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Pedicures, Lasers, and Other Mycobacterial Adventures

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Pedicures, Lasers, and Other Mycobacterial Adventures Pedicures, Lasers, and Other Mycobacterial Adventures Jason Stout, MD, MHS Division of Infectious Diseases Duke University Medical Center Disclosures-Funding • NIH (grant) • CDC (contract) • UpToDate (card author) Pus-top problems • 60 yr old woman with hypertension and osteoarthritis presents with progressive atypia of a nevus on the right thigh • Biopsy reveals melanoma, wide resection done • Noted some red papules around the wound and it never “sealed up” • 2 months later increased erythema and purulent drainage • Diagnosed with “spitting sutures” and prescribed amoxicillin/clavulanate • Two additional wound explorations and a steroid injection in the next 6 weeks, followed by a biopsy Pus-top problems • Culture grew Mycobacterium abscessus, started on empiric clarithromycin, with ciprofloxacin added 10 days later • Resistance profile returns: • S to amikacin and tigecycline • I to cefoxitin • R to cipro, clarithromycin, doxycycline, imipenem, minocycline, moxifloxacin, and linezolid The Mycobacteria Family Tree Mycobacteria M. leprae M. tuberculosis complex Nontuberculous mycobacteria Over 190 species of NTM Mycobacterium abscessus (Moore and Frerichs 1953) Kusunoki and Ezaki 1992, comb. nov. Mycobacterium kansasii Hauduroy 1955 (Approved Lists 1980), species. Mycobacterium agri (ex Tsukamura 1972) Tsukamura 1981, sp. nov., nom. rev. Mycobacterium komossense Kazda and Muller 1979 (Approved Lists 1980), species. Mycobacterium aichiense (ex Tsukamura 1973) Tsukamura 1981, sp. nov., nom. rev. Mycobacterium alvei Ausina et al. 1992, sp. nov. Mycobacterium kubicae Floyd et al. 2000, sp. nov. Mycobacterium aromaticivorans Hennessee et al. 2009, sp. nov. Mycobacterium lacus Turenne et al. 2002, sp. nov. Mycobacterium arosiense Bang et al. 2008, sp. nov. Mycobacterium lentiflavum Springer et al. 1996, sp. nov. Mycobacterium arupense Cloud et al. 2006, sp. nov. Mycobacterium leprae (Hansen 1880) Lehmann and Neumann 1896 (Approved Lists 1980), species. Mycobacterium asiaticum Weiszfeiler et al. 1971 (Approved Lists 1980), species. Mycobacterium aubagnense Adékambi et al. 2006, sp. nov. Mycobacterium lepraemurium Marchoux and Sorel 1912 (Approved Lists 1980), species. Mycobacterium aurum Tsukamura 1966 (Approved Lists 1980), species. Mycobacterium madagascariense Kazda et al. 1992, sp. nov. Mycobacterium austroafricanum Tsukamura et al. 1983, sp. nov. Mycobacterium mageritense Domenech et al. 1997, sp. nov. Mycobacterium avium Chester 1901 (Approved Lists 1980), species. Mycobacterium malmoense Schroder and Juhlin 1977 (Approved Lists 1980), species. Mycobacterium avium subsp. avium Chester 1901, subsp. nov. Mycobacterium avium subsp. paratuberculosis (Bergey et al. 1923) Thorel et al. 1990, comb. nov. Mycobacterium marinum Aronson 1926 (Approved Lists 1980), species. Mycobacterium avium subsp. silvaticum Thorel et al. 1990, subsp. nov. Mycobacterium montefiorense Levi et al. 2003, sp. nov. Mycobacterium boenickei Schinsky et al. 2004, sp. nov. Mycobacterium moriokaense Tsukamura et al. 1986, sp. nov. Mycobacterium bohemicum