DEAR DR. GOTT: This is the first time I have written you. I’m 79 and female in pretty good health. I have a pacemaker and am on Coumadin.
I was diagnosed with mycobacterium chelonae a year and a half ago after a CT scan and sputum testing in a petri dish in a lab in Denver. I guess this is rather rare. My infectious disease doctor said I would have a PICC in my arm and two very strong antibiotics injected. Because they have strong side effects, I will have my heart and kidneys monitored weekly. I now have nausea and a rash.
I am holding off because I take care of my husband who had a stroke and has vascular dementia. The doctor said it hasn’t gotten worse, so I will wait a few months before deciding. I do become very fatigued and the hoarseness and no voice is very difficult to handle – and the continual coughing is pretty bad most of the time. I have tried many things for my hoarseness but nothing works – even prescription antacids.
Can you please help me?
DEAR READER: Mycobacterium chelonae is a rare infection that can attack people with a normal immune system as well as those with a compromised immune system. The latter group are at higher risk of developing the condition. It is a gram-positive aerobic spore-producing, fast growing bacteria, most commonly found in municipal tap water, soil, in milk, and on animals along with the other non-tuberculous mycobacterium species. The organisms have been frequently found in environments such as medical offices and surgical suites that treat acquired infections of skin and soft tissue. Prime examples are from the infection that can follow the use of contaminated bronchoscopes, stepping on a nail and puncturing the skin of the foot, those with open skin lacerations and open fractures, and from wound infection following surgery or liposuction. The disorder is an increasingly recognized agent of inflammation of the cornea of the eye or following some other office ophthalmologic procedures. The infection is more frequent in males than in females, and in the elderly. Clinical evaluation may be necessary to determine the significance of a positive culture, primarily those from respiratory secretions.
Risk factors for localized infection include subcutaneous injections, trauma, chronic granulomatous infections involving tendon sheaths and joints following inoculation of a pathogen through accidental trauma, puncture wounds and surgical incisions. The lesions are non-tender subcutaneous (under the skin) nodules that appear singly or in groups on one or more extremities.
Small lesions will generally respond to antibiotic therapy such as Clarythromycin combined with normal wound care. More extensive lesions and those that are antibiotic-resistant may require surgical debridement. The prognosis for the otherwise healthy individual treated with antibiotics is extremely good. In those with a compromised immune system, the illness can be extremely severe.
Dignosis of pulmonary non-tuberculosis mycobacterial infection is difficult. If you have chronic lung disease, your culture could have been reported as a false positive or false negative because a culture by itself isn’t sufficient evidence to establish a diagnosis. Your incessant cough could be simple post nasal drip, allergies, COPD, or something else. The place to begin is with a visit to your primary care physician. Perhaps a referral to an ear-nose-and-throat specialist is in order to determine if there are any other, more easily treatable, possibilities.
Finally, I understand that you must take care of your husband, but until you are healthy, you cannot do this to the best of your ability. Perhaps temporary help, either with family members or a local visiting nurse association. In this instance, it is important that you put yourself first.
