Localized Skin and Soft Tissue Infection

Most species of NTM have been described causing cutaneous disease[9,10] (Table 2) or nosocomial skin and soft tissue infection, postinjection abscess, surgical wound infections, and infections because of long-term intravenous or peritoneal catheters. M. chelonae causes disseminated nodular skin disease in immunocompromised patients. M. marinum causing ''swimming pool granuloma'' or ''fish tank granuloma'' gets implanted while cleaning fish tanks or handling fish. Solitary papules get

Table 1 Runyon's classification of NTM

Type

Characteristics

Common organisms

Type 1 Slow grower, photochromogen

Type 2 Slow grower, scotochromogen

Type 3 Slow grower, nonchromogen

Type 4 Rapid grower

M. kansasii, M. marinum, M. simiae, Mycobacterium asiaticum Mycobacterium scrofulaceum, Mycobacterium szulgai, Mycobacterium gordonae, M. ulcerans

M. avium-intracellulare, Mycobacterium malmoense, Mycobacterium terrae, Mycobacterium haemophilum, M. ulcerans, M. xenopi M. fortuitum, M. chelonae, M. abscessus, Mycobacterium smegmatis formed that progress to ulceration and scar formation. Mycobacterium ulcerans causes disease in children and young adults, producing necrotic lesions of skin and underlying tissue.[9] In our experience, five cases (four wound infections following a laparoscopic surgery and one injection abscess) of M. chelonae (three isolates) and M. fortuitum (one isolate) were isolated which were sensitive to imipenem, amikacin, and ciprofloxacin.

Infections of Bursae, Joints, Tendon Sheaths, and Bones

Most of the NTM[9] can cause chronic granulomatous infection of the tendon sheaths, bursae, joints, and bones (Table 2). M. abscessus is a common cause of posttraumatic wound infection.[10]

Disseminated Disease

In immunosuppressed patients (AIDS with CD4 cell count <50 cells, posttransplant, long-term steroid use, malignancies), disseminated disease because of various NTM has been described (Table 2).[9,10] The disease can present as fever of unknown origin in case of M. avium complex[11] or as multiple localized abscesses or nodules.

The organism can be isolated from blood or bone marrow more so if M. avium.

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