1639. A Descriptive Analysis of Nontuberculous Mycobacterial Infections (NTM) of the Upper Extremity
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Al Knawy-3300008_F.pdf (3.0 MB)
  • Background: NTM are frequently reported as a cause of bone and soft-tissue infections of the upper extremities mainly in the hand and wrist. Limited information exists on clinical characteristics and treatment outcomes of patients with NTM infections of the upper extremity.

    Methods: A retrospective analysis was conducted of NTM infections of the upper extremity at Mayo Clinic Florida from December 2000 through December 2012.  Only patients with positive mycobacterial cultures from the upper extremities were included.  Data collection included demographic, radiologic and clinical characteristics, mycobacterial culture results, time to diagnosis and treatment outcomes. 

    Results: Forty-one patients were included; 70% were male and mean age was 59 ±18.2 years. 16 (39%) patients were diagnosed with skin/soft tissue infections and 14 (34%) had tenosynovitis. 26 (63%) patients were immunosuppressed. The most common underlying medical conditions were rheumatologic disorders (41%) and diabetes (17%).  16 (39%) patients were on glucocorticosteroids and 11 (27%) on TNF-α inhibitors at the time of diagnosis. Injuries to the affected extremity were reported in 61%. Fishing (20%) and gardening (12%) were the most common reported exposures.  Signs and symptoms of infection were localized to the skin in 61%, and joints in 51%.  Mycobacterium marinum (34%) and Mycobacterium chelonae/abscessus (34%) were the most commonly identified organisms. Radiologic studies were available in 29 (71%) patients.  Average time to clinical evaluation from onset of symptoms was 2.6 months and time to diagnosis from initial clinical evaluation was 4.4 months. 40 (97.5%) patients were treated. 27 (68%) patients received combined antimicrobial and surgical debridement, 9 (22%) with antimicrobial treatment alone, and 4 (10%) with surgical debridement alone.  25 (61%) patients were cured; 4 (9.8%) relapsed after treatment; 3 (7.3%) failed all treatment modalities, 6 (14.6%) were lost to follow-up, and 3 (7.3%) died of the infection.

    Conclusion: Diagnosis of NTM infections is often delayed given its indolent presentation and lack of clinical suspicion. Health care professionals should be aware of the increasing incidence of soft tissue NTM infections after percutaneous injuries, especially in immunosuppressed patients for prompt management.

    Moataz S. Al-Knawy, MBBS1, Wendelyn Bosch, MD1, Hillary W. Garner, MD2, John J. Cawley, M.M.Sc3, Peter M. Murray, MD4, Stephen D Trigg4, Lisa Brumble, MD1 and Salvador Alvarez, M.D.1, (1)Infectious Diseases, Mayo Clinic Florida, Jacksonville, FL, (2)Radiology, Mayo Clinic, Jacksonville, FL, (3)Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL, (4)Orthopedics, Mayo Clinic, Jacksonville, FL


    M. S. Al-Knawy, None

    W. Bosch, None

    H. W. Garner, None

    J. J. Cawley, None

    P. M. Murray, None

    S. D. Trigg, None

    L. Brumble, None

    S. Alvarez, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.