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Kim JH, Koh IC, Lim SY, Kang SH, Kim H. Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint: A case report. World J Clin Cases 2024; 12:6926-6934. [PMID: 39726922 PMCID: PMC11531982 DOI: 10.12998/wjcc.v12.i36.6926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 09/26/2024] [Accepted: 10/15/2024] [Indexed: 10/31/2024] Open
Abstract
BACKGROUND Musculoskeletal nontuberculous Mycobacterium (NTM) infections are rare, particularly post-acupuncture therapy, and present diagnostic challenges due to their infrequency and potential severity. Prompt recognition and appropriate management are crucial for optimal outcomes. NTM-infected wounds involving the joints are difficult to treat, and only a few cases have been reported. CASE SUMMARY We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment. An 81-year-old woman presented with a chronic, ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain. Magnetic resonance imaging revealed synovial thickening, effusion, and subcutaneous cystic lesions. An orthopedic surgeon performed open synovectomy and serial debridement. However, 1 month postoperatively, the wound had not healed and became chronic. A wound culture revealed NTM (Mycobacterium abscessus), and the patient was referred to the Department of Plastic and Reconstructive Surgery. Instead of surgical intervention, conservative wound care with intravenous antibiotics was provided, considering the wound status and the patient's poor general condition. Complete wound healing was achieved in 12 months, with no impact on the range of motion of the elbow joint. CONCLUSION With clinical awareness, musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.
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Affiliation(s)
- Jong Hyup Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
| | - In Chang Koh
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
| | - Soo Yeon Lim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
| | - Seong Hee Kang
- Division of Infectious Diseases, Department of Internal Medicine, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
| | - Hoon Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Institute, Daejeon 35365, South Korea
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Carbonell RCC, Oliveira LLF, Galan LEB, Filardi ETM, Lins ABM, Nattrodt JJM, Dantas DSM, Bernardi ACA, Cerni FA, Pucca MB. Beauty's Betrayal: Mycobacterium abscessus Case Series Following Aesthetic Procedures in the Brazilian Amazon. Infect Dis Rep 2024; 16:724-734. [PMID: 39195006 DOI: 10.3390/idr16040055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
The Brazilian market holds the second position globally in the beauty sector, poised to surpass the USD 50 billion mark in the upcoming years. Aesthetic procedures encompass a spectrum, ranging from non-invasive ones, such as drainage, radiofrequency, ultrasound, and cryolipolysis, to more invasive techniques, including fillers, botulinum toxin, microneedling, micropigmentation, carboxytherapy, and enzyme application. This wide array of treatments has yielded satisfactory cosmetic results for individuals who opt out of surgical procedures. However, despite being categorized as having low complexity, they still carry inherent risks. These risks are often exacerbated by the breach of the skin barrier, the exposure of organs and spaces, or the presence of implantable devices. Among the bacteria most isolated concerning this matter are non-tuberculous Mycobacteria. This study presents descriptive case reports involving three patients under the care of the Infectious Diseases Department at General Hospital of Roraima (HGR). These patients were diagnosed with Mycobacterium abscessus infections subsequent to undergoing enzyme application procedures. Although these cases involve the same microorganism, they exhibit varying degrees of severity, ranging from the development of locally nodular formations to a progression towards sepsis. These cases provide an opportunity to delve into the diagnostic subtleties and clinical implications of these infections while also prompting a critical evaluation of therapeutic strategies. Additionally, the report underscores the potential risks associated with routine aesthetic procedures.
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Affiliation(s)
- Roberto C C Carbonell
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil
- General Hospital of Roraima, Boa Vista 69305-455, Roraima, Brazil
| | - Letícia L F Oliveira
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil
| | - Luis E B Galan
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil
- General Hospital of Roraima, Boa Vista 69305-455, Roraima, Brazil
| | - Eloise T M Filardi
- Graduate Program in Bioscience and Biotechnology Applied to Pharmacy, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Campus Araraquara, Araraquara 14800-903, São Paulo, Brazil
| | - Alysson B M Lins
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil
- General Hospital of Roraima, Boa Vista 69305-455, Roraima, Brazil
| | | | - Domingos S M Dantas
- Programa Doutoral de Bioética da Faculdade de Medicina do Porto, 4050-290 Cidade do Porto, Portugal
| | - Adilson C A Bernardi
- Department of Biology and Health Sciences, University of Araraquara (UNIARA), Araraquara 14801-320, São Paulo, Brazil
| | - Felipe A Cerni
- Medical School, Federal University of Roraima, Boa Vista 69310-000, Roraima, Brazil
- Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus 69050-010, Amazonas, Brazil
| | - Manuela B Pucca
- Graduate Program in Bioscience and Biotechnology Applied to Pharmacy, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Campus Araraquara, Araraquara 14800-903, São Paulo, Brazil
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Campus Araraquara, Araraquara 14800-903, São Paulo, Brazil
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Zhang X, Feng Y, Li D, Han J, Shi D. Scalp Infection Caused by Mycobacterium abscessus Manifested as Patchy Alopecia in an Immunocompetent Female. Infect Drug Resist 2023; 16:5413-5419. [PMID: 37614680 PMCID: PMC10443697 DOI: 10.2147/idr.s416974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Mycobacterium abscessus (M. abscessus) is a fast-growing, non-tuberculous mycobacterium (NTM) that can cause human infections varying from superficial infection to pulmonary or even systemic infections. The latter is more commonly appeared in immunocompromised patients. The skin infection caused by M. abscessus often appears after trauma or surgical procedure. It is often manifested by subcutaneous nodules, papules, erythema, tender erythematous or violaceous plaques, cellulitis, abscesses, ulcerations, and draining sinuses. Herein, we present a non-typical cutaneous manifestation of M. abscessus infection in a 46-year-old woman who presented with alopecia on the scalp with no itching or pain. The pathogen was isolated and identified as M. abscessus by morphology and DNA sequencing. To our best knowledge, there was no report that this organism could cause skin lesions mimicking patchy alopecia. After 3 months of antibacterial treatment, the cutaneous lesion disappeared, and new growth of hair occurred in this patient.
