The clinical characteristics, outcome and treatment of non-tuberculous mycobacterial tenosynovitis are reviewed. From lesions localized in the hand, 10 different species of non-tuberculous mycobacteria have been reported. The most common are Mycobacterium marinum and Mycobacterium kansasii. Other less frequent organisms are Mycobacterium avium complex, Mycobacterium szulgai, Mycobacterium terrae, Mycobacterium fortuitum, Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium malmoense and Mycobacterium xenopi. The infections appear to be the result of previous trauma, surgical procedure, corticosteroid injection or non-apparent inoculation (water contamination). Immunosuppression is sometimes associated with the infections and can be considered as a risk factor. Surgical debridement and appropriate mycobacterial cultures are critical to enable diagnosis and appropriate management. Specimens should be inoculated on a range of media and incubated at a range of temperatures in order to isolate mycobacteria with different growth characteristics (with prolonged incubation). The optimal treatment of these infections is discussed.
"However, identification of the NTM species and drug susceptibility are often delayed or not routinely performed in the clinical lab. In one review, 13 different species of NTM were reported in NTM tenosynovitis  . The most common are M. marinum, M. avium complex and M. kansasii. "
[Show abstract][Hide abstract] ABSTRACT: Granulomatous tenosynovitis is a rare disease with an indolent, relapsing process, which can be caused by various pathogens. Here, we describe three immunocompetent patients with right wrist granulomatous tenosynovitis. Two cases were attributed to nontuberculous mycobacteria (NTM) infection. In the third case, no definite etiology was found. However, the symptoms and patient history were similar to the other two cases. All three patients were cured by surgical debridement and clarithromycin-based anti-NTM antibiotics.
Tzu Chi Medical Journal 12/2011; 23(4). DOI:10.1016/j.tcmj.2011.10.002
"The reported cases of human infection caused by M. szulgai revealed that pulmonary disease indistinguishable from that caused by M. tuberculosis was the commonest type of infection caused by this organism  . Other sites of involvement reported in the literature are skin  , olecranon bursitis , osteomyelitis  , tenosynovitis , and cervical adenitis . A disseminated M. szulgai infection has been also described in some patients  . "
[Show abstract][Hide abstract] ABSTRACT: Mycobacterium szulgai is a rare human pathogen that mainly causes pulmonary diseases. We report the first case of M. szulgai causing septic arthritis in a patient with human immunodeficiency virus. A culture from the joint aspiration was needed to isolate and identify this organism. The patient was treated successfully with ciprofloxacin, clarithromycin, and ethambutol.
[Show abstract][Hide abstract] ABSTRACT: Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open A 49-year old man suffered a superficial injury on the dorsum of the right hand. Subsequently, a wound developed which healed slowly despite several courses of oral antibiotics. Gradually, nodular lesions developed on the hand. A biopsy of the nodules showed granulomatous inflammation which was considered to be consistent with rheumatoid nodules. Local injections with corticosteroids were administered with only temporary relief. Eigtheen months after the original injury a biopsy was performed and sent for bacterial culture which grew Mycobacterium marinum. The patient received prolonged antimycobacterial treatment. Nevertheless, osteomyelitis eventually developed and a second course of drug therapy, as well as a surgical operation was required before the infection was eventually cured. Fjörutíu og níu ára gamall karlmaður fékk áverka á handarbak og sár í kjölfarið sem greri illa. Hann fékk sýklalyfjameðferð ítrekað án fullnægjandi svörunar. Einkenni ágerðust hægt og bítandi og breiddist bólgan út. Hnútar voru þreifanlegir á handarbaki. Tekið var vefjasýni er sýndi granulomatous (bólguhnúðaröskun) bólgu sem talin var samrýmast gigtarhnútum. Sjúklingur var meðhöndlaður með nokkrum barksterainnspýtingum í hið bólgna svæði, en einungis með tímabundinni svörun. Er einkenni höfðu staðið í eitt og hálft ár var tekið nýtt sýni frá hinu bólgna svæði og sent í ræktanir. Úr því óx Mycobacterium marinum. Sjúklingur þurfti á langtíma berklalyfjameðferð að halda. Þrátt fyrir það versnaði honum að nýju og var þá greindur með sýkingu í beini sem krafðist skurðaðgerðar og endurtekinnar lyfjameðferðar
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