Cutaneous nontuberculous mycobacterial infection in Thailand

Abstract

A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited. This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand. The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital. From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02). M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.

Disseminated Coinfection by Mycobacterium fortuitum and Talaromyces marneffei in a Non-HIV Case

“…The most commonly involved sites are the legs. 27 This is similar to our case of painful erythema nodosum in the bilateral legs. While for T. marneffei infection, characteristic skin manifestations are umbilicated papules.…”

New Practical Aspects of Sweet Syndrome

“…While SS itself is a non-infectious dermatosis, a number of infections have been reported to trigger or occur concurrently with SS. A 2020 Thai study of 88 patients with nontuberculous mycobacterial (NTM) infections reported the prevalence of SS to be 3.4%, and concluded SS to be the most common reactive dermatosis in NTM infections [120]. The incidence of SS in other bacterial infections is less well characterized, although SS has been reported in the setting of infection with Burkholderia pseudomallei [121], Erysipelothrix rhusiopathiae [122], Mycobacterium tuberculosis [123], and Treponema pallidum [124,125].…”

Mycobacterium haemophilum skin and soft tissue infection in a kidney transplant recipient: A case report and summary of the literature

“…We with at least two-drug combination therapy were more likely to be cured. 10,11 Drug-drug interactions are one of the caveats challenging clini- In a retrospective study linking healthcare databases across Canada, there was no significant difference observed in allograft dysfunction between kidney transplant recipients who received clarithromycin and azithromycin. 13 In our case, we informed transplant nephrologists of these potential effects and levels of immunosuppressants…”

“…A rationale that discourages monotherapy could be from a possibility of inducible macrolide resistance derived from erythromycin resistance methylase (erm) gene mutation and rifamycin resistance derived from rpoB gene mutation, which have been seldomly reported among M haemophilum isolates 9 . In two retrospective studies which included both transplant and non‐transplant immunocompromised individuals who were diagnosed with cutaneous M haemophilum infection suggested those who were treated with at least two‐drug combination therapy were more likely to be cured 10,11 …”