Pfyffer, Gaby E.

Russi, Erich W.

Strässle, Anni

Weder, Walter

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649CID 1998;27 (September) Brief ReportsFigure 1. A, Giemsa stainingshowing Klebsiella pneumoniae(arrow) adhering to HeLa cells. B,Fluorescein isothiocyanate-phalloi-din staining for filamentous actin ofHeLa cells infected with K. pneu-moniae. Actin aggregation is presentin a distribution consistent with ad-herence of the bacteria (bacteria atarrow). (Original magnification,11000.)Referencesvirulence of this K. pneumoniae strain might be the presenceof new virulence genes.1. Arora DR, Chugh TD, Vadhera DY. Enterotoxigenicity of Klebsiella pneu-moniae. Indian J Pathol Microbiol 1983;26:65–70.2. Minami J, Okabe A, Shiode J, Hayashi H. Production of a unique cytotoxinAcknowledgments by Klebsiella oxytoca. Microb Pathog 1989;7:203–11.3. Knutton S, Baldwin P, Williams P, Manjarrez-Hernandez A, Aitken A. TheThe authors gratefully acknowledge Prof. Sansonetti (Institut attaching and effacing virulence property of enteropathogenic Esche-richia coli. Zentralbl Bakteriol 1993;278:209–17.Pasteur) for accepting this strain and for his helpful comments,4. Garcia MI, Le Bouguenec C. Role of adhesion in pathogenicity of humanand Pascale Courcoux for his technical assistance.uropathogenic and diarrhoeagenic Escherichia coli. Bulletin de L InstitutPasteur 1996;94:201–36.Francois Guerin, Chantal Le Bouguenec, Jacques Gilquin, 5. Rosenhine I, Ruschkowski S, Stein M, Reinscheid DJ, Mills SD, Finlay BB.Fady Haddad, and Fred W. Goldstein A pathogenic bacterium triggers epithelial signals to form a functionalbacterial receptor that mediates actin pseudopod formation. EMBO JService de Microbiologie Me´dicale, Fondation Hoˆpital Saint Joseph,and Pathoge´nie Bacte´rienne des Muqueuses, Paris, France 1996;15:2613–24.ectasis nor parenchymal destruction present. A fiberoptic broncho-Mycobacterium heidelbergense Species Nov. Infectionscopic evaluation was normal, and cytologic evaluation of a bron-Mimicking a Lung Tumorchial brushing specimen did not reveal malignant cells.Nevertheless, a bronchial carcinoma was suspected and, becauseMycobacterium heidelbergense species nov. has recently beenthe patient was in excellent health and her pulmonary functiondescribed as a new agent of cervical lymphadenitis in two childrentesting was normal, she underwent a video-assisted thoracoscopic[1]. We describe a patient with pulmonary disease caused by thisresection of the middle lobe. Histological evaluation of a grayishnovel mycobacterium that mimicked, at first sight, a lung tumor.nodule in the lobe revealed epithelioid granulomatous inflamma-In a previously healthy, asymptomatic, life-long nonsmokingtory changes as well as caseous necrosis, both highly suggestive82-year-old woman, a tumor-like lesion was detected, on a chestof tuberculosis. The patient’s postoperative course was uneventfulradiograph, in the lateral segment of the middle lung lobe. Thisand she was discharged on the fifth postoperative day.lesion had not been present on a chest radiograph obtained 16After 5 weeks, cultures of a biopsy specimen obtained during themonths earlier. A CT scan of the chest showed a 2.5 1 2.5 1thoracoscopic procedure yielded a slow-growing nonphoto-2.0-cm lesion abutting the pleura that was not sharply demarcatedchromogenic mycobacterium on solid (Middlebrook 7H10 agar) butand did not contain calcium (figure 1). There was neither bronchi-not in a radiometric medium (BACTEC 12B; Becton DickinsonDiagnostic Instrument Systems, Sparks, MD). Subcultures did notgrow at 457C or in media containing 5% NaCl. With the exceptionof 687C catalase and urease, results of all routine biochemical testingReprints or correspondence: Dr. Gaby E. Pfyffer, Swiss National Center for were negative (nitrate and tellurite reduction, niacin production,Mycobacteria, Department of Medical Microbiology, University of Zurich,Tween hydrolysis, phosphatase, aryl sulfatase, and semiquantitativeGloriastrasse 30, 8028 Zurich, Switzerland.catalase). The pattern of cellular fatty acids as determined by use ofClinical Infectious Diseases 1998;27:649–50gas-liquid chromatography resembled that of Mycobacterium mal-q 1998 by the Infectious Diseases Society of America. All rights reserved.1058–4838/98/2703–0038$03.00 moense. The major components were C16:0 (24.5%), C18:1v9c/ 9c55$$se16 08-24-98 05:26:17 cidas UC: CID650 Brief Reports CID 1998;27 (September)susceptible to isoniazid, rifampin, ethambutol, and streptomycin(which is unusual for a nontuberculous mycobacterium), our strainwas resistant to these antituberculous agents as well as to pyrazi-namide, and, with the exception of ciprofloxacin, our strain wasalso resistant to all the second line agents: amikacin, rifabutin,clarithromycin, clofazimine, ofloxacin, and