Mycobacterium szulgai

M. szulgai belongs to the scotochromogenic mycobacteria with a yellow-orange pigmentation. M. szulgai can cause tuberculosis-like clinical pictures in patients with appropriate underlying pulmonary diseases, both in terms of local findings and general symptomatology. It should be noted that, as with M. kansasii, M. flavescens, and M. marinum, IGRA tests may be positive in this case, so they are not suitable for ruling out tuberculosis (Lalvani A et al. 2008).

Disseminated skin lesions have been described (rarely) in the context of bacteremia in immunosuppressed patients (Nunes AL et al. 2022).

In susceptibility testing, M. szulgai is generally resistant to INH and sensitive to EMB, RMP, clarithromycin. M. szulgai is treatable with most antifungal drugs. The optimal composition and duration of therapy has not been established. In addition to triple therapy based on infections caused by M. kansasii (12 months of INH, RMP, and EMB), the combination of RMP, EMB, and clarithromycin according to susceptibility testing also appears to be a viable approach, but must always be clinically verified (Griffith DE et al. 2007).

1. Griffith DE et al. (2007) Am J Respir Crit Care Med 175: 367-416.
2. Lalvani A et al (2008) Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmune Rev 8: 147-152

3. Nunes AL et al (2022) Mycobacterium szulgai: A Rare Cause of Non-Tuberculous Mycobacteria Disseminated Infection. J Med Cases 13:61-65.