized epidemiology report provided by the microbiology lab identified cancer patients who have been diagnosed with a RGM infection from 01/01/1990- 10/07/2008. Medical records from 45 patients were obtained, and the data was recorded and analyzed. Results: Of the 45 patients, 24 were female and 21 male. The median age of these patients was 58 years. Hematological malignancy was found to be the leading disease with 23 of the 45 patients (51.1%), while 9 of the 45 (20.0%) had breast cancer. Various forms of lung cancer accounted for 7 cases (15.6%), and 6 cases (13.3%) were distributed throughout other forms of primary malignancies. Within the 45 analyzed cases, four different species of RGM were observed. These were M. abscessus with 25 (55.6%) cases, M. fortuitum with 12 (26.7%) cases, M. chelonae with 6 (13.3%) cases, and 2 M. mucogenicum (4.4%) cases. Neutropenia was present in 14 patients (31.1%) at the time of their infection. Lung infection was the most common site with 17 (37.7%) cases; followed by bacteremia and catheter site infections with 8 (17.7%) and 7 (15.5%) cases respectively. The most common antibiotics used to treat RGM infections were azithromycin (84%), tigecycline (40%) and meropenem (36%), for a duration of one week to one year (average six weeks). Response to therapy was noted in 60% of patients and 8 patients died from the underlying malignancy. Conclusion: The results obtained in this chart review offer guidance for which malignancies are associated with RGM infections and reports the most prevalent Mycobacteria species. The three most frequent malignancies were: hematological, breast, and lung. The four most common RGM species, in order of predominance, were M. abscessus, M. fortuitum, M. chelonae, and M. mucogenicum.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
  • Source
    Infectious Disease in Clinical Practice 01/2014; DOI:10.1097/IPC.0000000000000147
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The first generation protease inhibitors has been the mainstay of hepatitis C treatment for the last couple of years, showing marked improvement in sustained virological response, but also increased side effects. Infection has emerged as a common complication of telaprevir and boceprevir in combination with peginterferon and ribavirin, usually caused by common pathogens. We present the case of a 65 years old man who developed a Mycobacterium abscessus pulmonary infection during treatment with telaprevir, peginterferon and ribavirin. The patient was successfully treated with amikacin, imipenem and chlarithromycin. The present case is relevant for increasing awareness for recognition of opportunistic infections and particularly nontuberculous mycobacterial infections in patients receiving triple therapy for chronic hepatitis C, especially in cirrhotic subjects who develop significant lymphopenia.


Available from