1887

Abstract

Introduction:

An official American Thoracic Society and Infectious Disease Society of America statement has shown that patients with pulmonary complex (MAC) disease who complete 10–12 months of negative cultures on therapy but then have either single or multiple positive MAC cultures are more likely to have reinfection with a new MAC strain.

Case presentation:

A 63‐year‐old woman was diagnosed with pulmonary disease caused by clarithromycin (CAM)‐susceptible MAC. Before initiating chemotherapy using a four‐drug regimen containing CAM, an investigation of the patient’s residential bathroom was conducted and one of the isolates recovered from the bathtub inlet was found to be genetically identical to sputum‐derived isolates by variable number tandem repeats analysis using tandem repeat loci (MATR‐VNTR). A second investigation of the bathroom during chemotherapy showed no isolates, and five consecutive sputum cultures were negative for 12 months until chemotherapy was discontinued. A recurrence occurred 3 months after the end of chemotherapy (at age 65 years). A third investigation of the bathroom was performed and MATR‐VNTR analysis revealed that the VNTR profile of the isolates recovered from the sputum at recurrence was identical to that of the isolates recovered from the sputum at initial diagnosis and the bathroom at the first investigation.

Conclusion:

The recurrence occurred due to endogenous reactivation of the initial isolate despite drug treatment for 12 months after sputum culture conversion. Further genetic analyses of MAC isolates recovered from patients and environments should be encouraged.

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2014-06-01
2019-10-20
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References

  1. Fujita K. , Ito Y. , Hirai T. , Maekawa K. , Imai S. , Tatsumi S. , Niimi A. , Iinuma Y. , Ichiyama S. . other authors ( 2013; ). Genetic relatedness of Mycobacterium avium–intracellulare complex isolates from patients with pulmonary MAC disease and their residential soils. . Clin Microbiol Infect 19:, 537–541.[CrossRef]
    [Google Scholar]
  2. Griffith D.E. , Aksamit T. , Brown‐Elliott B.A. , Catanzaro A. , Daley C. , Gordin F. , Holland S.M. , Horsburgh R. , Huitt G. . other authors ( 2007; ). An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. . Am J Respir Crit Care Med 175:, 367–416.[CrossRef]
    [Google Scholar]
  3. Ichikawa K. , Yagi T. , Inagaki T. , Moriyama M. , Nakagawa T. , Uchiya K. , Nikai T. , Ogawa K. . ( 2010; ). Molecular typing of Mycobacterium intracellulare using multilocus variable‐number of tandem‐repeat analysis: identification of loci and analysis of clinical isolates. . Microbiology 156:, 496–504.[CrossRef]
    [Google Scholar]
  4. Inagaki T. , Nishimori K. , Yagi T. , Ichikawa K. , Moriyama M. , Nakagawa T. , Shibayama T. , Uchiya K. , Nikai T. . other authors ( 2009; ). Comparison of a variable‐number tandem‐repeat (VNTR) method for typing Mycobacterium avium with mycobacterial interspersed repetitive‐unit‐VNTR and IS1245 restriction fragment length polymorphism typing. . J Clin Microbiol 47:, 2156–2164.[CrossRef]
    [Google Scholar]
  5. Maekawa K. , Ito Y. , Hirai T. , Kubo T. , Imai S. , Tatsumi S. , Fujita K. , Takakura S. , Niimi A. . other authors ( 2011; ). Environmental risk factors for pulmonary Mycobacterium avium–intracellulare complex disease. . Chest 140:, 723–729.[CrossRef]
    [Google Scholar]
  6. Nishiuchi Y. , Maekura R. , Kitada S. , Tamaru A. , Taguri T. , Kira Y. , Hiraga T. , Hirotani A. , Yoshimura K. . other authors ( 2007; ). The recovery of Mycobacterium avium complex (MAC) from the residential bathrooms of patients with pulmonary MAC. . Clin Infect Dis 45:, 347–351.[CrossRef]
    [Google Scholar]
  7. Ogawa K. . ( 2013; ). Genetic research about Mycobacterium avium complex. . Kekkaku 88:, 17–22.
    [Google Scholar]
  8. Taga S. , Niimi M. , Kurokawa K. , Nakagawa T. , Ogawa K. . ( 2012; ). A case of environmental infection with pulmonary Mycobacterium avium complex disease from a residential bathroom of a patient suggested by variable‐number tandem‐repeat typing of Mycobacterium avium tandem repeat loci. . Kekkaku 87:, 409–414. (in Japanese, abstract in English)
    [Google Scholar]
  9. Wallace R.J. Jr , Zhang Y. , Brown‐Elliott B.A. , Yakrus M.A. , Wilson R.W. , Mann L. , Couch L. , Girard W.M. , Griffith D.E. . ( 2002; ). Repeat positive cultures in Mycobacterium intracellulare lung disease after macrolide therapy represent new infections in patients with nodular bronchiectasis. . J Infect Dis 186:, 266–273.[CrossRef]
    [Google Scholar]
  10. Wallace R.J. Jr , Zhang Y. , Brown B.A. , Dawson D. , Murphy D.T. , Wilson R. , Griffith D.E. . ( 1998; ). Polyclonal Mycobacterium avium complex infections in patients with nodular bronchiectasis. . Am J Respir Crit Care Med 158:, 1235–1244.[CrossRef]
    [Google Scholar]
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