Nontuberculous mycobacterial osteomyelitis

Abstract

Osteomyelitis caused by nontuberculous mycobacteria (NTM) can have severe consequences and a poor prognosis. Physicians therefore need to be alert to this condition, especially in immunocompromised patients. Although the pathogenesis of NTM osteomyelitis is still unclear, studies in immunodeficient individuals have revealed close relationships between NTM osteomyelitis and defects associated with the interleukin-12–interferon-γ–tumor necrosis factor-α axis, as well as human immunodeficiency virus infection, various immunosuppressive conditions, and diabetes mellitus. Culture and species identification from tissue biopsies or surgical debridement tissue play crucial roles in diagnosing NTM osteomyelitis. Suitable imaging examinations are also important. Adequate surgical debridement and the choice of appropriate, combined antibiotics for long-term anti-mycobacterial chemotherapy, based on in vitro drug susceptibility tests, are the main therapies for these bone infections. Bacillus Calmette–Guerin vaccination might have limited prophylactic value. The use of multiple drugs and long duration of treatment mean that the therapeutic process needs to be monitored closely to detect potential side effects. Adequate duration of anti-mycobacterial chemotherapy together with regular monitoring with blood and imaging tests are key factors determining the recovery outcome in patients with NTM osteomyelitis.

The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature

“…In our experience, this is not the case except in mycobacterial osteomyelitis where samples may need specific culture mediums 42 and can be treated with antibiotic therapy alone. 43 , 44 Romano's classification may be intended for descriptive purposes only, and to the best of our knowledge, has not been validated clinically. Others reported that the number and type of organism are reported not to have a bearing on the outcome of treatment.…”

Nontuberculous mycobacterial infection of the musculoskeletal system in immunocompetent hosts

“…Clinically important species by group include Mycobacterium kansasii and Mycobacterium marinum (Group I); Mycobacterium gordonae and Mycobacterium scrofulaceum (Group II); Mycobacterium avium intracellulare and Mycobacterium ulcerans (Group III); and M. fortuitum , M. chelonae , Mycobacterium abscessus (Group IV) 311. Out of these, NTM strains often acquired by trauma are M. fortuitum , M. chelonae , and M. marinum 221…”

Osteomyelitis due to multiple rare infections in a patient with idiopathic CD4 lymphocytopenia

“…In a study from 1998 to 2011, 29 patients were diagnosed with musculoskeletal NTM infection (4). The treatment for NTM osteomyelitis is complicated requiring surgical debridement and long term chemotherapy (14). It is important to identify the NTM up to species level as the management is considerably different for different species.…”