Abstract
Three cases of atypical mycobacterial infection were encountered following laparoscopic surgery at the Colombo North Teaching Hospital over a period of eighteen months from September 2014 to April 2016. The patients presented with port site infections and sinus tract formation three to four weeks after laparoscopic surgery performed in the same operating theatre. These cases were clinically suspected as atypical mycobacterial infection. The Ziehl Neelsen stain showed acid fast bacilli with atypical morphology and cultures grew mycobacteria other than tuberculosis (MOTT). Histology of tissues showed chronic granulomatous inflammation. The infections resolved with surgical intervention and long term antibiotic therapy. Erroneous practice of disinfection of laparoscopic instruments with formaldehyde was thought to be the cause of these infections. No cases were reported after implementing protocols for proper cleaning and disinfection of laparoscopes.
Highlights
Laparoscopic procedures have become the practice of choice for many surgical conditions
Atypical mycobacterial infection at port sites is an increasing problem encountered in patients undergoing laparoscopic surgery and has been reported to cause nosocomial outbreaks.[1,2,3,4]
Atypical mycobacteria have been known to present in water and soil and can contaminate solutions, instruments and disinfectants used in hospital settings
Summary
Laparoscopic procedures have become the practice of choice for many surgical conditions. Atypical mycobacterial infection at port sites is an increasing problem encountered in patients undergoing laparoscopic surgery and has been reported to cause nosocomial outbreaks.[1,2,3,4] It leads to increased morbidity and long term treatment. Multidrug resistance further complicates the problem.[1] Atypical mycobacteria have been known to present in water and soil and can contaminate solutions, instruments and disinfectants used in hospital settings. Disinfection and sterilization of laparoscopic instruments is almost always responsible for such outbreaks.[2]
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