Characteristics of skin and soft tissue infection caused by non-tuberculous mycobacteria in Taiwan

Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 06/2011; 15(6):811-7. DOI: 10.5588/ijtld.10.0481
Source: PubMed


A medical centre in Taipei, Taiwan.
To investigate the clinicopathological and microbiological correlates of skin and soft tissue infection (SSTI) due to non-tuberculous mycobacteria (NTM).
Patients with NTM SSTI identified from 1999 to 2009 were included. Histological sections of the skin biopsy specimens from these patients were reassessed.
Among 58 patients with NTM SSTI, the most commonly isolated NTM were rapidly growing mycobacteria (RGM; n = 30), Mycobacterium marinum (n = 17) and M. avium complex (MAC) (n = 4). Twenty-nine (50%) of the NTM SSTI involved deep soft tissue; these progressed to local tenosynovitis in 20 patients. All of the cutaneous lesions infected with M. marinum occurred on the upper extremities; in 9 patients the skin eruptions developed after injury in an aquatic environment. Skin lesions with RGM infection usually occurred on the lower extremities, and in 6 patients the infection developed from wounds caused by medical procedures. Granulomatous inflammation with fibrinoid necrosis was present in 47% of lesions in patients with M. marinum infection and suppurative granulomatous inflammation was noted in 45% of patients with RGM infection.
Identification of a close clinicopathological correlate is useful for dermatologists and pathologists in the early diagnosis and treatment of NTM SSTI.

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    • "When compared to domestic research results, they showed similar results to Lee et al [13], who reported an incidence of 36% for M. fortuitum and 36% for M. abscessus. Providing overseas data, Hsiao et al [28] reported that M. abscessus was the most common strain in 58 patients with skin and soft tissue infections. In addition, Chen et al [29] reported a high occurrence of infection from M. fortuitum and M. marinum was reported to be associated with invasive procedures. "
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    ABSTRACT: Nontuberculous mycobacteria (NTM) are ubiquitous in soil and water. Most NTM cause disease in humans only rarely unless some aspect of host defense is impaired. Recently, rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. RGM causes a wide spectrum of pulmonary and extrapulmonary diseases and has been shown as an important source for opportunistic infection. We report 5 patients of skin and soft tissue infection due to RGM in tertiary medical center in Jeju Island and analyzed 21 patients of skin and soft tissue infection due to RGM in Republic of Korea. Clinical, microbiological and epidemiological data were collected from each patient. NTM isolates were identified using conventional and molecular methods including 16S rDNA gene sequencing. The mean age of the RGM patients (n=26) was 54.9 ± 15.9 years and 73% were women. Mycobacterium fortuitum complex was the most common (12/26). Antimicrobial resistance for clarithromycin and quinolone were 12% and 60%, respectively. Clarithromycin based therapy was done in 46%. The mean duration of treatment was 21.2 ± 8.7 weeks. Many cases can be cured after therapy for 4-7 month with at least 2 or 3 antibiotics according to in vitro susceptibility. Recent increasing of NTM cases suggests that species and subspecies identification is epidemiologically important, especially related to medical procedure, and surgery.
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