Extrapulmonary Mycobacterium malmoense infection in a patient with minimal immunosuppression
Bibliographic record
Abstract
Mycobacterium malmoense is an emerging non-tuberculous mycobacterial (NTM) pathogen that usually causes extrapulmonary disease, particularly, in significantly immunosuppressed patients. Recent reports from Scotland and the Netherlands, however, document an increasing proportion of pulmonary NTM infections due to M. malmoense, indicating a rising incidence in parts of Northern Europe-although still predominantly associated with pulmonary disease. We report a 78-year-old woman from north-eastern Germany with chronic tenosynovitis caused by M. malmoense under minimal long-term prednisone therapy. Diagnosis was established by histopathology, culture, and hsp65 gene sequencing. Although up to 40% of reported M. malmoense infections are extrapulmonary, nearly all described tenosynovitis cases have occurred in children or in profoundly immunosuppressed adults. This case, therefore, represents an exceptionally rare clinical constellation, demonstrating that even minimal immunosuppression can permit infection with this slow-growing NTM. It further underscores the diagnostic complexity, along with the absence of clear guideline recommendations regarding optimal therapy duration, highlighting the need for individualized, multidisciplinary management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".