Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.
Department of Clinical Laboratory, Shantou Central Hospital, Shantou, Guangdong Province, China.
BMC Infect Dis. 2024 Aug 22;24(1):853. doi: 10.1186/s12879-024-09741-y.
Non-tuberculous mycobacteria (NTM) are present widely in the natural environment and can invade the human body through the respiratory tract, gastrointestinal tract, and skin. Immunocompromised patients are particularly prone to infection, which primarily affects multiple organs, including the lungs, lymph nodes, and skin. However, cases of NTM bloodstream infections are rare. Here, we report a rare case of Mycobacterium marseillense bloodstream infection with concurrent skin fungal infection in a patient after kidney transplantation. Related literature was reviewed to enhance the understanding of this rare condition.
A 58-year-old male with a history of long-term steroid and immunosuppressant use after kidney transplantation presented with limb swelling that worsened over the past two months. Physical examination revealed redness and swelling of the skin in all four limbs, with a non-healing wound on the lower left limb. Skin tissue analysis by metagenomic next-generation sequencing (mNGS) and fungal culture indicated infection with Trichophyton rubrum. Blood culture results suggested infection with Mycobacterium marseillense. After receiving anti-NTM treatment, the patient's symptoms significantly improved, and he is currently undergoing treatment.
Mycobacterium marseillense is a NTM. Gram staining suffered from misdetection, and the acid-fast staining result was positive. This bacterium was identified by mass spectrometry and mNGS analyses. Antimicrobial susceptibility tests for NTM were performed using the broth microdilution method. The results of the susceptibility test showed that Mycobacterium marseillense was sensitive to clarithromycin, an intermediary between moxifloxacin and linezolid. Bacterial clearance requires a combination of drugs and an adequate course of treatment. NTM bloodstream infections are relatively rare, and early identification and proactive intervention are key to their successful management.
非结核分枝杆菌（NTM）广泛存在于自然环境中，可通过呼吸道、胃肠道和皮肤侵入人体。免疫功能低下的患者尤其容易感染，主要影响多个器官，包括肺、淋巴结和皮肤。然而，NTM 血流感染的病例很少见。在这里，我们报告了一例肾移植后患者同时发生分枝杆菌感染和皮肤真菌感染的罕见马赛分枝杆菌血流感染病例。回顾相关文献，以增强对这种罕见疾病的认识。
一名 58 岁男性，肾移植后长期使用类固醇和免疫抑制剂，因四肢肿胀加重 2 个月来诊。体格检查发现四肢发红、肿胀，左下肢体有一处未愈合的伤口。宏基因组下一代测序（mNGS）和真菌培养的皮肤组织分析提示感染红色毛癣菌。血培养结果提示感染马赛分枝杆菌。接受抗-NTM 治疗后，患者症状明显改善，目前正在接受治疗。
马赛分枝杆菌是一种 NTM。革兰氏染色容易漏检，抗酸染色阳性。通过质谱分析和 mNGS 分析对该细菌进行了鉴定。采用肉汤微量稀释法进行 NTM 药敏试验。药敏试验结果显示，马赛分枝杆菌对克拉霉素敏感，介于莫西沙星和利奈唑胺之间。细菌清除需要联合用药和足够的疗程。NTM 血流感染较为罕见，早期识别和积极干预是成功治疗的关键。
