Port-site Infection with Atypical Mycobacteria Post-laparoscopic Procedure: A Case Series

Abstract

Surgical site infections with atypical mycobacteria are uncommon but not unheard of. Atypical mycobacteria are abundantly present in soil and water and can cause infections when the immune system is compromised. We present four cases of atypical mycobacterial infections at the port site following laparoscopy. In the first case, a laparoscopic cholecystectomy, there was histopathologic evidence of mycobacterial infection, although the smear and culture tests were negative. The second case, post- laparoscopic sterilisation, also showed histopathologic evidence, but the smear test was negative. Similarly, the third case, post- laparoscopic appendectomy, had histopathologic evidence but a negative smear. The fourth case, a post-laparoscopic hernia repair, had histopathologic evidence, a positive smear, and positive culture. The Catridge-Based Nucleic Acid Amplification Test (CBNAAT) for Mycobacterium Tuberculosis (MTB) was negative for all four patients, indicating the absence of tuberculous infection. The first three patients were treated with conventional anti-tubercular treatment using four drugs: Isoniazid (INH), rifampicin, ethambutol, and pyrazinamide, along with an additional quinolone. The fourth patient was treated with a combination of Ciprofloxacin, Clarithromycin, and doxycycline. All four patients responded well to treatment. The use of tap water to dilute disinfectants is considered a risk factor for atypical mycobacterial infection.