title: Pseudooutbreak of rapidly growing mycobacteria due to Mycobacterium abscessus subsp bolletii in a digestive and respiratory endoscopy unit caused by the same clone as that of a countrywide outbreak.
abstract: The nontuberculous mycobacteria (NTM) are widely spread. In Brazil, 2,520 cases of rapidly growing mycobacteria (RGM) infections after medical procedures were reported, with 5.4% of cases related to nonsurgical invasive procedures and with an occurrence of 1 clone (BRA100) of Mycobacterium abscessus subsp bolletii.
  
  
  
  To describe a pseudooutbreak of M abscessus subsp bolletii in an endoscopy and bronchoscopy unit.
  
  
  
  The alert for a pseudooutbreak was given when 3 patients, in the same week, had a positive bronchoalveolar lavage culture for M abscessus subsp bolletii. The patients had no symptoms/signs of mycobacterial infection; thus, contamination of bronchoscopes was suspected. Samples for culturing were collected from bronchoscopes, digestive endoscopes, automated disinfection machines, and the water supply. Clinical samples were identified by polymerase chain reaction restriction-enzyme analysis (PRA) of the hsp65 gene and their pulsed-field gel electrophoresis pattern was compared with environmental samples.
  
  
  
  The investigation demonstrated a contamination of bronchoscopes, digestive endoscopes, and disinfection machines. Molecular typing demonstrated that all strains belonged to the same clone (MAB01), identical to clone BRA100.
  
  
  
  Cross-transmission due to poor disinfection as well as resistance to glutaraldehyde may play roles in the spread of MAB01 M abscessus subsp bolletii, which may have a unique resistance to the environment and adaption to human hosts. However the water supply may have played a role. Attention is needed to ensure the quality of water used to rinse disinfected equipment.
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. Electronic address: tguimaraes@terra.com.br.
authors.forename: Thaís
authors.initials: T
authors.lastname: Guimarães
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Erica
authors.initials: E
authors.lastname: Chimara
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Gladys Villas Boas
authors.initials: GV
authors.lastname: do Prado
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Lucilaine
authors.initials: L
authors.lastname: Ferrazoli
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Natalia Garcia Fernandes
authors.initials: NG
authors.lastname: Carvalho
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Fernanda Cristina Dos Santos
authors.initials: FC
authors.lastname: Simeão
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Andréia Rodrigues
authors.initials: AR
authors.lastname: de Souza
authors.affiliation: Instituto Adolfo Lutz, São Paulo, Brazil.
authors.forename: Christiane A R
authors.initials: CA
authors.lastname: Costa
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Cristina
authors.initials: C
authors.lastname: Viana Niero
authors.affiliation: Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Urze Adomaitis
authors.initials: UA
authors.lastname: Brianesi
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Thais Romano
authors.initials: TR
authors.lastname: di Gioia
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Laura Maria Brasileiro
authors.initials: LM
authors.lastname: Gomes
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Fernanda de Souza
authors.initials: FS
authors.lastname: Spadão
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Maria das Graças
authors.initials: MD
authors.lastname: Silva
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo Guimarães Hourneaux
authors.initials: EG
authors.lastname: de Moura
authors.affiliation: Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D001938:Brazil; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D020680:Bronchoscopes / Q000382:microbiology*; D001999:Bronchoscopy / Q000009:adverse effects*; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination; D006761:Hospitals; D006801:Humans; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology*; D000073358:Mycobacterium abscessus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length
keywords: Bronchoscopy; Endoscopy; Rapidly growing mycobacteria