Mycobacterium xenopi related spine infections: A case report and systematic literature review

Min Peng; Wei Li; Fengyi Li; Bo Tang; Yinhua Deng; Shuai Peng; Li Chen; Yingchun Dai

doi:10.1016/j.onehlt.2023.100502

Mycobacterium xenopi related spine infections: A case report and systematic literature review

One Health. 2023 Feb 11:16:100502. doi: 10.1016/j.onehlt.2023.100502. eCollection 2023 Jun.

Authors

Min Peng¹, Wei Li², Fengyi Li³, Bo Tang¹, Yinhua Deng¹, Shuai Peng¹, Li Chen¹, Yingchun Dai¹

Affiliations

¹ Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China.
² Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
³ Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China.

Abstract

Background and purpose: Nontuberculous mycobacteria (NTM) disease is an important infection disease throughout the world. Mycobacterium xenopi (M. xenopi) is a common NTM. Extrapulmonary infections due to M. xenopi, particularly spine infections, are a rare occurrence, but lack of research is cited as a constraint for implementing NTM control in such patients. The purposes of this paper are to describe a case of spondylodiscitis, to review the published literature on cases of M. xenopi spine infections, and to summarize the predisposing factors, diagnosis, and treatment of infection.

Methods: A case of spondylodiscitis was caused by M. xenopi in a patient with systemic lupus erythematosus (SLE). Research was conducted using the PubMed, ScienceDirect, Embase, Wiley Online Library, and Scopus databases using the following search terms: "Mycobacterium xenopi", "vertebral", "spinal", "spondylodiscitis", "infection", and "osteomyelitis".

Results: We retrieved 14 cases published before August 2022. The risk factors for infection were iatrogenic infections (3/14, 21.43%), SLE (4/14, 28.57%), AIDS (4/14, 28.57%), and immunocompetence without any comorbidities (3/14, 21.43%). The most common sites of infection were thoracic vertebrae (10/14, 71.43%) and lumbar vertebrae (4/14, 28.57%). A total of 14 cases were isolated and identified as M. xenopi from a toad by mycobacterial culture. The identification time was 55.00 ± 7.55 days (the present report identification time of metagenomic next generation sequencing (mNGS) was only 2 days). All patients were treated with antibiotic therapy, and the duration of treatment was 13.18 ± 2.13 months. Clarithromycin-based therapy showed a higher improvement rate (5/6, 83.33%). Surgical intervention was performed in 5 patients. Only 1 patient did not show any improvement after surgical treatment.

Conclusion: M. xenopi spine infection in humans presents with atypical clinical symptoms. mNGS identification may be a good choice. M. xenopi may be considered in immunocompromised patients with spinal infection. We recommend a clarithromycin-containing regimen and prolonging the duration of treatment to ensure effectiveness.

Keywords: Mycobacterium xenopi; Predisposing factors; Spine infections; Treatment.