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Inicio Medicina Clínica (English Edition) Infections with Mycobacterium chimaera and open chest surgery. An unresolved pro...
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Vol. 152. Issue 8.
Pages 317-323 (April 2019)
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Vol. 152. Issue 8.
Pages 317-323 (April 2019)
Review
Infections with Mycobacterium chimaera and open chest surgery. An unresolved problem
Infecciones por Mycobacterium chimaera y cirugía cardíaca. Un problema no resuelto
Magda Campins Martí
Corresponding author
mcampins@vhebron.net

Corresponding author.
, Blanca Borrás Bermejo, Lluis Armadans Gil
Servicio de Medicina Preventiva y Epidemiología, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Table 1. Ways the Mycobacterium chimaera disease presents.
Table 2. Suspicion and confirmation of Mycobacterium chimaera disease criteria.
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Abstract

Mycobacterium chimaera (M. chimaera) is a non-tuberculous mycobacterium of the Mycobacterium avium complex. Between 2013 and April 2018, more than 140 cases of severe infection have been identified, all of them in patients who had undergone cardiothoracic surgery with extracorporeal circulation.

The epidemiological investigations have shown that the majority of infections have a common source: contaminated normo-hypothermia modules. These devices have a water circuit inside and cooling fans that produce an aerosol, which can be contaminated with M. chimaera, and disperse it into the air in the operating room.

The clinical symptoms can take months, even years to appear after the extracorporeal surgery, with an average of 1.5 years. Sarcoidosis is the most frequently described entity as a misdiagnosis in these patients, so it is necessary to maintain a high diagnostic suspicion in all patients with a history of cardiac surgery with extracorporeal circulation.

Keywords:
Mycobacterium chimaera
Cardiothoracic surgery
Normo-hypothermia modules
Outbreak
Infection
Prevention and control
Resumen

Mycobacterium chimaera (M. chimaera) es una micobacteria no tuberculosa del complejo Mycobacterium avium complex. Desde 2013 hasta abril de 2018 se han identificado más de 140 casos de infección grave por M. chimaera, todos ellos en pacientes sometidos a cirugía cardiotorácica con circulación extracorpórea.

Las investigaciones epidemiológicas han mostrado que la mayoría de las infecciones tienen una fuente común: módulos de normo-hipotermia contaminados. Estos aparatos poseen en su interior un circuito de agua y ventiladores de enfriamiento que producen un aerosol, que puede contener M. chimaera, contaminar el aire del quirófano y transmitirse al paciente.

La sintomatología clínica puede tardar meses, incluso años, en aparecer tras la cirugía extracorpórea, con una media de 1,5 años, y en general se presenta en forma de síntomas constitucionales. La sarcoidosis es la entidad descrita con mayor frecuencia como error diagnóstico en estos pacientes, por lo que es necesario mantener una elevada sospecha diagnóstica en todos aquellos pacientes con antecedente de cirugía cardíaca con circulación extracorpórea.

Palabras clave:
Mycobacterium chimaera
Cirugía cardíaca
Módulos de normo-hipotermia
Brote
infección
Prevención y control

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