Pulmonary infection due to fluoroquinolone-resistant Mycolicibacterium fortuitum : a case report
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CASE REPORT
Open Access
Pulmonary infection due to fluoroquinolone-resistant Mycolicibacterium fortuitum: a case report Kana Kurokawa1, Norihiro Harada1* , Hitoshi Sasano1, Haruhi Takagi1, Satomi Takei2, Ayako Nakamura3, Keisuke Kamada4, Atsushi Yoshida4, Ken Kikuchi4 and Kazuhisa Takahashi1
Abstract Background: Mycolicibacterium fortuitum is a species of the rapidly growing mycobacteria that can cause pulmonary infection. It is susceptible to multiple antibiotics both in vitro and in clinical practice, so that any combination of susceptible drugs is effective. However, we encountered a case of infection due to fluoroquinoloneresistant M. fortuitum. In this study, we report the case and describe the mechanism of resistance. Case presentation: A 65-year-old man with a history of total gastrectomy and immunosuppressant treatment for rheumatoid arthritis developed a recurrence of pulmonary infection caused by M. fortuitum. He was treated with clarithromycin and levofloxacin as a first-line treatment, based on the favorable susceptibility at that time. After recurrence, a high minimum inhibitory concentration to fluoroquinolones was detected. DNA sequencing of the pathogen showed the substitution of serine for tryptophan at residue 83 in the gyrA gene. He was successfully treated with a combination of other antibiotics. Conclusion: This is the first report on the treatment of fluoroquinolone-resistant M. fortuitum and investigation of the mechanism of resistance. We suggest that the susceptibility test remains effective for determining the next line of treatment after a pathogen has acquired resistance, and resistance to fluoroquinolones in M. fortuitum can be attributed to a single change of amino acid. Keywords: Mycolicibacterium fortuitum, Fluoroquinolone, Resistance, DNA gyrase, gyrA
Background Non-tuberculous mycobacteria (NTM) are widespread in the natural environment, including natural waters, engineered water systems, and soils [1]. They can affect many organs and cause diseases, such as pulmonary disease, lymphadenitis, cutaneous disease, and disseminated disease [2]. Of these, pulmonary infection is the most common clinical manifestation [2]. The most common pathogens for lung disease are Mycobacterium avium * Correspondence: [email protected] 1 Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan Full list of author information is available at the end of the article
complex and Mycobacteroides abscessus, but Mycolicibacterium fortuitum is also important [3]. M. fortuitum is one of the rapidly growing mycobacteria (RGM), which is the categorization according to colony morphology and growth characteristics [2]. One characteristic of M. fortuitum is to show favorable susceptibility and clinical effect of multiple antibiotics [4]. The 2007 official American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) statement showed that M. fortuitum isolates were susceptible to amikacin (100%), c
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