Muthusami John C, Vyas Frederick L, Mukundan Umadevi, Jesudason Mark Ranjan, Govil Sanjay, Jesudason S R Banerjee
Department of Surgery, Christian Medical College and Hospital, Vellore 632-004, India.
ANZ J Surg. 2004 Aug;74(8):662-6. doi: 10.1111/j.1445-1433.2004.03018.x.
Mycobacterium fortuitum is an uncommon cause of soft tissue infections. Treatment is often inadequate with persistence of infection unless the aetiological agent and its antibiotic sensitivity are accurately established.
Medical records of 23 patients with chronic soft tissue infection caused by M. fortuitum over a 12-year period from 1991 to 2002 were studied.
In 20 patients the cause was iatrogenic, following intramuscular injections (12), laparoscopy (5) and other surgical procedures (3) and in three patients discharging sinuses developed spontaneously. Patients presented with recurrent abscesses or chronic discharging sinuses that did not respond to conventional surgical drainage. The diagnosis was established by isolating M. fortuitum from the tissues in all cases. The treatment consisted of a more aggressive surgical intervention in form of excision, debridement and extensive lay open with curettage and prolonged administration of appropriate antibiotics. The organism showed maximum sensitivity to amikacin and ciprofloxacin. Healing occurred in all cases. Three patients suffered recurrences: two responded to further debridement and antibiotics and are well at 2 and 5 years, respectively.
A high index of suspicion based on clinical presentation is essential to diagnose M. fortuitum as a cause of soft tissue infection. Treatment involves aggressive surgical debridement and administration of combination antibiotics based on sensitivity, which should be continued for a period that will ensure complete healing and prevent recurrence.
偶然分枝杆菌是软组织感染的罕见病因。除非准确确定病原体及其抗生素敏感性，否则治疗往往不充分，感染会持续存在。
研究了1991年至2002年12年间23例由偶然分枝杆菌引起的慢性软组织感染患者的病历。
20例患者的病因是医源性的，包括肌肉注射后（12例）、腹腔镜检查后（5例）和其他外科手术后（3例），3例患者的窦道是自发形成的。患者表现为复发性脓肿或慢性窦道，对传统手术引流无反应。所有病例均通过从组织中分离出偶然分枝杆菌确诊。治疗包括更积极的手术干预，如切除、清创、广泛切开并刮除，以及长期使用适当的抗生素。该菌对阿米卡星和环丙沙星敏感性最高。所有病例均治愈。3例患者复发：2例经进一步清创和抗生素治疗后分别在2年和5年时情况良好。
基于临床表现的高度怀疑指数对于将偶然分枝杆菌诊断为软组织感染的病因至关重要。治疗包括积极的手术清创和根据敏感性使用联合抗生素，抗生素应持续使用一段时间以确保完全愈合并防止复发。
