Incidental intraoperative diagnosis of Mycobacterium abscessus meningeal infection: a case report and review of the literature
Mycobacterium abscessus, and rapidly growing mycobacteria in general, are rare but increasing causes of central nervous system (CNS) infections. The aim of this study is to highlight the importance of considering these microorganism in the differential diagnosis of CNS infections, obtaining a prompt diagnosis, and improving clinical outcomes.
Case report and literature review.
We report a case of meningeal infection in a patient who underwent decompressive craniectomy after a craniofacial trauma. The diagnosis was made analyzing a sample obtained during a second operation of cranioplasty. A regimen of amikacin, clarithromycin, and imipenem/cilastatin was started. In the following days, the patient experienced a variety of side effects. So, first clarithromycin was replaced with linezolid, then amikacin was stopped and cefoxitin added to the therapy and at the end all the antibiotics were withdrawn. The patient was discharged in good conditions and a clinical interdisciplinary follow-up was started. After 12 months, the patient is still doing well. After a literature analysis, 15 cases of M. abscessus CNS infections were identified. Various modes of acquisition, underlying disease and therapeutic schemes were evident.
Considering the results of the literature analysis and the increasing incidence of M. abscessus, all specialists involved in the management of CNS infection should be aware of the importance of atypical microorganisms in differential diagnosis.
KeywordsMycobacterium abscessus complex Meningeal infection CNS infection
We thank Dr. Angela Bohnen for her contribution to the English language editing.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
An approval by an ethics committee was not applicable.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 2.Brown-Elliott BA, Philley JV. Rapidly growing mycobacteria. Microbiol Spectr. 2017;5(1). https://doi.org/10.1128/microbiolspec.TNMI7-0027-2016
- 5.Sali M, De Maio F, Caccuri F, Campilongo F, Sanguinetti M, Fiorentini S, Delogu G, Giagulli C. Multicenter evaluation of anyplex plus mtb/ntm mdr-tb assay for rapid detection of Mycobacterium tuberculosis complex and multidrug-resistant isolates in pulmonary and extrapulmonary specimens. J Clin Microbiol. 2016;54:59–63.CrossRefGoogle Scholar
- 6.Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ Jr, Winthrop K, Subcommittee ATSMD. American Thoracic S and Infectious Disease Society of A. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416.CrossRefGoogle Scholar