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Affiliation(s)
- Xiaoyu Zhang
- School of Clinical Medicine, Weifang Medical University, Weifang, People’s Republic of China
| | - Yahui Feng
- Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
| | - Dongmei Li
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, DC, USA
| | - Jingjian Han
- Department of Medical Cosmetology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
| | - Dongmei Shi
- Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining, People’s Republic of China
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4
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Feizi S, Cooksley CM, Ramezanpour M, Nepal R, Psaltis AJ, Wormald PJ, Vreugde S. Colloidal silver against macrophage infections and biofilms of atypical mycobacteria. Biometals 2023; 36:913-925. [PMID: 36729280 PMCID: PMC10393856 DOI: 10.1007/s10534-023-00494-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
Skin and soft tissue infection (SSTI) caused by atypical mycobacteria such as Mycobacterium abscessus and Mycobacterium avium intracellulare complex (MAIC) have increased in recent years. Current therapeutic options are limited, and hence new and better therapies are urgently required. Colloidal Silver (CS) has been identified for its widespread antibacterial properties and silver-impregnated dressings have been used for SSTIs caused by various pathogens. The efficacy of Green Synthesized Colloidal Silver (GSCS) was investigated for bacterial growth inhibition (BGI) using a microdilution method and minimum biofilm eradication concentration (MBEC) using resazurin assay and confocal scanning laser microscopy (CSLM) of M. abscessus (n = 5) and MAIC (n = 5). The antibacterial effect of GSCS against M. abscessus infected macrophages was also evaluated. The in vitro cytotoxicity of GSCS on a human keratinocyte cell line (HaCaT) and neonatal foreskin fibroblasts was analyzed by the crystal violet proliferation assay. Average BGI and MBEC of GSCS varied between 0.7 and 22 ppm for M. abscessus and MAIC. The concentration of 3 ppm reduced M. abscessus-infection in macrophages significantly. GSCS was not cytotoxic to HaCaT and neonatal foreskin fibroblast cells at concentrations < 3 ppm up to 2 h exposure time. GSCS therefore, has the potential for topical application against atypical mycobacterial SSTI.
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Affiliation(s)
- Sholeh Feizi
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Clare M Cooksley
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Mahnaz Ramezanpour
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Roshan Nepal
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Alkis J Psaltis
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia
- The University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, Australia.
- The University of Adelaide, Adelaide, Australia.
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5
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Liu Y, Chen Y. Surgical Treatment for Cutaneous Mycobacterium abscessus Infection Caused by Injections of Hyaluronic Acid. Clin Cosmet Investig Dermatol 2023; 16:687-692. [PMID: 36969385 PMCID: PMC10038003 DOI: 10.2147/ccid.s394594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
Background Facial injection has become popular in aesthetic dermatology. Although injections of these tissue fillers are considered a low-risk procedure, they are not without potentially significant drawbacks. Case Presentation We would like to report a case about cutaneous Mycobacterium abscessus infection after facial injection of hyaluronic acid in China, which obtained satisfactory clinical efficacy by drainage and surgical excision. Conclusion Biological techniques are useful in the diagnosis of cutaneous M. abscessus infection. Surgical excision of skin lesion is effective for cutaneous M. abscessus infection.
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Affiliation(s)
- Yuanzhi Liu
- Department of Medical Cosmetology, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Yongjun Chen
- Department of Medical Cosmetology, Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Yongjun Chen, Department of Medical Cosmetology, Dermatology Hospital, Southern Medical University, 2 Lujing Road, Yuexiu District, Guangzhou, 523326, Guangdong, People’s Republic of China, Tel/Fax +86 20-87257353, Email
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Muacevic A, Adler JR, Schwartz G, Sharan J, Boyle RP, Shoja MM. Mycobacterium abscessus Complex Osteomyelitis of the Wrist. Cureus 2022; 14:e32593. [PMID: 36654591 PMCID: PMC9840847 DOI: 10.7759/cureus.32593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Mycobacterium abscessus (M. abscessus) is a ubiquitous, rapidly growing non-tuberculous mycobacterium, which is known to cause life-threatening lung infections in immunocompromised individuals following exposure to contaminated injectable products. We report a case of M. abscessus osteomyelitis of the right wrist in a 28-year-old patient with a history of intravenous drug use and a recent surgical repair of the right radial artery pseudoaneurysm. The patient underwent surgical debridement of the right distal radius infection. Histopathological examination and culture of the debrided tissue revealed M. abscessus complex infection. The patient was placed on intravenous amikacin, azithromycin, and cefoxitin for six weeks, followed by oral linezolid and clofazimine for six months.
