Characteristics of skin and soft tissue infection caused by non-tuberculous mycobacteria in Taiwan
ABSTRACT 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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ABSTRACT: Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.11/2014; 41(6):759-67. DOI:10.5999/aps.2014.41.6.759
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ABSTRACT: Rapidly growing mycobacteria (RGM) can cause a broad spectrum of both community and healthcare-associated infections in humans. The aim of this study was to report the clinical management and outcomes of successive patients following cesarean delivery with healthcare-associated surgical site infections (SSIs) caused by RGM. Patients who were admitted to Chung Shan Medical University Hospital, Taichung, Taiwan, between September 2006 and July 2008, and who developed SSIs following cesarean delivery at an obstetrics hospital and were then referred to our hospital, were enrolled. Demographic characteristics of the patients and clinical isolates were obtained retrospectively and an environmental investigation was performed. PCR-restriction fragment length polymorphism (PCR-RFLP) analysis of the hsp65gene and pulsed-field gel electrophoresis (PFGE) of large genomic DNA restriction fragments were applied to differentiate Mycobacterium species. Seventeen patients were diagnosed with RGM infections by microbiology and/or histopathology. Mycobacterial isolates by PCR-RFLP analysis from 15 patients revealed Mycobacterium abscessus (M. abscessus) and M. lentiflavum. Most of the patients received surgical debridement and combination antimicrobial therapy and were eventually cured. Our study demonstrates the potential that RGM infections have in causing healthcare-associated SSIs. Surgery plus prolonged combination antimicrobial therapy seemed to be an effective option for the management of M. abscessus infections.The Journal of Infection in Developing Countries 02/2014; 8(2):184-92. DOI:10.3855/jidc.3821 · 1.27 Impact Factor
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ABSTRACT: A 17-year-old male patient was admitted into our hospital with granulomatous eruption (primarily on the lower extremities), diarrhea, fever, and weight loss for 6 months. F-FDG PET/CT scan was performed to rule out the possibility of malignant metastasis or paraneoplastic syndromes. F-FDG PET/CT scan showed multiple bone and skin lesions with significantly intense FDG uptakes and lymph nodes with moderate FDG uptake. A biopsy of the skin lesions was performed, and the tissue was sent for a broad-range polymerase chain reaction amplification, which showed that the pathogenic organism was Mycobacterium avium complex.Clinical nuclear medicine 01/2014; DOI:10.1097/RLU.0000000000000346 · 2.86 Impact Factor