Indiana University Infectious Diseases Fellowship
30 Jan,
12 tweets, 6 min read
#idboardreview 30 F 🇦🇺 s/p biomesotherapy presents with skin lesions. Biopsy shown citrate+ catalase+ oxidase- nitrate-
Diagnosis? #medEd #idmedEd #IDtwitter
Diagnosis? #medEd #idmedEd #IDtwitter
#mycobacterium #chelonae more dramatic presentation here in a gardener sciencedirect.com/science/articl…
M #chelonae ubiquitous in environment: soil, water, and aquatic animals. grows at 30-32 °C commonly associated w/ skin and soft tissue infections, especially of extremities (cellulitis, abscessus). Can causes catheter-related or post-surgical infections post implants, injections
bacteremia, osteomyelitis, intraabdominal abscess, disseminated cutaneous infections common in immunosuppressed on steroids, monoclonal antibodies, post-transplant immunosuppression. cancer and or CKD also susceptible to disseminated and invasive disease due to M. #chelonae
Skin lesions due to M. #chelonae rusk: sclerotherapy, acupuncture tattoos, other injections. Skin lesions can progress to pustules, hemorrhagic crusts, and abscess formation. M. chelonae can also present with Nodular lymphangitis (sporotrichoid lymphocutaneous infection)
M. #chelonae uniformly resistant to cefoxitin. Isolates are susceptible to tobra, clarithromycin, linezolid. Less susceptible to imipenem (60%), amikacin (50%), clofazimine, doxycycline (25%), and ciprofloxacin (20%).
SSTI: Use 2 agents x 4 months #chelonae tmp-smx, levaquin, doxy, clarithro/azithro
Biochemically, M #chelonae are nitrate negative, do not tolerate 5% NaCl, fail to turn dark brown when grown on ferric ammonium citrate (iron uptake).
M#chelonae & M#abscessus can be separated biochemically by citrate
#chelonae 100% citrate+ unlike #abscessus 80% citrate-
chelonae catalase+ oxidase-
but biochemical methods inadequate for clinical use. molecular techniques are used for diagnosis of atypical NTM
#chelonae 100% citrate+ unlike #abscessus 80% citrate-
chelonae catalase+ oxidase-
but biochemical methods inadequate for clinical use. molecular techniques are used for diagnosis of atypical NTM
Previous case #mycobacterium #chelonae
https://twitter.com/IUIDfellowship/status/1318337335021502465
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