Skip to main content

Advertisement

Log in

Nontuberculous mycobacterial infection of the musculoskeletal system in immunocompetent hosts

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Nontuberculous mycobacteria (NTM) were considered saprophytic organisms for many years but now are recognized as human pathogens. Although humans are routinely exposed to NTM, the rate of clinical infection is low. Such infections usually occur in the elderly and in patients who are immunocompromised. However, there has been an increasing incidence in recent years of infections in immunocompetent hosts. NTM infections in immunocompetent individuals are secondary to direct inoculation either contamination from surgical procedures or penetrating injuries rather than hematogenous dissemination. Clinically and on histopathology, musculoskeletal infections caused by NTM resemble those caused by Mycobacterium tuberculosis but are mostly resistant to routine antituberculosis medicines.

Materials and Methods

Six cases of NTM infection in immunocompetent hosts presenting to the department from 2004 to 2015 were included in study. Of which two cases (one patella and one humerus) of infection were following an open wound due to trauma while two cases (one hip and one shoulder) of infection were by inoculation following an intraarticular injection for arthrogram of the joint, one case was infection following arthroscopy of knee joint and one case (calcaneum) was infection following local injection for the treatment of plantar fasciitis. All patients underwent inaging and tissue diagnosis with samples being sent for culture, staining, and histopathology.

Results

Clinical suspicion of NTM inoculation led to the correct diagnosis (four cases with culture positive and two cases with histopathological diagnosis). There treatment protocol for extrapulmonary NTM infection was radical surgical debridement and medical management based on drug sensitivity testing in culture positive cases. At a mean follow up of 3 years (range1–9 years) all patients had total remission and excellent results.

Conclusions

Whenever a case of chronic granulomatous infection is encountered that does not respond to standard anti-tuberculous treatment, with a history of open trauma, surgical intervention, or injection as shown in this study, a possible NTM infection should be considered and managed appropriately.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wallace RJ Jr., O’Brein R, Glassroth J, Raleigh J, Dutta A. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am Rev Respir Dis 1990;142:940–53.

    Article  Google Scholar 

  2. Bi S, Hu FS, Yu HY, Xu KJ, Zheng BW, Ji ZK, et al. Nontuberculous mycobacterial osteomyelitis. Infect Dis (Lond) 2015;47:673–85.

    Article  Google Scholar 

  3. Lee WJ, Kang SM, Sung H, Won CH, Chang SE, Lee MW, et al. Non-tuberculous mycobacterial infections of the skin: A retrospective study of 29 cases. J Dermatol 2010;37:965–72.

    Article  Google Scholar 

  4. Jarzembowski JA, Young MB. Nontuberculous mycobacterial infections. Arch Pathol Lab Med 2008;132:1333–41.

    PubMed  Google Scholar 

  5. Chapman JS. The ecology of the atypicalmycobacteria. Arch Environ Health 1971;22:41–6.

    Article  CAS  Google Scholar 

  6. Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis 1992;15:1–10.

    Article  CAS  Google Scholar 

  7. Tebruegge M, Pantazidou A, MacGregor D, Gonis G, Leslie D, Sedda L, et al. Nontuberculous mycobacterial disease in children — Epidemiology, diagnosis & management at a tertiary center. PLoS One 2016;11:e0147513.

    Article  Google Scholar 

  8. Resnick D, Niwayama G. Osteomyelitis, septic arthritis, and soft tissue infection: Organisms. In: Resnick D, editor. Diagnosis of Bone and Joint Disorders, 3rd ed. Philadelphia: Saunders; 1995. p. 2448–25589.

  9. Theodorou DJ, Theodorou SJ, Kakitsubata Y, Sartoris DJ, Resnick D. Imaging characteristics and epidemiologic features of atypical mycobacterial infections involving the musculoskeletal system. AJR Am J Roentgenol 2001;176:341–9.

    Article  CAS  Google Scholar 

  10. Gunaydin M, Yanik K, Eroglu C, Sanic A, Ceyhan I, Erturan Z, et al. Distribution of nontuberculous mycobacteria strains. Ann Clin Microbiol Antimicrob 2013;12:33.

    Article  Google Scholar 

  11. Falkinham JO. Impact of human activities on the ecology of nontuberculous mycobacteria. Future Microbiol 2010;5:951–60.

    Article  Google Scholar 

  12. Honda JR, Bernhard JN, Chan ED. Natural disasters and nontuberculous mycobacteria: A recipe for increased disease? Chest 2015;147:304–8.

    Article  Google Scholar 

  13. Brown-Elliott BA, Wallace RJ Jr. Infections caused by nontuberculous my-cobacteria. In: Mandell GL, Bennett JC, Dolin R, editors. Mandell, Douglas, and Bennett’s: Principles and Practice of Infectious Disease. Vol. 2. 6th ed. Philadelphia: Elsevier; 2005. p. 2909–16.

  14. von Reyn CF, Maslow JN, Barber TW, Falkinham JO 3rd, Arbeit RD. Persistent colonisation of potable water as a source of Mycobacterium avium infection in AIDS. Lancet 1994;343:1137–41.

