Mycobacterium chelonae‐abscessus Complex Principal investigators are responsible for communicating this information to staff working with or around this agent, and for mitigation of associated risks. This document is not intended to be used as a sole source for diagnosis, medical treatment, or medical advice. Consult a CSU Authorized Treating Physician for concerns about work related medical conditions. CONTAINMENT AND SPECIAL PRECAUTIONS Containment  BSL‐3 Level practices, containment equipment and facilities are recommended for work involving potentially infectious materials Special Considerations  Some strains worked with at CSU are drug resistant and researchers should be aware of strains being worked with and antibiotic resistance profiles.  Physical conditions that increase susceptibility to infection include: compromised immune system; pre‐existing lung damage (e.g. cystic fibrosis, emphysema, smokers); and diabetes. Persons taking certain medications such as TNF alpha inhibitors and post‐ menopausal caucasian women are also more susceptible to infection. HAZARD IDENTIFICATION Disease: Pulmonary most common, cutaneous and ocular infections also possible Transmission: Ingestion, inhalation, injections, wounds or abrasions. Found in water, soil and dust. No human to human transmission has been documented. Infection usually caused by injections of substances contaminated with the bacterium or through invasive medical procedures employing contaminated equipment or material. Communicability: Person to person transmission not likely Incubation: Ranges from ~1‐8 weeks, some reports up to a year Infectious dose: unknown in human VIABILITY/INACTIVATION Stability: Can survive on surfaces and in soil for months. Inactivation:  Mycobacteria are very resistant to inactivation, and inactivation methods should consider susceptibility of the strain and species being worked with.  Mycobacteria are autoclave sensitive, but longer cycles may be required.  M. chelonae is NOT susceptible to 2% glutaraldehyde  The following disinfectants may be effective for inactivation, depending on species and strain: o in 5% phenol or 5% formaldehyde o 70% ethanol for surface decontamination o Minimum concentration of 20% bleach (10,000 ppm available sodium hypochlorite) (Note that bleach
should not be used when waste will be subsequently processed by autoclaving) MEDICAL Signs and Symptoms:  Non‐specific symptoms ‐fever, chills, fatigue muscle aches, weight loss 
Pulmonary disease is the most common Page 1 of 4 Colorado State University Environmental Health Services Biosafety Office (970) 491‐0270 Updated 2013 **Disclaimer** This document is for informational purposes ONLY. This document should not be used in lieu of professional medical attention, and medical
professionals should seek appropriate resources for diagnosis and treatment.**
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Dyspnea (shortness of breath) Hemoptysis (act of coughing up blood) Chest pain Severe bronchiectasis with impaired pulmonary function 
Cutaneous form‐ acquired through wound or break in skin: o Red, warm, tender, swollen, and/or painful around wound site. 
Lymphadenitis and bacteremia are rare Pre‐exposure prophylaxis:  None Diagnosis: 
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Diagnosis from lesions is obtained through culture of pus or biopsy of infected tissue (CDCM). For pulmonary symptoms, at least two sputum and one bronchial wash specimens collected on separate days for AFB analysis; A CXR or HRCT of the lungs and exclusion of other disorders like TB (JH). Demonstrates visual growth on solid media within 7 days. Culture data is valuable in the treatment for drug susceptibility testing. If disease is severe, blood is drawn for culture. Treatment:  Mycobacteria are inherently resistant to many drugs, and resistance depends on species and strain. Specific antibiotic regimes must be determined on a case‐by‐case basis.  Post‐exposure prophylaxis: o Prophylactic antibiotic regimen may be initiated, depending on the strain involved and the nature of the exposure.  Treatment of clinical cases: o Knowing the antibiotic sensitivity is helpful for guidance in determining the most appropriate treatment for each patient. o Infection with this bacterium usually does not improve with the usual antibiotics used to treat skin infections and is resistant to traditional antituberculosis agents. Antimicrobial therapy is more difficult with M. abscessus. o Draining collections of pus and administering the appropriate combination of antibiotics for a prolonged period of time for skin infections. o Amikacin, clarithromycin, tigecycline, and cefoxitin. Macrolides generally included in treatment regimen if possible (JH). WHAT TO DO IF AN EXPOSURE OCCURS Employees, Graduate Students, Work Study 1. Employee notifies Biosafety (970‐491‐0270) and/or Occupational Health Program Coordinator (970‐420‐8172) to inform where medical attention will be sought and if transportation is needed.  