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Case Reports
. 2020 Jun 16:7:243.
doi: 10.3389/fmed.2020.00243. eCollection 2020.

Disseminated Mycobacterium chimaera Following Open-Heart Surgery, the Heater-Cooler Unit Worldwide Outbreak: Case Report and Minireview

Emmanuel Lecorche  1   2   3 , Gauthier Pean de Ponfilly  3 , Faiza Mougari  1   2   3 , Hanaa Benmansour  1   2   3 , Elodie Poisnel  4 , Frederic Janvier  5   6 , Emmanuelle Cambau  1   2   3
Affiliations
Case Reports

Disseminated Mycobacterium chimaera Following Open-Heart Surgery, the Heater-Cooler Unit Worldwide Outbreak: Case Report and Minireview

Emmanuel Lecorche et al. Front Med (Lausanne). .

Abstract

Invasive cardiovascular infections by Mycobacterium chimaera associated with open-heart surgery have been reported worldwide since 2013. Here, we report a case of a 61 year old man, without any other particular medical background, who underwent cardiac surgery for replacing part of the ascending aorta by a bio-prosthetic graft. Eighteen months later, the patient was painful at the lower back with fever. A pyogenic vertebral osteomyelitis due to M. chimaera associated to graft infection was diagnosed after 6 months of sub-acute infection. The patient presented a disseminated disease with cerebral lesions, chorioretinitis, and chronic renal failure. Despite adequate antimicrobial treatment and graft explantation, the patient died after 6 years. We reviewed the literature on M. chimaera infections associated with open-heart surgery. The worldwide outbreak has been explained by airborne bioaerosol generated by the 3T heater-cooler unit (HCU) used during cardiac by-pass surgical procedures. These infections are difficult to diagnose because of a long latency period (up to several years), with no specific symptoms and a highly specialized microbiological diagnosis. The treatment is based on antibiotics and surgery. These infections are also difficult to treat, since the mortality rate is high around 50%. Prevention is necessary by modifying the use of HCUs in operating rooms.

Keywords: HCU; NTM; cardiac surgery; non-tuberculous mycobacteria; spondylodiscitis.

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Figures

Figure 1
Figure 1
Timeline of the patient's clinical course after cardiac surgery.
Figure 2
Figure 2
Vertebral magnetic resonance imaging of the vertebral lesions. Vertebral magnetic resonance imaging revealed lesions of the vertebral bodies at T8-T9-L4-L5-S1 and invertebral disks between T8-T9 (A) and L4-L5-S1 (B), with an epidural abscess of 5 cm at the L3 and L4 levels, consistent with a pyogenic vertebral osteomyelitis.
Figure 3
Figure 3
Mycobacterium chimaera infections associated with open heart surgery characteristics.
See this image and copyright information in PMC

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