Final Diagnosis -- Atypical Mycobacterium (mycobacterium abscessus) Infection
DIAGNOSIS: -- MYCOBACTERIUM ABSCESSUS SOFT TISSUE INFECTION.
M. abscessus skin and soft tissue infections are rare and are usually associated with immunocompromised hosts or patients on long term corticosteroid treatment. M. abscessus lives in water and soil and causes infection by traumatic inocculation into skin or direct contact with preexisting skin lesions. The organism has been documented in skin and soft tissue infections of immunocompromised (1) and immunocompetent hosts (2), keratitis (3), lymphadenitis(4), and otomastoiditis(5). A variety of foreign bodies and other medical devices have been infected including vascular catheters, peritoneal catheters, prosthetic valves, mammoplasty implants, and hemodialyzers(6). The presence of M. abscessus in bronchial washings due to a contaminated fiberoptic brochoscope is well documented in the literature (7). Conventional antituberculous medications are not effective against M. abscessus and treatment may require both surgical debridement and antibiotics (8). Clarithromycin has been successful in some reports, but resistance to monotherapy with this drug has been documented (1,9).
- Tebas,P. et. al. Rapid development of resistance to clarithromycin following monotherapy for disseminated Mycobacterium chelonae infection in a heart transplant patient. Clinics of Infectious Diseases. 20(2):443-4, 1995.
- Kelley L.C., Deering, D.C., Kaye, E.T. Cutaneous Mycobacterium chelonei presenting in an immunocompetent host: case report and review of the literature. Cutis. 56(5):293-5, 1995.
- Broadway, D.C., Kerr-Muir, M.G., Eykyn, S.J., Pambakian, H. Mycobacterium chelonei keratitis: a case report and review of previously reported cases. Eye.8(Pt.1):134-42, 1994.
- Eichman,A., Huszar, A., Bon, A. Mycobacterium chelonae infection of lymph nodes in an HIV-infected patient. Dermatology. 187 (4):299-300, 1993.
- TerKonda, R.P., et. al. Atypical mycobacterial otomastoiditis.
Laryngoscope. 105 (12 Pt.1): 1275-8, 1995 .
- Wallace, R.J., et.al. Spectrum of Disease Due to Rapidly Growing Mycobacteria. Reviews of Infectious Diseases. 5(4):657-679, 1983.
- Wang, H.C., et. al. A pseudoepidemic of Mycobacterium chelonae infection caused by a contamination of a fibreoptic bronchoscope suction channel. The European Respiratory Journal.8(8):1259-62, 1995.
- Wallace, R.J., et.al. Skin, Soft Tissue, and Bone infections Due to Mycobacterium chelonae, chelonae: Importance of Prior Corticosteroid Therapy, Frequency of Disseminated Infections, and Resistance to Oral Antimicrobials Other than Clarithromycin. The Journal of Infectious Diseases. 166: 405-412, 1992.
- Wallace, R.J., et. al. Clinical trial of clarithromycin for cutaneous(disseminated) infection due to Mycobacterium chelonae. Annals of Internal Medicine.119:482-6, 1993.
Contributed by Christine Dorvault, MD, Uma Rao, MD, John P. Anhalt, PhD, MD, Ellen Wald, MD and William A. Pasculle, Sc. D.