Case Report
Cavitary pneumonia secondary to Tsukamurella in an AIDS patient. First case and a review of the literature

https://doi.org/10.1016/S0163-4453(03)00139-7Get rights and content

Abstract

Tsukamurella is a Gram-positive, variable rod-shaped, weakly acid-alcohol-fast, non motile, aerobic bacterium that belongs to the genus Rhodococcus. Tsukamurella has been reported as a cause of infections in humans with immunosuppression and indwelling foreign bodies. It has also been isolated in one patient with AIDS (Acquired Immunodeficiency Syndrome) as a saprophytic organism. Optimal management of infections secondary to this micro-organism is still uncertain due to the paucity of cases. The combination of a beta-lactam and an aminoglycoside, along with removal of medical devices, appear to be the treatment of choice. We report the case of an AIDS patient who presented with multiple lung cavitary lesions secondary to Tsukamurella. This is the first case reported of Tsukamurella as a pathogenic agent in an AIDS patient. We also propose a successful oral antibiotic regimen with fluoroquinolone and rifampin to treat infections secondary to this uncommon micro-organism.

Section snippets

Case report

A 55-year-old Latin man presented to the Clinical Immunology clinic at Jackson Memorial Hospital (Miami) complaining of two-week history of weakness, fever, and cough with minimal whitish sputum. His past medical history included cutaneous T-cell lymphoma and Acquired Immunodeficiency Syndrome (AIDS). The patient had history of chronic use of tobacco (1–2 pack of cigarettes/day for 40 years). Travel history included many Central and South American countries, last time more than 10 years ago. He

References (15)

  • A Von Graevenitz

    Antimicrobial therapy of infections with aerobic Gram-positive rods

    Clin Microbiol Infect

    (2001)
  • M.A Schwartz et al.

    Central venous catheter-related bacteremia due to Tsukamurella species in the immunocompromised host: a case series and review of the literature

    CID

    (2002)
  • D Rey et al.

    Tsukamurella infections. Review of the literature apropos of a case

    Pathol Biol (Paris)

    (1997)
  • Y Chong et al.

    Tsukamurella inchonensis bacteremia in a patient who ingested hydrochloric acid

    Clin Infect Dis

    (1997)
  • J Maetens et al.

    Catheter related bacteriemia due to Tsukamurella pulmonis

    Clin Microbiol Infect

    (1998)
  • R.S Jones et al.

    Persistent bacteremia due to Tsukamurella paurometabolum in a patient undergoing hemodialysis: case report and a review

    Clin Infect Dis

    (1994)
  • M.M Kattar et al.

    Tsukamurella strandjordae sp. Nov., a proposed new species causing sepsis

    J Clin Microbiol

    (2001)
There are more references available in the full text version of this article.

Cited by (40)

  • Septic pulmonary emboli caused by Tsukamurella inchonensis: A case report

    2021, Journal of Infection and Chemotherapy
    Citation Excerpt :

    Hence, neither susceptibility methods nor the treatment regimen for the organisms has been standardized. Based on the previous studies, Tsukamurella species are resistant to penicillins (oxacillin and piperacillin), cephalosporins (cefoxitin and cefotaxime), tetracycline, and chloramphenicol but possibly susceptible to macrolides (clarithromycin and azythromycin), aminoglycosides (gentamycin, amikacin), fluoroquinolones (ciprofloxacin), carbapenems (imipenem), and sulfamethoxazole [5,6,8]. With these facts and the actual results of MICs, we successfully treated the case with imipenem.

  • Role of Tsukamurella species in human infections: first literature review

    2018, New Microbes and New Infections
    Citation Excerpt :

    Lung disease in immunodeficient patients has long been attributed to Tsukamurella infection. The most commonly reported sources of Tsukamurella infection include bacteraemia [17–24], meningitis [25], peritonitis [26], keratitis [27–29], cutaneous infection [30], conjunctivitis [23,29,31], brain abscess [32], respiratory tract infection [29,33–38], catheter-related bloodstream infection [16,19,23,29,39–44] and acute otitis media [16]. In addition, Tsukamurella is a threat to people with immunodeficiency, including HIV infection [34,45].

  • Other Gram-Positive Bacilli

    2018, Principles and Practice of Pediatric Infectious Diseases

  • Clinical Conditions Where Precise Identification of Coryneform Bacteria is Recommended

    2017, Infectious Diseases, 2-Volume Set

  • Other Coryneform Bacteria and Rhodococci

    2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

  • Tuberculosis-like pneumonias by the aerobic actinomycetes Rhodococcus, Tsukamurella and Gordonia

    2012, Microbes and Infection
    Citation Excerpt :

    At the end of this voyage in the field of AE pneumonias, we would like to leave few take-home messages to readers. Cases of airway infection by AEs are rarely described in the literature; particularly, with the exception of illnesses by R. equi that have been widely investigated [11], sporadic reports of Gordonia (three cases [15,16,18]) and Tsukamurella (five cases [9,26–28,46]) lung disease have been described, that look like to be proven infections. Interest in the characterization and taxonomy of these organisms has been increasing as a result of the greater and greater amount of compromised individuals in the population who are at risk for acquiring them [61].

View all citing articles on Scopus
View full text
Copyright © 2003 The British Infection Society. Published by Elsevier Ltd. All rights reserved.