Otitis Media and Mastoiditis Due to Mycobacterium fortuitum: Case Report, Review of Four Cases, and a Cautionary Note

Abstract

Mycobacterium fortuitum is a rarely reported cause of otitis media and mastoiditis. We report such a case recently seen at our institution and review the four previously published cases of this disease entity. Amikacin is recommended in the current medical literature as empirical treatment of disease due to M. fortuitum, but the isolate from our patient showed high-level resistance to amikacin, which is rare in clinical isolates of this species; this resistance was probably related to prior treatment with topical aminoglycosides. Our patient's infection responded to a 12-month course of therapy with clarithromycin and trimethoprim-sulfamethoxazole.

Osteomyelitis due to Mycobacterium fortuitum after Open Tibial fracture Case Report and a Summary of Diagnostic and Therapeutic Aspects

“…We, as well as others [9,13], observed persistent drainage and the development of chronic ulcerations without tenderness or swelling. In contrast, tenderness, swelling and fever have been described in cases of prosthetic infections by M. fortuitum [16].…”

“…In contrast, tenderness, swelling and fever have been described in cases of prosthetic infections by M. fortuitum [16]. Fever has been observed in localized [5] and disseminated [13] infections, but patients undergoing NTM infections may also remain afebrile [5,9]. Febrile temperatures and an elevation of leukocyte counts have been reported in cases of sternal wound infections due to M. fortuitum where routine cultures grew normal skin flora [3], suggesting that mixed infections may explain the appearance of tenderness, redness and fever.…”

“…Plastic surgery wound infections occurred after various operations [5,6]. Furthermore, articles dealing with sporadic shunt-related [7], catheter-related [8] or stent-related [9] NTM infections have been published. In visceral surgery, a single case of postoperative NTM infection is described after incisional hernia repair using synthetic mesh [10].…”

Clinical and Taxonomic Status of Pathogenic Nonpigmented or Late-Pigmenting Rapidly Growing Mycobacteria

“…The authors also reported that surgery alone for more serious wound infections, without antimicrobial therapy, was followed by healing but that relapse often occurred within 4 to 6 weeks of the surgery. In contrast, surgical excision and/or debridement of the wound site combined with appropriate antimicrobial therapy resulted in healing without relapse (131,194,203,205). Likewise, when a foreign body such as breast implant, percutaneous catheter, etc., is involved, removal of the foreign body appears to be essential to recovery (38,41,97,185,196).…”

“…Only a few cases of M. fortuitum chronic otitis media or mastoiditis have been reported (2,43,131). The earliest report of otitis media due to M. fortuitum was described by Austin and Lockey (2).…”