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Respiratory tract isolation of Mycobacterium europaeum following influenza infection in an immunocompromised patient: a case report.

Phelippeau M, Delord M, Drancourt M, Brouqui P - J Med Case Rep (2014)

Bottom Line: A 49-year-old Caucasian woman with a 26-year history of human immunodeficiency virus-hepatitis C virus co-infection was admitted for significant influenza-like syndrome in a context of repetitive exacerbations of chronic obstructive pulmonary disease.Reverse-transcriptase polymerase chain reaction of her nasopharyngeal aspiration confirmed influenza A H1N1.M. europaeum warrants further attention in immunosuppressed patients with influenza, using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry and rpoB partial sequencing as tools for its accurate identification.

View Article: PubMed Central - PubMed

Affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire « Méditerranée Infection », AP-HM, 13005 Marseille, France. michel.drancourt@univ-amu.fr.

ABSTRACT

Introduction: Mycobacterium europaeum, a slow-growing nontuberculous mycobacteria belonging to the Mycobacterium simiae complex, was described after the seminal characterization of five isolates collected from three sputum specimens and a jaw gland biopsy in Italy, Greece and Sweden. Five respiratory tract isolates were further reported in Iran. Here, we report the first isolation of M. europaeum in France, in the respiratory tract of a patient co-infected with human immunodeficiency virus and hepatitis C virus.

Case presentation: A 49-year-old Caucasian woman with a 26-year history of human immunodeficiency virus-hepatitis C virus co-infection was admitted for significant influenza-like syndrome in a context of repetitive exacerbations of chronic obstructive pulmonary disease. Significant biological parameters included lymphocytes of 1.6G/L including 237/mm3 T4 lymphocytes, a human immunodeficiency virus viral load of 1.6 log and a hepatitis C virus viral load of 6 log. Reverse-transcriptase polymerase chain reaction of her nasopharyngeal aspiration confirmed influenza A H1N1. Three sputum specimens lacked acid-fast bacilli but one grew mycobacteria identified by using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry as M. europaeum with a 1.56 log score. A 1,482-bp 16S ribosomal ribonucleic acid gene sequence yielded 99% similarity with both Mycobacterium parascrofulaceum ATCC BAA-614 and M. europaeum DSM 45397T and partial rpoB polymerase chain reaction-sequencing yielded a 725-bp sequence exhibiting 100% similarity with M. europaeum strain DSM 45397T.

Conclusions: We report the first isolation of M. europaeum in France, in the respiratory tract of a patient co-infected with human immunodeficiency virus and hepatitis C virus. M. europaeum warrants further attention in immunosuppressed patients with influenza, using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry and rpoB partial sequencing as tools for its accurate identification.

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Matrix-assisted laser desorption ionization/ time-of-flight analysis ofMycobacterium europaeum. A. Matrix-assisted laser desorption ionization/time-of-flight mass spectrometry profile of Mycobacterium europaeum CSUR P1344 using colonies from egg-based Löwenstein–Jensen medium. B. Phylogenetic tree constructed using the neighbor-joining method (bootstrapped 1000 times) and Kimura’s two-parameter distance correction model based on rpoB partial sequences of 18 mycobacterial species including isolate CSUR P1344 collected in our patient’s sputum. Bootstrap values above 90% are given at nodes. Mycobacterium tuberculosis H37Rv was used as out-group. The scale bar represents 1% difference in nucleotide sequences. GenBank accession numbers are given in parentheses. M. is Mycobacterium.
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Fig1: Matrix-assisted laser desorption ionization/ time-of-flight analysis ofMycobacterium europaeum. A. Matrix-assisted laser desorption ionization/time-of-flight mass spectrometry profile of Mycobacterium europaeum CSUR P1344 using colonies from egg-based Löwenstein–Jensen medium. B. Phylogenetic tree constructed using the neighbor-joining method (bootstrapped 1000 times) and Kimura’s two-parameter distance correction model based on rpoB partial sequences of 18 mycobacterial species including isolate CSUR P1344 collected in our patient’s sputum. Bootstrap values above 90% are given at nodes. Mycobacterium tuberculosis H37Rv was used as out-group. The scale bar represents 1% difference in nucleotide sequences. GenBank accession numbers are given in parentheses. M. is Mycobacterium.

