What is the pathophysiology of mycobacterium chelonae infection?

Updated: Dec 20, 2018
  • Author: Alfred Scott Lea, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

M chelonae, like many NTM, are ubiquitous in the environment and have been isolated from both natural and potable freshwater sources, soil, contaminated solutions, and reptiles. [7] The organism can grow in distilled and unsupplemented water. It is hydrophobic and adheres to surfaces, owing to the structure and make up of its mycolic acids resulting in biofilm formation. [8, 9] Like most RGM, it is resistant to chlorine and some industrial grade detergents (ie, glutaraldehyde) commonly used in hospital settings. [10] Household water heaters are favorable growth environments owing to the stagnant water and its elevated temperature. [11]

M chelonae causes disease sporadically, as well as in patients with identifiable risk factors, owing to its hardiness, resistance to chemical and antimicrobial degradation, and ubiquitous environmental presence.

M chelonae most commonly causes infection of the skin and skin structures where infections can be classified as a localized cellulitis, as a subcutaneous abscess, or as disseminated disease. [12] According to some series, as many as 75% of patients with disseminated disease are initially colonized with M chelonae, and skin trauma is thought to be the etiology for cutaneous invasion. [13, 14]

Accidental penetrating trauma, particularly when associated with pedicure salons and footbaths are well-known risk factors for disease. Initial reports of NTM cutaneous infection associated with tattoos occurred in 2003. M chelonae has caused outbreaks of skin infections associated with tattoo parlors and has been found in contaminated tattoo ink. [15] Disseminated infection is associated with organ transplants, diabetes mellitus, malignancy, long-term corticosteroid administration, immunosuppressant therapy, and tumor necrosis factor-alpha (TNF-α) inhibitors. [15, 16]


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