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7
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Singsing ME, Duncan SG, Vachon MJ, Goff HW. Clinical features of mesotherapy-associated non-tuberculous mycobacterial infections: A systematic review. Int J Womens Dermatol 2022; 8:e059. [PMID: 39916988 PMCID: PMC11801139 DOI: 10.1097/jw9.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/06/2022] [Indexed: 02/09/2025] Open
Abstract
Cutaneous infections from non-tuberculous mycobacteria (NTM) are a well-documented but poorly characterized adverse event following mesotherapy injections. Objective This study aims to consolidate the available literature to characterize demographic and clinical features of mesotherapy-associated NTM infections. Methods Using PRISMA guidelines, a systematic review of PubMed, Scopus, and Embase databases was undertaken for articles reporting cases of NTM skin infections following mesotherapy. Data were analyzed using Microsoft Excel. Results Of 1966 search results, 30 articles (N = 423 patients) met inclusion criteria. Studies were largely from South America, and patients were mostly women aged 16-55 with NTM infections arising in the abdomen, buttocks, or thighs. Nearly all patients developed multiple, well-localized lesions without systemic symptoms. Effect summary by meta-analysis revealed most infections resolved after antibiotic therapy, though many patients required multiple antibiotic courses and/or agents to resolve infection. Infections often took weeks to resolve and were complicated by post-treatment scarring. Limitations The main limitation of this study was the heterogeneity and lack of consistency between case reports. Conclusion Cutaneous NTM infections associated with mesotherapy generally occur in women of childbearing age, arise from injections contaminated by the environment, and are often complicated by scarring/poor cosmesis and prolonged treatment course.
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Affiliation(s)
| | | | | | - Heather W. Goff
- University of Texas Southwestern Medical School, Dallas, Texas
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8
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Moreno-Izquierdo C, Zurita J, Contreras-Yametti F, Jara-Palacios M. Mycobacterium abscessus subspecies abscessus infection associated with cosmetic surgical procedures: Cases series. IDCases 2020; 22:e00992. [PMID: 33194548 PMCID: PMC7644577 DOI: 10.1016/j.idcr.2020.e00992] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/03/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022] Open
Abstract
Mycobacterium abscessus is a drug-resistant nontuberculous mycobacterium (NTM). Cutaneous & subcutaneous NTM infections post-cosmetic surgery are poorly diagnosed. Initial surgical evaluation facilitates early suspicion of M. abscessus infection. Rapidly evolving infection & negative culture/antibiotic response are indicators. Amikacin, imipenem, & clarithromycin combination may treat M. abscessus infection. Background Mycobacterium abscessus is one of the most pathogenic and drug-resistant opportunistic microorganisms among the nontuberculous mycobacteria (NTM) involved in skin and soft tissue infections (SSTI) associated with cosmetic surgical procedures. However, NTM infection is often wrongly diagnosed initially causing prolonged suffering. Here is described the author’s experience working with patients who developed M. abscessus SSTI after cosmetic procedures. Methods Patients who developed NTM infection after undergoing cosmetic procedures, and who presented at the Hospital Metropolitano and Hospital Vozandes (Quito, Ecuador) between 2013–2016. A review of patient medical records was performed. Results Five patients with culture proven M. abscessus subspecies abscessus SSTI after cosmetic surgeries were identified. All patients were treated with aggressive surgical debridement and antibiotics. Conclusions A rapidly spreading wound infection presenting two or more weeks after a cosmetic procedure that fails to respond to standard antimicrobial therapy should raise suspicion for NTM infection. Samples for acid-fast bacilli smear, cultures, and PCR from infected tissue should be taken. Surgical drainage and debridement are recommended along with a long course of antibiotics. In the absence of clinical trials, a combination of amikacin, imipenem, and clarithromycin may be an adequate initial treatment for M. abscessus subspecies abscessus SSTI in immunocompetent patients.
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Affiliation(s)
- C. Moreno-Izquierdo
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
- Servicio de Microbiología y Tuberculosis, Hospital Vozandes, Quito, Ecuador
- Servicio de Infectología, Hospital Metropolitano, Quito, Ecuador
- Corresponding author at: Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Ecuador.
