title: Report of two fatal cases of Mycobacterium mucogenicum central nervous system infection in immunocompetent patients.
abstract: Neurological infections due to rapidly growing mycobacteria (RGM) have rarely been reported. We recently investigated two unrelated immunocompetent patients, one with community-acquired lymphocytic meningitis and the other with cerebral thrombophlebitis. Mycobacterium mucogenicum was isolated in pure culture and detected by PCR sequencing of cerebrospinal fluid samples. Both patients eventually died. The two isolates exhibited an overlapping antimicrobial susceptibility pattern. They were susceptible in vitro to tetracyclines, macrolides, quinolones, amikacin, imipenem, cefoxitin, and trimethoprim-sulfamethoxazole and resistant to ceftriaxone. They shared 100% 16S rRNA gene sequence similarity with M. mucogenicum ATCC 49650T over 1,482 bp. Their partial rpoB sequences shared 97.8% and 98.1% similarity with M. mucogenicum ATCC 49650T, suggesting that the two isolates were representative of two sequevars of M. mucogenicum species. This case report should make clinicians aware that M. mucogenicum, an RGM frequently isolated from tap water or from respiratory specimens and mostly without clinical significance, can even be encountered in the central nervous system of immunocompetent patients.
authors.affiliation: Unité des Rickettsies, CNRS UMR 6020 IFR 48, Faculté de Médecine, Université de la Méditerranée, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 05, France.
authors.forename: Toïdi
authors.initials: T
authors.lastname: Adékambi
authors.forename: Cedric
authors.initials: C
authors.lastname: Foucault
authors.forename: Bernard
authors.initials: B
authors.lastname: La Scola
authors.forename: Michel
authors.initials: M
authors.lastname: Drancourt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020806:Central Nervous System Bacterial Infections / Q000276:immunology / Q000382:microbiology*; D004269:DNA, Bacterial / Q000235:genetics; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D024881:Drug Resistance, Bacterial; D017809:Fatal Outcome; D005798:Genes, Bacterial; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008969:Molecular Sequence Data; D009165:Mycobacterium Infections, Nontuberculous / Q000276:immunology / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D013045:Species Specificity
chemical_list: D004269:DNA, Bacterial; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit