A Case of Meningitis Caused by Mycobacterium abscessus in a Paediatric Patient

D. R. Gayathri Devi¹, H. B. Mallikarjuna², Anusha Chaturvedi¹, S. Vishnu Prasad³

¹Department of Microbiology, M. S. Ramaiah Medical College, Bangalore, India.
²Department of Pediatrics, M. S. Ramaiah Medical College, Bangalore, India.
³Department of Microbiology, Centre for Basic Sciences, Kasturba Medical College, Manipal University, Manipal, India.

DOI: 10.4236/jtr.2015.32008                

Abstract

Mycobacterium abscessus, a rapidly growing and potentially pathogenic Mycobacterium, is an environmental contaminant and is commonly found in tap water supplies. We report a case of M. abscessus meningitis following VP shunt insertion. A 9-year-old male patient with previous history of aqueductal stenosis and hydrocephalus with VP shunt in situ, presented with pain abdomen of 10 days duration. Investigations revealed multiple mesenteric lymph nodes with impacted VP shunt tip within the omentum. Ascitic fluid and CSF tap showed Acid-Fast Bacilli, later confirmed to be M. abscessus. The patient was treated with Clarithromycin and Amikacin, leading to resolution of the infection. To the best of our knowledge, this is the first reported case of M. abscessus meningitis in an immunocompetent individual. We discuss the possible sources of infection and therapeutic challenges. It is of utmost importance to consider, with high index of suspicion, nontubercular Mycobacteria as the causative organism in patients, who do not respond to regular anti-tubercular regimen.

Keywords

Ventriculo-Peritoneal (VP) Shunt, Non-Tubercular Myobacteria (NTM), Peritonitis, Meningitis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bailey & Scott (2014) Mycobacteria. In: Tille, P.M., Ed., Diagnostic Microbiology, Elsevier, Mosby, 484-512.
[2]	CDC (2008) Mycobacterium abscessus in Healthcare Settings. http://www.cdc.gov/hai/organisms/mycobacterium.html
[3]	Maniu, C.V., Hellinger, W.C., Chu, S.Y., Plamer, R. and Alvarez-Elcoro, S. (2001) Failure of Treatment for Chronic Mycobacterium abscessus Meningitis Despite Adequate Clarithromycin Levels in Cerebrospinal Fluid. Clinical Infectious Diseases, 33, 745-748. http://dx.doi.org/10.1086/322633
[4]	García-Agudo, L. and García-Martos, P. (2012) Clinical Significance and Antimicrobial Susceptibility of Rapidly Growing Mycobacteria. Science against Microbial Pathogens: Communicating Current Research and Technological advance, 1, 363-377.
[5]	Colomba, C., Rubino, R., Di Carlo, P., Mammina, C., Bonura, C., Siracusa, L., Titone, L. and Saporito, L. (2012) Probable Disseminated Mycobacterium abscessus Subspecies Bolletii Infection in a Patient with Idiopathic CD4+ T Lymphocytopenia: A Case Report. Journal of Medical Case Reports, 6, 277. http://dx.doi.org/10.1186/1752-1947-6-277
[6]	Song, J.Y., Son, J.B., Lee, M.K., Gwack, J., Lee, K.S. and Park, J.Y. (2012) Case Series of Mycobacterium abscessus Infections Associated with a Trigger Point Injection and Epidural Block at a Rural Clinic. Epidemiology and Health, 34, Article ID: 3272546. http://dx.doi.org/10.4178/epih/e2012001
[7]	Thomson, R., Tolson, C., Sidjabat, H., Huygens, F. and Hargreaves, M. (2013) Mycobacterium abscessus Isolated from Municipal Water—A Potential Source of Human Infection. BMC Infectious Diseases, 13, 241. http://dx.doi.org/10.1186/1471-2334-13-241
[8]	Phillipsa, M.S. and von Reyn, C.F. (2001) Nosocomial Infections Due to Nontuberculous Mycobacteria. Clinical Infectious Diseases, 33, 1363-1374. http://dx.doi.org/10.1086/323126
[9]	Wongkitisophon, P., Rattanakaemakorn, P., Tanrattanakorn, S. and Vachiramon, V. (2011) Cutaneous Mycobacterium abscessus Infection Associated with Mesotherapy Injection. Case Reports in Dermatology, 3, 37-41. http://dx.doi.org/10.1159/000324766
[10]	Jarand, J., Levin, A., Zhang, L.N., Huitt, G., Mitchell, J.D. and Daley, C.L. (2011) Clinical and Microbiologic Outcomes in Patients Receiving Treatment for Mycobacterium abscessus Pulmonary Disease. Clinical Infectious Diseases, 52, 565-571. http://dx.doi.org/10.1093/cid/ciq237
[11]	Han, X.Y., Dé, I. and Jacobson, K.L. (2007) Rapidly Growing Mycobacteria Clinical and Microbiologic Studies of 115 Cases. American Journal of Clinical Pathology, 128, 612-621. http://dx.doi.org/10.1309/1KB2GKYT1BUEYLB5
[12]	Nessar, R., Cambau, E., Rayrat, J.M., Murray, A. and Gicquel, B. (2012) Mycobacterium abscessus: A New Antibiotic Nightmare. Journal of Antimicrobial Chemotherapy, 67, 810-818. http://dx.doi.org/10.1093/jac/dkr578
[13]	Park, S., Kim, S., Park, E.M., Kim, H., Kwon, O.J., Chang, C.L., Lew, W.J., Park, Y.K. and Koh, W.J. (2008) In Vitro Antimicrobial Susceptibility of Mycobacterium abscessus in Korea. Journal of Korean Medical Sciences, 23, 49-52. http://dx.doi.org/10.3346/jkms.2008.23.1.49