Atypical Mycobacterial Infections of the Upper Extremity

Abstract

Background: Atypical mycobacterial infections are uncommon and characterized by a chronic, indolent course before diagnosis. Historically, these infections are associated with marine-related injury and/or immune dysfunction. Our institution has successfully diagnosed and treated an increasing number of these infections. The objective of this study is to review our experience with these rare infections and verify the developing trends encountered. Methods: A retrospective review was performed for patients with positive nontuberculous mycobacterial cultures of the upper extremity from 2000 to 2013. Patient demographics, source of transmission, symptom duration, mycobacterial species, operative and antibiotic treatments, and outcomes were recorded. Results: Thirty-four patients were identified. The mean symptomatic period before diagnosis was 9 months (range, 1-60 months). Fourteen patients had identifiable causes of immune dysfunction while the rest appeared immune competent. Patients were infected by Mycobacterium marinum (n = 14), Mycobacterium abscessus (n = 8), Mycobacterium fortuitum (n = 7), and other less common species (n = 5). Although most patients had unidentifiable causes of infection (n = 15), some could correlate infection to marine injury, lacerations, insect bites, animal bites, and tattoos. All patients received operative intervention including debridement. Antibiotics were given for a mean duration of 5 months. Ninety-seven percent had complete resolution of disease. Conclusions: Although M. marinum infections make up the majority of infections at our institution, we report a higher total incidence of nonmarinum infections. These infections are occurring in seemingly healthy individuals with no history of exposure with marine water. Successful treatment relies on having a heightened clinical awareness and adequate diagnosis.

Increasing Recognition of Community-Acquired, Non-Tuberculous Mycobacterial Infections of the Hand and Wrist

“…Cutaneous NTM infections involving the hand and wrist have been increasingly recognized by others in case reports and single-center studies [3,[10][11][12][13][14][15][16]. While there has been speculation regarding the explanation for these observations [3], the etiology for this increase remains unclear.…”

“…Furthermore, those who were found to have M. marinum isolates had a shorter time to diagnosis than those with either MAC or M. abscessus isolates. However, a larger study of 34 patients with NTM infections of the upper extremity by Lopez et al reported a significantly longer time to diagnosis with M. marinum species [ 16 ]. Interestingly, the majority of patients included in this study had unknown exposures, with only five of 34 patients having an identifiable aquatic exposure.…”

Tattoos: A summary knowledge for the practising clinician

“…Inoculation of mycobacterium organisms, including tuberculosis, into the skin, has been reported. [7,32,33] Viruses are a complication. Transmission of viral hepatitis is a major infective complication.…”

What’s New in Musculoskeletal Infection: Update on Biofilms

“…Atypical infections caused by Mycobacterium tuberculosis (TB) [103][104][105][106][107] , nontuberculous mycobacteria (NTM) 104,[108][109][110][111][112][113] , and fungi 104,[114][115][116][117] were associated with delays in diagnosis, and the authors suggest a need for a heightened index of suspicion 103,104,110 , and when ordered, 2.4% of cultures were positive for acid-fast bacilli (AFB) and 5.3% were positive for fungi 104 . M. marinum is the most common NTM, but several other species were also investigated [108][109][110]112,113 . Clinical findings were described, and about half of the cases occurred in healthy hosts who had no apparent portal of entry or causative event 103,107,111 .…”