Mycobacterium fortuitum and Mycobacterium abscessus infections in the foot and ankle in two immunocompetent patients

Abstract

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 Mycobacterium fortuitum and Mycobacterium abscessus 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 Pseudomonas aeruginosa and Mycobacterium abscessus. 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 Mycobacterium fortuitum 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.

A clinical case and a review of Mycobacterium fortuitum infections direct diagnosis approach and treatment in a patient with leg fractures

“…The language was restricted to English. The literature review showed 6 cases of M. fortuitum complex associated with open fracture infection (Table 2) [1,4,[25][26][27][28]. Osteomyelitis is a known complication of open fracture, but M. fortuitum infections are very rare.…”

“…Non-tuberculous mycobacteria (NTM), excluding Mycobacterium tuberculosis and Mycobacterium leprae, is an opportunistic pathogen, widely present in natural environments such as water, soil, dust, vegetables, domestic animals, and dairy products [1]. In recent years, the incidence of NTM infections is on the rise worldwide.…”

Antimicrobial susceptibility testing using MYCO test-system and MIC distribution of 8 drugs against clinical isolates from Shanghai of Nontuberculous Mycobacteria

“…To combat the growing clinical burden of multidrug-resistant NTM, novel and repurposed drugs have been tested both in vitro and in vivo. Based on the commonly used anti-NTM antibacterial drugs, 8 drugs were repurposed, namely, vancomycin (VA), bedaquiline (BDQ) (5), delamanid (DLM) (6), faropenem (FAR) (7), meropenem (MPM), clofazimine (CFZ) (8)(9)(10), avibactam (CAZ) (11), and Cefoxitin (FOX) (12) were selected in this study to evaluate drug sensitivity in vitro. These drugs may have antimicrobial activity against different NTM species, although only limited data to support this are available.…”

Mycobacterium fortuitum osteomyelitis of the cuboid bone treated with CERAMENT G and V: a case report

“…Mycobacterium fortuitum (M. fortuitum) is a fast-growing, gram-positive, opportunistic human pathogen belonging to the nontuberculous mycobacteria (NTM) family that is commonly found in water and soil. NTM infection of the musculoskeletal tissue is a rare disease that may occur in both immunocompetent and immunocompromised individuals; moreover, it is commonly missed or its diagnosis is delayed due to the absence of systemic symptoms and the difficulty involved with isolating the pathogen (Wong et al, 2020;Kasperbauer and Daley, 2020).…”

“…Several surgical procedures are available to deliver antibiotics locally and manage bone defects, with these treatments mainly differing with respect to the material used to fill the defect, such as autologous bone grafting or antibiotic-loaded cement-based grafts (Wassif et al, 2021). Although a few reports have described M. fortuitum osteomyelitis of the cuboid bone (Vasiliadis et al, 2021;Miron et al, 2000;Wong et al, 2020), this is the first case, to our knowledge, in which bone defect restoration has been performed with a single-stage treatment using absorbable, gentamicin-and vancomycin-loaded, calcium sulfate-hydroxyapatite biocomposites.…”