Molecular characterization of Mycobacterium massiliense and Mycobacterium bolletii in outbreaks of infections after laparoscopic surgeries and cosmetic procedures

Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de São Paulo, São Paulo, Brazil; Instituto Evandro Chagas, Belém, Brazil, Hospital Universitário João de Barros Barreto, Belém, Brazil; Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil

^* To whom correspondence should be addressed. Email: sylvia.leao{at}unifesp.br.

	Abstract

An outbreak of infections affecting 311 patients submitted to different invasive procedures occurred in 2004-2005, at the city of Belém, in the North region of Brazil. Sixty-seven isolates were studied, 58 from patients submitted to laparoscopic surgeries, one from a post-injection abscess, and eight from patients subjected to mesotherapy. All isolates were rapidly-growing non-pigmented mycobacteria and presented the PRA-hsp65 pattern with BstEII [bp] (235, 210) and HaeIII [bp] (200, 70, 60, 50), which is common to Mycobacterium abscessus type 2, Mycobacterium bolletii, and Mycobacterium massiliense. hsp65 and rpoB gene sequencing was used for discrimination between these three species, with a subset of 20 isolates. hsp65 and rpoB sequences from 11 isolates chosen at random among 58 isolates from surgical patients and the post-injection abscess isolate presented highest similarities with the corresponding sequences of M. massiliense. Eight mesotherapy isolates were in the same way identified as M. bolletii. Molecular typing by PFGE grouped all 58 surgical isolates, while mesotherapy isolates presented three different PFGE patterns and the post-injection abscess isolate showed a unique PFGE pattern. In conclusion, molecular techniques for identification and typing were essential for the discrimination of two concomitant outbreaks and one case, the post-injection abscess, not related to either outbreak, all originally attributed to a single strain of M. abscessus.