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Case Reports
. 2025 Aug;53(4):1495-1499.
doi: 10.1007/s15010-025-02534-8. Epub 2025 Apr 7.

Mycobacterium chelonae infection of a cardiovascular bioprosthesis linked to a recent outbreak

Johanna Kessel  1   2 , Axel Braner  3 , Margo Diricks  4   5   6 , Thomas Walther  7 , Tomas Holubec  7 , Rudolf Werner  8 , Michael Hogardt  2   9 , Thomas A Wichelhaus  2   9 , Stefan Niemann  4   5   6 , Annette Moter  10   11   12 , Inna Friesen  5 , Nils Wetzstein  13   14   15   16   17   18
Affiliations
Case Reports

Mycobacterium chelonae infection of a cardiovascular bioprosthesis linked to a recent outbreak

Johanna Kessel et al. Infection. 2025 Aug.

Abstract

Objectives: Mycobacterium chelonae is a rapid-growing non-tuberculous mycobacterium that has occasionally been described in connection with foreign material infections, e.g. after orthopaedic joint replacement or cosmetic surgery. In a recent outbreak, several cases of M. chelonae endocarditis associated with biological heart valve prostheses were reported.

Case history: A 64-year-old female patient with a history of myalgia and recurrent joint swelling presented to our hospital. Initially suspected for rheumatoid arthritis, the patient underwent a series of orthopedic and rheumatologic treatments, including prednisolone and methotrexate. Subsequent history revealed a Ross operation in 2014 and a PET-CT was suspicious of a biological valved conduit infection leading to surgical replacement. Utilizing fluorescence in situ hybridization (FISH) diagnostic techniques, DAPI, Kinyoun and Ziehl-Neelsen staining, mycobacterial infection was confirmed in both the prosthesis and adjacent muscle tissue. Molecular methods identified a mycobacterium most closely related to the M. chelonae/abscessus complex indicating an association to a previously described outbreak of M. chelonae contaminated heart valves. Antimycobacterial therapy was initiated and the patient remains stable at the time of writing. To date, all mycobacterial cultures remained negative.

Conclusions: Non-tuberculous mycobacteria (NTM) are rare and possibly underdiagnosed pathogens in infections of bioprosthetic flap bearing conduits. Mycobacterial foreign-body infections can manifest many years after implantation. As NTM can be difficult to detect, molecular identification methods are of particular importance. Here, modern imaging, molecular and microscopic techniques might be of special use in diagnosing prolonged prosthetic graft infections.

Keywords: Mycobacterium chelonae; BioIntegral; Bioprosthetic valve bearing conduit; Cardiac surgery; Endocarditis; Mycobacterial infection; NTM; Non-tuberculous mycobacteria.

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Conflict of interest statement

Declarations. Ethics, consent to participate and consent to publication: The patient signed informed consent for publication of her case history. Competing interests: Johanna Kessel, Axel Braner, Margo Diricks, Thomas Walther, Michael Hogardt, Stefan Niemann, Inna Friesen, and Nils Wetzstein have nothing to disclose.Tomas Holubec has received consultancy fees and honoraria from Abbott, USA; Artivion, USA; Fehling, Germany and Getinge, Sweden, outside the submitted work. Rudolf Werner has received speaker honoraria from Novartis/AAA and PentixaPharm, reports advisory board work for Novartis/AAA and Bayer and in involved in 68Ga-PentixaFor PET Imaging in PAN Cancer (FORPAN), sponsored and planned by PentixaPharm. Thomas A. Wichelhaus reports research grants from BMBF, JPIAMR, Deutsche Krebshilfe, MSD as well as speaker fees and consulting honoraria from Landesärztekammer Hessen, Insmed, Osartis, all outside the submitted work. Annette Moter holds shares in MiKi Analytics GmbH and runs Moter Diagnostics private practice.

Figures

Fig. 1
Fig. 1
FDG-PET-CT scan indicating prosthetic graft infection in pulmonary position (frontal plane -A; horizontal plane -B), FDG-PET-CT - 18 F-fluorodeoxyglucose positron emission tomography-computed tomography
Fig. 2
Fig. 2
Fluorescence in situ hybridization on tissue sections of removed cardiac tissue shows bacterial colonization of muscle tissue (A), overview shows the filter sets for the nucleic acid stain DAPI (blue) staining host cell nuclei and the autofluorescent tissue background in green. The inset (B) marks the region that is further inspected at higher magnification. At higher magnification numerous rods are visible in spaces between and around muscle cells, as shown by nucleic acid stain DAPI in black and white. No FISH signals were detected with a pan-bacterial or NTM-specific FISH probe, indicating a low ribosome content of the bacteria (data not shown), (C) shows the identical location stained with Kinyoun reveals acid-fast bacilli. DAPI – 4′,6-diamidino-2-phenylindole; FISH – Fluorescence in situ hybdridization; NTM – non-tuberculous mycobacteria
See this image and copyright information in PMC

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