Clinical characteristics and an evaluation of predictors for a favourable outcome of Mycobacterium abscessus otomastoiditis: a systematic review and meta-analysis of individual participant data

Abstract

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Mycobacterial Infection in Recalcitrant Otomastoiditis: A Case Series and Literature Review

“…To treat patients with otomastoiditis caused by M. abscessus, a multidrug regimen administered for a minimum of 6 months should be required. Moreover, the symptoms of otalgia might imply local disease spread, predict-ing a significantly prolonged antimycobacterial treatment duration [7]. In our study, two patients had otomastoiditis caused by M. abscessus (Cases 1 and 6), and a longer treatment course of 9 months was noted for the patient described in Case 6 who had otalgia.…”

“…Our study included two male and four female patients (Table 1). Three of the six patients had previous ear disease or predisposing factors: Case 1 had CSOM and previously underwent tympanoplasty; Case 5 underwent ventilation tube insertion before the occurrence of recalcitrant otomastoiditism, which promotes the risk of biofilm formation by mycobacteria, leading to infection in the ear [7]; and Case 3 had diabetes mellitus, which is considered to be an immunosuppressive condition and recognized as a risk factor for TB and NTM infection [8]. Four patients had an initial presentation of tympanic membrane perforation (Cases 1, 2, 3, and 6): three patients had a central perforation (Cases 1, 2, and 6) and one patient had multiple perforations (Case 3).…”

“…Medical treatment included rifampin-isoniazid, ethambutol, and pyrazinamide for TOM and moxifloxacin, clarithromycin, rifampin-isoniazid, ethambutol, and pyrazinamide for NTM otomastoiditis. Specialist consultation is important because each treatment course has both effectivity and adverse effects that need to be evaluated carefully [7]. The purpose of surgical treatment was not to completely eradicate the infected tissue, but to decrease the bacterial load and obtain specimens for diagnosis using histology or tissue culture; thus, appropriate antibiotics should be administered to treat mycobacterial infections.…”

“…We suggest an algorithm for diagnosing and managing recalcitrant otomastoiditis, in which mycobacterial infection should also be considered (Figure 8). and adverse effects that need to be evaluated carefully [7]. The purpose of surgical treatment was not to completely eradicate the infected tissue, but to decrease the bacterial load and obtain specimens for diagnosis using histology or tissue culture; thus, appropriate antibiotics should be administered to treat mycobacterial infections.…”