Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures

Bae, Jin Ho; Yun, In Sik; Roh, Tai Suk; Kim, Young Seok

doi:10.14730/aaps.2020.02327

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Further 2-3 months may be continued after the clinical cure. 3 In the present, treatment was given empirically due to the lack of availability of drug sensitivity tests, which was the major limitation. Providing NTM diagnosis, speciation, and drug sensitivity, testing facilities is rare in resource-constrained developing countries.…”

Section: Discussionmentioning

confidence: 98%

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Case Report: Multiple Scalp Abscesses due to Mycobacterium abscessus Infection Following Triamcinolone Injection in an Immunocompetent Person

Mohanty

Mishra

Sirka

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Mycobacterium abscessus complex is a group of nontuberculous mycobacteria (NTM). The NTM may involve skin, soft tissue, and other organs like the eye and central nervous system. Clinically may mimic multidrug resistance. Here, we present a case of a 29‐year man with a history of multiple scalp swellings with mild symptoms. He had undergone multiple triamcinolone acetonide injections on his scalp to stop hair fall and baldness 2 months prior. As there was a history of injections on the scalp and lesions associated with minimal symptoms, we suspected the possibility of NTM and fungal infections. As a part of treatment and obtaining a sample for investigation, lesions were aspirated with a needle. The swellings contained gelatinous material, which was sent for microscopic examination, and revealed the presence of acid‐fast bacilli (AFB). Xpert MTB/RIF assay was negative for mycobacteria (MTB complex), but culture revealed NTM, identified as M. abscessus complex by line probe assay. Based on the diagnosis, the patient was treated with an injection of amikacin, moxifloxacin, and azithromycin. The lesions improved. The patient has completed over a year of follow-up with no recurrence noted. Mycobacterium abscessus, a rapidly growing NTM, has been occasionally reported to cause cutaneous soft tissue infection when injected with nonsterile medicine or needles. Therefore, a high index of suspicion for NTM infection is warranted in patients with cutaneous scalp abscess following scalp injections for hair loss.

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Section: Discussionmentioning

confidence: 98%

“…Clinical improvement was noticed after 3-4 weeks of initiation of treatment, and all lesions were healed. The treatment with moxifloxacin 500 mg and azithromycin 500 mg daily was continued for 3 months after clinically cure as per Bae et al 3 The patient is followed up to date with no recurrence (Figure 2).…”

Section: Case Detailsmentioning

confidence: 99%

Case Report: Multiple Scalp Abscesses due to Mycobacterium abscessus Infection Following Triamcinolone Injection in an Immunocompetent Person

Mohanty

Mishra

Sirka

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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“…Previously, the focus of treatment was on the simple removal of infection through resection or non-surgical treatment with antibiotics only [5]. If the wound is infected with bacteria resistant to empirical antibiotics or if the wound is complex involving structures other than soft tissue, effective treatment will be delayed.…”

Section: Discussionmentioning

confidence: 99%

“…Mycobacterial infections are not rare, but SSTIs account for a low percentage of cases. SSTIs show nonspecific symptoms ranging from minor wounds, such as localized ulcers or abscesses, to systemic reactions in immunosuppressed patients [3][4][5]. In mycobacterial SSTIs, mycobacterial culture is the main method of diagnosis, but culture time can exceed several weeks and the detection rate is low.…”

Section: Introductionmentioning

confidence: 99%

Resurfacing defects from mycobacterial skin and soft tissue infections using thoracodorsal artery perforator free flaps

