Mycobacterium chimaera (M. chimaera) is a slow-growing, environmental non-tuberculosis mycobacterium (NTM). A rapid assessment from the European Centre for Disease Prevention and Control (ECDC) was issued in 2015 regarding a possible link between M. chimaera and a specific heater cooler unit (HCU) used in regulating body temperature during cardiac operations. A number of countries have since reported cases of invasive M. chimaera infection in patients after open cardiac surgery, with a lengthy incubation period of up to five years.
In July 2016, the HSE issued a national clinical pathway to all GPs that should be followed where a clinician has concerns or suspicion. Early referral to the patient's cardiothoracic surgical centre is advised for patients with suspected M. chimaera infection. This guidance has again been issued to all GPs in March 2017.
It is important that all GPs continue to be vigilant for invasive infection caused by non- tuberculosis mycobacteria M. chimaera arising in patients who have been exposed to heater-cooler units (HCUs) used during open cardiac surgery and extra corporeal membrane oxygenation (ECMO). While available data suggests that the risk of being infected by mycobacteria following open cardiac surgery is very low, it is important that GPs consider NTM infection in patients who present with endocarditis like symptoms. M. chimaera may be a factor in cases of infective endocarditis, sternal wound infections, disseminated NTM infection or pyrexia of unknown origin. M. chimaera should be considered in adult and paediatric presentations.
Information for patients is available on the HSE website at http://www.hse.ie/eng/about/Who/acute/MycobacteriumChimaera.html. A patient pamphlet is also downloadable on this page.
Any potential cases of invasive M. chimaera infection should be notified to the Health Protection Surveillance Centre, using the case reporting form available at http://www.hse.ie/eng/about/Who/acute/MycobacteriumChimaera.html.
The HSE has previously conducted a case finding investigation to identify M. chimaera infections potentially associated with HCUs, the report of which is available on the HSE website: http://www.hse.ie/eng/about/Who/acute/MycobacteriumChimaera.html
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