Mycobacterium kansasii infection

Malkin J, Shiimpton A, Wiselka M, Barer MR, Duddridge M, Pereta N. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behget s disease. J Med Microbiol 2009 58(3) 371-3. 

Increasingly the existence of multiresistant strains is reported, especially in the United States but also elsewhere. Also the occurrence of infections with difficult to treat, so called atypical mycobacteria like Mycobacterium avium intracellulare and Mycobacterium kansasii is on the rise. These infections are especially seen in patients with a compromised immune system. In vitro these atypical mycobacteria often show resistance against first-choice drugs. However this in vitro lack of sensitivity does not always correspond with in vivo responses. 

A 35-year old Caucasian man with AIDS and multiple opportunistic infections, including Mycobacterium kansasii and Mycobacterium avium complex (MAC) disease developed moderate to severe primary sensorineural hearing loss after 4—5 months of therapy with oral azithromycin 500 mg/day. Other medications included ethambutol, isoniazid, rifabutin, ciprofloxacin, co-trimoxazole, fluconazole, zidovudine (later switched to stavudine), lamivudine, indinavir, methadone, mod-ified-release oral morphine, pseudoephedrine, diphenhydramine, megestrol acetate, trazodone, sorbitol, salbutamol by metered-dose inhaler and nebulizer, ipratropium, and oral morphine solution as needed. Significant improvement of the hearing impairment was documented 3 weeks after drug withdrawal. 

A 75-year-old woman developed progressively worse peripheral vision in both eyes after taking ethambutol 1200 mg/day for almost 1 year, plus clarithromycin and rifampicin for infection with Mycobacterium avium complex and Mycobacterium kansasii. Best corrected visual acuity was 20/80— in the right eye and 20/60-1-in the left eye. Eye movements were full. Slit lamp exam showed -1-1 nuclear sclerosis in both eyes. On fundoscopy the optic discs were not swollen or pale. A 30-2 Humphrey visual field showed bitemporal hemianopia. An MRI scan of the brain was normal, as was optical coherence tomography. 

Miscellaneous Hew Antituberculous Compounds — The phenanthrotriazine (T.285, Hoechst) (XII) was active in mice infected with the atypical Mycobacterium kansasii. was somewhat less active than k,4 -bis-iso-... 

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