Mycobacterium szulgai: an unusual cause of disseminated mycobacterial infections

Excerpt

The incidence of nontuberculous mycobacterial infections in the USA has significantly increased during the past three decades, specifically after the advent of HIV/AIDS [1‐4]; however, the incidence of tuberculosis in the United States is low when compared to developing countries. For most of the nontuberculous mycobacteria (NTM), the pathogenicity and clinical relevance are poorly understood. Likewise, the role of in vitro susceptibility testing of NTM isolates related to the approach of patient care management remains a topic of debate, despite the fact that consensus guidelines for optimal diagnosis, treatment, and prevention for NTM infections were published in 2007 [5]. This fact is mainly related to the limited number of cases caused by certain NTM species and is further related to some variability in antimicrobial resistance profiles. Mycobacterium szulgai was first described in 1972; since then, it has been repeatedly recognized as a cause of pulmonary infections that often clinically and radiologically resemble patterns of disease caused by M. tuberculosis [6‐9]. Based on a recent case of a fatal M. szulgai infection in a patient with disseminated disease and underlying hematologic malignancy in our institution, we reviewed the current literature with regard to epidemiology, diagnosis, and treatment approaches for M. szulgai infections. The infection in our patient was unrecognized for an undetermined amount of time, prior to presentation to our hospital. Our literature review identified only a few case reports and no comprehensive review of the subject was identified. …