| | - J. Zurita
- Servicio de Microbiología y Tuberculosis, Hospital Vozandes, Quito, Ecuador
- Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador
| | - F.I. Contreras-Yametti
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - M.A. Jara-Palacios
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
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9
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Veraldi S, Spigariolo CB, Cusini M, Nazzaro G, Gianotti R. Skin infections by
Mycobacterium chelonae
following mesotherapy: A report of two cases and review of the literature. J Cosmet Dermatol 2020; 19:1915-1917. [DOI: 10.1111/jocd.13441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Veraldi
- Department of Pathophysiology and Transplantation Università degli Studi IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Cristina Beatrice Spigariolo
- Department of Pathophysiology and Transplantation Università degli Studi IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Marco Cusini
- Department of Pathophysiology and Transplantation Università degli Studi IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Gianluca Nazzaro
- Department of Pathophysiology and Transplantation Università degli Studi IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Raffaele Gianotti
- Department of Pathophysiology and Transplantation Università degli Studi IRCCS Foundation Cà Granda Ospedale Maggiore Policlinico Milan Italy
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Chirasuthat P, Triyangkulsri K, Rutnin S, Chanprapaph K, Vachiramon V. Cutaneous nontuberculous mycobacterial infection in Thailand: A 7-year retrospective review. Medicine (Baltimore) 2020; 99:e19355. [PMID: 32150075 PMCID: PMC7478711 DOI: 10.1097/md.0000000000019355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A remarkable increase in the prevalence of cutaneous nontuberculous mycobacterial (NTM) infection has occurred worldwide. However, updated data regarding cutaneous NTM infection in Thailand is limited.This study aim to describe the clinical manifestations, pathogenic organism, and prognostic factors of cutaneous NTM infections among patients living in Thailand.The electronic medical records of all patients with confirmatory diagnosis of cutaneous NTM infection from either positive cultures or polymerase chain reaction were retrospectively reviewed at a university-based hospital.From 2011 to 2017, a total of 88 patients with a confirmed diagnosis of cutaneous NTM infection were included. Mycobacterium abscessus was the most common pathogens followed by M haemophilum and M marinum (61.4%, 10.2%, and 8.1%, respectively). Nodule and plaque were 2 most common lesions (26.4% and 25.5%, respectively) and lower leg is the most common site of involvement (50.9%). The majority of patients presented with single lesion (67%). Seven patients (7.9%) had history of surgical procedure and/or cosmetic injection before the development of lesion and all pathogenic organisms in this group were rapidly growing mycobacteria. Sweet's syndrome and erythema nodosum were the 2 most common reactive dermatoses, presented in 3.4% and 2.3%, respectively. The majority of patients infected with cutaneous M haemophilum infections were immunocompromised and lacked history of preceding trauma (77.8%). Patients with cutaneous NTM that receiving less than 3 medications was associated with higher disease relapse (odds ratio 65.86; P = .02).M abscessus is the most common pathogen of cutaneous NTM infection in Thailand. The prevalence of M haemophilum is increasing and should be particularly cautious in immunocompromised patients. Rapidly growing mycobacteria should be suspected in all cases of procedure-related cutaneous NTM. We recommend at least 3 antibiotics should be considered for cutaneous NTM infection to reduce the rate of relapse.
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11
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Plachouri KM, Georgiou S. Mesotherapy: Safety profile and management of complications. J Cosmet Dermatol 2019; 18:1601-1605. [PMID: 31444843 DOI: 10.1111/jocd.13115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/20/2019] [Accepted: 08/01/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Mesotherapy is a procedure that involves the injection of active substances into the dermis and subcutaneous tissue in order to treat several local medical and cosmetic conditions. Despite being considered as a relatively safe method, a series of adverse reactions can occur due to its wide application and lack of standardization processes. OBJECTIVES The aim of this paper is to summarize all the mesotherapy-related complications published so far, and to provide an insight into their management. PATIENT/METHODS Articles derived from the databases, PubMed, EMBASE, and SCOPUS, and published between 1992 and 2018, were analyzed for this review. The study was conducted according to the PRISMA guidelines. RESULTS In this literature, there is a number of case series and isolated case reports describing various side effects of different severities. The therapeutic management of these complications is-in most cases-individualized. CONCLUSIONS Larger systematic studies are needed in order to adequately evaluate the safety profile of mesotherapy, and in order to determine standardized therapy parameters, so as to minimize the risk of potential adverse reactions.
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Affiliation(s)
| | - Sophia Georgiou
- Dermatology Department, University of Patras, Patras, Greece
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12
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Fang RY, Sun QN. Mycobacterium abscessus infections following injection of botulinum toxin. J Cosmet Dermatol 2019; 19:817-819. [PMID: 31402555 DOI: 10.1111/jocd.13094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/27/2019] [Accepted: 07/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The incidence of Mycobacterium abscessus infections has increased in recent years. Some of these infections are caused by invasive cosmetic procedures. AIMS Raising the awareness of cosmetic procedure related Mycobacterium abscessus infection for clinicians. PATIENTS/METHODS We presented a 28-year-old woman who developed multiple erythema and painful nodules in her lower extremities after injections of botulinum toxin. RESULTS Mycobacterium culture and strain identification of the tissue confirmed Mycobacterium abscessus. Combination antibiotics therapy was given and the lesion healed with scar and pigmentation. CONCLUSION Mycobacterium abscessus infections following injection of botulinum toxin are rare and easily misdiagnosed as common suppurative infections. Early microbiologic tests are necessary for diagnose. Standardized operation should be performed to avoid this particular infection.
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Affiliation(s)
- Rou-Yu Fang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
| | - Qiu-Ning Sun
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
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13
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Shim HH, Cai SCS, Chan W, Low JGH, Tan HH, Ling KL. Mycobacterium abscessus Infection During Ustekinumab Treatment in Crohn's Disease: A Case Report and Review of the Literature. J Crohns Colitis 2018; 12:1505-1507. [PMID: 30169620 DOI: 10.1093/ecco-jcc/jjy126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The introduction of ustekinumab, an interleukin [IL]12/23 p40 inhibitor, to the therapeutic armamentarium of Crohn's disease has provided a much needed treatment option for patients who have failed conventional biologics with anti-tumour necrosis factor [TNF] and anti-integrin agents. Despite targeting two major cytokine pathways, the side effect profile of ustekinumab appears to be favourable in clinical trials. In particular, the risk of tuberculosis infection was observed to be lower than in patients who have received anti-TNF agents. The risk of non-tuberculosis mycobacterium infection, however, remains unknown. Here, we report the first case of a patient with Crohn's disease who developed Mycobacterium abscessus infection while on ustekinumab treatment.
