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| {{Taxobox | | __NOTOC__ |
| | color = lightgrey
| | {{Mycobacterium abscessus}} |
| | name = ''Mycobacterium abscessus''
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| | regnum = [[Bacterium|Bacteria]]
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| | phylum = [[Actinobacteria]]
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| | ordo = [[Actinomycetales]]
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| | subordo = [[Corynebacterineae]]
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| | familia = [[Mycobacterium|Mycobacteriaceae]]
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| | genus = ''[[Mycobacterium]]''
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| | species = '''''M. abscessus'''''
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| | binomial = ''Mycobacterium abscessus''
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| | binomial_authority = Kusonoki and Ezaki 1992 ATCC 19977
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| }}
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| {{SI}}
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| {{CMG}} | | {{About1|Mycobacterium abscessus causes}} |
| | {{CMG}}; {{AE}} {{Rim}} |
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| {{SK}} M. abcessus | | {{SK}} M. abcessus, non tuberculous mycobacterium, NTM, rapidly growing mycobacterium, RGM |
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| ==Overview== | | ==[[Mycobacterium abscessus overview|Overview]]== |
| Mycobacterium abscessus is a rapidly growing [[mycobacterium]] that is a common water contaminant. Mycobacterium abscessus is a bacterium distantly related to the ones that cause [[tuberculosis]] and [[leprosy]]. It is part of a group known as rapidly growing mycobacteria and is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices. M. abscessus can cause a variety of infections. Healthcare-associated infections due to this bacterium are usually of the skin and the soft tissues under the skin. It is also a cause of serious lung infections in persons with various chronic lung diseases, such as cystic fibrosis, post-traumatic wound infections, and disseminated cutaneous diseases, mostly in patients with suppressed immune systems.
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| ==Historical Perspective== | | ==[[Mycobacterium abscessus historical perspective|Historical Perspective]]== |
| ''Mycobacterium abscessus'' was first isolated in 1953 from gluteal abscesses in a 62-year-old patient who had injured her knee as a child and had a disseminated infection 48 years later.<ref name="pmid13035193">{{cite journal| author=MOORE M, FRERICHS JB| title=An unusual acid-fast infection of the knee with subcutaneous, abscess-like lesions of the gluteal region; report of a case with a study of the organism, Mycobacterium abscessus, n. sp. | journal=J Invest Dermatol | year= 1953 | volume= 20 | issue= 2 | pages= 133-69 | pmid=13035193 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13035193 }} </ref> It was until 1992 that Mycobacterium abscessus is considered a separate organism from [[Mycobacterium chelonae]].
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| | ==[[Mycobacterium abscessus causes|Causes]]== |
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| The species ''M. bolletii'', named after the late microbiologist and taxonomist [[Claude Bollet]], was described in 2006. In current taxonomy, ''M. bolletii'' and ''M. massiliense'' (named for Massilia, the ancient Greek and Roman name for Marseille, where the organism was isolated) have been incorporated into ''M. abscessus'' subsp. ''bolletii''. <ref> Etymologia: Mycobacterium abscessus subsp. bolletii. Emerg Infect Dis [Internet]. 2014 Mar [February 20, 2014]. http://dx.doi.org/10.3201/eid2003.ET2003 </ref>
| | ==[[Mycobacterium abscessus epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Classification== | | ==[[Mycobacterium abscessus risk factors|Risk Factors]]== |
| * M. abscessus sensu stricto
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| * Mycobacterium massiliense<ref name="pmid15583272">{{cite journal| author=Adékambi T, Reynaud-Gaubert M, Greub G, Gevaudan MJ, La Scola B, Raoult D et al.| title=Amoebal coculture of "Mycobacterium massiliense" sp. nov. from the sputum of a patient with hemoptoic pneumonia. | journal=J Clin Microbiol | year= 2004 | volume= 42 | issue= 12 | pages= 5493-501 | pmid=15583272 | doi=10.1128/JCM.42.12.5493-5501.2004 | pmc=PMC535245 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15583272 }} </ref>
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| * Mycobacterium bolletii<ref name="pmid16403878">{{cite journal| author=Adékambi T, Berger P, Raoult D, Drancourt M| title=rpoB gene sequence-based characterization of emerging non-tuberculous mycobacteria with descriptions of Mycobacterium bolletii sp. nov., Mycobacterium phocaicum sp. nov. and Mycobacterium aubagnense sp. nov. | journal=Int J Syst Evol Microbiol | year= 2006 | volume= 56 | issue= Pt 1 | pages= 133-43 | pmid=16403878 | doi=10.1099/ijs.0.63969-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16403878 }} </ref>
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| ==Pathophysiology== | | ==[[Mycobacterium abscessus natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ===Pathogen===
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| Mycobacterium abscessus is a bacterium distantly related to the ones that cause [[tuberculosis]] and [[leprosy]]. It is part of a group known as rapidly growing mycobacteria and is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices.