Reischl et al. 1998, sp. nov. Mycobacterium mucogenicum Springer et al. 1995, sp. nov. Mycobacterium bolletii Adékambi et al. 2006, sp. nov. Mycobacterium murale Vuorio et al. 1999, sp. nov. Mycobacterium botniense Torkko et al. 2000, sp. nov. Mycobacterium bouchedurhonense Ben Salah et al. 2009, sp. nov. Mycobacterium neoaurum Tsukamura 1972 (Approved Lists 1980), species. Mycobacterium branderi Koukila-Kähköläet al. 1995, sp. nov. Mycobacterium nebraskense Mohamed et al. 2004, sp. nov. Mycobacterium brisbanense Schinsky et al. 2004, sp. nov. Mycobacterium neworleansense Schinsky et al. 2004, sp. nov. Mycobacterium brumae Luquin et al. 1993, sp. nov. Mycobacterium nonchromogenicum Tsukamura 1965 (Approved Lists 1980), species. Mycobacterium canariasense Jiménez et al. 2004, sp. nov. Mycobacterium caprae (Aranaz et al. 1999) Aranaz et al. 2003, comb. nov. Mycobacterium novocastrense Shojaei et al. 1997, sp. nov. Mycobacterium celatum Butler et al. 1993, sp. nov. Mycobacterium obuense (ex Tsukamura and Mizuno 1971) Tsukamura and Mizuno 1981, sp. nov., nom. rev. Mycobacterium chelonae corrig. Bergey et al. 1923 (Approved Lists 1980), species. Mycobacterium palustre Torkko et al. 2002, sp. nov. Mycobacterium chelonae subsp. abscessus corrig. (Moore and Frerichs 1953) Kubica et al. 1972 (Approved Lists 1980), subspecies. Mycobacterium parafortuitum Tsukamura et al. 1965 (Approved Lists 1980), species. Mycobacterium chelonae subsp. chelonae corrig. (Bergey et al. 1923) Kubica et al. 1972 (Approved Lists 1980), subspecies. Mycobacterium chimaera Tortoli et al. 2004, sp. nov. Mycobacterium parascrofulaceum Turenne et al. 2004, sp. nov. Mycobacterium chitae Tsukamura 1967 (Approved Lists 1980), species. Mycobacterium paratuberculosis Bergey et al. 1923 (Approved Lists 1980), species. Mycobacterium chlorophenolicum (Apajalahti et al. 1986) Briglia et al. 1994, comb. nov. Mycobacterium parmense Fanti et al. 2004, sp. nov. Mycobacterium chlorophenolicum (Apajalahti et al. 1986) Häggblomet al. 1994, comb. nov. Mycobacterium peregrinum (ex Bojalil et al. 1962) Kusunoki and Ezaki 1992, sp. nov., nom. rev. Mycobacterium chubuense (ex Tsukamura 1973) Tsukamura 1981, sp. nov., nom. rev. Mycobacterium confluentis Kirschner et al. 1992, sp. nov. Mycobacterium phlei Lehmann and Neumann 1899 (Approved Lists 1980), species. Mycobacterium conspicuum Springer et al. 1996, sp. nov. Mycobacterium pinnipedii Cousins et al. 2003, sp. nov. Mycobacterium cookii Kazda et al. 1990, sp. nov. Mycobacterium porcinum Tsukamura et al. 1983, sp. nov. Mycobacterium cosmeticum Cooksey et al. 2004, sp. nov. Mycobacterium poriferae Padgitt and Moshier 1987, sp. nov. Mycobacterium diernhoferi (ex Bönicke and Juhasz 1965) Tsukamura et al. 1983, sp. nov., nom. rev. Mycobacterium psychrotolerans Trujillo et al. 2004, sp. nov. Mycobacterium doricum Tortoli et al. 2001, sp. nov. Mycobacterium duvalii Stanford and Gunthorpe 1971 (Approved Lists 1980), species. Mycobacterium pulveris Tsukamura et al. 1983, sp. nov. Mycobacterium elephantis Shojaei et al. 2000, sp. nov. Mycobacterium pyrenivorans Derz et al. 2004, sp. nov. Mycobacterium fallax Lévy-Frébault et al. 1983, sp. nov. Mycobacterium rhodesiae (ex Tsukamura et al. 1971) Tsukamura 1981, sp. nov., nom. rev. Mycobacterium