Mycobacterium chelonae infection of a cardiovascular bioprosthesis linked to a recent outbreak

• DOI: 10.1007/s15010-025-02534-8
• Publication Date: 2025-04-07T08:38:49Z
• Authors: Johanna Kessel; Axel Braner; Margo Diricks; Thomas Walther; Tomas Holubec; Rudolf Werner; Michael Hogardt; Thomas A. Wichelhaus; Stefan Niemann; Annette Moter; Inna Friesen; Nils Wetzstein
• Keywords: Mycobacterium chelonae; Nontuberculous Mycobacteria; Mycobacterium avium complex; Mycobacterium fortuitum

Abstract Objectives Mycobacterium chelonae is a rapid-growing non-tuberculous mycobacterium that has occasionally been described in connection with foreign material infections, e.g. after orthopaedic joint replacement or cosmetic surgery. In recent outbreak, several cases of M. endocarditis associated biological heart valve prostheses were reported. Case history A 64-year-old female patient myalgia and recurrent swelling presented to our hospital. Initially suspected for rheumatoid arthritis, the underwent series orthopedic rheumatologic treatments, including prednisolone methotrexate. Subsequent revealed Ross operation 2014 PET-CT was suspicious valved conduit infection leading surgical replacement. Utilizing fluorescence situ hybridization (FISH) diagnostic techniques, DAPI, Kinyoun Ziehl-Neelsen staining, mycobacterial confirmed both prosthesis adjacent muscle tissue. Molecular methods identified most closely related chelonae/abscessus complex indicating an association previously outbreak contaminated valves. Antimycobacterial therapy initiated remains stable at time writing. To date, all cultures remained negative. Conclusions Non-tuberculous mycobacteria (NTM) are rare possibly underdiagnosed pathogens infections bioprosthetic flap bearing conduits. Mycobacterial foreign-body can manifest many years implantation. As NTM be difficult detect, molecular identification particular importance. Here, modern imaging, microscopic techniques might special use diagnosing prolonged prosthetic graft infections.