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Affiliation(s)
- Hang Hock Shim
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | | | - Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | | | | | - Khoon Lin Ling
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Lamb GS, Starke JR. Mycobacterium abscessus Infections in Children: A Review of Current Literature. J Pediatric Infect Dis Soc 2018; 7:e131-e144. [PMID: 29897511 DOI: 10.1093/jpids/piy047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022]
Abstract
There is limited literature on Mycobacterium abscessus infections in children and limited data about its diagnosis and management. The incidence of infections due to M abscessus appears to be increasing in certain populations and can be a significant cause of morbidity and mortality.Management of these infections is challenging and relies on combination antimicrobial therapy and debridement of diseased tissue, depending on the site and extent of disease. Treatment regimens often are difficult to tolerate, and the antimicrobials used can cause significant adverse effects, particularly given the long duration of therapy needed.This review summarizes the literature and includes information from our own institution's experience on pediatric M abscessus infections including the epidemiology, transmission, clinical manifestations, and the management of these infections. Adult data have been used where there are limited pediatric data. Further studies regarding epidemiology and risk factors, clinical presentation, optimal treatment, and outcomes in children are necessary.
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Rocchetti TT, Silbert S, Gostnell A, Kubasek C, Campos Pignatari AC, Widen R. Detection of Mycobacterium chelonae, Mycobacterium abscessus Group, and Mycobacterium fortuitum Complex by a Multiplex Real-Time PCR Directly from Clinical Samples Using the BD MAX System. J Mol Diagn 2017; 19:295-302. [DOI: 10.1016/j.jmoldx.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/03/2016] [Accepted: 10/07/2016] [Indexed: 11/16/2022] Open
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Cortesia C, Bello T, Lopez G, Franzblau S, de Waard J, Takiff H. Use of green fluorescent protein labeled non-tuberculous mycobacteria to evaluate the activity quaternary ammonium compound disinfectants and antibiotics. Braz J Microbiol 2016; 48:151-158. [PMID: 27789202 PMCID: PMC5221367 DOI: 10.1016/j.bjm.2016.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
Although infections with NonTuberculous Mycobacteria have become less common in AIDS patients, they are important opportunistic infections after surgical procedures, likely because they are ubiquitous and not efficiently killed by many commonly used disinfectants. In Venezuela there have recently been many non-tuberculous mycobacteria soft tissue infections after minor surgical procedures, some apparently related to the use of a commercial disinfectant based on a Quaternary Ammonium Compound. We studied the activity of this and other quaternary ammonium compounds on different non-tuberculous mycobacteria by transforming the mycobacteria with a dnaA-gfp fusion and then monitoring fluorescence to gauge the capacity of different quaternary ammonium compounds to inhibit bacterial growth. The minimum inhibitory concentration varied for the different quaternary ammonium compounds, but M. chelonae and M. abscessus were consistently more resistant than M. smegmatis, and M. terrae more resistant than M. bovis BCG.
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Affiliation(s)
- Claudia Cortesia
- Instituto Venezolano de Investigaciones Científicas, Laboratorio de Genética Molecular, Altos de Pipe, Miranda, Venezuela
| | - Teresita Bello
- Universidad Central de Venezuela (UCV), Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela
| | - Gustavo Lopez
- Instituto Venezolano de Investigaciones Científicas, Laboratorio de Genética Molecular, Altos de Pipe, Miranda, Venezuela
| | - Scott Franzblau
- University of Illinois at Chicago, Institute for Tuberculosis Research, Department of Medicinal Chemistry and Pharmacognosy, Chicago, United States
| | - Jacobus de Waard
- Universidad Central de Venezuela (UCV), Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela
| | - Howard Takiff
- Instituto Venezolano de Investigaciones Científicas, Laboratorio de Genética Molecular, Altos de Pipe, Miranda, Venezuela.
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Mougari F, Guglielmetti L, Raskine L, Sermet-Gaudelus I, Veziris N, Cambau E. Infections caused by Mycobacterium abscessus: epidemiology, diagnostic tools and treatment. Expert Rev Anti Infect Ther 2016; 14:1139-1154. [PMID: 27690688 DOI: 10.1080/14787210.2016.1238304] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mycobacterium abscessus is an emerging mycobacteria that is responsible for lung diseases and healthcare-associated extrapulmonary infections. Recent findings support its taxonomic status as a single species comprising 3 subspecies designated abscessus, bolletii and massiliense. We performed a review of English-language publications investigating all three of these subspecies. Areas covered: Worldwide, human infections are often attributable to environmental contamination, although the isolation of M. abscessus in this reservoir is very rare. Basic research has demonstrated an association between virulence and cell wall components and cording, and genome analysis has identified gene transfer from other bacteria. The bacteriological diagnosis of M. abscessus is based on innovative tools combining molecular biology and mass spectrometry. Genotypic and phenotypic susceptibility testing are required to predict the success of macrolide (clarithromycin or azithromycin)-based therapeutic regimens. Genotyping methods are helpful to assess relapse and cross-transmission and to search for a common source. Treatment is not standardised, and outcomes are often unsatisfactory. Expert commentary: M. abscessus is still an open field in terms of clinical and bacteriological research. Further knowledge of its ecology and transmission routes, as well as host-pathogen interactions, is required. Because the number of human cases is increasing, it is also necessary to identify more active treatments and perform clinical trials to assess standard effective regimens.
