Nontuberculous Mycobacterium Skin Infections Associated With One Tattoo Studio-Oregon, January-April 2023.

Cutaneous Mycobacterium chelonae infection presenting clinically as a mycetoma

Trimethoprim-Sulfamethoxazole for Skin and Soft Tissue Infections—Let Us Not Forget the Risks

Nontuberculous Mycobacteria in Solid Organ Transplant Recipients

BackgroundMycobacteirum wolinskyi is a member of the Mycobacterium smegmatis group, which is less frequently found in clinical settings than other nontuberculous mycobacterium (NTM) species. However, its clinical significance has recently increased in opportunistic infections. This case is the first report of facial skin and soft tissue infection by M. wolinskyi complicating cosmetic procedures.Case presentationA 56-year-old Asian female patient with a history of receiving multiple facial cosmetic procedures over the preceding 2 years was admitted to our institution with swelling, local pain, and erythema on the right cheek. Mycobacteirum fortuitum complex isolated from a pus culture was identified as M. wolinskyi by rpoB sequencing. Metallic foreign bodies and abscess were detected by radiologic imaging. The pus was incised and drained. Treatment comprised clarithromycin (500 mg every 12 h), amikacin (200 mg every 8 h), and ciprofloxacin (400 mg every 6 h).ConclusionWe report the first case of facial skin and soft tissue infection with M. wolinskyi after multiple cosmetic procedures of filler injection and laser lipolysis. Increased occurrence of NTM infection in nosocomial settings suggests the importance of appropriate treatment including culturing and rpoB gene sequencing when patients who have undergone cosmetic procedures display symptoms and signs of soft tissue infection indicative of NTM infection.

Cutaneous atypical mycobacterial infection with Mycobacterium fortuitum arising after endovenous radiofrequency ablation

Background/Aims: Non-tuberculous Mycobacterium (NTM) infections usually result in chronic disease, and making a diagnosis is often difficult. Skin and soft tissue infections due to NTM are not common and are usually diagnosed relatively late. We investigated the clinical characteristics of nine cases of skin and soft tissue infections with NTM. Methods: Nine patients with an NTM infection who were confirmed consecutively by skin and soft tissue and/or adjacent bone cultures at a teaching hospital between August 2006 and July 2013 were enrolled in this study. The demographics, clinical characteristics, underlying diseases, treatment, and prognosis between different NTM species were reviewed retrospectively. Results: The most common NTM species causing a soft tissue infection was Mycobacterium abscessus (five patients, 55.6%). Common sites of infection were the knee and lumbar spine. Five patients (55.6%) had underlying diseases. Six patients (77.8%) were treated with combined surgical treatment (incision and drainage) plus antibiotics. The duration from symptom onset to diagnosis was long (77.7 ± 44.6 days) due to inadequate microbiological evaluation and disregard for the clinical significance of the NTM culture. All patients were cured with treatment; however, the treatment duration was long (181.7 ± 140.0 days). Procedure and cosmetic surgery were the most important risk factors for infection. Conclusions: The diagnosis of NTM skin and soft tissue infections tends to be delayed in a clinical setting. Therefore, a high index of suspicion for NTM infection in chronic localized soft tissue infections is essential for diagnosis. Mycobacterium abscessus appears to be the most common NTM species causing soft tissue infections. (Korean J Med 2014;87:311-317)

Skin and soft tissues infections (SSTIs) caused by nontuberculous mycobacteria (NTM) are underrecognized and difficult to treat. Controversies exist for optimal medical management and the role of surgery. Defining the epidemiology in the environment, in animals and in healthcare aids disease prevention. This review focuses on recent advances in epidemiology, risk factors, diagnostics and therapy. The increasing consumer appetite for cosmetic and body-modifying procedures (e.g. tattooing, mesotherapy, liposuction) has been associated with rises in sporadic cases and outbreaks of NTM SSTIs. In mainstream healthcare, recent epidemiological studies have helped to quantify the increased risk of NTM infection related to anti-tumour necrosis factor-α monoclonal antibody therapy. Cervicofacial lymphadenitis in children poses management dilemmas, but recent studies and resultant algorithms have simplified decision-making. Molecular studies have led to a better understanding of the epidemiology, therapy and course of Mycobacterium ulcerans infection (Buruli ulcer) that remains prevalent in many areas including sub-Saharan Africa and southeastern Australia. Apart from molecular methods, the widespread adoption of matrix-assisted laser desorption ionization-time of flight mass spectrometry by routine laboratories has potential to simplify and expedite the laboratory identification of NTMs. An improved understanding of the epidemiology of NTM SSTIs indicates a need to apply effective infection control and ensure regulation of cosmetic and related procedures associated with nonsterile fluids. Broader access to newer diagnostic methods will continue to improve recognition of NTM disease. Along with a paucity of therapeutic agents, there is need for more reliable methods to assess susceptibility and selection of effective combination therapy.

