1. • Congestive heart
failure
• Decrease cardiac
output
• Diabetes Mellitus,
• Dilated
cardiomyopathy,
• Deep Vein Thrombosis
of upper extremity
• Hyperlipidemia
• Hypertension
• Hypothyroidism not
otherwise specified
• Impaired skin integrity
• Infection
• Obesity
• Pain management,
• Pneumonia
• Renal disease
• Sleep apnea.
Patient Outcome
REVIEW OF A RAPID GROWER MYCOBACTERIUM:
MYCOBACTERIUM MAGERITENSE
Acknowledgements
Abstract
The Department of Medical Laboratory
Science at Armstrong State University made
this Case study possible.
Any opinions, findings, and conclusions or
recommendations expressed in this material
are those of the author and do not necessarily
reflect the views of the Armstrong State
University.
Infections caused by Mycobacteria are
aggressive and have a poor prognosis, but if
diagnosed early in the disease process a
number of antibiotic regiments are available
for treatments. For this case study follow up
with patient indicates that treatments with a
combination of doxycycline, moxifloxacin and
Imipenem were successful and the patient is
now free of infection.
Medical History
Merveille Grant
Department of Medical Laboratory Science , Armstrong State University, Savannah, GA
•Hematology abnormal labs:
– Platelets 30 Plt/ microliter (Normal range 155-
410 Plt/ microliter).
– WBC 4.21 wbc/ microliter (Normal Range 4.8-
5.2 wbc/ microliter)
•Microbiology Labs:
– Culture source chest wound positive Acid Fast
Bacilli after 3 days of incubation.
Current Research
Chief Complaints
49 y/o male with history of ischemic cardiomyopathy with
Implantable Cardioverter Defibrillator placement that was
extracted due to vegetation and was put on antibiotics for
treatment at home. Months later, Patient presented to
emergency room with pacemaker pocket and lead infection
with Mycobacterium mageritense. He was admitted with
thrombocytopenia and low white blood cell count but his other
physical examination results were within normal limits.
Mycobacterium mageritense shares
similarities with other species and the most
common one is Mycobacterium fortuitum and
current technologies such as partial gene
sequencing, high-performance liquid
chromatography, restriction fragment length
polymorphism and polymerase chain reaction
(PCR) make it very easy to differentiate these
species so a proper treatment regiment can be
administered.
Laboratory Tests & Results
Treatment
Mycobacterium mageritense is a rapidly
growing Mycobacterium species that was first
isolated in (Madrid) Spain in 1987. In 1997, it was
described as a new species and in 2002, it was
associated with disease in the United Sates.
Mycobacterium mageritense has been isolated from
respiratory specimens, blood of the
immunocompromised, and wound infections
(Center of disease control, 2011).
This case study gives an overview of
Mycobacterium mageritense that was isolated from
a male patient that presented in the emergency
room with a chest wound infection. His laboratory
findings indicated low levels of platelets and a
reduced white blood cell count. The patient’s blood
culture tested positive and a gram stain was
performed revealing gram-positive bacilli. An acid-
fast stain was also performed, yielding a positive
result. The organism was then sub cultured to a
Lowenstein Jensen slant for isolation. The
Mycobacterium species grew rapidly and profusely.
The specimen was then sent to a reference lab for
species identification and susceptibility testing. The
organism was identified as Mycobacterium
mageritense and was found susceptible to
Imipenem, Ciprofloxin, Moxifloxacin, Amikacin,
and Linezolid. It was intermediate in susceptibility
to Cefoxitn and resistant to Clarithromycin,
Tobramycin, Doxycycline, Minocycline, and
Tigecycline.
Antibiotics MIC (mcg/ml) Interpretation
Imipenem <=2 Susceptible
Ciprofloxaxin 0.25 Susceptible
Moxifloxacin <=0.25 Susceptible
Amikacin 16 Susceptible
Linezolid 8 Susceptible
Patient’s specimen on blood agar
Patient’s specimen on LG slant