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Background   Mycobacterium abscessus  complex (MABC) is the most drug resistant of the mycobacterial pathogens.  M. abscessus  subsp.  abscessus  encodes a functional erythromycin ribosomal methylase gene,  erm (41), causing inducible macrolide resistance. However, some clinical isolates of  M. abscessus  subsp.  abscessus  harboring nonfunctional  erm (41) were susceptible to macrolide, even after extended incubation of 14 days. Loss of function of the  erm (41) genes was associated with a T-to-C substitution at position 28 of the gene (T28C), leading to an amino acid change from Trp to Arg at codon 10. Pulmonary disease caused by  M. abscessus  subsp.  abscessus  strains with an nonfunctional  erm (41) (C28 sequevar) may be responsive to macrolide-containing antibiotic regimens. Therefore, all  M. abscessus  subsp.  abscessus  strains with a functional  erm (41) (T28 sequevar) were thought to be resistant to macrolide with extended incubation. Here, we report the first case of pulmonary disease caused by a strain of  M. abscessus  subsp.  abscessus  which was susceptible to macrolide due to T19 sequevar of  erm (41) gene.    Case presentation  A 62-year-old Korean female was referred to our hospital due to chronic cough, sputum, and hemoptysis lasting more than 5 months. The patient’s sputum was positive for acid-fast bacilli staining and nontuberculous mycobacteria (NTM) were isolated twice from sputum specimens. The isolate was identified as  M. abscessus  subsp.  abscessus . The isolate had a point mutation of C → T at position 19 (C19 → T) in the  erm (41) gene, instead of expected C28 sequevar of  erm (41), and had no  rrl  mutation. The isolate displayed a clarithromycin susceptible phenotype with an Arg → Stop codon change in  erm (41). The patient was successfully treated with a macrolide-containing regimen.    Conclusion  This is the first case of pulmonary disease caused by a strain of  M. abscessus  subsp.  abscessus  showing clarithromycin susceptible phenotype due to T19 sequevar of the  erm (41) gene. The  erm (41) gene is clinically important, and non-functional  erm  alleles may be an important issue for the management of MABC lung disease. The presence of a non-functional  erm (41) allele in  M. abscessus  subsp.  abscessus  isolates may be associated with better outcomes.

bmc infectious diseases

Successful antibiotic treatment of pulmonary disease caused by Mycobacterium abscessus subsp. abscessus with C-to-T mutation at position 19 in erm(41) gene: case report