Mycobacterium haemophilum is a nontuberculous mycobacterium that causes skin, joint, bone, and pulmonary infections in immunocompromised persons and lymphadenitis in children.
M haemophilum was first isolated from subcutaneous abscesses in a patient with Hodgkin disease. Most recent infections have occurred in patients with AIDS, in transplant recipients, and in patients receiving tumor necrosis factor-alpha inhibitors.[2, 3, 4] M haemophilum skin infection has been associated with permanent eyebrow makeup and tattoos, as well as accupuncture treatments.
M haemophilum is a fastidious (requires special growth media) mycobacterium that requires heme-supplemented culture media and low temperatures for growth. Because of these features, it is probably underdiagnosed.
The pathophysiology, natural habitat, and mechanism for acquisition of M haemophilum infection are not known. Water reservoirs may be the source of M haemophilum infections. Immunocompromised adults with M haemophilum infection most commonly present with skin lesions. Septic arthritis and osteomyelitis may also occur. Pulmonary infection is much less common and may follow skin disease. M haemophilum infection occasionally causes pulmonary infection initially. Mycobacteremia may occur.
More than 40 cases of M haemophilum infection have been reported, including 10 cases in Arizona from 1984-1994. Most cases occurred in immunosuppressed patients. The incidence of disease is unknown.
Cases of M haemophilum infection have been reported sporadically from Australia, France, Germany, Canada, Israel, United Kingdom, and South Africa.
M haemophilum infection is more common in males than in females. This may be related to the higher incidence of HIV infection in males.
Biopsy specimens of skin lesions show granulomatous panniculitis and caseating or noncaseating granulomas. Patients with AIDS have poorly formed granulomas. A neutrophilic infiltrate with multinucleated giant cells may be observed. AFB smear results are usually positive, revealing large, pleomorphic, or curved AFB.
Lymph node biopsy may reveal granulomas, necrosis, granulating tissue, or multinucleated giant cells, and the specimen may be smear-positive for AFB.
Although no standardized treatment exists, a regimen that includes a combination of at least 2 drugs with low minimum inhibitory concentrations (MICs) against M haemophilum is preferred.
A 3-drug combination of ciprofloxacin, clarithromycin, and rifampin or rifabutin has been used for cutaneous disease in bone marrow transplant recipients. No standard treatment exists; optimal treatment time is unknown.
Clinical Context: Macrolide with activity against various nontuberculous mycobacteria. Binds to bacterial 50S ribosomal subunit and inhibits RNA-dependent protein synthesis.
Clinical Context: Important drug used in the treatment of infection with M tuberculosis and nontuberculous mycobacterial infections. Inhibits DNA-dependent RNA polymerase activity.
Clinical Context: Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth. Other quinolones such as levofloxacin, sparfloxacin, and ofloxacin may also be effective.
Clinical Context: Expected to be a powerful drug for mycobacteremia. Starting amikacin may be beneficial at least as long as the patient is septic.
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.