It is often difficult to discern true mycobacterial infection from colonization due to Mycobacterium gordonae (. M. gordonae) since this organism is ubiquitous and is commonly an innocuous saprophyte. This study reports a rare case of caseating hilar adenopathy and pulmonary disease caused by M. gordonae in a patient with chronic obstructive pulmonary disease (COPD) and rheumatoid arthritis (RA) on maintenance steroids and methotrexate. Pathologic exam and cultures of lymph node excision biopsy and bronchoalveolar lavage (BAL) confirmed the diagnosis.Triple antimycobacterial therapy with azithromycin, ethambutol and rifabutin was administered. The patient had significant clinical and radiologic improvement and follow-up cultures confirmed microbiologic cure.Mycobacterium gordonae can be a rare cause of significant pulmonary infection, and positive sputum or BAL cultures for M. gordonae should not be automatically discarded and considered as nonpathogenic contaminants or colonizing organisms, especially in immunocompromised hosts with comorbidities. A detailed review of the case and relevant literature is provided.

Submitted by Bruno Giorno Eberhardt (bruno.giorno@agricultura.gov.br) on 2018-04-21T01:40:57Z No. of bitstreams: 1 TESE DOUTORADO - BRUNO GIORNO EBERHARDT.pdf: 3876871 bytes, checksum: 3c2c7eac21349ce401f54a1cb03fae4f (MD5) / Approved for entry into archive by Maria Lucia Martins Frederico null (mlucia@fca.unesp.br) on 2018-04-23T12:55:33Z (GMT) No. of bitstreams: 1 eberhardt_bg_dr_botfca.pdf: 2911225 bytes, checksum: 9f9ad5ea743405838741796482e9ab66 (MD5) / Made available in DSpace on 2018-04-23T12:55:33Z (GMT). No. of bitstreams: 1 eberhardt_bg_dr_botfca.pdf: 2911225 bytes, checksum: 9f9ad5ea743405838741796482e9ab66 (MD5) Previous issue date: 2018-03-01 / EBERHARDT, B.G. Avaliação de micro-organismos zoonóticos em filés de tilápia do Nilo (Oreochromis niloticus). Botucatu, 2018. 71p. Tese (Doutorado) – Faculdade de Medicina Veterinária e Zootecnia, Campus de Botucatu, Universidade Estadual Paulista. RESUMO Cinquenta filés de tilápia do Nilo (Oreochromis niloticus) obtidos em mercado de peixes no município de Ourinhos, Estado de São Paulo, foram analisados quanto à prevalência para Aeromonas hydrophila, Edwardsiella tarda, Mycobacterium spp. e Cianobactérias. Amostras de músculo foram avaliadas por PCR para Aeromonas hydrophila, Edwardsiella tarda e Mycobacterium spp., enquanto que as amostras para cianobactérias foram analisadas por PCR em Tempo Real (qPCR). Os resultados obtidos demonstraram ausência de Aeromonas hydrophila e Edwardsiella tarda nas amostras de filés. A prevalência para Mycobacterium spp. foi de 100% (50/50). Realização posterior de sequenciamento revelou Mycobacterium gordonae. Esta bactéria é considerada um colonizador comum, normalmente não patogênico, porém, há relatos de literatura que demonstram risco de infecção em indivíduos imunossuprimidos e até mesmo imunocompetentes. A taxa de prevalência para cianobactérias foi de 48% (24/50). As cianobactérias (algas azuis) produzem grande quantidade de metabólitos bioativos ou mesmo tóxicos, incluindo toxinas associadas a problemas ambientais e de saúde pública. Considerando a natureza e o papel das cianobactérias como patógenos emergentes, a elevada prevalência deste organismo em um alimento popular como o filé de tilápia do Nilo desperta preocupação, uma vez que os métodos tradicionais de inspeção são incapazes de detectar o patógeno, pelo fato de não provocar alterações macroscópicas nos produtos, bem como pelo potencial de toxicidade para humanos. Entretanto, estudos adicionais são necessários a fim de entender se estes compostos tóxicos estão presentes nos peixes e, caso estejam, se podem sofrer bioacumulação em níveis suficientes para afetar a saúde humana. Palavras-chave: Aeromonas hydrophila, Edwardsiella tarda, Mycobacterium spp, Mycobacterium gordonae, cianobactéria, cianotoxina, tilápia do Nilo, Oreochromis niloticus, diagnóstico. / Fifty fillets of Nile tilapia (Oreochromis niloticus) from a Ourinhos fish market, Sao Paulo State (Southeast Brazil) were analyzed for the prevalence of Aeromonas hydrophila, Edwardsiella tarda, Mycobacterium spp. and cyanobacteria. Muscle samples were evaluated by PCR for Aeromonas hydrophila, Edwardsiella tarda and Mycobacterium spp. Samples for cyanobacteria were analyzed by real time PCR. Both Aeromonas hydrophila and Edwardsiella tarda were not present in fish samples. The prevalence of Mycobacterium spp. was 100% (50/50). Sequencing revealed Mycobacterium gordonae. This agent is usually a ubiquitous and commonly nonpathogenic colonizing organism, although many research publications have reported disease in immunocompromised or even in immunocompetent patients. Prevalence for cyanobacteria was 48% (24/50). Cyanobacteria (blue-green algae) produce a diversity of toxic or otherwise bioactive metabolites, including a number of toxins that have been associated with human and environmental health concerns. Considering the nature and role of cyanobacteria as a pathogen of emerging importance, the high prevalence of this organism in a popular food item such as Nile tilapia raises concern, since no macroscopic alterations can be detected through regular food inspection methods. However, further studies are necessary in order to understand whether these compounds are present in fish and, if so, if they could accumulate sufficiently to affect human health.