Acute respiratory failure involving an R variant of Mycobacterium abscessus

Abstract

We report the case of a cystic fibrosis patient colonized with a smooth-morphotype form of Mycobacterium abscessus who developed acute respiratory failure with the emergence of an isogenic rough (R) variant while he was recovering from peritonitis-induced shock. This report emphasizes the role of R forms in severe M. abscessus infections.

FIG. 1.

Dynamics of pulmonary function, microbiological results, and antimycobacterial treatments (identified as 1st, 2nd, and 3rd). a, Regimen of clarithromycin, ciprofloxacin, and doxycycline; b, regimen of clarithromycin, imipenem (5 months), amikacin (4½ months), and nebulized amikacin (6 months). Open and closed circles represent negative and positive culture results, respectively; letters above the circles indicate the samples studied (where no sample is listed, sputum samples were used), and letters below indicate the M. abscessus morphotypes (where no morphotype is given, the morphotype was not determined). Abbreviations: PB, pulmonary biopsy specimen; BAL, bronchoalveolar lavage fluid; and FEV, forced expiratory volume.

FIG. 2.

Patient's chest radiographs at admission (A) and at day 12 (B).

FIG. 3.

Randomly amplified polymorphic DNA PCR patterns of our patient's six M. abscessus isolates with the primer OPA2 (lane 1, S morphotype, and lanes 2 to 6, R morphotypes) compared to those of the type strain M. abscessus ATCC 19977 (R and S phenotypes) (lanes 7 and 8).