Table 1.
Summary of patients with invasive M. chimaera disease
| Patient | Preceding cardiac surgery (months prior to presentation) | Presenting symptoms (duration in months) | Clinical scenario (disease type) | Specimen source | Days to positive AFB culture | Days to identify MAC from AFB culture | Days to speciate M. chimaera from AFB culture | Days to detect M. chimaera by plasma NGSa | Additional organisms detected by plasma NGS | Days on MAC therapy at time of plasma NGS (regimen) | Patient outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 (illus-trative case) | AVR, ARR (17) | Fatigue, weight loss, night sweats (4) | Pancytopenia, renal failure, severe aortic insufficiency and rocking of prosthetic valve (disseminated) | Blood (1 of 3 positive) | 43 | 47 | 62 | 6c | None | 0 (azithromycin, ethambutol, rifabutin, amikacin) |
Alive (s/p redo surgery) |
| Valve | 5 | 6 | Not done | ||||||||
| 2 | AVR, ARR (14) | Fatigue, weight loss, cough, fever, night sweats (4) | Pancytopenia, granulomatous hepatitis and nephritis (disseminated) | Blood (4) | Negative | N/A | N/A | 3c | None | 12 (azithromycin, ethambutol, rifampin) |
Expired |
| Bone marrow | Negative | N/A | N/A | ||||||||
| Liver | 14 | 17 | 43 | ||||||||
| Urine | 18 | 20 | 41 | ||||||||
| 3 | AVR, MVR (22) | Nausea and chills (3) | Pancytopenia, large MV vegetation, granulomatous hepatitis and bone marrow granulomas (disseminated) | Blood (2) | Negative | N/A | N/A | 5c | EBV | 0 (azithromycin, ethambutol, rifabutin, amikacin) |
Expired |
| Bone marrow | 20 | 22 | Not done | ||||||||
| Valve | 6 | 8 | 23 | ||||||||
| 4 | AVR (17) | Lower back pain (2) | T11-T12 diskitis and vertebral osteomyelitis (disseminated) | Disk | 20 | 23 | 39 | 2 | EBV | 22 (azithromycin, ethambutol, rifabutin) |
Expired |
| 5 | AVR, ARR (21) | Fatigue, fever, night sweats (3) | Fluid collection surrounding aorta (localized) | Blood (3) | Negative | N/A | N/A | Negative | None | 0 (azithromycin, ethambutol, rifampin, amikacin, moxifloxacin) |
Alive (s/p redo surgery) |
| Graft/valve | 24 | 27 | 41 | ||||||||
| 6 | AVR (14) | Weakness, weight loss, fever, night sweats (3) | Thrombocyto-penia, granulomatous hepatitis (disseminated) | Liver | 26 | 35 | 92 | 6 | Actinomyces oris, Prevotella corporis, Prevotella buccalis, Gardnerella vaginalis, Acinetobacter baumannii | 103 (clarithromycin, ethambutol, rifabutin) |
Expired |
| 7 | AVR, ARR (27) | Dyspnea, lower extremity edema, weight loss (5) | Anemia, thrombocyto-penia, cholestatic hepatitis, aortic root abscess (disseminated) | Blood (1 of 5 positive) | 28 | 28 | Not done | 2c | N/Ab | 0 (azithromycin, ethambutol, rifampin, moxifloxacin) |
Expired |
| Sputum | 17 | 20 | 38 | ||||||||
| Bone marrow | 25 | 26 | 34 | ||||||||
| 8 | AVR (25) | Weakness, cough, fever (0.75) | Pancytopenia, cholestatic hepatitis (disseminated) | Blood (1) | Negative | N/A | N/A | 3c | N/Ab | 3 (azithromycin, ethambutol, rifampin, moxifloxacin, amikacin) |
Alive (s/p redo surgery) |
| Sputum | 23 | Not done | 42 | ||||||||
| Bone marrow | 27 | 29 | Not done | ||||||||
| Liver | 24 | 27 | Not done | ||||||||
| Valve | 6 | 10 | 34 | ||||||||
| 9 | AVR, ARR (12) | Chest pain, weight loss, fatigue (9) | Anemia, mediastinal mass (localized) | Blood (4) | Negative | N/A | N/A | 4c | N/Ab | 0 (azithromycin, ethambutol, rifampin, moxifloxacin) |
Alive (s/p redo surgery) |
| Urine (2) | Negative | N/A | N/A | ||||||||
| Mediastinal lymph node | 15 | 24 | 43 | ||||||||
| 10 | AVR, ARR (21) | Weakness, fatigue, weight loss, fever (2) | Pancytopenia, bone marrow granulomas (disseminated) | Blood (2 of 2 positive) | 14 | 17 | 46 | 4c | N/Ab | 0 (azithromycin, ethambutol, rifabutin) |
Expired |
| 15 | 18 | Not done |
AVR = aortic valve replacement, ARR = aortic root replacement, MVR = mitral valve replacement, AFB = acid-fast bacilli, MAC = Mycobacterium avium complex, NGS = next-generation sequencing
aIncludes only the first positive plasma NGS
bDedicated M. chimaera plasma NGS
cNGS provided the first microbiological confirmation of M. chimaera infection. For patients 4 and 6, the plasma NGS was not performed until approximately 6 weeks and 4.5 months after AFB cultures had been collected