Mycobacterium chelonae and Mycobacterium fortuitum infection following open fracture: A case report and review of the literature

Abstract

We report a case of dual nontuberculous mycobacterial infections complicating an open distal radius and ulna fracture after polytrauma in a 35-year-old man. There was persistent wound discharge after definitive fixation of this fracture, but microbiological cultures did not yield any organism. The patient underwent multiple debridement, and subsequent tissue grew Mycobacterium chelonae and Mycobacterium fortuitum. Despite appropriate chemotherapy and surgical debridement the infection persisted until radical bone excision and tissue debridement were done. This case indicates that nontuberculous mycobacterial infections should be considered when conventional microbiological assays fail to identify the infecting agent in suspected osteomyelitis following open fracture. A combination of radical debridement, including removal of infected bone, and prolonged antimicrobial therapy are required to eradicate the infection completely.

Nontuberculous mycobacterial osteomyelitis

“…Many slow-growing NTM species have demonstrated the ability to cause NTM osteomyelitis, including M. avium-intracellulare complex (MAC) [ 3 , 8–48 ], M. ulcerans [ 49–51 ], M. marinum [ 52–57 ], M. kansasii [ 9 , 33 , 36 , 58–63 ], M. xenopi [ 64–66 ], M. gordonae [ 67 ], M. haemophilium [ 33 , 68 , 69 ], M. scrofulaceum [ 45 , 70 ], M. szulgai [ 71–74 ], M. longobardum [ 75 ], and M. flavescens [ 76 ]. Among the rapidly growing mycobacteria, osteomyelitis can be caused by M. abscessus [ 3 , 77–81 ], M. fortuitum [ 82–94 ], M. chelonae [ 5 , 25 , 83 , 95–104 ], M. smegmatis [ 105 ], M. peregrinum [ 82 ], and M. thermoresistibile [ 106 ]. Some authors have argued that the otomastoiditis attributed to M. fortuitum or M. chelonae was actually caused by M. abscessus [ 107 ], though this disagreement is actually a taxonomic issue.…”

Extensive infection of face by mycobacterium chelonae: An unusual presentation

“…[34] Mycobacterium fortuitum is reported from injection abscess, postoperative infections. [45] While cases of Mycobacterium chelonae infection are reported from postoperative wound infections and a case from open fracture,[67] M. chelonae has been associated with prosthetic valve endocarditis and central line infections. It can cause keratitis in contact lens wearers and wound infection after ocular surgery, including LASIK surgery or postcataract lens replacement surgery.…”

Laboratory aspects of clinically significant rapidly growing mycobacteria

“…M. fortuitum and M. chelonae dual infection following open fractures has been reported. [31] M. goodii and M. wolinskyi have also been associated with osteomyelitis. [7] Central nervous system disease CNS disease involving RGM is rare.…”