Iemura-Kashiwagi Maho, Ito Isao, Ikeguchi Ryosuke, Kadoya Masatoshi, Iemura Tomoki, Yoshida Shiomi, Suzuki Katsuhiro, Hirai Toyohiro
Department of Respiratory Medicine, Kyoto University Hospital, Japan.
Department of Respiratory Medicine, Kyoto University Hospital, Japan.
J Infect Chemother. 2020 Jan;26(1):136-139. doi: 10.1016/j.jiac.2019.06.013. Epub 2019 Jul 23.
Mycolicibacter kumamotonensis (M. kumamotonensis), formerly Mycobacterium kumamotonense, is a nontuberculous mycobacteria species, which was first separated from Mycobacterium terrae complex in 2006. Reports about infections caused by M. kumamotonensis are extremely rare, with most of them being lung infection. Here, we report the case of a 68-year-old man with a hobby of gardening who developed swelling in his right middle finger. He underwent surgical debridement at a previous hospital and was diagnosed with nontuberculous mycobacteria infection based on positive findings of acid-fast staining of pus obtained from the surgical specimen. He was treated with rifampicin, ethambutol, and clarithromycin, but the swelling worsened. Therefore, he was referred to our hospital for further examination and treatment. We performed a second debridement and added isoniazid to the treatment regimen, but the swelling continued to worsen. We then administered levofloxacin, but his condition did not change. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry and DNA sequencing analysis confirmed M. kumamotonensis as the causative bacterium. Since the finger swelling did not improve, the patient underwent a third debridement and amikacin was added to the treatment regimen. Finally, the infection was controlled. He completed amikacin therapy and will continue treatment with the other five antibiotics for a total of 24 months. To the best of our knowledge, this is the first report of a patient with M. kumamotonensis soft tissue infection. We consider this case might provide important insights into the diagnosis and treatment of soft tissue infections caused by M. kumamotonensis.
熊本分枝杆菌（以前称为熊本结核分枝杆菌）是一种非结核分枝杆菌，于2006年首次从地分枝杆菌复合体中分离出来。关于熊本分枝杆菌引起感染的报道极为罕见，其中大多数为肺部感染。在此，我们报告一例68岁有园艺爱好的男性病例，其右手中指出现肿胀。他曾在之前的医院接受手术清创，根据手术标本脓液抗酸染色阳性结果被诊断为非结核分枝杆菌感染。他接受了利福平、乙胺丁醇和克拉霉素治疗，但肿胀加剧。因此，他被转诊至我院进行进一步检查和治疗。我们进行了第二次清创，并在治疗方案中加入异烟肼，但肿胀仍持续加重。随后我们给予左氧氟沙星治疗，但他的病情没有变化。基质辅助激光解吸/电离飞行时间质谱和DNA测序分析证实熊本分枝杆菌为致病菌。由于手指肿胀未改善，患者接受了第三次清创，并在治疗方案中加入丁胺卡那霉素。最终，感染得到控制。他完成了丁胺卡那霉素治疗，并将继续使用其他五种抗生素总共治疗24个月。据我们所知，这是首例熊本分枝杆菌软组织感染患者的报告。我们认为该病例可能为熊本分枝杆菌引起的软组织感染的诊断和治疗提供重要见解。
