Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint:A case report

BACKGROUND Musculoskeletal nontuberculous Mycobacterium(NTM)infections are rare,partic-ularly post-acupuncture therapy,and present diagnostic challenges due to their infrequency and potential severity.Prompt recognition and appropriate manage-ment 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.

Value of Metagenomic Next-Generation Sequencing in Clinical Diagnosis and Targeted Therapy of Nontuberculous Mycobacteria Infection

The purpose of this study was to assess the value of metagenomic next-generation sequencing(mNGS)for rapid diagnosis of diseases caused by nontuberculous mycobacteria(NTM).We retrospectively reviewed four NTM-infected cases diagnosed by smear microscopy,mycobacterial culture and mNGS methods.We found that the mNGS method not only had a shorter detection turnaround time(3–4 days)than Mycobacterium culture(15–20 days)but also had higher sensitivity and specificity to identify NTM compared with conventional detection methods.In addition,mNGS was able to identify coinfections by NTM and other bacteria,fungi or viruses.Overall,diagnosis of NTM by mNGS can provide timely and precise guidance for subsequent clinical treatment of NTM infections.

Diagnostic Value of Targeted Next-generation Sequencing in Pulmonary Mycobacterial Infections

Objective This study aimed to explore the diagnostic value of novel technique-targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary mycobacterial infections.Methods This retrospective study was conducted on patients who underwent bronchoscopy and tNGS,smear microscopy,and mycobacterial culture of BALF.Patients with positive Mycobacterium tuberculosis(MTB)culture or GeneXpert results were classified into the tuberculosis case group.Those diagnosed with nontuberculous mycobacteria(NTM)-pulmonary disease(NTM-PD)composed the case group of NTM-PD patients.The control group comprised patients without tuberculosis or NTM-PD.Sensitivity,specificity,and receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance.Results For tuberculosis patients with positive mycobacterial culture results,the areas under the ROC curves(AUCs)for tNGS,GeneXpert,and smear microscopy were 0.975(95%CI:0.935,1.000),0.925(95%CI:0.859,0.991),and 0.675(95%CI:0.563,0.787),respectively.For tuberculosis patients with positive GeneXpert results,the AUCs of tNGS,culture,and smear microscopy were 0.970(95%CI:0.931,1.000),0.850(95%CI:0.770,0.930),and 0.680(95%CI:0.579,0.781),respectively.For NTM-PD,the AUCs of tNGS,culture,and smear-positive but GeneXpert-negative results were 0.987(95%CI:0.967,1.000),0.750(95%CI:0.622,0.878),and 0.615(95%CI:0.479,0.752),respectively.The sensitivity and specificity of tNGS in NTM-PD patients were 100%and 97.5%,respectively.Conclusion tNGS demonstrated superior diagnostic efficacy in mycobacterial infection,indicating its potential for clinical application.

Nontuberculous mycobacteria： susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008

Background An increasing incidence of disease caused by nontuberculous mycobacteria （NTM） is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai. Methods All NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system. Results A total of 21 221 specimens were cultured, of which 4868 （22.94%） grew acid fast bacilli （AFB）, and 248 （5.09%） of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae （26.7%）, followed by M. fortuitum （15.4%）, M. kansasii （14.2%）, M. avium-intracellulare complex （13.1%） and M. terrae （6.9%）. The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. 9ordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance. Conclusions The prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.

Nontuberculous mycobacteria in China:incidence and antimicrobial resistance spectrum from a nationwide survey

Background:Information on the prevalence and resistance spectrum of nontuberculous mycobacteria(NTM)in China is mainly based on regional or local data.To estimate the proportion of NTM cases in China,a national survey of NTM pulmonary disease was carried out based on acid-fast positive sputum samples collected in 2013.

Drug resistance and its clinical relevance of nontuberculous mycobacteria in Sichuan area

Objective To analyze the status of infection and drug resistance of nontuberculous mycobacteria(NTM)and its clinical relevance in Sichuan area.Methods Mycobacteria laboratory specimens from January 2014 to December 2015 in Public Health Clinical Center of Chengdu were retrospectively collected and analyzed.NTM identification was performed by gene chip or 16S

Epidemiology and Clinical Features of Mycobacterium avium Complex Pulmonary Disease in a Brazilian Amazon Cohort

The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.

Giant Bursitis of Wrist and Multiple Tenosynovitis of Hand with Rice Body Formation: Unusual Case of an Atypical Mycobacteria Infection

We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.

