Silent Invaders - A case series of CRBSI caused by Non-Tuberculous Mycobacteria in Hemodialysis patients

 

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Silent Invaders - A case series of CRBSI caused by Non-Tuberculous Mycobacteria in Hemodialysis patients

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Akshaya
Jayachandran
Manish Lalwani manishmedicine1308@gmail.com CMC Vellore Nephrology Vellore India -
Sudhaker Sadhasivam sudhaker.91@gmail.com CMC Vellore Nephrology Vellore India -
Suceena Alexander suceena@gmail.com CMC Vellore Nephrology Vellore India -
Santosh Varughese santosh.vellore@gmail.com CMC Vellore Nephrology Vellore India -
Vinoi George David vinoigd@hotmail.com CMC Vellore Nephrology Vellore India -
Joseph Johny josephjohny1857@gmail.com CMC Vellore Nephrology Vellore India -
Akshaya Jayachandran aks.251192@gmail.com CMC Vellore Nephrology Vellore India *
 
 
 
 
 
 
 
 

Non-tuberculous mycobacteria (NTM) are rare but increasingly

recognized causes of catheter-related bloodstream infections (CRBSI) in

hemodialysis patients. Their indolent course, atypical presentation, and delayed

culture growth often lead to diagnostic challenges and inappropriate empirical

therapy.

We report two cases of NTM CRBSI in maintenance hemodialysis patients. Both presented with persistent low-grade fever. The first patient had a non-tunnelled jugular catheter placed elsewhere and kept in-situ for a period of 2 months, and the second patient had a recently placed tunnelled catheter for an RPRF. Blood cultures grew rapidly growing mycobacteria—Mycobacterium Mucogenicum  in one case and Mycobacterium abscessus in the other—confirmed by molecular identification. Catheter removal and targeted antimicrobial therapy led to resolution of infection in both patients.

These cases highlight the need for clinical suspicion of NTM in dialysis patients with indolent or relapsing CRBSI, especially when routine cultures are negative and symptoms persist. Early use of mycobacterial culture techniques, species identification, and multidisciplinary management (nephrology, microbiology, infectious disease) are essential for optimal outcomes.

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NTM should be considered an emerging pathogen in catheter-related infections among dialysis patients. Prompt recognition and appropriate therapy can prevent prolonged morbidity and vascular access loss

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