The Many Faces of MRSA: Community-Acquired Infection Knows No Bounds

Mycobacterium smegmatis is an acid-fast bacillus of rapidly growing mycobacteria (RGM) of nontuberculous mycobacteria (NTM). M. smegmatis was considered nonpathogenic to humans until 1986, when the first patient was linked to the infection. To date, fewer than 100 cases have been reported in the literature, mainly related to various surgical procedures. Herein, we report two immunocompetent patients who acquired M. smegmatis infection following cosmetic procedures. Due to the rarity of M. smegmatis infection in routine clinical practice, it is challenging for medical providers to diagnose and treat patients with M. smegmatis infection. M. smegmatis infection should be considered for patients with chronic skin and soft tissue infections at the injection site or surgical site following cosmetic procedures. Histological findings, pathogen identification by molecular testing or bacterial culture are required to make a definitive diagnosis. Medical providers should raise awareness of M. smegmatis infection for patients with chronic skin and soft tissue infections after cosmetic procedures. Stringent sterile procedures for surgical instruments, supplies, and environments should be enforced.

Mycobacterium abscessus subspecies abscessus infection associated with cosmetic surgical procedures: Cases series.

Methicillin-Resistant Staphylococcus aureus: A Pharmacotherapy Primer

Non‐tuberculous mycobacteria (NTM) are Mycobacterium species other than M. tuberculosis and M. leprae. - referred to as ‘atypical’. They are acid-fast bacilli residing in soil and water that cause cutaneous infections primarily after trivial trauma, surgery and cosmetic procedures. Skin and soft tissue infections (SSTI) caused by NTM species are increasing in incidence. They have a wide spectrum of clinical manifestations. NTM SSTI should be suspected when the skin infection does not respond to empirical antibiotics; Although, even with a sound clinical suspicion, the relatively low sensitivity of AFB & Fite staining as well as non-specific histopathology findings, the diagnosis is difficult. Optimal therapy is not well established, but usually is species dependent and includes use of multiple antibiotics for several months and potential use of adjunctive surgery. We report a case of 40-year-old female presented with chief complaint of multiple painful swellings over abdomen for 2 years not subsiding with standard antibiotic and surgical management. Investigations were done to rule out cutaneous tuberculosis, mycetoma and septic panniculitis; Automated mycobacterial culture on Modified Middlebrook 7H9 broth showed growth of NTM after 13 days of aerobic incubation. Though species could not be identified due to lack of resources, she was treated with combination of Rifampicin, Clarithromycin and Minocycline for 6 months; Good response was seen within 3 weeks and complete clearance of abscess was seen after 2 months of follow-up.