Prevalence and Antimicrobial Susceptibility of Mycobacterium abscessus in a General Hospital, China

Objective To gain greater insight into the prevalence drug resistant profiles of M. abscessus from a general hospital in Beijing, China. Methods Partial gene sequencing of 16 S, hsp65, and rpo B were used to distinguish the species of NTM isolates. All strains identified as M. abscessus were further enrolled in the drug susceptibility testing by using broth microdilution method. Results We found that M. avium complex was the most frequent NTM organism, accounting for 54.1%（33/61） of all isolates. Behind MAC, the second most common organisms were M. abscessus（22 out of 61, 36.1%）. Average rates of resistance were 4.5% for AMK, 9.1% for LZD, and 13.6% for CLA, respectively. In contrast, resistance to LEV（17/22, 77.3%）, IMI（9/22, 40.9%）, and SMX（10/22, 45.5%） was noted in more than 40% of M. abscessus isolates. DNA sequencing revealed that all the CLA-resistant isolates harbored nucleotide substitutions in position 2058（1/3, 33.3%） or 2059（2/3, 66.7%） of 23 S r RNA. Conclusion In conclusion, our data demonstrated that M. intracellulare and M. abscessus were the most common NTM species in the general hospital of Beijing. CLA, AMK, LZD showed promising activity, where as LEV, IMI, and SMX exhibited poor activity against M. abscessus in vitro.

Lumbar infection caused by Mycobacterium paragordonae:A case report

Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.

Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin:A case report

BACKGROUND In recent years,the cosmetic intervention related infections caused by nontuberculous mycobacteria(NTM)are increasing as the informal cosmetic treatments are performed.However,many dermatologists are inexperienced in the diagnosis and management of similar cases.Here we report a case of subcutaneous infection caused by Mycobacterium abscessus(M.abscessus)following cosmetic injections of botulinum toxin.CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin.Her lesions did not show any alleviation after 2-wk prescription of antibiotics.Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases.The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff(PAS)and Acidfast staining and the culture yielded no microbiome.Afterwards,the puncture on abscess was performed and M.abscessus was successfully isolated.The pathogen was identified by acid-fast staining and DNA sequencing.The patient was treated with the strategy of clarithromycin,ofloxacin,and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts.In a word,the mycobacterium infection should be aware in patients after cosmetic performance.

CUTANEOUS MYCOBACTERIUM MARINUM INFECTION DIAGNOSED BY PCR-RFLP ANALYSIS

Objective To identify Mycobacterium marinum （M. marinum ） inducing misdiagnosis and treatment failure. Methods The lesional specimen of patient with cutaneous M. marinum were cultivated on L6wenstein-Jensen medium. The isolate was identified by biochemical tests and polymerase chain reaction （PCR）-restriction fragment length polymorphism （RFLP） analysis of the hsp65 gene. Results Smooth and non- pigmented colonies were noted after incubation at 32 ℃ for 2 weeks. The isolate was acid-fast bacilli and confirmed as M. marinum by biochemical tests and PCR-RFLP. Conclusion For a correct diagnosis of cutaneous M. marinum infection, it is crucial for clinicians to have a high index of suspicion, obtain the history of exposure and trauma and understand growth characteristics of the organism. Compared with conventional biochemical techniques, PCR-RFLP analysis is a more rapid, accurate and reliable method for mycobacterial identification to species level.

A detailed report on mycobacteriosis in Pampus argenteus along the coast of Bay of Bengal,West Bengal,India

Objective:To investigate granuloma associated mycobacteriosis in Pampus argenteus(P.argenteus)(silver pomfrets)and its seasonal prevalence in marine and coastal aquaculture systems of West Bengal,India.Methods:P.argenteus having granulomatous infection were sampled from coastal areas of East Midnapore District of West Bengal from January 2014 to December 2015,encompassing the various seasons.Tissue samples were collected for confirmation by biochemical studies and their prevalence and degree of infection and histopathology was conducted.Results:A total of 197 fishes having haemorrhage like infections in skin and viscera were confirmed for mycobacteria by biochemical analysis,with prevalence of 22.6%.Post-winter season showed higher prevalence(47.97%)followed by winter(35.25%),pre-winter(27.81%),summer(12.5%)and rainy season(2.57%)respectively.Histopathological assessment showed necrotic granuloma in skin,gills and some internal tissues.Ziehl-Neelsen staining of infected tissue samples showed the deposition of acid fast organisms causing swelling and haemorrhages in the tissues.Severity of infection was evaluated by mean cumulative granuloma score(7.89)score.Majority of the acid fast bacilli were recovered from skin,gills and other organs.Biochemical assessment of the acid fast rods confirmed the presence of Mycobacterium spp.Conclusions:The result suggests that the nontuberculous mycobacterial species are responsible for the granulomatous infection in P.argenteus.This infection seems to be influenced by environmental temperature,with the lower temperature favoring the pathogens.