Infect Chemother.  2013 Mar;45(1):85-93.

Skin and Soft Tissue Infection due to Rapidly Growing Mycobacteria: Case Series and Literature Review

• Yu JR
• Heo ST
• Lee KH
• Kim J
• Sung JK
• Kim YR
• Kim JW

Abstract

BACKGROUND
Nontuberculous mycobacteria (NTM) are ubiquitous in soil and water. Most NTM cause disease in humans only rarely unless some aspect of host defense is impaired. Recently, rapidly growing mycobacteria (RGM) is not uncommon, and the prevalence of RGM infection has been increasing. RGM causes a wide spectrum of pulmonary and extrapulmonary diseases and has been shown as an important source for opportunistic infection.
MATERIALS AND METHODS
We report 5 patients of skin and soft tissue infection due to RGM in tertiary medical center in Jeju Island and analyzed 21 patients of skin and soft tissue infection due to RGM in Republic of Korea. Clinical, microbiological and epidemiological data were collected from each patient. NTM isolates were identified using conventional and molecular methods including 16S rDNA gene sequencing.
RESULTS
The mean age of the RGM patients (n=26) was 54.9 +/- 15.9 years and 73% were women. Mycobacterium fortuitum complex was the most common (12/26). Antimicrobial resistance for clarithromycin and quinolone were 12% and 60%, respectively. Clarithromycin based therapy was done in 46%. The mean duration of treatment was 21.2 +/- 8.7 weeks.
CONCLUSIONS
Many cases can be cured after therapy for 4-7 month with at least 2 or 3 antibiotics according to in vitro susceptibility. Recent increasing of NTM cases suggests that species and subspecies identification is epidemiologically important, especially related to medical procedure, and surgery.

Keyword

Rapidly growing mycobacteria; Soft tissue infection; Jeju Island

MeSH Terms

Anti-Bacterial Agents
Clarithromycin
DNA, Ribosomal
Female
Humans
Mycobacterium fortuitum
Nontuberculous Mycobacteria
Prevalence
Republic of Korea
Skin
Soft Tissue Infections
Soil
Anti-Bacterial Agents
Clarithromycin
DNA, Ribosomal
Soil

Figure

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  Figure 1 Erythematous swelling and discharge on the right thenar region (arrow).

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  Figure 2 (A) Marked chronic inflammatory cell infiltrates along perivascular spaces in the reticular dermis (black arrow; H&E, ×100). (B) Diffuse granulomatous inflammation of the dermis. The infiltrated cells are composed of lymphocyte, neutrophils, histiocyte and foreign body-type multinucleated giant cells (black arrow; H&E, ×200).

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  Figure 3 Contrast enhanced T1 weighted magnetic resonance imaging of the left shoulder at the initiation of treatment showed synovial thickening with high signal intensity (arrow) and fluid collection in the synovium (arrow head).

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