Sections

Sections Mycobacterium haemophilum Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Overview

Background

Mycobacterium haemophilum is an acid-fast bacillus that has a wide geographic distribution, having been described in many parts of the world, including France, the United Kingdom, Israel, parts of Africa, Australia, Canada, the United States, and Brazil. In addition to infecting humans, M haemophilum has been isolated from the environment and has been found in several animal species.^[1]

Distinct from most other nontuberculous mycobacteria, M haemophilum in vitro growth requires a lower incubation temperature and iron supplementation. M haemophilum is unable to synthesize iron-binding siderophores, so it requires iron supplementation to grow in culture. Its preference for lower temperatures, similar to that of Mycobacterium leprae and Mycobacterium marinum, has been associated with a predilection for clinical infections to be located over the extremities.^[1]

M haemophilum can cause localized or disseminated infection, usually in individuals with an underlying immunomodulatory condition such as HIV/AIDS, organ transplant recipients, and patients with autoimmune disorders undergoing immunomodulation. The source of M haemophilum is often environmental habitats such as water reservoirs. While most reported cases do not have a clearly identified source, infection in adults has been associated with tattoo parlors and acupuncture needles.^[1]

Pathophysiology

The pathophysiology, natural habitat, and mechanism for acquisition of M haemophilum infection are not known. Water reservoirs may be the source of M haemophilum infections. Immunocompromised adults with M haemophilum infection most commonly present with skin lesions. Septic arthritis and osteomyelitis may also occur. Pulmonary infection is much less common and may follow skin disease. M haemophilum infection occasionally causes pulmonary infection initially. Mycobacteremia may occur.

Frequency

United States

More than 40 cases of M haemophilum infection have been reported, including 10 cases in Arizona from 1984-1994. Most cases occurred in immunosuppressed patients. The incidence of disease is unknown.

International

Cases of M haemophilum infection have been reported sporadically from Australia, France, Germany,^[2]Canada, Israel, United Kingdom, and South Africa.

Mortality/Morbidity

In healthy children, localized cervical lymphadenopathy is a benign disease that responds well to excision of the involved lymph nodes.

In immunocompromised patients, the outcome of disease is determined by the degree of underlying immunosuppression. Some patients with AIDS respond to therapy, while others respond initially but relapse later. Fatalities have occurred in bone marrow transplant recipients.

Sex

M haemophilum infection is more common in males than in females. This may be related to the higher incidence of HIV infection in males.

Age

Lymphadenitis occurs in young children.

Most cases in immunocompromised patients occur in adults.

Prognosis

Prognosis for children with localized lymphadenitis is good.

In adults, the outcome is determined by their immune function.

In severely immunosuppressed patients, disease may require long-term therapy. Despite maintenance therapy, infection may persist or recur.

Patient Education

Adherence to medication is of utmost importance to prevent resistance.

Instruct patients to list all medications to avoid drug interactions.

Rifampin and rifabutin may interfere with contraceptives and numerous other medications, especially HIV-related therapy.

Clinical Presentation

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Wang SX, Sng LH, Leong HN, Tan BH. Direct identification of Mycobacterium haemophilum in skin lesions of immunocompromised patients by PCR-restriction endonuclease analysis. J Clin Microbiol. 2004 Jul. 42(7):3336-8. [QxMD MEDLINE Link].
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Bruijnesteijn van Coppenraet LE, Kuijper EJ, Lindeboom JA, Prins JM, Claas EC. Mycobacterium haemophilum and lymphadenitis in children. Emerg Infect Dis. 2005 Jan. 11(1):62-8. [QxMD MEDLINE Link].
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Minani TJ, Saubolle MA, Yu E, Sussland Z. Mycobacterium haemophilum as a novel etiology of cervical lymphadenitis in an otherwise healthy adult patient. J Clin Microbiol. 2010 Jul. 48(7):2636-9. [QxMD MEDLINE Link]. [Full Text].
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Aslam A, Green RL, Motta L, Ghrew M, Griffiths CE, Warren RB. Cutaneous Mycobacterium haemophilum infection in a patient receiving infliximab for psoriasis. Br J Dermatol. 2013 Feb. 168(2):446-7. [QxMD MEDLINE Link].
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Author

Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai

Aaron E Glatt, MD, MACP, FIDSA, FSHEA is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Natalie C Klein, MD, PhD Associate Director, Infectious Disease Division, Associate Professor of Medicine, The School of Medicine at Stony Brook University Medical Center

Natalie C Klein, MD, PhD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, New York County Medical Society, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Former Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Sections Mycobacterium haemophilum Infection
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Mycobacterium haemophilum Infection

Background

Pathophysiology

Epidemiology

Frequency

Mortality/Morbidity

Sex

Age

Prognosis

Patient Education

References

Tables

Contributor Information and Disclosures

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