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Affiliation(s)
- Faiza Mougari
- a Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA) , Assistance publique-Hôpitaux de Paris (APHP) , Paris , France.,b AP-HP, Hôpital Lariboisière-Fernand Widal , Service de Bactériologie , Paris , France.,c IAME, UMR 1137, INSERM , Université Paris Diderot, Sorbonne Paris Cité , Paris , France
| | - Lorenzo Guglielmetti
- a Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA) , Assistance publique-Hôpitaux de Paris (APHP) , Paris , France.,b AP-HP, Hôpital Lariboisière-Fernand Widal , Service de Bactériologie , Paris , France.,d Sorbonne Universités, UPMC Université Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology) , Paris , France.,e INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology) , Paris , France
| | - Laurent Raskine
- a Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA) , Assistance publique-Hôpitaux de Paris (APHP) , Paris , France.,b AP-HP, Hôpital Lariboisière-Fernand Widal , Service de Bactériologie , Paris , France
| | - Isabelle Sermet-Gaudelus
- f AP-HP, Groupe Hospitalier Necker-Enfants Malades , Centre de Ressources et de Compétences pour la Mucoviscidose (CRCM) et Centre de Formation de Traitement à Domicile Chez l'Enfant (CFTDE) , Paris , France
| | - Nicolas Veziris
- a Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA) , Assistance publique-Hôpitaux de Paris (APHP) , Paris , France.,d Sorbonne Universités, UPMC Université Paris 06, CR7, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology) , Paris , France.,e INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology) , Paris , France.,g AP-HP, Hôpital Pitié-Salpêtrière , Laboratory of Bacteriology , Paris , France
| | - Emmanuelle Cambau
- a Centre National de Référence des Mycobactéries et Résistance des Mycobactéries aux Antituberculeux (CNR-MyRMA) , Assistance publique-Hôpitaux de Paris (APHP) , Paris , France.,b AP-HP, Hôpital Lariboisière-Fernand Widal , Service de Bactériologie , Paris , France.,c IAME, UMR 1137, INSERM , Université Paris Diderot, Sorbonne Paris Cité , Paris , France
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Sousa PPD, Cruz RCDS, Schettini APM, Westphal DC. Mycobacterium abscessus skin infection after tattooing--Case report. An Bras Dermatol 2016; 90:741-3. [PMID: 26560222 PMCID: PMC4631242 DOI: 10.1590/abd1806-4841.20153362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/27/2014] [Indexed: 11/23/2022] Open
Abstract
Mycobacterium abscessus is a rapidly growing mycobacterium that has
been affecting people undergoing invasive procedures, such as videosurgery and
mesotherapy. This bacterium has global distribution, being found in numerous niches.
The frequency of published reports of infection by rapidly growing mycobacteria
associated with tattooing procedures has increased in recent years. However, in
Brazil there were no case reports of M. abscessus after tattooing in the literature
until now. In this paper, we describe the case of a patient with a nine-month history
of lesion on a tattoo site. The diagnosis of infection with Mycobacterium
abscessus was established by correlation between dermatological and
histopathological aspects, culture and molecular biology techniques. The patient had
significant improvement of symptoms with the use of clarithromycin monotherapy.
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Calif E, Neuberger A, Stahl S. Iatrogenic Mycobacterium abscessus infection in a trigger finger. Indian J Tuberc 2015; 62:114-6. [PMID: 26117482 DOI: 10.1016/j.ijtb.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 04/07/2015] [Indexed: 11/18/2022]
Abstract
An immunocompetent 63-year-old lady developed Mycobacterium abscessus soft tissue infection of the hand following local corticosteroid injection for trigger finger. The patient was successfully treated with repeated radical debridement and prolonged antimicrobial therapy. Atypical mycobacterial infections, including those caused by M. abscessus, albeit rare, should be considered in cases of late-onset indolent infection following local injury surgical procedures, and injections. Clinical vigilance, timely diagnosis, combined directed antimicrobial treatment, coupled with adequate surgical debridement are key for successful management.
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Affiliation(s)
- Edward Calif
- Hand Surgery Specialist, Hand Surgery Unit, Rambam Health Care Campus, Haifa, Israel.
| | - Ami Neuberger
- Specialist in Infectious Diseases, Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Shalom Stahl
- Hand Surgery Specialist, Hand Surgery Unit, Rambam Health Care Campus, Haifa, Israel
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Saeb-Lima M, Solis-Arreola GV, Fernandez-Flores A. Mycobacterial infection after cosmetic procedure with botulinum toxin a. J Clin Diagn Res 2015; 9:WD01-2. [PMID: 26023629 DOI: 10.7860/jcdr/2015/11741.5756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/27/2015] [Indexed: 12/21/2022]
Abstract
We report a case of mycobacterial infection at the sites of previous injections of botulinum toxin A in a 45-year-old woman. She presented with erythematous, swollen, warm, and tender plaques and nodules at the points of injection from which a biopsy was taken, demonstrating a deep dermal and hypodermal abscessified epithelioid granulomatous inflammatory infiltrate in which some acid-fast bacilli were identified with Ziehl-Neelsen and Fite-Faraco stains. The lesion was first treated with clarithromycin plus azithromycin, to which rifampicin was later added. A good therapeutic response was obtained.
