A clinical case and a review of Mycobacterium fortuitum infections direct diagnosis approach and treatment in a patient with leg fractures

Abstract

Mycobacterium fortuitum infections of the musculoskeletal system are commonly missed, given their rarity and the absence of systemic symptoms. In this study, we isolated the M. fortuitum from the skin sinus tract of a traffic accident patient's right medial knee surgical incision (over the open fracture wound), and confirmed by Morphological analysis, MALDI-TOF MS, 16S rRNA gene sequencing, and mNGS. Then we adjusted the treatment plan and treated the patient with cefoxitin, amikacin, and doxycycline. At three months follow-up review, his wound had completely healed. This report may provide a reference for the clinical treatment of Mycobacterium fortuitum infection in patients with open fractures.

Treatment of non-tuberculosis mycobacteria skin infections

“…A study ( Chew et al, 2021 ) of 86 isolates showed that M. fortuitum is resistant to clarithromycin and tobramycin but susceptible to tetracyclines and quinolones. Similarly, a retrospective case series ( Wang J. et al, 2022 ) of 18 patients with cutaneous M. fortuitum complex infections found that five uncomplicated infection cases showed an excellent response to the treatments. One patient received monotherapy of doxycycline for 8 weeks with no recurrence; the other four patients were treated with combined antibiotics, clarithromycin-minocycline, clarithromycin-ciprofloxacin, clarithromycin-TMP-SMX, and ciprofloxacin-TMP/SMX.…”

Drugs for treating infections caused by non-tubercular mycobacteria: a narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine

“…Regardless of in vitro data, in general, there are favorable experiences in including cefoxitin in multidrug regimens to treat infections due to M. fortuitum and M. abscessus. These positive experiences include challenging clinical situations, such as bone and joint infections, pacemaker infection, meningeal infections, renal allograft, and sepsis [86][87][88][89]. It can be used with good success rates in the initial phase of combination treatment (first 4-8 weeks), in the treatment of Mabs disease as a substitute for carbapenems or in intensifying treatment regimens [70,90,91].…”