Isolation of Mycobacterium arupense from pleural effusion: culprit or not?

BMC Infect Dis. 2018 May 15;18(1):221. doi: 10.1186/s12879-018-3136-3.

Abstract

Background: Mycobacterium arupense, first identified in 2006, is a slow-growing nontuberculous mycobacterium (NTM) and an emerging cause of tenosynovitis, potentially associated with immunosuppression. However, unlike the diagnostic value of its isolation from osteoarticular specimens, the significance of detecting M. arupense in respiratory specimens is not yet clear.

Case presentation: To our knowledge, we, for the first time, described the identification of M. arupense from the pleural effusion of an immunocompetent patient, who presented with fever and chylothorax. The symptoms resolved with doxycycline treatment for 45 days and a low-fat, high-protein diet. Follow-up at 14 months showed no relapse.

Conclusions: Because the patient fully recovered without combined anti-NTM treatment, we did not consider M. arupense the etiological cause in this case. This indicates that M. arupense detected in pleural effusion is not necessarily a causative agent and careful interpretation is needed in terms of its clinical relevance.

Keywords: Chylothorax; Mycobacterium arupense; Nontuberculous mycobacterium; Pleural effusion.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Capreomycin / pharmacology
  • Dexamethasone / therapeutic use
  • Humans
  • Laryngitis / complications
  • Laryngitis / diagnosis
  • Laryngitis / drug therapy
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Moxifloxacin / pharmacology
  • Mycobacterium Infections, Nontuberculous / complications
  • Mycobacterium Infections, Nontuberculous / diagnosis*
  • Mycobacterium Infections, Nontuberculous / drug therapy
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Nontuberculous Mycobacteria / drug effects
  • Nontuberculous Mycobacteria / genetics
  • Nontuberculous Mycobacteria / isolation & purification*
  • Pleural Effusion / complications
  • Pleural Effusion / diagnosis*
  • Pleural Effusion / drug therapy
  • Pleural Effusion / microbiology
  • RNA, Ribosomal, 16S / chemistry
  • RNA, Ribosomal, 16S / metabolism
  • Tomography, X-Ray Computed

Substances

  • Anti-Bacterial Agents
  • RNA, Ribosomal, 16S
  • Capreomycin
  • Dexamethasone
  • Moxifloxacin