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Affiliation(s)
- Marcela Saeb-Lima
- Consultant Dermatologist, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hospital Angeles Lomas , Centro Medico ABC, Mexico City, Mexico
| | | | - Angel Fernandez-Flores
- Dermatopathologist, Department of Cellular Pathology, Hospital El Bierzo , Ponferrada, Spain
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Nontuberculous mycobacterial infections: a potential complication of cosmetic procedures. Int J Womens Dermatol 2015; 1:51-54. [PMID: 28491956 PMCID: PMC5418664 DOI: 10.1016/j.ijwd.2014.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 12/02/2022] Open
Abstract
Interest in surgical and non-surgical cosmetic procedures has increased significantly over the last few decades. Billions of dollars are spent on these procedures annually. Although the associated risk is generally low, multiple cases of skin and soft tissue infections have been reported. Nontuberculous mycobacteria (NTM), in particular M. chelonae, M. fortuitum, and M. abscessus, have been increasingly identified as causative of numerous cosmetic procedure–related infections worldwide. This has therefore become a public health concern. Delays in diagnosis and appropriate management may occur given subtleties in diagnostic methods. The purpose of this review is to highlight the NTM-related skin and soft tissue infections associated with more common cosmetic procedures, describe methods of identification, and outline best treatment practices.
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Abstract
PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.
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Ali A, Botha J, Tiruvoipati R. Fatal skin and soft tissue infection of multidrug resistant Acinetobacter baumannii: A case report. Int J Surg Case Rep 2014; 5:532-536. [PMID: 25016080 PMCID: PMC4147652 DOI: 10.1016/j.ijscr.2014.04.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 01/22/2014] [Accepted: 04/17/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Acinetobacter baumannii is usually associated with respiratory tract, urinary tract and bloodstream infections. Recent reports suggest that it is increasingly causing skin and soft tissue infections. It is also evolving as a multidrug resistant organism that can be difficult to treat. We present a fatal case of multidrug resistant A. baumannii soft tissue infection and review of relevant literature. PRESENTATION OF CASE A 41 year old morbidly obese man, with history of alcoholic liver disease presented with left superficial pre-tibial abrasions and cellulitis caused by multidrug resistant (MDR) A. baumannii. In spite of early antibiotic administration he developed extensive myositis and fat necrosis requiring extensive and multiple surgical debridements. He deteriorated despite appropriate antibiotic therapy and multiple surgical interventions with development of multi-organ failure and died. DISCUSSION Managing Acinetobacter infections remains difficult due to the array of resistance and the pathogens ability to develop new and ongoing resistance. The early diagnosis of necrotizing soft tissue infection may be challenging, but the key to successful management of patients with necrotizing soft tissue infection are early recognition and complete surgical debridement. CONCLUSION A. baumannii is emerging as an important cause of severe, life-threatening soft tissue infections. Multidrug resistant A. baumannii soft tissue infections may carry a high mortality in spite of early and aggressive treatment. Clinicians need to consider appropriate early empirical antibiotic coverage or the use of combination therapy to include MDR A. baumannii as a cause of skin and soft tissue infections.
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Affiliation(s)
- Aqsa Ali
- Department of Intensive Care Medicine Frankston Hospital, Frankston, Victoria 3199, Australia.
| | - John Botha
- Department of Intensive Care Medicine Frankston Hospital, Frankston, Victoria 3199, Australia.
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Sinagra JLM, Kanitz EE, Cerocchi C, Cota C, Fantetti O, Prignano G, Donati P, Tortoli EM, D'Ancona FP, Capitanio B. Mycobacterium abscessus hand-and-foot disease in children: rare or emerging disease? Pediatr Dermatol 2014; 31:292-7. [PMID: 24758202 DOI: 10.1111/pde.12333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mycobacterium abscessus is emerging as an important cause of cutaneous infections in sporadic cases and outbreak settings. Although immunosuppressed or elderly patients are most commonly affected, in 2006 an outbreak of clinically distinct cutaneous lesions on the hands and feet caused by M. abscessus in a population of healthy children using a public swimming pool was reported. This article describes an outbreak of skin infection in a population of healthy Italian children attending the same school and using the same swimming pool. In January 2010 we identified three children with multiple, painful nodules on the palms and soles. M. abscessus was isolated from one child's lesions. A public health investigation was conducted and a team of dermatologists and public health officers visited all of the children; 514 children were screened and 29 cases were identified overall. All of the affected children had used the school's swimming pool. These children were treated with oral clarithromycin for 4 to 8 weeks. Because of the long period of time between the presentation and diagnosis of the first cases, the possibility that the number of cases may have been underestimated cannot be excluded. To our knowledge, this is the second largest reported cluster of M. abscessus skin infection suspected to be related to swimming pool exposure in a population of otherwise healthy children. It is unclear whether this disease is rare or should be considered as an emerging clinical entity.
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Lin SS, Lee CC, Jang TN. Soft Tissue Infection Caused by Rapid Growing Mycobacterium following Medical Procedures: Two Case Reports and Literature Review. Ann Dermatol 2014; 26:236-40. [PMID: 24882980 PMCID: PMC4037678 DOI: 10.5021/ad.2014.26.2.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/20/2011] [Accepted: 10/31/2011] [Indexed: 11/08/2022] Open
Abstract
Non-tubecrulosis mycobacterium infections were increasingly reported either pulmonary or extrapulmonary in the past decades. In Taiwan, we noticed several reports about the soft tissue infections caused by rapid growing mycobacterium such as Mycobacterium abscessus, Mycobacterium chelonae, on newspaper, magazines, or the multimedia. Most of them occurred after a plastic surgery, and medical or non-medical procedures. Here, we reported two cases of these infections following medical procedures. We also discussed common features and the clinical course of the disease, the characteristics of the infected site, and the treatment strategy. The literatures were also reviewed, and the necessity of the treatment guidelines was discussed.
