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• W2894712832 abstract "SESSION TITLE: Chest Infections 1 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: 10/09/2018 03:45 PM - 04:45 PM INTRODUCTION: Zoonotic infection from Mycobacterium Bovis remains an important consideration for tuberculous disease in the developing world. We present a challenging case of hematogenous Mycobacterial dissemination from an uncommon culprit. CASE PRESENTATION: A 53 year old Bacillus-Calmette-Guerin (BCG) vaccinated and otherwise healthy Mexican male presented with complaints of fever, productive cough, arthralgias and weight loss over the preceding 21 days. He had already completed two separate outpatient courses of oral antibiotics without improvement. He denied any travel outside of the continental United States over the last 13 years and denied any recent sick contacts. He also owned 2 pet parrots. His physical exam and initial laboratory work up was unremarkable. A Chest X-ray (Fig. 1) revealed diffuse, bilateral, micronodular opacities, warranting further evaluation with Computed Tomography (CT) (Fig. 2). Initial acid-fast bacilli (AFB) sputum stains, bronchoalveolar lavage stains, cytology brushings and trans-bronchial biopsies were all negative. Hypersensitivity pneumonitis and opportunistic fungal panels were obtained which were unremarkable. Interferon gamma release assay was positive however equivocal given patient's BCG vaccination status. CT Chest, Abdomen and Pelvis (Fig. 3) was performed, which incidentally revealed an enlarged, heterogeneous prostate with fluid collections. Ultrasound guided aspiration of the prostate yielded pus and a strongly positive AFB smear. Eventually, the AFB cultures from the initial BAL came back positive. The patient was started on RIPE therapy with symptomatic improvement. Final speciation returned as M. Bovis and accordingly, pyrazinamide was stopped. DISCUSSION: M. bovis disease was common in the industrialized world before the practice of pasteurization became widely implemented in the 1940s. Current estimates in the USA and Europe identify between 1.3%-1.6% of tuberculosis cases attributable to M. Bovis. Infections are typically contracted via ingestion of unpasteurized dairy products from infected livestock and may remain dormant for many years, as was likely the situation in this case. Given the oral inoculation route, most cases of M.bovis manifest primarily with extrapulmonary findings. Of note, M. Bovis has documented intrinsic resistance to pyrazinamide which necessitates modification of typical RIPE treatment strategy. CONCLUSIONS: Diagnosis of disseminated TB remains a challenge. Regarding M. Bovis, the mean time to diagnosis has increased among practitioners given the diminishing incidence of infection. Vigilance of the disseminated and often extra-pulmonary form of tuberculosis caused by M. Bovis continues to be warranted. Patients at particular risk for M.bovis are those from developing countries, with frequent exposure to livestock and/or the practice of unpasteurized dairy product consumption. Reference #1: Scott. C. Human Tuberculosis Caused by Mycobacterium bovis in the United States, 2006-2013. Clin Infect Dis. 2016 Sep 1;63(5):594-601. Reference #2: Sherman LF. Patient and health care system delays in the diagnosis and treatment of tuberculosis. Int J Tuberc Lung Dis. 1999 Dec;3(12):1088-95. Reference #3: Majoor, C.J. Epidemiology of Mycobacterium bovis disease in humans, The Netherlands, 1993-2007. Emerg Infect Dis. 2011 Mar;17(3):457-63. DISCLOSURES: no disclosure on file for Christopher Barrios; No relevant relationships by Armin Krvavac, source=Web Response No relevant relationships by Scott Maughan, source=Web Response No relevant relationships by Pujan Patel, source=Web Response" @default.
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• W2894712832 date "2018-10-01" @default.
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• W2894712832 title "DIAGNOSING MILLIARY MYCOBACTERIUM BOVIS FROM THE PROSTATE OF AN IMMUNOCOMPETENT HOST" @default.
• W2894712832 doi "https://doi.org/10.1016/j.chest.2018.08.102" @default.
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