    Article  Google Scholar 

  15. Meissner G, Anz W. Sources of Mycobacterium avium complex infection resulting in human diseases. Am Rev Respir Dis 1977;116:1057–64.

    CAS  PubMed  Google Scholar 

  16. Tichenor WS, Thurlow J, McNulty S, Brown-Elliott BA, Wallace RJ Jr., Falkinham JO 3rd. Nontuberculous mycobacteria in household plumbing as possible cause of chronic rhinosinusitis. Emerg Infect Dis 2012;18:1612–7.

    Article  CAS  Google Scholar 

  17. Falkinham JO 3rd. Nontuberculous mycobacteria from household plumbing of patients with nontuberculous mycobacteria disease. Emerg Infect Dis 2011;17:419–24.

    Article  Google Scholar 

  18. Feazel LM, Baumgartner LK, Peterson KL, Frank DN, Harris JK, Pace NR. Opportunistic pathogens enriched in showerhead biofilms. Proc Natl Acad Sci U S A 2009;106:16393–9.

    Article  CAS  Google Scholar 

  19. Selvaraju SB, Khan IU, Yadav JS. Biocidal activity of formaldehyde and nonformaldehyde biocides toward Mycobacterium immunogenum and Pseudomonas fluorescens in pure and mixed suspensions in synthetic metalworking fluid and saline. Appl Environ Microbiol 2005;71:542–6.

    Article  CAS  Google Scholar 

  20. Katoch VM. Infections due to non-tuberculous mycobacteria (NTM). Indian J Med Res 2004;120:290–304.

    CAS  PubMed  Google Scholar 

  21. Woods GL, Washington JA 2nd. Mycobacteria other than Mycobacterium tuberculosis: Review of microbiologic and clinical aspects. Rev Infect Dis 1987;9:275–94.

    Article  CAS  Google Scholar 

  22. Lim JM, Kim JH, Yang HJ. Management of infections with rapidly growing mycobacteria after unexpected complications of skin and subcutaneous surgical procedures. Arch Plast Surg 2012;39:18–24.

    Article  Google Scholar 

  23. Orme IM, Ordway DJ. Host response to nontuberculous mycobacterial infections of current clinical importance. Infect Immun 2014;82:3516–22.

    Article  Google Scholar 

  24. Jeong J, Kim SR, Lee SH, Lim JH, Choi JI, Park JS, et al. The Use of High performance liquid chromatography to speciate and characterize the epidemiology of mycobacteria. Lab Med 2011;42:612–7.

    Article  Google Scholar 

  25. Hale YM, Pfyffer GE, Salfinger M. Laboratory diagnosis of mycobacterial infections: New tools and lessons learned. Clin Infect Dis 2001;33:834–46.

    Article  CAS  Google Scholar 

  26. Klatt EC, Jensen DF, Meyer PR. Pathology of Mycobacterium avium-intracellulare infection in acquired immunodeficiency syndrome. Hum Pathol 1987;18:709–14.

    Article  CAS  Google Scholar 

  27. Marchevsky AM, Damsker B, Green S, Tepper S. The clinicopathological spectrum of non-tuberculous mycobacterial osteoarticular infections. J Bone Joint Surg Am 1985;67:925–9.

    Article  CAS  Google Scholar 

  28. Cohen RJ, Samoszuk MK, Busch D, Lagios M. Occult infections with M. intracellulare in bone-marrow biopsy specimens from patients with AIDS. N Engl J Med 1983;308:1475–6.

    CAS  PubMed  Google Scholar 

  29. Wilson ML, Stone BL, Hildred MV, Reves RR. Comparison of recovery rates for mycobacteria from BACTEC 12B vials, middlebrook 7H11-selective 7H11 biplates, and Lowenstein Jensen slants in a public health mycobacteriology laboratory. J Clin Microbiol 1995;33:2516–8.

    Article  CAS  Google Scholar 

  30. Heifets LB. Quantitative cultures and drug susceptibility testing of Mycobacterium avium clinical isolates before and during antimicrobial therapy. Res Microbiol (Paris) 1994;145:188–96.

    Article  CAS  Google Scholar 

  31. García-Agudo L, García-Martos P. Clinical significance and antimicrobial susceptibility of rapidly growing mycobacteria. Science Against Microbial Pathogens: Communicating Current Research and Technological Advances.; 2011. p. 363–77.

  32. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007;175:367–416.

    Article  CAS  Google Scholar 

  33. Lim JM, Kim JH, Yang HJ. Management of infections with rapidly growing mycobacteria after unexpected complications of skin and subcutaneous surgical procedures. Arch Plast Surg 2012;39:18–24.

    Article  Google Scholar 

  34. Bamias G, Daikos GL, Siakavellas SI, Kaltsa G, Smilakou S, Katsogridakis I, et al. Atypical mycobacterial infection presenting as persistent skin lesion in a patient with ulcerative colitis. Case Rep Med 2011;2011:480987.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Manit K. Gundavda.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gundavda, M.K., Patil, H.G., Agashe, V.M. et al. Nontuberculous mycobacterial infection of the musculoskeletal system in immunocompetent hosts. IJOO 51, 205–212 (2017). https://doi.org/10.4103/0019-5413.201718

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.201718

Key words

MeSH terms

Navigation