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| ===Transmission===
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| Infection with M. abscessus is usually caused by injections of substances contaminated with the bacterium or through invasive medical procedures employing contaminated equipment or material. Infection can also occur after accidental injury where the wound is contaminated by soil. There is very little risk of transmission from person to person.
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| ===Microscopy===
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| *Gram-positive, nonmotile and acid-fast rods (1.0-2.5µm x 0.5µm).
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| ===Colony characteristics===
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| *Colonies on Löwenstein-Jensen media may occur as smooth as well as rough, white or greyish and nonphotochromogenic.
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| ===Physiology===
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| *Growth at 28°C and 37°C after 7 days but not at 43°C.
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| *On MacConkey agar at 28°C and even 37°C.
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| *Tolerance to 5% NaCl and 500mg/l hydroxylamine (Ogawa egg medium) and 0.2% picrate (Sauton agar medium).
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| *Positive degradation of p-aminosalicylate.
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| *Production of arylsulfatase but not of nitrate reductase and Tween 80 hydrolase.
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| *Negative iron uptake test. No utilisation of fructose, glucose, oxalate and citrate as sole carbon sources.
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| ===Differential characteristics===
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| *M. abscessus and M. chelonae can be distinguished from M. fortuitum or M. peregrinum by their failure to reduce nitrate and to take up iron.
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| *Tolerance to 5% NaCl in Löwenstein-Jensen media tolerance to 0.2% picrate in Sauton agar and non-utilisation of citrate as a sole carbon source are characteristics that distinguish M. abscessus from M. chelonae.
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| *M. abscessus and M. chelonae sequevar I share an identical sequence in the 54-510 region of 16S rRNA, However, both species can be differentiated by their hsp65 or ITS sequences
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| ===Strains===
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| ATCC 19977 = CCUG 20993 = CIP 104536 = DSM 44196 = JCM 13569 = NCTC 13031
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| ===Genetics===
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| A draft genome sequence of ''M. abscessus'' subsp. ''bolletii'' BD<sup>T</sup> was completed in 2012.<ref>{{cite journal|last=Choi|first=G.-E.|author2=Cho, Y.-J. |author3=Koh, W.-J. |author4=Chun, J. |author5=Cho, S.-N. |author6= Shin, S. J. |title=Draft Genome Sequence of Mycobacterium abscessus subsp. bolletii BDT|journal=Journal of Bacteriology|date=24 April 2012|volume=194|issue=10|pages=2756–2757|doi=10.1128/JB.00354-12}}</ref> More than 25 different strains of this subspecies, including pathogenic isolates, have had their genomes sequenced.<ref>{{cite journal|last=Davidson|first=Rebecca M.|coauthors=Hasan, Nabeeh A.; de Moura, Vinicius Calado Nogueira; Duarte, Rafael Silva; Jackson, Mary; Strong, Michael|title=Phylogenomics of Brazilian epidemic isolates of Mycobacterium abscessus subsp. bolletii reveals relationships of global outbreak strains|journal=Infection, Genetics and Evolution|date=December 2013|volume=20|pages=292–297|doi=10.1016/j.meegid.2013.09.012}}</ref>
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| ==Risk Factors== | |
| * Open wounds
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| * Injections without appropriate skin disinfection
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| * Immune suppression
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| * Chronic lung disease (for example, [[cystic fibrosis)
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| * Post-tympanostomy tube [[otitis media]]
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| ==Diagnosis== | | ==Diagnosis== |
| ===History===
| | [[Mycobacterium abscessus diagnostic criteria|Diagnostic Criteria]] | [[Mycobacterium abscessus history and symptoms|History and Symptoms]] | [[Mycobacterium abscessus physical examination|Physical Examination]] | [[Mycobacterium abscessus laboratory findings|Laboratory Findings]] | [[Mycobacterium abscessus chest X ray|Chest X Ray]] | [[Mycobacterium abscessus other imaging findings|Other Imaging Findings]] |
| The patient should be asked about a recent history of received procedures, such as surgery or injections.
