Mycobacterium abscessus Complex Infections in Humans

Abstract

Mycobacterium abscessus complex comprises a group of rapidly growing, multidrug-resistant, nontuberculous mycobacteria that are responsible for a wide spectrum of skin and soft tissue diseases, central nervous system infections, bacteremia, and ocular and other infections. M. abscessus complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. The 2 major subspecies, M. abscessus subsp. abscessus and M. abscessus subsp. massiliense, have different erm(41) gene patterns. This gene provides intrinsic resistance to macrolides, so the different patterns lead to different treatment outcomes. M. abscessus complex outbreaks associated with cosmetic procedures and nosocomial transmissions are not uncommon. Clarithromycin, amikacin, and cefoxitin are the current antimicrobial drugs of choice for treatment. However, new treatment regimens are urgently needed, as are rapid and inexpensive identification methods and measures to contain nosocomial transmission and outbreaks.

Keywords: Mycobacterium abscessus; Mycobacterium abscessus complex; Mycobacterium bolletii; Mycobacterium massiliense; bacteria; clinical disease; cosmetic procedures; identification methods; multidrug resistant; mycobacteria; nomenclature; nontuberculous; nosocomial; outbreaks; taxonomy; transmission.

Figure 1

Serial changes in the nomenclature and taxonomic classification of Mycobacterium abscessus complex, 1992–2013.

Figure 2

Spectrum of Mycobacterium abscessus subsp. abscessus and M. abscessus subsp. massiliense created by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Biotyper system (Microflex LT; Bruker Daltonik GmbH, Bremen, Germany). The absolute intensities of the ions are shown on the y-axis, and the masses (m/z) of the ions are shown on the x-axis. The m/z values represent the mass-to-charge ratio.

Figure 3

Chest radiograph (A) and computed tomography scan (B) images for a patient with pulmonary disease due to Mycobacterium abscessus subsp. abscessus. A) The arrow indicates a cavity with surrounding consolidation over the left upper lung. B) Vertical arrow indicates bronchiectasis; horizontal arrow indicates nodules.

Figure 4

Skin lesions caused by Mycobacterium abscessus subsp. abscessus. A) Diffuse erythematous papular eruptions on the face and bilateral cervical lymphadenitis in a middle-aged man. B) A circumscribed subcutaneous nodule with pus discharge on the right arm of a 12-year-old boy. C) Wound infection over both upper eyelids of a 36-year-old woman; the infection developed 1 week after cosmetic surgery.

Figure 5

Brain computed tomography scan images for a patient with central nervous system infection caused by Mycobacterium abscessus subsp. bolletii. Arrows indicate abnormal nodular pachymeningeal thickening and leptomeningeal and intraparenchymal extension with multiple rim-enhancing lesions in the right cerebellum (A) and right temporal lobe (B), indicating cerebral abscesses.