Mycobacterium fortuitum,

Transcription

1 Mycobacterium fortuitum 1 1) 2) 3) 1) 1) 4) 4) 5) 2) 1) 1) 2) 3) 4) 5) Mycobacterium fortuitum 1 39 BHI 2 Ziehl Neelsen M. fortuitum MIC CPFX 0.2 mg/ml, MINO 0.78 mg/ml, CAM 100 mg/ml, AMK 6.25 mg/ml, IPM 100 mg/ml M. fortuitum IPM, CAM, AMK 3 IPM CPFX LVFX 6 Key words: Mycobacterium fortuitum Mycobacterium fortuitum, Mycobacterium abscessus, Mycobacterium chelonae Runyon 4 1), 2) M. fortuitum 1 ( ) TEL: FAX: toru@saitama-med.ac.jp I /60 mmhg 73/ /ml, 7.7 g/dl, 23.9, /ml, / ml 80.4, 15.9, 3.1, mg/dl, 0.54 mg/dl, 3.4 Vol. 19 No

2 BHI Ziehl Neelsen g/dl, AST 13 IU/L, ALT 16 IU/L, LDH 115 IU/L, CRP 11.1 mg/dl II. Brain Heart Infusion Broth BHI 35 5 CO 2 2 G Ziehl Neelsen 1 3 R 2mm mm R 2 DNA DNA hybridization DDH : M. fortuitum Middlebrook 7H10 agar (DIFCO) Middlebrook OADC Enrichment (BBL) 180 ml 20 ml 13 (10, mg/ml) 100 ml 10 ml mg/ml McFarland minimum inhibi- 56 Vol. 19 No

3 Mycobacterium fortuitum MIC (mg/ml) Ciprofloxacin 0.2 Minocycline 0.78 Amikacin 6.25 Clarithromycin 100 Imipenem 100 tory concentration (MIC: mg/ml) 72 clarithromycin (CAM), ciprofloxacin (CPFX), amikacin (AMK), imipenem (IPM), minocycline (MINO) 5 M. fortuitum MIC 1 III M. fortuitum, M. abscessus, M. chelonae IPM/CS 1.5 g/ CAM 800 mg/ AMK 200 mg/ 30 IPM/CS 7 2 IPM/CS CPFX 600 mg/ 7 6 M. fortuitum 1 CAM CPFX AMK 2 2 CPFX AMK CPFX levofloxacin (LVFX) 400 mg/ 9 16 MINO 200 mg/ 1 LVFX LVFX IV. M. fortuitum 3) 4) 5) 6) M. fortuitum 3. Vol. 19 No

4 180 2) M. fortuitum CV BHI 2 Ziehl Neelsen Runyon IV 2 48 M. fortuitum 3 72 AMK, doxycycline (DOXY), MINO, CPFX, CAM 4 7) 2 6 8) M. fortuitum, M. abscessus, M. chelonae M. fortuitum AMK (100 ), CPFX ofloxacin (OFLX) (100 ), cefoxitin (CFX) (50 ), IPM (100 ), CAM (80 ), DOXY (50 ) M. abscessus CAM (100 ), AMK (90 ), CFX (70 ), IPM (50 ), M. chelonae AMK (50 ), tobramycin (TOB) (100 ), CAM (100 ), IPM (60 ), DOXY (25 ), CPFX (20 ) 8) Middlebrook 7H9 broth M. fortuitum 33 MIC 50 LVFX mg/ml, CAM 16 mg/ml, AMK 4.0 mg/ ml 9) IPM/CS, CAM, AMK 3 IPM/CS CPFX 5 CPFX 0.2 mg/ml, MINO 0.78 mg/ml 1 National Committee for Clinical Laboratory Standards (NCCLS), Clinical Laboratory Standards Institute; CLSI M24-A 10) CPFX susceptible (S), AMK (S), CAM resistant (R), IPM (R) CPFX 200 mg mg/ml 11) 7 2 CPFX 600 mg/ (300 mg 2) CPFX 3 NTM MAC, M. kansasii 12) M. fortuitum Etest MIC 13) 2 CAM, AMK, IPM MIC in vitro 8) MIC M. fortuitum 58 Vol. 19 No

5 181 1) (4): ) Brown-Elliott, B. A., R. J. Wallace, Jr p In: Principle and Practice of Infectious Diseases 6 th ed. (Mandell, G. L. ed.), Philadelphia: Churchill Livingstone. 3) Wallace, Jr. R. J The clinical presentation, diagnosis, and therapy of cutaneous and pulmonary infection due to the rapidly growing mycobacteria M. fortuitum and M. chelonae. Clin. Chest Med. 10: ) : ) 2006 Mycobacterium fortuitum 1 46: ) 2006 Mycobacterium fortuitum 1 81: ) Reena, J., S. K. Tyring Therapy of nontuberculous mycobacterial infections. Dermatologic Therapy 17: ) American Thoracic Society Documents An O$cial ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. Am. J. Respir. Crit. Care Med. 175: ) Middlebrook 4 Nontuberculous Mycobacterial Broth MIC NTM 50: ) National Committee for Clinical Laboratory Standards Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard. M24-A. 11) Silverman, S. H., M. Johnson, D. W. Burdon, M. R. Keighley Pharmacokinetics of single dose intravenous ciprofloxacin in patients undergoin gastrointestinal surgery. J. Antimicrob. Chemother. 18(1): ) Mycobacterium fortuitum 46: ) 2003 Mycobacterium fortuitum 4 52: A Case of Subcutaneous Port Infection Due to Mycobacterium fortuitum Toru Kawamura, 1) Akiko Miyazato, 2) Norihiro Iwasa, 3) Saori Seki, 1) Yoshitada Taji, 1) Masahiro Shimojima, 4) Yoshikazu Hashikita, 5) Noriyuki Watanabe, 5) Kotaro Mitsutake, 2) Kenji Ikebuchi 1) 1) Department of Laboratory Medicine 2) Department of Infectious Diseases and Infection Control 3) Department of Gynecologic Oncology, Saitama International Medical Center, Saitama Medical University 4) Bio Medical Laboratories, Inc. 5) Department of Laboratory Medicine, Saitama Medical University Hospital A 39-year-old woman demonstrated abdominal pain and fever and was suspected of developing an infection from the infusion port subcutaneously implanted for chemotherapy of her ovarian cancer. The port was removed and subjected to a culture of microbes containing brain heart infusion broth (BHI). On the second day, acid-fast bacilli (AFB) smear-positive organisms had grown and were subsequently identified as Mycobacterium fortuitum. Susceptibility tests demonstrated that the isolate was resistant to imipenem (IPM, MIC 100 mg/ml) and clarithromycin (CAM, MIC 100 mg/ml), although MIC of ciprofloxacin (CPFX), minocycline (MINO) and amikacin (AMK) were 0.2, 0.78 and 6.25 mg/ml, respectively. Removal of the infected device followed by combination therapy caused rapid improvement of the patient s symptoms. During the 6-month course of treatment, which included oral CPFX monotherapy, no recurrence was observed. Vol. 19 No