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Mycobacterium chimaera encephalitis following cardiac surgery in three adult immunocompetent patients: first detailed neuropathological report

Published online by Cambridge University Press:  05 September 2019

SK Das ,
D Lau ,
R Cooper ,
J Chen ,
VL Sim ,
JA McCombe ,
GJ Tyrrell ,
R Bhargavi ,
B Adam  and
E Chapman
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SK Das
Affiliation:
Department of Laboratory Medicine and Pathology Neuroscience and Mental Health Institute
D Lau
Affiliation:
Department of Medicine
R Cooper
Affiliation:
Department of Medicine
J Chen
Affiliation:
Department of Medicine
VL Sim
Affiliation:
Division of Neurology, Department of Medicine;
JA McCombe
Affiliation:
Division of Neurology, Department of Medicine;
GJ Tyrrell
Affiliation:
ProvLAB – Alberta Health Services, Edmonton, Alberta, and Division of Diagnostic and Applied Microbiology
R Bhargavi
Affiliation:
Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada;
B Adam
Affiliation:
Department of Laboratory Medicine and Pathology
E Chapman
Affiliation:
Department of Laboratory Medicine and Pathology
C Garady
Affiliation:
Department of Laboratory Medicine and Pathology
K Antonation
Affiliation:
National Microbiology Laboratory, Winnipeg, Manitoba, Canada
S Ip
Affiliation:
Department of Medicine
L Saxinger
Affiliation:
Department of Medicine
FKH van Landeghem
Affiliation:
Department of Laboratory Medicine and Pathology Neuroscience and Mental Health Institute
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Abstract

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Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.

LEARNING OBJECTIVES

This presentation will enable the learner to:

  1. 1. Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis

  2. 2. Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management

Type
Abstracts
Information
Canadian Journal of Neurological Sciences , Volume 46 , Supplement s2: ABSTRACT: 58th Annual Canadian Association of Neuropathologists Meeting , September 2019 , pp. S65 - S66
Copyright
© The Canadian Journal of Neurological Sciences Inc. 2019