The Principal Investigator/Supervisor must also be notified 2. Employee goes to an Authorized Treating Physician 3. After the visit, individual fills out the following forms:  Biosafety Incident report form: http://www.ehs.colostate.edu/WBiosafety/PDF/IncidentReportForm.pdf  Workers’ Compensation (within 4 days or as soon as possible): http://www.ehs.colostate.edu/WWorkComp/Home.aspx 4. Employee follows up as directed. Page 2 of 4 Colorado State University Environmental Health Services Biosafety Office (970) 491‐0270 Updated 2013 **Disclaimer** This document is for informational purposes ONLY. This document should not be used in lieu of professional medical attention, and medical
professionals should seek appropriate resources for diagnosis and treatment.**
Student Not Paid by CSU 1. Contact supervisor/PI 2. Student or supervisor contact Biosafety (491‐0270) or Occupational Health (420‐8172) to report, to inform where attention is being sought, and to arrange transportation if needed. 3. Student goes to CSU Health Network (Formerly Hartshorn Health Services) 4. After the visit to CSU Health Network, student fills out Biosafety Incident Report form http://www.ehs.colostate.edu/WBiosafety/PDF/IncidentReportForm.pdf Volunteers and Visitors 1. Contact supervisor/PI 2. Contact Biosafety (491‐0270) or Occupational Health (420‐8172) to report, to inform where attention is being sought, and to arrange transportation if needed. 3. Individual goes to their personal physician, or as otherwise directed by their physian 4. Individual fills out Biosafety Incident Report form http://www.ehs.colostate.edu/WBiosafety/PDF/IncidentReportForm.pdf REFERENCES o
CDC Web Page: http://www.cdc.gov/HAI/organisms/mycobacterium.html o
Emedicine: http://emedicine.medscape.com/article/1105570‐overview o
Public Health Agency of Canada Pathogen Data Sheet: http://www.phac‐aspc.gc.ca/lab‐bio/res/psds‐
ftss/mycobacterium‐eng.php o
Alvaro Villanueva, Raul Villanueva Calderon, Braxedi Acosta Vargas, Fernando Ruiz, Sonia Aguero, Yansheng Zhang, Barbara A. Brown, and Richard J. Wallace, Jr. Report on an Outbreak of Post injection Abscesses Due to Mycobacterium abscessus, Including Management with Surgery and Clarithromycin Therapy and Comparison of Strains by Random Amplified Polymorphic DNA Polymerase Chain Reaction Clin Infect Dis. 1997. 24(6): 1147‐1153 doi:10.1086/513656 (http://cid.oxfordjournals.org/content/24/6/1147.long) o
Chan, E.D., Bai, Z., Kartalija, M., Orme, I.M., Ordway, D.J. Host Immune Response to Rapidly Growing Mycobacteria, an emerging Cause of Chronic Lung Disease. 2010. Am. J. Resipir. Cell Mol. Biol. 43: 387‐393 (http://www.atsjournals.org/doi/pdf/10.1165/rcmb.2009‐0276TR). o
Colombo, R.E., Kenneth N. Oliver. Diagnosis and Treatment of Infection Caused by Rapidly Growing Mycobacteria. 2008. Semin Respir Crit Care Med. 29(5):577‐88. (http://www.ncbi.nlm.nih.gov/pubmed/18810691) o
De Groote, M.A., Huitt, G. Infections Due to Rapidly Growing Mycobacteria. 2006. Clin. Inf. Dis. 42 (12):1756‐1763. (http://cid.oxfordjournals.org/content/42/12/1756.full.pdf+html) Best, M., Sattar, S. A., Springthorpe, V. S., & Kennedy, M. E. (1990). Efficacies of selected disinfectants against Mycobacterium tuberculosis. Journal of Clinical Microbiology, 28(10), 2234‐2239 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC268154/pdf/jcm00058‐0086.pdf) o
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Jarand, J, Levin, A, Zhang, L, Huitt, G, Mitchell, JD, and Daley, CL. Clinical and Microbiologic Outcomes in Patients Receiving Treatment for Mycobacterium abscessus Pulmonary Disease Clin Infect Dis. 2011. 52(5): 565‐571. (http://cid.oxfordjournals.org/content/52/5/565.full.pdf+html) Page 3 of 4 Colorado State University Environmental Health Services Biosafety Office (970) 491‐0270 Updated 2013 **Disclaimer** This document is for informational purposes ONLY. This document should not be used in lieu of professional medical attention, and medical
professionals should seek appropriate resources for diagnosis and treatment.**
CONTENT REVIEW This document has been reviewed by:  CSU subject matter experts: Dr. Diane Ordway‐Rodriguez Page 4 of 4 Colorado State University Environmental Health Services Biosafety Office (970) 491‐0270 Updated 2013 **Disclaimer** This document is for informational purposes ONLY. This document should not be used in lieu of professional medical attention, and medical
professionals should seek appropriate resources for diagnosis and treatment.**