Mentions: A 49-year-old Caucasian woman with a 26-year history of HIV-HCV co-infection was admitted to an Infectious and Tropical Diseases Department in Marseille, France in February 2014 for significant influenza-like syndrome in a context of repetitive exacerbations of chronic obstructive pulmonary disease. Pulmonary auscultation found diffuse wheezing. Significant biological parameters included a C-reactive protein level of 57mg/L, lymphocytes of 1.6G/L including 237/mm3 T4 lymphocytes, a HIV viral load of 1.6 log and a HCV viral load of 6 log. Her chest radiography was normal. Reverse-transcriptase polymerase chain reaction (PCR) of her nasopharyngeal aspiration confirmed influenza A H1N1. At a 6-month follow-up, her clinical outcome was favorable with initial supportive treatment only. Three sputum specimens lacked acid-fast bacilli (AFB) after Ziehl–Neelsen staining and microscopic observation but one grew AFB after 21-day incubation in MGIT (Becton Dickinson, Le Pont-de-Claix, France) at 37°C in a 5% carbon dioxide atmosphere. After subculture on Coletsos (bioMérieux, La-Balme-les-Grottes, France), the isolate was deposited in our collection (CSUR P1344) and tentatively identified by using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF-MS), the bioMérieux extraction protocol, a MicroFlex™ mass spectrometer (Bruker Daltonics, Bremen, Germany) and the Bruker MALDI Biotyper procedures as previously described [4]. A reproducible profile (Figure 1A) yielded a 1.56 log score with M. europaeum DSM 45397T listed in the Bruker Mycobacterium Library 1.0 and 2.0 databases. A 1,482-bp 16S ribosomal ribonucleic acid (rRNA) gene sequence (GenBank LN680852) yielded 99% similarity with both Mycobacterium parascrofulaceum ATCC BAA-614 (GenBank GQ153273) and M. europaeum DSM 45397T (GenBank HM022196), two species known to share almost identical 16S rRNA gene sequence [1]. Partial rpoB PCR-sequencing [5] yielded a 725-bp sequence (GenBank LK021335) exhibiting 100% similarity with M. europaeum strain DSM 45397T (GenBank HM022215; Figure 1B).Figure 1


Respiratory tract isolation of Mycobacterium europaeum following influenza infection in an immunocompromised patient: a case report.

Phelippeau M, Delord M, Drancourt M, Brouqui P - J Med Case Rep (2014)

Matrix-assisted laser desorption ionization/ time-of-flight analysis ofMycobacterium europaeum. A. Matrix-assisted laser desorption ionization/time-of-flight mass spectrometry profile of Mycobacterium europaeum CSUR P1344 using colonies from egg-based Löwenstein–Jensen medium. B. Phylogenetic tree constructed using the neighbor-joining method (bootstrapped 1000 times) and Kimura’s two-parameter distance correction model based on rpoB partial sequences of 18 mycobacterial species including isolate CSUR P1344 collected in our patient’s sputum. Bootstrap values above 90% are given at nodes. Mycobacterium tuberculosis H37Rv was used as out-group. The scale bar represents 1% difference in nucleotide sequences. GenBank accession numbers are given in parentheses. M. is Mycobacterium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307153&req=5