Wang

Lee

Kim

2022

Arch Hand Microsurg

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Purpose: Skin and soft tissue infections (SSTIs) caused by mycobacteria are rare and difficult to diagnose and treat. Furthermore, systematic treatment protocols for mycobacterial SSTIs have not been established. This study introduces a strategy with radical resection and resurfacing using thoracodorsal artery perforator (TDAP) free flaps.Methods: From December 2013 to February 2022, 13 patients with mycobacterial SSTIs underwent radical resection and reconstruction using TDAP free flaps. Exact mapping of the lesion extent was performed preoperatively with magnetic resonance imaging. When the extent was limited to soft tissue, resection and reconstruction were performed in a single stage. However, in cases with bone or joint involvement, two-stage reconstruction was applied with radical resection and negative-pressure wound therapy followed by resurfacing with a flap. Complex defects formed after resection were filled with a musculocutaneous or chimeric flap. All patients were administered antimycobacterial medications.Results: Mycobacterial infection recurred in one patient; therefore, a total of 14 cases of reconstruction were performed. Reconstruction was performed with a TDAP free flap alone in 10 cases, with a chimeric flap in three cases, and with a musculocutaneous flap in one case. The flaps ranged in size from 7×5 cm2 to 25×12 cm2 (mean, 97.2 cm2). The mycobacterial species identified were Mycobacterium tuberculosis (n=8) and nontuberculous mycobacteria (n=5).Conclusion: For mycobacterial SSTIs, radical resection followed by resurfacing and reconstruction using TDAP free flaps can be an effective surgical treatment strategy.

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“…1). [3][4][5][6][7] Nontuberculous mycobacteria infection occurs through a variety of pathways, including the rapid growing infections associated with the use of contaminated syringes and reintroduced injection devices. 8 Nontuberculous mycobacteria infection is uncommon but has been reported in lung, skin, and soft tissue infections.…”

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confidence: 99%

Chemical Sterilization of Lipoplasty Cannula and Nontuberculous Mycobacteria Disinfection: An Experimental Study

Lee

Kim

et al. 2021

Journal of Craniofacial Surgery

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Background: Nontuberculous mycobacteria are commonly found pathogens; however, skin and soft tissue infections due to nontuberculous mycobacteria are often associated with surgical procedures, particularly after lipoplasty. Although nontuberculous mycobacteria are resistant to some chemical disinfectants, glutaraldehyde, peracetic acid, povidone iodine, alcohol, and chlorine are still used for the sterilization of medical instruments. This study investigated the efficacy of various disinfectants in a fatty environment with adipose and a bloody environment without adipose. In addition, this study was also used to identify the most effective disinfectant against nontuberculous mycobacteria. Methods: Three nontuberculous mycobacteria (Mycobacterium avium, M. abscessus, and M. fortuitum), pathogens frequently found in skin and soft tissue infections, were used. Seven chemical disinfectants were tested in both fatty and bloody environments. The disinfectants used were considered to have a sterilization effect when the log 10 reduction factor exceeded 5. Results: Most disinfectants had some sterilizing effects against nontuberculous mycobacteria; however, glutaraldehyde was the most effective against all 3. Chlorhexidine and povidone iodine also displayed sterilizing effects. Of the disinfectants tested, only alkyldiaminoethylglycine hydrochloride showed a diminished effect with statistical significance, specifically against M. fortuitum in a fatty environment, whereas it had effective results in a bloody environment. Conclusions: Glutaraldehyde showed the greatest sterilizing effect on nontuberculous mycobacteria with a log 10 reduction factor >5 in both fatty and bloody environments. However, some chemical disinfectants did not show sufficient sterilizing effects in a fatty environment and, therefore, should be used with caution for the sterilization of nontuberculous mycobacteria.

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Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures

Cited by 4 publications

References 22 publications

Case Report: Multiple Scalp Abscesses due to Mycobacterium abscessus Infection Following Triamcinolone Injection in an Immunocompetent Person

Case Report: Multiple Scalp Abscesses due to Mycobacterium abscessus Infection Following Triamcinolone Injection in an Immunocompetent Person

Resurfacing defects from mycobacterial skin and soft tissue infections using thoracodorsal artery perforator free flaps

Chemical Sterilization of Lipoplasty Cannula and Nontuberculous Mycobacteria Disinfection: An Experimental Study

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