Increasing Recognition of Community-Acquired, Non-Tuberculous Mycobacterial Infections of the Hand and Wrist.

Jerec Ricci,Milton B Armstrong,Lisa L Steed,Alice Le,Pierce Jones,Fernando A Herrera

doi:10.7759/cureus.22105

Abstract

BackgroundIn this study, we present our experience with community-acquired, culture-positive, non-tuberculous mycobacterial (NTM) infections of the hand and wrist and compare the clinical features, risk factors, diagnostic delays, and treatment outcomes among patients referred for surgical consultation at our institution over a five-year period.MethodologyWe retrospectively identified patients on chart review who were diagnosed with culture-positive, extrapulmonary, cutaneous NTM infections between January 1, 2014, and December 31, 2018. Only patients with community-acquired NTM infections of the hand and wrist were included. Patient demographics, risk factors, location, diagnostic delays, NTM species isolated, treatment modalities, and treatment outcomes were collected and analyzed. These variables were further compared between patients who participated in fishing-related activities and those who did not.ResultsA total of 10 patients were identified with community-acquired NTM infections of the hand or wrist. Of these patients, eight (80%) were male, and six (60%) had participated in fishing-related activities prior to the initial presentation. The majority of patients had Mycobacterium marinum isolates (n = 6, 60%) and involved the hand (n = 8, 80%). M. marinum isolates were associated with a significantly shorter time to diagnosis (p = 0.02). All patients underwent surgical management with a prolonged course of postoperative antibiotics and were cured of their infection at the end of their treatment course.ConclusionsProper risk factor documentation and heightened clinical awareness are essential to reduce delays in the diagnosis of NTM skin and soft tissue infections and provide the best chance for curative therapy.

Highlights

Non-tuberculous mycobacteria (NTM) are ubiquitously present in the environment and reside in many locations such as soil, biofilms, aerosols, and water
The skin and soft tissue infections caused by non-tuberculous mycobacterial (NTM) are characterized by an indolent course and non-specific presentation, which often result in a delay in diagnosis three to five months after the first clinical signs appear [4]
The following demographic information was extracted from the electronic health records of each patient: age, gender, date of initial presentation, date of surgery, date of culture positivity, comorbidities (obesity, body mass index (BMI), diabetes, hyperlipidemia, hypertension, immunosuppression), clinical presentation, exposure to known risk factors, profession, duration of symptoms prior to presentation, time to diagnosis, duration from exposure, time from surgical consultation to surgical intervention, diagnostic tests performed (e.g., including X-rays, electromyography (EMG), magnetic resonance imaging (MRI), acidfast bacteria (AFB) operative cultures, antibiotic susceptibility testing), NTM species isolated, medical treatment regimens, and surgical procedures performed

Summary

Introduction

Non-tuberculous mycobacteria (NTM) are ubiquitously present in the environment and reside in many locations such as soil, biofilms, aerosols, and water. Exposure to aquatic environments and water-related activities is a well-known risk factor for cutaneous NTM infection, as reported by the majority of our patients in this study. These exposures need to be well documented to prevent further delays in diagnosis [4]. We present our experience with community-acquired, culture-positive, non-tuberculous mycobacterial (NTM) infections of the hand and wrist and compare the clinical features, risk factors, diagnostic delays, and treatment outcomes among patients referred for surgical consultation at our institution over a five-year period

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Results

Conclusion