A Cluster of Nontuberculous Mycobacterial Tenosynovitis Following Hurricane Relief Efforts

Abstract

Background Non-tuberculous mycobacteria (NTM) are a rare cause of infectious tenosynovitis of the upper extremity. Using molecular methods, clinical microbiology laboratories are increasingly reporting identification down to the species level. Improved methods for speciation are revealing new insights into the clinical and epidemiologic features of rare NTM infections. Methods We encountered three cases of epidemiologically linked upper extremity NTM tenosynovitis associated with exposure to hurricane-damaged wood. We conducted whole genome sequencing to assess isolate relatedness followed by a literature review of NTM infections involving the upper extremity. Results Despite shared epidemiologic risk, the cases were caused by three distinct organisms. Two cases were rare infections caused by closely related but distinct species within the M. terrae complex that could not be differentiated by traditional methods. The third case was caused by M. intracellulare. An updated literature review focusing on articles using modern molecular speciation methods found that several species within M. terrae complex are increasingly reported as a cause of upper extremity tenosynovitis, often in association with environmental exposures. Conclusions These cases illustrate the importance of molecular methods for speciating phenotypically similar NTM, as well as the limitations of laboratory-based surveillance in detecting point-source outbreaks when the source is environmental and may involve multiple organisms.

Nontuberculous Mycobacteria: Ecology and Impact on Animal and Human Health

“…Extrapulmonary mycobacterioses have been described primarily as skin infections. The following species of NTM have been demonstrated: tattoo-associated cutaneous Mycobacterium (M.) mageritense infection [ 28 ], M. marinum hand infection masquerading as tinea manuum [ 29 ] and the treatment and outcome of M. marinum infections in 40 patients in the Netherlands [ 30 ], M. terrae and M. intracellulare tenosynovitis following hurricane relief efforts in the USA [ 31 ], and M. smegmatis skin infection following cosmetic procedures [ 32 ]. Two M. abscessus outbreaks at pediatric dental clinics were documented with more than 20 confirmed infected children with a median age of 6 years in both clinics in Atlanta, Georgia [ 4 ], and Anaheim, California [ 33 ].…”

A neonate with multiple hand flexor tendon ruptures due to methicillin-susceptible Staphylococcus aureus sepsis: a case report

“…Intravenous antibiotics should be administered within 24 h of the onset of symptoms because delayed treatment can worsen the prognosis, including dysfunction such as limited range of motion of finger joints and amputation [ 1 – 3 ]. Since there are no reports of neonates, data from adults indicate that complications occur in 38% of pyogenic tenosynovitis, including stiffness, deformity, deep infection, adhesions, persistent infection, tendon necrosis [ 2 ], and tendon rupture after infection [ 4 , 5 ]. Poor prognostic factors include beta-hemolytic group A streptococci, and delayed surgical management [ 6 ].…”

A Neonate with Multiple Hand Flexor Tendon Ruptures due to Methicillin-susceptible Staphylococcus aureusSepsis: A Case Report

“…Intravenous antibiotics should be administered within 24 hours of the onset of symptoms because delayed treatment can worsen the prognosis, including dysfunction such as limited range of motion of nger joints and amputation [1][2][3]. Since there are no reports of neonates, data from adults indicate that complications occur in 38% of pyogenic tenosynovitis, including stiffness, deformity, deep infection, adhesions, persistent infection, tendon necrosis [2], and tendon rupture after infection [4,5]. Poor prognostic factors include beta-hemolytic group A streptococci, and delayed surgical management [6].…”