Wong Khai Phang, Tang Zhi Hao, Tan Gek Meng
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.
Biomedicine (Taipei). 2020 Dec 1;10(4):52-56. doi: 10.37796/2211-8039.1021. eCollection 2020.
Nontuberculous mycobacteria (NTM) infections of the musculoskeletal system are commonly missed due to its rarity and the absence of systemic symptoms. A high clinical index of suspicion is required to recognize such infections as they may occur in immunocompetent hosts. We present two cases of foot and ankle NTM infections involving and in two such patients. The first case involves an 83-year old lady who presented with a two-month history of multiple foot abscesses initially treated at a rural hospital. She underwent drainage and debridement of her foot, with eventual cultures growing and . She was initially treated with clarithromycin and doxycycline. At one year follow-up review, her wound healed completely. The second case involves a 55-year old man who presented with infection following midfoot fusion and anterolateral thigh flap for an open complex fracture dislocation of his right foot. Cultures eventually grew and he was treated with cefoxitin, clarithromycin and doxycycline. 10 months after his initial injury, the infection has cleared and his flap was clean. Through these 2 cases, we hope to highlight the unusual presentations of such infections and illustrate that with a high initial index of suspicion and appropriate treatment, these infections can be treated successfully.
由于肌肉骨骼系统的非结核分枝杆菌（NTM）感染较为罕见且缺乏全身症状，所以常常被漏诊。对于此类感染，由于其可能发生在免疫功能正常的宿主中，因此需要较高的临床怀疑指数才能识别。我们报告两例足部和踝关节NTM感染病例，分别涉及两名此类患者。第一例患者为一名83岁女性，有两个月的足部多处脓肿病史，最初在一家乡村医院接受治疗。她接受了足部引流和清创术，最终培养出[具体菌种1]和[具体菌种2]。她最初接受了克拉霉素和强力霉素治疗。在一年的随访复查中，她的伤口完全愈合。第二例患者为一名55岁男性，因右足开放性复杂骨折脱位接受中足融合和股前外侧皮瓣手术后出现感染。培养最终长出[具体菌种3]，他接受了头孢西丁、克拉霉素和强力霉素治疗。在初次受伤10个月后，感染已清除，皮瓣情况良好。通过这两个病例，我们希望强调此类感染的不寻常表现，并说明通过较高的初始怀疑指数和适当的治疗，这些感染可以成功治愈。
