WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Sharma et al.

World Journal of Pharmacy and Pharmaceutical Sciences

Volume 3, Issue 4, 1520-1524.

Research Article

ISSN 2278 4357

TWO CASES OF MYCOBACTERIUM FORTUITUM REPORTED AT

TERTIARY CARE CENTER FROM NAVI MUMBAI,
MAHARASHTRA, INDIA.
Bhattacharjee Minakshi 1,2, Sharma Revati*1, Kar Harapriya2
1

MGM Central Research Laboratory, MGM Medical College and Hospital, Kamothe, Navi
Mumbai 410209.

Department of Microbiology, MGM Medical College and Hospital, Kamothe, Navi Mumbai 410209.
ABSTRACT

Article Received on
02 March 2014,

Mycobacterium fortuitum has been implicated in surgical site infection,

Revised on 19 March 2014,

Accepted on 8 April 2014

implanted device associated infections and injection site abscesses.

Two cases of Mycobacterium fortuitum infections one with post
operative umbilical hernia abscess and other with inguinal swelling

*Correspondence for Author

Dr. Revati Sharma

and abscess are described as per our knowledge for the first time from

MGM Central Research

Navi Mumbai, Maharashtra.

Laboratory, MGM Medical

Key Words:

College and Hospital,

operative, Trauma.

Mycobacterium fortuitum, Real time PCR, Post

Kamothe, Navi Mumbai

410209.

INTRODUCTION
Outbreaks and cases of health care associated infections caused by

patelhetal1609@gmail.com

atypical Mycobacteria have been reported now and then since the first case was described in
1938.

[1]

Atypical Mycobacteria, common environmental inhabitants have been known to

easily contaminate solutions and disinfectants under appropriate circumstances and cause
diseases. These saprophytes have increasingly being found to be associated with nosocomial
infections establishing themselves as opportunistic and deadly pathogens at times as well.[2]
About a one third of the Non-tuberculous mycobacteria species identified are found to be
associated with human diseases.

[2]

Surgical site infection, implanted device associated

infections, injection site abscesses are some of the often encountered complications.

[3]

The

current case report addresses two incidences of Mycobacterium fortuitum infections in a

tertiary care center of Navi Mumbai, Maharashtra.

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World Journal of Pharmacy and Pharmaceutical Sciences

Case1
A 49year old hypertensive male with diabetes type II visited the surgery out patient
department of the tertiary care center. He did not undergo surgery in the center but came in
for the post operative complications. The healing stitch site was infected with fluid oozing
out of it. Aspirated fluid from non healing wound was received in the Central Research
Laboratory for TB PCR in June 2013. DNA was extracted using spin columns from Quiagen
according to the manufacturers insert. Real time PCR (LC480, Light cycler II) was performed
on the extracted DNA by three color hydrolysis probe format. The channels selected were
FAM(465-510), VIC/HEX(533-580), Cy5(618-660). Amplification was observed only in
Cy5 channel which can be interpreted as Mycobacterium other than Tubercle bacilli
(MOTT). The PCR positive (MOTT) sample was further subjected to culture for
identification upto the species level. After the growth was observed, Ziehl Neelsen stain of
the secondary smear was performed and biochemically identified as Mycobacterium
fortuitum.
Case2
A 16 years old female came to the out patient department of surgery with painless inguinal
swelling. She complained of pain since six months and on and off low grade fever. She had
no history of weight loss. An aspirate from the mass was received in the Central Research
Laboratory for TB PCR in December 2013. The sample was processed as in case 1. The real
Time PCR showed amplification in both FAM and CY5 channels in this case indicating the
presence of MOTT. The Lowenstein Jensen media showed growth in two to four days. Smear
of the isolate was found to be positive for Acid Fast Bacilli. The isolate which was presumed
to be rapidly growing Mycobacterium by its rate of growth was confirmed to be
Mycobacterium fortuitum with the help of traditional biochemical methods.

Image1: Ziehl Neelsen Staining of the Colonies.

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World Journal of Pharmacy and Pharmaceutical Sciences

Image2: Growth after four days on Lowenstein Jensen medium.

Image3: Real Time PCR Amplification Curve for MOTT

DISCUSSION
Non-tuberculous mycobacteria (NTM) has always been ubiquitously present in the
environment, but the incidence of their colonization and causing disease in humans is not yet
completely understood.

[2,4]

Reports of NTM causing infection after trauma or undergoing

surgery, liposuction, silicon injection, pedicures and subcutaneous injections has been seen
over the last few years. [5,6,7,8,9,10,11] NTM in health care facilities are seen more, probably due
to inadequate temperature of sterilization or concentration of sterilization agents. They can
make their way into the wound site through water, dressing matter, hospital instruments, or
any other like source harboring them. [12] In almost all cases of nosocomial infections caused
by NTM, poor sterilization process of solutions, surgical instruments and medical devices
were found to be the causative factors. [12]
Mycobacterium fortuitum-chelonei complex categorized as Rapid Growers, group IV of
Runyons classification, though commonly associated with cutaneous diseases, disseminated
infections are seen as well. [13]
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Few cases of Mycobacterium fortuitum infection are reported from India due to lack of
suspicion of its presence among clinicians and microbiologists. [5,13,14,15] Any non healing or
delayed healing wound not responding to antibiotics for acute pyogenic infection should
consider of NTM, both from diagnostic and therapeutic point of views. Timely and efficient
management of patients could be sought by high index of clinical suspicion followed by
microbiological evaluation.
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12. Michael SP, Fordham C. Nosocomial Infection due to Nontuberculous Mycobacteria.

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