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| ===Symptoms===
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| * Red, warm, tender to the touch, swollen, and/or painful [[skin]]
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| * [[Boil]]s
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| * Pus-filled [[vesicle]]s
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| *[[Fever]]
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| *[[Chills]]
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| *[[Muscle aches]]
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| *[[Malaise]]
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| ===Physical Examination===
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| ===Skin===
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| *Skin infected with M. abscessus is usually red, warm, tender to the touch, swollen, and/or painful.
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| *Infected areas can also develop [[boils]] or pus-filled [[vesicles]].
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| ===Laboratory Studies===
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| To reach a definitive diagnosis, the organism has to be cultured from the infection site or, in severe cases, from a blood culture. The diagnosis is made by growing this bacterium in the laboratory from a sample of the pus or biopsy of the infected area.
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| ==Treatment== | | ==Treatment== |
| ===Medical Therapy===
| | [[Mycobacterium abscessus medical therapy|Medical Therapy]] | [[Mycobacterium abscessus surgery|Surgery]] | [[Mycobacterium abscessus primary prevention|Primary Prevention]] |
| The recommended treatment strategy is to combine three drugs
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| 1. [[Clarithromycin]]
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| 2. [[Amikacin]] or another [[aminoglycoside]]
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| 3. An injectable agent such as either [[cefoxitin]] or [[imipenem]]
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| ===Surgical Treatment===
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| Treatment of infections due to M. abscessus consists of draining collections of pus or removing the infected tissue and administering the appropriate combination of antibiotics for a prolonged period of time. Infection with this bacterium usually does not improve with the usual antibiotics used to treat skin infections. Testing the bacteria against different antibiotics is helpful in guiding doctors to the most appropriate treatment for each patient.
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| ==Primary Prevention==
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| *Anyone who touches or cares for the infected site should wash their hands carefully with soap and water.
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| *Patients should follow all instructions given by their healthcare provider following any surgery or medical procedure.
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| *Avoid receiving procedures or injections by unlicensed persons.
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| ==Source==
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| Publicly available content from the United States CDC
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| ==References==
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| {{Reflist|2}}
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| *'''Kusunoki,S.,T. Ezaki.''' 1992. Proposal of Mycobacterium peregrinum sp. nov., nom. rev., and elevation of Mycobacterium chelonae subsp. abscessus (Kubica et al.) to species status: Mycobacterium abscessus comb. nov. Int. J. Syst. Bacteriol. 42, 240-245.
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| [[Category:Acid fast bacilli]] | | [[Category:Acid fast bacilli]] |
| [[Category:Corynebacterineae]]
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| [[Category:Nontuberculous mycobacteria]] | | [[Category:Nontuberculous mycobacteria]] |
| [[Category:Infectious disease]]
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