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Facts About...

MYCOBACTERIUM ABSCESSUS
Information to Health Care Providers


What is it?

Mycobacterium abscessus (M. abscessus), also known as Mycobacterium chelonae subspecies abscessus in the past, is a rapidly growing atypical non-tuberculous mycobacteria. It is ubiquitous in the environment and can be found in water, soil, and dust, as well as in animals. It is resistant to chlorine so can be found in municipal or well water treated with chlorine. It can also grow in other chemical disinfectants such as glutaraldehdye.

What illnesses can it cause?

M. abscessus rarely causes illness in humans. It has occasionally been associated with a variety of illnesses and clinical syndromes including skin and soft-tissue infections (following puncture wounds or inoculations with contaminated medication), pulmonary infection, infections related to foreign material (e.g., porcine and prosthetic cardiac grafts, prosthetic joints, intravenous and dialysis catheters, tympanoplasty tubes, and augmentation mammoplasty), and post-surgical infections. Rare disseminated disease, usually with disseminated skin and soft tissue lesions, occurs almost exclusively in the setting of immunosuppression (e.g., AIDS).

What is the incubation period for it?

Although most people will have symptoms of illness within one month of exposure to M. abscessus, incubation periods of up to 1 year have been documented.

Who is at risk of developing infection with it?

People of all ages are at risk if exposed. Although healthy people occasionally develop infections with these bacteria, the disease may be more severe in immunocompromised patients.

How is it spread?

M. abscessus is not spread directly from person to person. It causes illness most frequently when it enters wounds (traumatic or surgical) or contaminates injectable medication or medical devices that are placed under the skin. Clusters of cases of M. abscessus infection have mostly been associated with non-sterile water, contaminated surgical instruments and injectable medication, especially injectable medication dispensed in multi-dose vials. Outbreaks have been linked to multi-dose vials of lidocaine and adrenal extract.

What symptoms are caused by it?

The type of illness will depend on the infection site. Individuals with abscesses due to M. abscessus will initially experience painless nodules that become erythematous, swollen and painful. Ulcerative lesions may develop that may drain small amounts of purulent discharge. In some cases fever and chills may also occur.

How can I diagnose it?

Diagnosis of M. abscessus infection relies on culture and identification of the organism. Although swab culture of visible skin lesions and aspirates of fluid collection can all be sent for atypical mycobacteria culture the preferred test is culture of a skin biopsy. The Central Public Health Laboratory (CPHL) can perform these tests. Rapidly growing mycobacteria such as M. abscessus can be cultured in 5 to 8 days on specific culture media but further testing is required to rule out diphtheroids which resemble M. abscessus. Species identification and susceptibility testing can also be conducted at the CPHL.

How is this infection treated?

A combination of surgical drainage and antibiotic therapy may be necessary to ensure cure of infections with M. abscessus. Many isolates of M. abscessus are susceptible to clarithromycin, amikacin, imipenem, and cefoxitin but variations in resistance patterns make it imperative to determine the drug susceptibilities of each clinical isolate. Monotherapy may be considered for localized skin infections where the risk of selection for resistance appears to be lower. Combination chemotherapy with at least two antimicrobial agents to which the isolate is susceptible is advised for disseminated disease because monotherapy has been shown to contribute to the development of resistance. Localized disease typically responds to 6 months of monotherapy with clarithromycin in immunocompetent hosts. Disseminated infections can require greater than 6 months of antibiotic therapy.

More information can be obtained from

Durham Region Health Department, Environmental Help Line 905-723-3818 or 1-888-777-9613

April 22, 2013