Fig1: Matrix-assisted laser desorption ionization/ time-of-flight analysis ofMycobacterium europaeum. A. Matrix-assisted laser desorption ionization/time-of-flight mass spectrometry profile of Mycobacterium europaeum CSUR P1344 using colonies from egg-based Löwenstein–Jensen medium. B. Phylogenetic tree constructed using the neighbor-joining method (bootstrapped 1000 times) and Kimura’s two-parameter distance correction model based on rpoB partial sequences of 18 mycobacterial species including isolate CSUR P1344 collected in our patient’s sputum. Bootstrap values above 90% are given at nodes. Mycobacterium tuberculosis H37Rv was used as out-group. The scale bar represents 1% difference in nucleotide sequences. GenBank accession numbers are given in parentheses. M. is Mycobacterium.
Mentions: A 49-year-old Caucasian woman with a 26-year history of HIV-HCV co-infection was admitted to an Infectious and Tropical Diseases Department in Marseille, France in February 2014 for significant influenza-like syndrome in a context of repetitive exacerbations of chronic obstructive pulmonary disease. Pulmonary auscultation found diffuse wheezing. Significant biological parameters included a C-reactive protein level of 57mg/L, lymphocytes of 1.6G/L including 237/mm3 T4 lymphocytes, a HIV viral load of 1.6 log and a HCV viral load of 6 log. Her chest radiography was normal. Reverse-transcriptase polymerase chain reaction (PCR) of her nasopharyngeal aspiration confirmed influenza A H1N1. At a 6-month follow-up, her clinical outcome was favorable with initial supportive treatment only. Three sputum specimens lacked acid-fast bacilli (AFB) after Ziehl–Neelsen staining and microscopic observation but one grew AFB after 21-day incubation in MGIT (Becton Dickinson, Le Pont-de-Claix, France) at 37°C in a 5% carbon dioxide atmosphere. After subculture on Coletsos (bioMérieux, La-Balme-les-Grottes, France), the isolate was deposited in our collection (CSUR P1344) and tentatively identified by using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF-MS), the bioMérieux extraction protocol, a MicroFlex™ mass spectrometer (Bruker Daltonics, Bremen, Germany) and the Bruker MALDI Biotyper procedures as previously described [4]. A reproducible profile (Figure 1A) yielded a 1.56 log score with M. europaeum DSM 45397T listed in the Bruker Mycobacterium Library 1.0 and 2.0 databases. A 1,482-bp 16S ribosomal ribonucleic acid (rRNA) gene sequence (GenBank LN680852) yielded 99% similarity with both Mycobacterium parascrofulaceum ATCC BAA-614 (GenBank GQ153273) and M. europaeum DSM 45397T (GenBank HM022196), two species known to share almost identical 16S rRNA gene sequence [1]. Partial rpoB PCR-sequencing [5] yielded a 725-bp sequence (GenBank LK021335) exhibiting 100% similarity with M. europaeum strain DSM 45397T (GenBank HM022215; Figure 1B).Figure 1

Bottom Line: A 49-year-old Caucasian woman with a 26-year history of human immunodeficiency virus-hepatitis C virus co-infection was admitted for significant influenza-like syndrome in a context of repetitive exacerbations of chronic obstructive pulmonary disease.Reverse-transcriptase polymerase chain reaction of her nasopharyngeal aspiration confirmed influenza A H1N1.M. europaeum warrants further attention in immunosuppressed patients with influenza, using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry and rpoB partial sequencing as tools for its accurate identification.

View Article: PubMed Central - PubMed

Affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, Institut Hospitalo-Universitaire « Méditerranée Infection », AP-HM, 13005 Marseille, France. michel.drancourt@univ-amu.fr.

ABSTRACT

Introduction: Mycobacterium europaeum, a slow-growing nontuberculous mycobacteria belonging to the Mycobacterium simiae complex, was described after the seminal characterization of five isolates collected from three sputum specimens and a jaw gland biopsy in Italy, Greece and Sweden. Five respiratory tract isolates were further reported in Iran. Here, we report the first isolation of M. europaeum in France, in the respiratory tract of a patient co-infected with human immunodeficiency virus and hepatitis C virus.

Case presentation: A 49-year-old Caucasian woman with a 26-year history of human immunodeficiency virus-hepatitis C virus co-infection was admitted for significant influenza-like syndrome in a context of repetitive exacerbations of chronic obstructive pulmonary disease. Significant biological parameters included lymphocytes of 1.6G/L including 237/mm3 T4 lymphocytes, a human immunodeficiency virus viral load of 1.6 log and a hepatitis C virus viral load of 6 log. Reverse-transcriptase polymerase chain reaction of her nasopharyngeal aspiration confirmed influenza A H1N1. Three sputum specimens lacked acid-fast bacilli but one grew mycobacteria identified by using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry as M. europaeum with a 1.56 log score. A 1,482-bp 16S ribosomal ribonucleic acid gene sequence yielded 99% similarity with both Mycobacterium parascrofulaceum ATCC BAA-614 and M. europaeum DSM 45397T and partial rpoB polymerase chain reaction-sequencing yielded a 725-bp sequence exhibiting 100% similarity with M. europaeum strain DSM 45397T.

Conclusions: We report the first isolation of M. europaeum in France, in the respiratory tract of a patient co-infected with human immunodeficiency virus and hepatitis C virus. M. europaeum warrants further attention in immunosuppressed patients with influenza, using matrix-assisted laser desorption ionization/time-of-flight mass spectrometry and rpoB partial sequencing as tools for its accurate identification.

Show MeSH
Related in: MedlinePlus