TY - JOUR
T1 - Cutaneous nontuberculous mycobacteria infections
T2 - A retrospective case series of 78 patients from the Texas Gulf Coast region
AU - Philips, Rebecca C.
AU - Hoyer, Paige E.
AU - White, Skyler M.
AU - Tinkey, Katherine T.
AU - Loeffelholz, Michael
AU - Andersen, Clark R.
AU - Wilkerson, Michael G.
AU - Gibson, Bernard R.
AU - Kelly, Brent C.
N1 - Publisher Copyright:
© 2019 American Academy of Dermatology, Inc.
PY - 2019/9
Y1 - 2019/9
N2 - 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.
AB - 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.
KW - acid-fast bacilli
KW - antibiotic susceptibility
KW - atypical mycobacteria
KW - case series
KW - cutaneous
KW - diagnosis
KW - nontuberculous mycobacteria
KW - risk factors
KW - skin
KW - treatment
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U2 - 10.1016/j.jaad.2019.04.022
DO - 10.1016/j.jaad.2019.04.022
M3 - Article
C2 - 31002850
AN - SCOPUS:85069000011
SN - 0190-9622
VL - 81
SP - 730
EP - 739
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 3
ER -