Antimicrobial Drug Resistance in Corynebacterium diphtheriae mitis

2010 had distinct random amplifi ed patterns that differed from those generated from isolates A–G (Figure). A previous study in Taiwan showed that the incidence (no. cases/100,000 inpatients and outpatients) of all pulmonary disease caused by NTM increased signifi cantly from 2.7 (1.26) in 2000 to 10.2 (7.94) in 2008 (6). The most common organism in localized pulmonary infection and disseminated infection was Mycobacteriam avium cellular complex, and M. abscessus predominated in skin and soft tissue infection and lymphadenitis (6,8). The rise in pulmonary infections or colonization by NTM over recent decades, particularly among immunocompromised populations, is reported to be partly associated with the increased use of showers (3–5,9). Recently, a few studies have shown a link between pulmonary M. avium complex infections and home showerhead water microbiology (3,4). Although pulmonary disease caused by M. abscessus did not develop in the patient reported here, multiple respiratory specimens showed evidence of pulmonary colonization. The fact that cultures of the swabs taken from the interior surface of 4 showerheads were positive for M. abscessus but that cultures of the shower water were negative for the organism support previous fi ndings that assemblages of NTM can occur inside biofi lm that forms on the interior surface of showerheads (5). The same strains of M. abscessus isolated from different showerheads suggested the possibility of contamination in the environment by the aerosolized microorganism from respiratory secretions of the patient. The mechanisms of susceptibility to mycobacterial infection in the patient with Sjögren’s syndrome remain unknown (1,2). Previous studies suggest that toll-like receptor 2, dectin-1, tumor necrosis factor–α, interferon-γ, leptin, T-cells, and possibly neutrophils are major components in the host defense of HIV-noninfected patients against rapidly growing mycobacterial infections, including those caused by M. abscessus (10). In summary, we report a case of bacteremic lymphadenitis caused by M. abscessus in a patient with Sjögren syndrome. Our data provide evidence that the interior surface of showerheads may serve as a source of infection by this waterborne and aerosolized microorganism.