Mycobacterium chelonae hand infection following ferret bite
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CASE REPORT
Mycobacterium chelonae hand infection following ferret bite K. P. Iyengar • J. B. Nadkarni • R. Gupta N. J. Beeching • I. Ullah • W. Y. Loh
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Received: 10 April 2012 / Accepted: 13 July 2012 / Published online: 29 August 2012 Ó Springer-Verlag 2012
Abstract We present a case of hand infection caused by Mycobacterium chelonae. The patient was a 58-year-old woman with Type II diabetes mellitus and stage 4 chronic kidney disease. The infection occurred following a ferret bite and had not responded to oral antibiotics in the primary care setting. She developed signs of pyogenic flexor tenosynovitis of the index and middle fingers of her left hand. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Ultrasound imaging confirmed the clinical diagnosis. Plain radiographs showed no osseous involvement. The infection was treated with surgical debridement and broad spectrum parental antibiotics. The intra-operative tissue specimens were initially negative on aerobic and anaerobic cultures. Following transient improvement of her inflammatory parameters and clinical signs, she developed a recurrence with added features of osteomyelitis of the index and middle finger metacarpal heads on repeat radiographs. A revision surgical debridement of the flexor tenosynovitis and osteomyelitis with specific long-term antibiotic cover has led to resolution of the infection. Extended cultures of the tissue specimens at the regional laboratory confirmed the causative organism to be M. chelonae. To our K. P. Iyengar (&) J. B. Nadkarni I. Ullah W. Y. Loh Department of Trauma and Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Town Lane, Kew, Southport PR8 6PN, UK e-mail: [email protected] R. Gupta Department of Microbiology, Southport and Ormskirk Hospital NHS Trust, Town Lane, Kew, Southport PR8 6PN, UK N. J. Beeching Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
knowledge, this is the first reported case of M. chelonae infection resulting from a ferret bite. This case reminds us of the need for a high index of suspicion for infection with uncommon pathogens following animal bites, especially in patients with altered immune status. Keywords Infection Flexor tenosynovitis Nontuberculous mycobacteria Mycobacterium chelonae Animal bite
Introduction Mycobacterium chelonae is one of the non-tuberculous mycobacteria (NTM) which are widely distributed in the environment, and which differ from members of the Mycobacterium tuberculosis (MTB) MTB complex by being opportunistic pathogens without any evidence of person-to-person transmission. Mycobacteria can also be divided into two groups on the basis of their growth rates on agar. The slow-growing organisms (which take several weeks of incubation) include M. tuberculosis, M. bovis, M. africanum and M. microti and some nontuberculous species such as the M. avium complex. The rapidly growing mycobacteria (a few days), which include M. chel
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