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Affiliation(s)
- Shih-Sen Lin
- Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Chin-Cheng Lee
- Department of Pathology and Laboratory Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Tsrang-Neng Jang
- Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan. ; School of Medicine, Catholic Fu-Jen University, New Taipei City, Taiwan
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Zaragoza J, Delaplace M, Benamara M, Estève E. [A rare side effect of mesotherapy: Nicolau syndrome]. Ann Dermatol Venereol 2013; 140:713-7. [PMID: 24206808 DOI: 10.1016/j.annder.2013.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 06/03/2013] [Accepted: 07/01/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nicolau's livedoid dermatitis is associated with drug-induced embolism in the cutaneous arterial bed, generally as a result of accidental intra-arterial injection. Herein, we report a case that is somewhat surprising because of its late onset following mesotherapy injections. CASE REPORT A 53-year-old man, with a history solely of tendinopathy for which he underwent mesotherapy sessions, consulted for livedoid lesions of the front of the knee with central necrosis. History-taking revealed a final course of mesotherapy three weeks earlier for patellar tendinitis below the left kneecap; intradermal injection of procaine and piroxicam had been unusually and intensely painful. The remainder of the clinical examination revealed additional livedoid lesions on the outside of the left ankle as well as purpuric lesions on the pads of the toes on the left foot. Laboratory tests revealed nothing of note. Skin biopsies of the livedoid circumference of the lesion showed arteriolar emboli of an amorphous material within the dermis obliterating the arteriolar lumen. The clinical appearance of skin lesions after mesotherapy led us to a diagnosis of Nicolau livedoid dermatitis. DISCUSSION Nicolau dermatitis is a rare skin complication described as occurring mainly as a result of intramuscular injections. The reported case is special because it comprises Nicolau dermatitis arising out of a session of mesotherapy employing an intradermal injection. However, there are only very few cases in which subcutaneous injections have induced Nicolau dermatitis. The pathophysiology is not well known, but several mechanisms are involved: arterial ischaemia by vasospasm or thrombosis. In this case, the semiotic appearance of the lesions and histological analysis militate in favour of accidental injection of a skin product into an arteriole, resulting in obliteration of the latter. Mesotherapy can induce Nicolau dermatitis.
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Affiliation(s)
- J Zaragoza
- Service de dermatologie, hôpital Porte-Madeleine, CHR d'Orléans, 1, rue Porte-Madeleine, 45032 Orléans cedex 1, France
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Falsey RR, Kinzer MH, Hurst S, Kalus A, Pottinger PS, Duchin JS, Zhang J, Noble-Wang J, Shinohara MM. Cutaneous Inoculation of Nontuberculous Mycobacteria During Professional Tattooing: A Case Series and Epidemiologic Study. Clin Infect Dis 2013; 57:e143-7. [DOI: 10.1093/cid/cit347] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Liu CY, Lin HS, Hsiao YP, Lee YT, Yang JH. Pulmonary Mycobacterium abscessus infection-induced erythema induratum. DERMATOL SIN 2013. [DOI: 10.1016/j.dsi.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kothavade RJ, Dhurat RS, Mishra SN, Kothavade UR. Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis 2012; 32:161-88. [PMID: 23139042 DOI: 10.1007/s10096-012-1766-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Rapidly growing mycobacteria (RGM) are known to cause pulmonary, extra-pulmonary, systemic/disseminated, and cutaneous and subcutaneous infections. The erroneous detection of RGM that is based solely on microscopy, solid and liquid cultures, Bactec systems, and species-specific polymerase chain reaction (PCR) may produce misleading results. Thus, inappropriate therapeutic measures may be used in dermatologic settings, leading to increased numbers of skin deformity cases or recurrent infections. Molecular tools such as the sequence analyses of 16S rRNA, rpoB and hsp65 or PCR restriction enzyme analyses, and the alternate gene sequencing of the superoxide dismutase (SOD) gene, dnaJ, the 16S-23S rRNA internal transcribed spacers (ITS), secA, recA1, dnaK, and the 32-kDa protein gene have shown promising results in the detection of RGM species. PCR restriction enzyme analyses (PRA) work better than conventional methods at identifying species that are closely related. Recently introduced molecular tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), pyrosequencing, DNA chip technology, and Beacon probes-combined PCR probes have shown comparable results in the detection of various species of RGM. Closely related RGM species (e.g., Mycobacterium fortuitum, M. chelonae, and M. abscessus) must be clearly differentiated using accurate molecular techniques because their therapeutic responses are species-specific. Hence, this paper reviews the following aspects of RGM: (i) its sources, predisposing factors, clinical manifestations, and concomitant fungal infections; (ii) the risks of misdiagnoses in the management of RGM infections in dermatological settings; (iii) the diagnoses and outcomes of treatment responses in common and uncommon infections in immunocompromised and immunocompetent patients; (iv) conventional versus current molecular methods for the detection of RGM; (v) the basic principles of a promising MALDI-TOF MS, sampling protocol for cutaneous or subcutaneous lesions and its potential for the precise differentiation of M. fortuitum, M. chelonae, and M. abscessus; and (vi) improvements in RGM infection management as described in the recent 2011 Clinical and Laboratory Standards Institute (CLSI) guidelines, including interpretation criteria of molecular methods and antimicrobial drug panels and their break points [minimum inhibitory concentrations (MICs)], which have been highlighted for the initiation of antimicrobial therapy.
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Affiliation(s)
- R J Kothavade
- Microbiology Lab, Epcor, 10065 Jasper Ave NW, Edmonton, AB, T5J 3B1, Canada.
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