Extrapulmonary infections caused by a dominant strain of Mycobacterium massiliense (Mycobacterium abscessus subspecies bolletii)

• Published in: Clinical microbiology and infection Vol. 19; no. 10; pp. E473 - E482
• Main Authors: Cheng, A., Liu, Y.-C., Chen, M.-L., Hung, C.-C., Tsai, Y.-T., Sheng, W.-H., Liao, C.-H., Hsueh, P.-R., Chen, Y.-C., Chang, S.-C.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2013; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia - epidemiology; Bacteremia - microbiology; Brazil - epidemiology; Child; Child, Preschool; Disease Outbreaks - statistics & numerical data; DiversiLab; Female; Humans; Infant; Male; Middle Aged; Molecular Epidemiology; Molecular Typing; Mycobacterium; Mycobacterium abscessus; Mycobacterium bolletii; Mycobacterium Infections - epidemiology; Mycobacterium Infections - microbiology; Mycobacterium massiliense; Nontuberculous Mycobacteria - classification; Nontuberculous Mycobacteria - genetics; Nontuberculous Mycobacteria - isolation & purification; PFGE; Postoperative Complications - epidemiology; Postoperative Complications - microbiology; rep-PCR; Retrospective Studies; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Taiwan - epidemiology; Brazil; Taiwan; Mycobacterium massiliense; rep-PCR; DiversiLab; Mycobacterium bolletii; PFGE; Mycobacterium abscessus
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/1469-0691.12261

A single strain of Mycobacterium massiliense (BRA 100), a subspecies of the Mycobacterium abscessus complex, has been responsible for an epidemic of post-surgical infections in Brazil. Outside Brazil, this is the first report to describe a single emerging strain of M. massiliense (TPE 101) associated with extrapulmonary infections. This phenomenon may be underestimated because sophisticated molecular typing of M. abscessus is not routinely performed. Our molecular epidemiology study was triggered by an outbreak investigation. Nine case isolates were grown from the surgical sites of nine mostly paediatric patients receiving operations from 2010 to 2011. All available non-duplicated isolates of M. abscessus during this period were obtained for comparison. Mycobacteria were characterized by multilocus sequence analysis (MLSA), repetitive sequence PCR (rep-PCR) and pulsed-field gel electrophoresis (PFGE). Of 58 isolates of M. abscessus overall, 56 were clinical isolates. MLSA identified 36 of the isolates as M. massiliense. All case isolates were indistinguishable by PFGE and named the TPE 101 pulsotype. Of the stored strains of M. abscessus, TPE 101 strains were over-represented among the control surgical wound (7/7, 100%) and subcutaneous tissue isolates (4/5, 80%) but rare among the respiratory isolates (1/16, 6%) and absent from external skin, ocular and environmental samples. In conclusion, a unique strain of M. massiliense has emerged as a distinctive pathogen causing soft tissue infections in Taiwan. Further study to identify whether this is due to an occult common source or to specific virulence factors dictating tissue tropism is warranted.