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The information provided is offered as a resource for Wisconsin Laboratories and Health Care Facilities
Mycobacteriology at the Wisconsin State Laboratory of Hygiene The Wisconsin State Laboratory of Hygiene (WSLH) mycobacteriology laboratory serves as a primary diagnostic facility and reference laboratory for clinicians and private mycobacteriology laboratories located throughout Wisconsin, and as a public health laboratory serving the Wisconsin Division of Public Health and local public health agencies. The focus of the WSLH mycobacteriology laboratory is the public health aspects of TB infection, with emphasis on rapid detection and reporting of infection, drug susceptibility, and possible outbreak situations. The WSLH mycobacteriology laboratory is a full-service Level III laboratory (as defined by CDC guidelines), providing state-of-the-art TB laboratory services in a biosafety level 3 (BSL-3) laboratory. The WSLH mycobacteriology laboratory uses recommended basic and rapid methodologies for the isolation, identification, and susceptibility testing of Mycobacterium tuberculosis, following the guidelines set forth by the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC).
Information about Specific Agents
M. abscessus is part of the M. fortuitum complex, a group of rapidly-growing Mycobacteria that are ubiquitous in the environment (soil and water). M. fortuitum complex includes: M. fortuitum, M. peregrinum, M. chelonae, M. abscessus, and M. mucogenicum. M. fortuitum complex isolates are responsible for almost all human infections caused by rapidly-growing Mycobacteria. Infections range from localized wound infections to respiratory disease to serious disseminated infections. M. abscessus usually causes respiratory and soft tissue/skin infections. It is necessary to differentiate the M. fortuitum group ( M. fortuitum and M. peregrinum) from M. chelonae and M. abscessus as the latter two species of the complex are very resistant to antimycobacterial drug therapies. Resource for M. abscessus: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
Mycobacterium avium complex (MAC or MAIC): M. avium complex (MAC) is the most commonly isolated group of Mycobacteria at WSLH. MAC is widely distributed in nature (water, soils, birds and other animals and dust). Infections in immunocompetent patients are usually pulmonary; infections in immunosuppressed patients (AIDS; CD4+ counts less than 200) are usually disseminated. MAC isolates are very drug resistant and difficult to treat; treatment is only recommended for the immunosuppressed and in cases of repeated isolation where clinical symptoms exist. It is not clinically significant to separate the species in the complex: M. avium- more common in AIDS patients with disseminated disease M. intracellulare- more common in immunocompetent patients with existing pulmonary disease M. species X- strains similar to MAC isolates but uncharacterized at this time (similar HPLC peak profiles; negative for MAC by DNA probe) Resource for M. avium complex: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
M. chelonae is part of the M. fortuitum complex, a group of rapidly-growing Mycobacteria that are ubiquitous in the environment (soil and water). M. fortuitum complex includes: M. fortuitum, M. peregrinum, M. chelonae, M. abscessus, and M. mucogenicum. M. fortuitum complex isolates are responsible for almost all human infections caused by rapidly-growing Mycobacteria. Infections range from localized wound infections to respiratory disease to serious disseminated infections. M. chelonae usually causes soft tissue and skin infections. It is necessary to differentiate the M. fortuitum group ( M. fortuitum and M. peregrinum) from M. chelonae and M. abscessus as the latter two species of the complex are very resistant to antimycobacterial drug therapies. Resource for M. chelonae: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
Mycobacterium fortuitum group (M. fortuitum, M peregrinum) M. fortuitum and M. peregrinum are part of the M. fortuitum complex, a group of rapidly-growing Mycobacteria that are ubiquitous in the environment (soil and water). M. fortuitum complex includes: M. fortuitum, M. peregrinum, M. chelonae, M. abscessus, and M. mucogenicum. M. fortuitum complex isolates are responsible for almost all human infections caused by rapidly-growing Mycobacteria. Infections range from localized wound infections to respiratory disease to serious disseminated infections. M. fortuitum/peregrinum usually cause trauma/wound infections, and opportunistic respiratory disease. Resource for M. fortuitum: Ribosomal Differentiation of Medical Microorganisms (RIDOM) Resource for M. peregrinum: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
M. gordonae is known as the "tap water bacillus" and is ubiquitous in water environments. One of the most commonly isolated Mycobacteria from clinical specimens, M. gordonae is saprophytic; very rarely implicated in human infection. M. gordonae is a common laboratory contaminant. Resource for M. gordonae: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
M. kansasii is a significant cause of chronic pulmonary disease in humans (may resemble disease caused by M. tuberculosis). In contrast to M. tuberculosis infection, there is minimal risk of human to human transmission. Infection is more common in the Midwestern U.S.; risk factors often predispose infection (underlying pulmonary disease, cancer, alcoholism, etc.). M. kansasii is commonly isolated from water samples; infection is thought to be via aerosol route. M. kansasii is the second most common cause of mycobacterial infection in AIDS patients (after M. avium complex). Resource for M. kansasii: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
M. marinum is a fish pathogen found in environmental waters. It is responsible for "swimming pool granuloma" infections in humans, localized infections of the skin at sites of cuts or abrasions (most often the extremities). Patients infected with M. marinum often acquire the Mycobacteria through contact with aquariums or insufficiently chlorinated swimming pools. Disseminated M. marinum infections may occur in the immunosuppressed. Resource for M. marinum: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
Previously MCLO "M. chelonae-like organisms", M. mucogenicum is part of the M. fortuitum complex, a group of rapidly-growing Mycobacteria that are ubiquitous in the environment (soil and water). M. fortuitum complex includes: M. fortuitum, M. peregrinum, M. chelonae, M. abscessus, and M. mucogenicum. M. mucogenicum is the rare cause of human disease; it is estimated that most respiratory isolates are non-pathogenic (except in immunocompromised patients) while most non-respiratory isolates are pathogenic (usually wound infections). M. mucogenicum isolates have a mucoid appearance on laboratory media. Resource for M. mucogenicum: Ribosomal Differentiation of Medical Microorganisms (RIDOM)
Mycobacterium tuberculosis complex The Mycobacterium tuberculosis complex (MTBC) includes M. tuberculosis, M. bovis, M. bovis BCG, M. africanum, M. microti, M. canettii, M. caprae, and M. pinnipedii. Members of the MTBC are not routinely differentiated at WSLH by HPLC with the exception of M. bovis BCG (which has a distinct HPLC mycolic acid peak profile).
Evidence suggests the source of human M. xenopi infection is aerosolized water, similar to M. avium complex. M. xenopi is not as ubiquitous in all water supplies as M. avium, preferring to grow in hot water supplies. Wisconsin shares high incidence of M. xenopi infection with areas of Canada when compared to other areas of North America. For immunocompetent patients, pulmonary disease is most common; risk factors include underlying lung disease, heavy smoking, alcohol abuse and exposure to water containing these Mycobacteria. AIDS is another risk factor for M. xenopi infection, often leading to disseminated infection in these patients.
Forms Call WSLH Clinical orders at 1-800-862-1088 or 608-265-2966 to order the WSLH Communicable Disease Division (CDD) A requisition form. Specimen Collection Instructions
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