Department of Dermatology, University of Texas Medical Branch, Galveston, Texas.
Department of Dermatology, University of Texas Medical Branch, Galveston, Texas.
J Am Acad Dermatol. 2019 Sep;81(3):730-739. doi: 10.1016/j.jaad.2019.04.022. Epub 2019 Apr 16.
The incidence of cutaneous nontuberculous mycobacteria (NTM) infections is increasing. These infections are a diagnostic and therapeutic challenge.
We investigated the clinical features, diagnosis, and management of cutaneous NTM infections.
A retrospective case series studied 78 patients from a Gulf Coast tertiary referral center diagnosed with cutaneous NTM infection by culture or stain of a skin biopsy specimen.
A history of trauma, procedure, or environmental exposure was common. The mean time between the initial evaluation and diagnosis was 12 weeks. Only 15% of acid-fast bacillus-positive cultures had a positive acid-fast bacillus smear, and only 43% of those accompanied by skin biopsy specimen had a positive Fite stain. Immunosuppressed patients were more likely to have a positive Fite stain. Treatment included surgery and multiple antibiotics. Immunosuppressed patients and Mycobacterium abscessus group infections were more likely to have persistent disease.
M chelonae and M abscessus isolates were indistinguishable and therefore were reported together. Five cases were not confirmed by culture.
Even with clinical suspicion, the diagnosis of NTM infection can be difficult. Results of acid-fast bacillus smears and special stains are frequently negative. Antibiotic resistance is common. Multidrug treatment is often required, and surgical therapy may be needed.
皮肤非结核分枝杆菌（NTM）感染的发病率正在上升。这些感染是诊断和治疗的挑战。
我们研究了皮肤 NTM 感染的临床特征、诊断和治疗方法。
回顾性病例系列研究了来自墨西哥湾沿岸三级转诊中心的 78 例经培养或皮肤活检标本染色诊断为皮肤 NTM 感染的患者。
常见的有创伤、手术或环境暴露史。从最初评估到诊断的平均时间为 12 周。仅 15%的抗酸杆菌阳性培养物抗酸杆菌涂片阳性，仅有 43%的伴有皮肤活检标本的培养物阳性。免疫抑制患者更可能出现 Fite 染色阳性。治疗包括手术和多种抗生素。免疫抑制患者和 M. abscessus 组感染更可能出现持续性疾病。
M. chelonae 和 M. abscessus 分离株无法区分，因此一起报告。有 5 例未通过培养证实。
即使有临床怀疑，NTM 感染的诊断也可能很困难。抗酸杆菌涂片和特殊染色的结果经常为阴性。抗生素耐药很常见。通常需要多药治疗，可能需要手术治疗。