farcinogenes Chamoiseau 1973 (Approved Lists 1980), species. Mycobacterium saskatchewanense Turenne et al. 2004, sp. nov. Mycobacterium flavescens Bojalil et al. 1962 (Approved Lists 1980), species. Mycobacterium fortuitum da Costa Cruz 1938 (Approved Lists 1980), species. Mycobacterium scrofulaceum Prissick and Masson 1956 (Approved Lists 1980), species. Mycobacterium fortuitum subsp. acetamidolyticumTsukamura et al. 1986, subsp. nov. Mycobacterium senegalense (Chamoiseau 1973) Chamoiseau 1979 (Approved Lists 1980), species. Mycobacterium fortuitum subsp. fortuitum da Costa Cruz 1938, subsp. nov. Mycobacterium septicum Schinsky et al. 2000, sp. nov. Mycobacterium frederiksbergense Willumsen et al. 2001, sp. nov. Mycobacterium shimoidei (ex Tsukamura et al. 1975) Tsukamura 1982, sp. nov., nom. rev. Mycobacterium gadium Casal and Calero 1974 (Approved Lists 1980), species. Mycobacterium gastri Wayne 1966 (Approved Lists 1980), species. Mycobacterium shottsii Rhodes et al. 2003, sp. nov. Mycobacterium genavense Böttger et al. 1993, sp. nov. Mycobacterium simiae Karassova et al. 1965 (Approved Lists 1980), species. Mycobacterium gilvum Stanford and Gunthorpe 1971 (Approved Lists 1980), species. Mycobacterium smegmatis (Trevisan 1889) Lehmann and Neumann 1899 (Approved Lists 1980), species. Mycobacterium goodii Brown et al. 1999, sp. nov. Mycobacterium sphagni Kazda 1980, sp. nov. Mycobacterium gordonae Bojalil et al. 1962 (Approved Lists 1980), species. Mycobacterium haemophilum Sompolinsky et al. 1978 (Approved Lists 1980), species. Mycobacterium szulgai Marks et al. 1972 (Approved Lists 1980), species. Mycobacterium hassiacum Schröder et al. 1997, sp. nov. Mycobacterium terrae Wayne 1966 (Approved Lists 1980), species. Mycobacterium heckeshornense Roth et al. 2001, sp. nov. Mycobacterium thermoresistibile Tsukamura 1966 (Approved Lists 1980), species. Mycobacterium heidelbergense Haas et al. 1998, sp. nov. Mycobacterium tokaiense (ex Tsukamura 1973) Tsukamura 1981, sp. nov., nom. rev. Mycobacterium hiberniae Kazda et al. 1993, sp. nov. Mycobacterium triplex Floyd et al. 1997, sp. nov. Mycobacterium hodleri Kleespies et al. 1996, sp. nov. Mycobacterium holsaticum Richter et al. 2002, sp. nov. Mycobacterium triviale Kubica 1970 (Approved Lists 1980), species. Mycobacterium houstonense Schinsky et al. 2004, sp. nov. Mycobacterium tusciae Tortoli et al. 1999, sp. nov. Mycobacterium immunogenum Wilson et al. 2001, sp. nov. Mycobacterium ulcerans MacCallum et al. 1950 (Approved Lists 1980), species. Mycobacterium interjectum Springer et al. 1995, sp. nov. Mycobacterium vaccae Bönicke and Juhasz 1964 (Approved Lists 1980), species. Mycobacterium intermedium Meier et al. 1993, sp. nov. Mycobacterium intracellulare (Cuttino and McCabe 1949) Runyon 1965 (Approved Lists 1980), species. Mycobacterium vanbaalenii Khan et al. 2002, sp. nov. Mycobacterium wolinskyi Brown et al. 1999, sp. nov. Mycobacterium xenopi Schwabacher 1959 (Approved Lists 1980), species. http://www.bacterio.net/mycobacterium.html Commonly Encountered Species • Mycobacterium marinum • Water exposure: aquariums, boating • Rapidly growing mycobacteria • Many different exposures • M. fortuitum • M. chelonae • M. abscessus • Don’t
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