sparfloxacin. Given theunique patterns generated by 65-kD-HSP-PRA, in particular, the100% homology of the hypervariable signature regions within the16S rRNA gene, our isolate was unambiguously identified asM. heidelbergense.Lung infections due to nontuberculous mycobacteria among HIV-negative patients are most commonly caused by Mycobacteriumavium complex and Mycobacterium kansasii. Examples of otherpathogens that sometimes cause pulmonary diseases include Myco-bacterium xenopi, M. malmoense, and Mycobacterium simiae [4].These organisms largely affect patients with preexisting lung condi-tions such as old tuberculosis or bronchiectases. Occasionally, infec-tions due to these organisms present as a mass lesion that is indistin-Figure 1. CT scan at the level of the middle lung lobe showing a guishable from lung cancer on chest radiography [5].2.5 1 2.5 1 2.0-cm solid lesion located subpleurally, without calcifi-cation or necrosis (arrow) and with normal lung parenchyma.Gaby E. Pfyffer, Walter Weder, Anni Stra¨ssle,and Erich W. RussiSwiss National Center for Mycobacteria, Department of Medical(33.5%), and tuberculostearic acid (14.7%). The guanine plus cyto- Microbiology, University of Zurich, and Departments of Surgery andInternal Medicine, University Hospital, Zurich, Switzerlandsine content of the DNA was 66.7 mol%. Mycolic acids consistedof a- and a*-mycolates in addition to ketomycolate. Our isolateexhibited a novel PCR-RFLP (restriction fragment length polymor- Referencesphism) pattern of the amplified 65-kD heat shock protein gene frag- 1. Haas WH, Butler WR, Kirschner P, et al. A new agent of mycobacterialment (65-kD-HSP-PRA [PCR/restriction enzyme analysis] [2]). lymphadenitis in children: Mycobacterium heidelbergense sp. nov. J ClinAfter digestion of BstEII and HaeIII, 254/220 bp and 140/115/80 bp Microbiol 1997;35:3203–9.2. Telenti A, Marchesi F, Balz M, Bally F, Bo¨ttger EC, Bodmer T. Rapid identifi-bands were obtained, respectively. Direct 16S rRNA gene sequencecation of mycobacteria to the species level by polymerase chain reaction andanalysis revealed a unique sequence for each of the hypervariablerestriction enzyme analysis. J Clin Microbiol 1993;31:175–8.regions A and B [3], both of which were 100% homologous to the3. Kirschner P, Springer B, Vogel U, et al. Genotypic identification of myco-sequence of M. heidelbergense.bacteria by nucleic acid sequence determination: report of a 2-year experi-On the basis of its combined morphological and biochemicalence in a clinical laboratory. J Clin Microbiol 1993;31:2882–9.properties, it was determined that our pulmonary isolate exhibited4. Wayne LG, Sramek HA. Agents of newly recognized or infrequentlythe same characteristics as the proposed new microorganism encountered mycobacterial disease. Clin Microbiol Rev 1992; 5:1 –M. heidelbergense species nov. In addition, on the basis of its 25.strictly aerobic growth, the organism can be easily distinguished 5. Gribetz AR, Damsker B, Bottone EJ, Kirschner PA, Teirstein AS. Solitaryfrom the closely related M. malmoense, which is microaerophilic. pulmonary nodules due to nontuberculous mycobacterial infection. AmJ Med 1981;70:39–43.Although the original strain 2554/91 of Haas et al. [1] was fullya patient who was treated with piperacillin/tazobactam (PT) andImmune Thrombocytopenia Caused by Piperacillin/who developed antibodies to platelets, resulting in severe thrombo-Tazobactamcytopenia.A 69-year-old woman with diabetes presented for evaluationThrombocytopenia is a rare side effect associated with b-lactamof fever and pain in the right hypochondriac and inferior chestantibiotic therapy [1], and isolated thrombocytopenia induced byregions of 2 days’ duration. Laboratory evaluation revealed aureidopenicillins seems to be particularly uncommon. We describeWBC count of 22,000/mm3 with a left shift, and values forRBCs and platelets were within normal limits. Results of serumchemistry studies, blood gas evaluation, and urinalysis wereReprints or correspondence: Dr. Jose´ A. Riancho, Department of Internal normal, and findings on a chest radiograph were normal. Ab-Medicine, Hospital Universitario Marques de Valdecilla, Santander 39008, dominal ultrasonography was suspicious for cholecystitis. Ther-Spain.apy was initiated with 4 g of piperacillin plus 0.5 g of tazobac-Clinical Infectious Diseases 1998;27:650–1 tam (Tazocel; Lederle, Madrid, Spain) every 8 hours. Findingsq 1998 by the Infectious Diseases Society of America. All rights reserved.1058–4838/98/2703–0039$03.00 on a repeated ultrasonographic scan and a biliary isotopic scan/ 9c55$$se16 08-24-98 05:26:17 cidas UC: CID

Mycobacterium heidelbergense Species Nov. Infection Mimicking a Lung Tumor

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