Mycobacterial Diseases LAWRENCE G
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CLINICAL MICROBIOLOGY REVIEWS, Jan. 1992, p. 1-25 Vol. 5, No. 1 0893-8512/92/010001-25$02.00/0 Agents of Newly Recognized or Infrequently Encountered Mycobacterial Diseases LAWRENCE G. WAYNE* AND HILDA A. SRAMEK Veterans Affairs Medical Center, Long Beach, California 90822 INTRODUCTION ............................................................................... 2 PREVIOUSLY WELL-DOCUMENTED SPECIES OF SLOWLY GROWING PPEM.............................3 M. kansasii .............................................................................. 3 Systematics .............................................................................. 3 Clinical and epidemiologic aspects .............................................................................. 3 M. marinum .............................................................................. 3 Systematics .............................................................................. 3 Clinical and epidemiologic aspects .............................................................................. 3 M. scrofulaceum.............................................................................. 4 Systematics .............................................................................. 4 Clinical and epidemiologic aspects .............................................................................. 4 M. simiae .............................................................................. 4 Systematics .............................................................................. 4 Clinical and epidemiologic aspects ............................................................................... 4 M. szulgai.............................................................................. 4 Systematics .............................................................................. 4 Clinical and epidemiologic aspects ............................................................................... 5 M. ulcerans..............................................................................5 M. xenopi..............................................................................5 Systematics .............................................................................. 5 Clinical and epidemiologic aspects .............................................................................. 5 PREVIOUSLY WELL-DOCUMENTED SPECIES OF RAPIDLY GROWING PPEM............................5 M. fortuitum Complex .............................................................................. 5 Systematics ............................................................................... 5 Clinical and epidemiologic aspects .............................................................................. 5 MAJOR RECENT DEVELOPMENTS IN THE TAXONOMY OF AND CLINICAL CONDITIONS ASSOCIATED WITH SOME COMMONLY ENCOUNTERED PPEM..........................................6 M. avium Complex .............................................................................. 6 Systematics .............................................................................. 6 (i) Taxonomic status .............................................................................. 6 (ii) Identification .............................................................................. 7 Newer clinical and epidemiological aspects.............................................................................. 7 (i) AIDS ............................................................................... 7 (ii) Crohn's disease ............................................................................... 8 NEWLY CHARACTERIZED MYCOBACTERIA OR MYCOBACTERIAL DISEASES .........................8 M. asiaticum .............................................................................. 8 Systematics ............................................................................... 8 Clinical and epidemiologic aspects ............................................................................... 9 M. haemophilum ............................................................................. 9 Systematics .............................................................................. 9 Clinical and epidemiologic aspects.............................................................................. 10 M. malmoense ............................................................................. 11 Systematics.............................................................................. 11 (i) Taxonomic status .............................................................................. 11 (ii) Identification.............................................................................. 11 Clinical and epidemiologic aspects .............................................................................. 11 M. shimoidei............................................................................. 13 Systematics.............................................................................. 13 Clinical and epidemiologic aspects .............................................................................. 13 SPECIES OF MYCOBACTERIA GENERALLY CONSIDERED TO BE NONPATHOGENIC ...............13 M. gasi............................................................................... 13 Systematics.............................................................................. 13 Clinical and epidemiologic aspects .............................................................................. 13 * Corresponding author. 1 2 WAYNE AND SRAMEK CLIN. MICROBIOL. REV. M. gordonae ................................................ 14 Systematics.......................................................... 14 Clinical and epidemiologic aspects ................................................. 14 M. terrae Complex ................................................. 15 Systematics................................................. 15 Clinical and epidemiologic aspects ................................................. 15 Rapid Growers Other than Members of the M. fortuitum Complex ................................................16 Systematics................................................. 16 Clinical and epidemiologic aspects ................................................. 16 (i) M. flavescens................................................ 16 (ii) M. neoaurum ................................................ 16 (iii) M. smegmatis ................................................ 16 (iv) M. thermoresistibile ................................................ 16 (v) Unknown species................................................. 16 MEASURES TO MINIMIZE THE RISK OF FAILING TO ISOLATE OR MISIDENTIFYING INFREQUENTLY ENCOUNTERED PPEM.................................................. 17 Isolation of the Organism from Appropriate Specimens .................................................. 17 Skin lesions .................................................. 17 Other specimens .................................................. 17 Identification of Organisms and Detection of Mixed Cultures .................................................. 18 Assessment of Significance .................................................. 18 CONCLUSIONS.................................................. 18 ACKNOWLEDGMENTS .................................................. 18 REFERENCES .................................................. 19 INTRODUCTION Although other investigators soon recognized that this iso- late was actually a member of the genus Mycobacterium, it For many years following the discovery of the human was not until 1965 that Runyon formally changed the name tubercle bacillus, only the three acid-fast species presently from "N. intracellularis" to the present one, M. intracellu- known as Mycobacterium tuberculosis, M. bovis, and M. lare (158). In 1951, Norden and Linell (134) published a leprae were consistently recognized as human pathogens. As report on swimming pool granuloma and described and early as 1935, Pinner applied the term "atypical acid-fast named "M. balnei," which was later recognized to be microorganisms" to some isolates that appeared to be the synonymous with the fish pathogen, M. marinum, that cause of human disease but that he could differentiate from Aronson had described in 1926 (3). In 1952, Prissick and M. tuberculosis on the basis of colony morphology, pigment, Masson described a pigmented Mycobacterium species that and virulence in animals (142, 143). In some cases passage in caused cervical adenitis in children (147); in 1956, they animals seemed to cause these isolates to revert to the named this organism M. scrofulaceum (148). In 1953, Buhler morphology and virulence characteristic of M. tuberculosis; and Pollak (19, 145) reported on a human pulmonary disease Pinner speculated that transmutation of types could be caused by a novel acid-fast organism that was later named occurring, although he took pains to point out that the M. kansasii by Hauduroy (74). evidence was not conclusive. He also noted the inadequacy These descriptions of newly recognized mycobacterial of taxonomic criteria that could be applied to the mycobac- pathogens of humans were largely based on a fairly small teria at that time. This inadequacy forced him to rely almost number of case reports. In that same period, Timpe and exclusively on the highly variable parameters of pathogenic- Runyon were systematically assembling a large collection of ity testing. In retrospect, it seems likely that some of his mycobacteria other than classical tubercle