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- 1. ? Congestive heart failure ? Decrease cardiac output ? Diabetes Mellitus, ? Dilated cardiomyopathy, ? Deep Vein Thrombosis of upper extremity ? Hyperlipidemia ? Hypertension ? Hypothyroidism not otherwise specified ? Impaired skin integrity ? Infection ? Obesity ? Pain management, ? Pneumonia ? Renal disease ? Sleep apnea. Patient Outcome REVIEW OF A RAPID GROWER MYCOBACTERIUM: MYCOBACTERIUM MAGERITENSE Acknowledgements Abstract The Department of Medical Laboratory Science at Armstrong State University made this Case study possible. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the Armstrong State University. Infections caused by Mycobacteria are aggressive and have a poor prognosis, but if diagnosed early in the disease process a number of antibiotic regiments are available for treatments. For this case study follow up with patient indicates that treatments with a combination of doxycycline, moxifloxacin and Imipenem were successful and the patient is now free of infection. Medical History Merveille Grant Department of Medical Laboratory Science , Armstrong State University, Savannah, GA ?Hematology abnormal labs: ¨C Platelets 30 Plt/ microliter (Normal range 155- 410 Plt/ microliter). ¨C WBC 4.21 wbc/ microliter (Normal Range 4.8- 5.2 wbc/ microliter) ?Microbiology Labs: ¨C Culture source chest wound positive Acid Fast Bacilli after 3 days of incubation. Current Research Chief Complaints 49 y/o male with history of ischemic cardiomyopathy with Implantable Cardioverter Defibrillator placement that was extracted due to vegetation and was put on antibiotics for treatment at home. Months later, Patient presented to emergency room with pacemaker pocket and lead infection with Mycobacterium mageritense. He was admitted with thrombocytopenia and low white blood cell count but his other physical examination results were within normal limits. Mycobacterium mageritense shares similarities with other species and the most common one is Mycobacterium fortuitum and current technologies such as partial gene sequencing, high-performance liquid chromatography, restriction fragment length polymorphism and polymerase chain reaction (PCR) make it very easy to differentiate these species so a proper treatment regiment can be administered. Laboratory Tests & Results Treatment Mycobacterium mageritense is a rapidly growing Mycobacterium species that was first isolated in (Madrid) Spain in 1987. In 1997, it was described as a new species and in 2002, it was associated with disease in the United Sates. Mycobacterium mageritense has been isolated from respiratory specimens, blood of the immunocompromised, and wound infections (Center of disease control, 2011). This case study gives an overview of Mycobacterium mageritense that was isolated from a male patient that presented in the emergency room with a chest wound infection. His laboratory findings indicated low levels of platelets and a reduced white blood cell count. The patient¡¯s blood culture tested positive and a gram stain was performed revealing gram-positive bacilli. An acid- fast stain was also performed, yielding a positive result. The organism was then sub cultured to a Lowenstein Jensen slant for isolation. The Mycobacterium species grew rapidly and profusely. The specimen was then sent to a reference lab for species identification and susceptibility testing. The organism was identified as Mycobacterium mageritense and was found susceptible to Imipenem, Ciprofloxin, Moxifloxacin, Amikacin, and Linezolid. It was intermediate in susceptibility to Cefoxitn and resistant to Clarithromycin, Tobramycin, Doxycycline, Minocycline, and Tigecycline. Antibiotics MIC (mcg/ml) Interpretation Imipenem <=2 Susceptible Ciprofloxaxin 0.25 Susceptible Moxifloxacin <=0.25 Susceptible Amikacin 16 Susceptible Linezolid 8 Susceptible Patient¡¯s specimen on blood agar Patient¡¯s specimen on LG slant