Nontuberculous Mycobacterial Skin Infections: A 20-Year Retrospective Study
Abstract
Background: Cutaneous nontuberculous mycobacterial infections can present with a wide variety of clinical and histopathological features, and there are currently no standard treatment guidelines. Objectives: To investigate the clinical characteristics, histopathologic findings, treatment protocols and clinical outcomes of patients with nontuberculous mycobacterial skin infections. Materials and Methods: The medical records of patients with culture-positive cutaneous nontuberculous mycobacterial infections who attended granuloma clinic at the Department of Dermatology, Siriraj Hospital, between January 1994 and December 2014 were reviewed retrospectively. Results: Of 98 culture-positive patients, 37 (37.8%) were male, 61 (62.2%) were female, and the mean age was 42.53 (±16.39) years. Legs were the most common affected site. Plaques, nodules, and papules were the most observed presenting morphologies. The major causative organisms were rapidly growing mycobacteria, especially Mycobacterium abscessus (36.6%). The most frequent histopathologic findings were mixed cell granuloma and suppurative granuloma. In vitro antimicrobial resistance rates of rapidly growing mycobacteria were higher than Mycobacterium marinum. Empirically, clarithromycin combined with ciprofloxacin was prescribed for rapidly growing mycobacteria (RGM) infections, and doxycycline for M. marinum infections. The overall response rate was 95.5%. Conclusion: Cutaneous lesions with a high index of suspicion of nontuberculous mycobacterial infections are recommended to request for histopathological study, microbiological culture, and antimicrobial susceptibility test. For localized RGM skin infections, a proper initial empirical protocol is a combination therapy with macrolide-based regimens, such as clarithromycin and ciprofloxacin. Doxycycline monotherapy is effective for M. marinum infection. The treatments can be modified based on laboratory reports and clinical responses.
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