Introduction The recently published BTS guidelines on Non-Tuberculous Mycobacteria (NTM) outline management recommendations for pulmonary NTM infection. There has been an increase in reported skin and soft tissue NTM infection (SSI-NTM) over recent years,1 yet evidence for treatment is largely based on small case series. Objective To assess treatment and outcome of SSI-NTM cases presenting to a London teaching hospital from January 2013 – December 2017. Methods All positive NTM cultures from January 2013 to December 2017 from a large London teaching hospital were examined retrospectively. Case notes were reviewed for site of infection, species identification, time to initiate treatment, treatment duration, antibiotic choice, co-existing immunosuppression, complications and recurrence. All HIV, paediatric and pulmonary NTM cases were excluded. Results 239 patients with NTM were identified. 15 were SSI-NTM (6%). 4 patients were excluded as three have not completed treatment and one was a post-mortem finding (n=11). Details of these 11 cases are shown in the table 1. M. chelonae and M. fortuitum were the most frequently identified (n=6). Treatment duration for M. Marinum, fortuitum and chelonae ranged from 3 to 8 months, and for M. abscessus, intracellularae and kansasii 10 to 18 months. One case was cured with surgical debridement alone. Mean delay was 78 days from symptom onset to treatment initiation. Ten (90%) cases had complete cure with no recurrence. Conclusions SSI–NTM is under recognised and can present late, potentially following previous multiple attempts of standard antibacterial therapy. It should be considered particularly in cases of immunosuppression, non-healing surgical wounds, injection sites, vascular grafts and cosmetic procedures. Our data suggests that SSI–NTM can be successfully managed with combination antibiotics leading to complete resolution. Clarithromycin may be considered as a single agent for M. chelonae. Surgical debridement and removal of foreign bodies may also aid recovery and limit treatment duration. Further research is needed to guide optimal treatment regimen and duration, as management of these complex cases will become increasingly relevant to the TB and respiratory physician. Reference Misch E, et al. Skin and soft tissue infections due to non tuberculous mycobacteria. Current Infectious Disease Reports2018;20:6.

This study investigated the characteristics of patients with skin and soft tissue infections (SSTIs) caused by nontuberculous mycobacteria (NTM) and identified the risk factors for treatment failure in these patients. Data of patients with NTM SSTIs who received treatment between January 2014 and December 2019 at Taipei Veterans General Hospital were collected retrospectively. Possible risk factors were determined using univariate and multivariate analysis with logistic regression models. A total of 47 patients (24 male, 23 female; age, 57.1 ± 15.2 years) were enrolled. Type 2 diabetes mellitus was the most common comorbidity. The most common mycobacterial species was the Mycobacterium abscessus complex, and the most commonly affected site was the axial trunk. Treatment was successful in 38 patients (81%). Six patients had recurrent infections (13%) after the treatment course was completed, and 3 patients (6.4%) died of NTM-related infection. Delayed treatment for more than 2 months and antibiotic-alone treatment were 2 independent risk factors for treatment failure of NTM SSTIs. Delayed treatment for more than 2 months and antibiotic-alone treatment were associated with a higher failure rate in patients with NTM SSTIs. Therefore, the differential diagnosis of NTM infection should always be considered when the treatment course is prolonged but not effective. Early identification of causative NTM species and appropriate antibiotic treatment may lower the risk of treatment failure. Prompt surgical treatment is suggested if available.

Injection lipolysis is used for body and face contouring due to its minimal invasiveness and cost-effectiveness, but related complications such as nontuberculous mycobacterium infection significantly affect its clinical application. This study aimed to review the literature on NTM infection after injection lipolysis. We conducted a literature review of scientific journals published in Medline and PubMed up to September 2022 on patients with NTM skin and soft tissue infections. We used the keywords: nontuberculous mycobacterium, infection, injection lipolysis, and lipolytic solution in various combinations with the Boolean operators AND, OR, and NOT. Only articles available in English and full version publications were considered for this review. Here, we reviewed the relevant mechanisms and drugs for injectable lipolysis and analyzed the possible correlation between NTM infection and injection lipolysis. We also summarize methods for the diagnosis and treatment of NTM infections and present some perspectives on this therapy. Many patients with NTM infections had a history of fat-related surgery or therapy. NTM infection after injection lipolysis may be related to inadequate disinfection and sterilization of injection equipment and clinical procedures, the unqualified medication itself and free fatty acids released during injection lipolysis. Currently, diagnosis and treatment of NTM infection after lipolysis injections remains challenging. Injection lipolysis represents a helpful option for local fat reduction. Doctors should strictly abide by the aseptic operation standards and use qualified products for there is a correlation between skin and soft tissue infection of nontuberculous mycobacterium and injection lipolysis. Providers should understand the mechanism, indications, and associated risks of injection lipolysis when injecting fat-dissolving drugs to reduce localized fat.