Mycobacterium spp (NOT M. tuberculosis Complex or M. abscessus-chelonae Complex)

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Mycobacterium spp (NOT M. tuberculosis Complex or
M. abscessus-chelonae 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-2 Level practices, containment equipment and facilities are recommended for work involving potentially infectious
materials
 BSL3 Level practices, containment equipment, and facilities may be required for certain activities involving
concentrated culture, animal work, and/or activities that could potentially generate aerosols. Consult with CSU
Biosafety office related to such work.
Special Considerations
 Many of the 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: Usually pulmonary, cutaneous or lymphatic also possible; Infections with M. avium are primarily lymphatic
Transmission: Ingestion, inhalation, injections, wounds or abrasions; direct contact with environmental contaminants or clinical
specimens from animals. Found in water, soil, domestic and wild animals. M. avium and M. marinum are zoonotic.
Communicability: Person to person transmission not evident.
Incubation: From 2 to 3 weeks or higher
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
 The following disinfectants may be effective for inactivation, depending on species, strain, and conditions:
o 5% phenol or 5% formaldehyde
o 2% glutaraldehyde is not effective against all species
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)
Colorado State University
Page 1 of 4
Environmental Health Services Biosafety Office
Updated 2013
(970) 491-0270
**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.**
MEDICAL
Signs and Symptoms:
 Non-specific symptoms -fever, chills, fatigue muscle aches, weight loss
 Pulmonary disease
o Cough
o Night sweats
o Chest pain

Cutaneous form- acquired through wound or break in skin:
o Most commonly acquired from M. marinum, M. leprae, and M. ulcerans
o

Red, warm, tender, swollen, and/or painful lesion becoming ulcerative
Lymphadenitis (swollen glands)
Pre-exposure prophylaxis:
 None
Diagnosis:






Symptom based
Direct smear microscopy for acid fast bacilli
Culture of clinical specimens
Histopathology of aspirates or biopsies
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.
Genetic methods (PCR, DNA probes, DNA fingerprinting)
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
o
Rifabutin can be used in immuno-compromised individuals post exposure to M. avium
o
Patient is monitored for symptoms
o Treatment of clinical cases:
o
Knowing the antibiotic sensitivity is helpful for guidance in determining the most appropriate treatment for
each patient.
o
Persons who develop clinical signs are treated with a long-term combination of several antibiotics, which could
include isoniazid, ethambutol, and/or macrolids,
o
Treatment of ulcerative lesions could include surgical removal of tissues.
Colorado State University
Page 2 of 4
Environmental Health Services Biosafety Office
Updated 2013
(970) 491-0270
**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.**
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.
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 physician
4. Individual fills out Biosafety Incident Report form
http://www.ehs.colostate.edu/WBiosafety/PDF/IncidentReportForm.pdf
REFERENCES


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://jcm.asm.org/content/28/10/2234).
CDC Web Page, Mycobacterium avium: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/mycobacteriumavium_t.htmChan,
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)

Colombo, R.E., Kenneth N. Oliver. Diagnosis and Treatment of Infection Caused by Rapidly Growing Mycobacteria. Seminars
in Respiratory and Critical Care Medicine. 2008. 29:5; p. 577-588.

Emedicine, Atypical Mycobacterial Diseases: http://emedicine.medscape.com/article/1105570-overview

Emedicine, Mycobacterium intracellulare: http://emedicine.medscape.com/article/222664-overview#a0156

Hopkins Guides, Mycobacterium avium:
http://www.hopkinsguides.com/hopkins/ub/view/Johns_Hopkins_ABX_Guide/540361/all/Mycobacterium_avium_complex
__MAC_MAI_non_HIV_?q=mycobacterium%20avium

Lab Tests: http://labtestsonline.org/understanding/conditions/ntm/

National Jewish Hospital Web Page: http://www.nationaljewish.org/healthinfo/conditions/ntm/

http://ntminfo.org/index.php
Colorado State University
Page 3 of 4
Environmental Health Services Biosafety Office
Updated 2013
(970) 491-0270
**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.**


Petrini, B. Non-tuberculous mycobacterial infections. Scandinavian J Inf Dis. 2006; 38:246-255. (Available at:
http://informahealthcare.com/doi/pdf/10.1080/00365540500444652)
Public Health Agency of Canada - Mycobacterium non tuberculous: http://www.phac-aspc.gc.ca/lab-bio/res/psdsftss/mycobacterium-eng.php
CONTENT REVIEW
This document has been reviewed by:
 CSU subject matter expert: Dr. Diane Ordway-Rodriguez
Colorado State University
Page 4 of 4
Environmental Health Services Biosafety Office
Updated 2013
(970) 491-0270
**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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