Cutaneous nontuberculous mycobacteria infections: A retrospective case series of 78 patients from the Texas Gulf Coast region

Rebecca C. Philips, Paige E. Hoyer, Skyler M. White, Katherine T. Tinkey, Michael Loeffelholz, Clark R. Andersen, Michael Wilkerson, Bernard Gibson, Brent Kelly

Research output: Contribution to journalArticle

Abstract

Background: The incidence of cutaneous nontuberculous mycobacteria (NTM) infections is increasing. These infections are a diagnostic and therapeutic challenge. Objective: We investigated the clinical features, diagnosis, and management of cutaneous NTM infections. Methods: A retrospective case series studied 78 patients from a Gulf Coast tertiary referral center diagnosed with cutaneous NTM infection by culture or stain of a skin biopsy specimen. Results: A history of trauma, procedure, or environmental exposure was common. The mean time between the initial evaluation and diagnosis was 12 weeks. Only 15% of acid-fast bacillus-positive cultures had a positive acid-fast bacillus smear, and only 43% of those accompanied by skin biopsy specimen had a positive Fite stain. Immunosuppressed patients were more likely to have a positive Fite stain. Treatment included surgery and multiple antibiotics. Immunosuppressed patients and Mycobacterium abscessus group infections were more likely to have persistent disease. Limitations: M chelonae and M abscessus isolates were indistinguishable and therefore were reported together. Five cases were not confirmed by culture. Conclusions: Even with clinical suspicion, the diagnosis of NTM infection can be difficult. Results of acid-fast bacillus smears and special stains are frequently negative. Antibiotic resistance is common. Multidrug treatment is often required, and surgical therapy may be needed.

Original languageEnglish (US)
JournalJournal of the American Academy of Dermatology
DOIs
StatePublished - Jan 1 2019

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Nontuberculous Mycobacterium Infections
Coloring Agents
Skin
Bacillus
Acids
Biopsy
Environmental Exposure
Therapeutics
Mycobacterium
Microbial Drug Resistance
Infection
Tertiary Care Centers
Anti-Bacterial Agents
Incidence
Wounds and Injuries

Keywords

  • acid-fast bacilli
  • antibiotic susceptibility
  • atypical mycobacteria
  • case series
  • cutaneous
  • diagnosis
  • nontuberculous mycobacteria
  • risk factors
  • skin
  • treatment

ASJC Scopus subject areas

  • Dermatology

Cite this

Cutaneous nontuberculous mycobacteria infections : A retrospective case series of 78 patients from the Texas Gulf Coast region. / Philips, Rebecca C.; Hoyer, Paige E.; White, Skyler M.; Tinkey, Katherine T.; Loeffelholz, Michael; Andersen, Clark R.; Wilkerson, Michael; Gibson, Bernard; Kelly, Brent.

In: Journal of the American Academy of Dermatology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: The incidence of cutaneous nontuberculous mycobacteria (NTM) infections is increasing. These infections are a diagnostic and therapeutic challenge. Objective: We investigated the clinical features, diagnosis, and management of cutaneous NTM infections. Methods: A retrospective case series studied 78 patients from a Gulf Coast tertiary referral center diagnosed with cutaneous NTM infection by culture or stain of a skin biopsy specimen. Results: A history of trauma, procedure, or environmental exposure was common. The mean time between the initial evaluation and diagnosis was 12 weeks. Only 15{\%} of acid-fast bacillus-positive cultures had a positive acid-fast bacillus smear, and only 43{\%} of those accompanied by skin biopsy specimen had a positive Fite stain. Immunosuppressed patients were more likely to have a positive Fite stain. Treatment included surgery and multiple antibiotics. Immunosuppressed patients and Mycobacterium abscessus group infections were more likely to have persistent disease. Limitations: M chelonae and M abscessus isolates were indistinguishable and therefore were reported together. Five cases were not confirmed by culture. Conclusions: Even with clinical suspicion, the diagnosis of NTM infection can be difficult. Results of acid-fast bacillus smears and special stains are frequently negative. Antibiotic resistance is common. Multidrug treatment is often required, and surgical therapy may be needed.",
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