title: Respiratory tract isolation of Mycobacterium europaeum following influenza infection in an immunocompromised patient: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.forename: Michael
authors.initials: M
authors.lastname: Phelippeau
authors.forename: Marion
authors.initials: M
authors.lastname: Delord
authors.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.
authors.forename: Michel
authors.initials: M
authors.lastname: Drancourt
authors.forename: Philippe
authors.initials: P
authors.lastname: Brouqui
mesh_terms: D060085:Coinfection; D005260:Female; D005602:France; D015658:HIV Infections / Q000150:complications / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D013058:Mass Spectrometry; D008875:Middle Aged; D009161:Mycobacterium / Q000302:isolation & purification*; D012137:Respiratory System / Q000276:immunology / Q000382:microbiology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013183:Sputum / Q000382:microbiology