Nontuberculous mycobacterial skin and soft tissue infection in Hawaiʻi

Abstract

Background Hawaiʻi has the highest nontuberculous mycobacterial (NTM) lung infection prevalence in the United States. Limited data regarding skin and soft tissue infections (SSTI) due to NTM in Hawaiʻi exists. This study describes patient demographics, clinical courses of infection, treatment patterns, and clinical outcomes of NTM SSTIs in Hawaiʻi. Methods A retrospective chart review (n = 50) of patients diagnosed and treated at Hawaiʻi Pacific Health facilities for NTM SSTIs between January 2010 and July 2021 was conducted. Patient demographics, clinical course, and treatment data were collected from electronic medical records. Results Half of the patient population consisted of females, and the average age of patients during infection was 49 years (SD = 25.6). The majority of cases (80%) were caused by rapidly growing mycobacteria (RGM), most commonly Mycobacterium abscessus. NTM SSTI by race were Asian (48%), White (28%), and Native Hawaiian and Other Pacific Islanders (16%). Almost all Asian patients with NTM SSTI were Filipino or Japanese. Diagnosis was frequently delayed. The average time to diagnosis was 116 days. Most patients achieved complete resolution (72%) following a prolonged course of antimicrobial treatment (mean = 196 days) with surgical debridement. Conclusion Increased awareness among physicians and the community of non-mycobacterial skin infections is essential in Hawaiʻi due to the high prevalence of NTM and the high percentage of predisposed populations. Increased awareness of NTM could reduce delayed diagnosis and improve patient care. Further studies are required to inform optimal treatment and diagnostic strategies, improve patient outcomes, and aid public health surveillance efforts.

Gout in Native Hawaiian Patients in Hawaiʻi: Clinical Characteristics and Disparities

“…Race and ethnicity data were provided by patient self‐report at intake and included one primary race. Multiethnic individuals were represented by self‐report of their primary race identification 7,11,12 . Racial and ethnicity data used in this study have more granular racial categories than the combined Native Hawaiian and other Pacific Islander categories used by the US Census.…”

“…Multiethnic individuals were represented by self-report of their primary race identification. 7,11,12 Racial and ethnicity data used in this study have more granular racial categories than the combined Native Hawaiian and other Pacific Islander categories used by the US Census. For this study, patients were categorized by the primary race they reported.…”

“…For this study, patients were categorized by the primary race they reported. Patients who reported a primary race of only Native Hawaiian were included in the Native Hawaiian group 7,11,12 . We excluded other Pacific Islander patients to focus solely on the Native Hawaiian population.…”

“…Hawaiʻi has a distinct racial composition compared to the continental United States, with a higher proportion of Asian Americans, Native Hawaiians, and Pacific Islanders. 7 The Native Hawaiian people consist of an ethnocultural group native to Hawaiʻi. More than 145,000 Native Hawaiian people are living in Hawaiʻi today.…”

Skin and soft tissue infections due to rapidly growing mycobacteria

“…In this study, M. abscessus was the most frequent causative agent, followed by M. fortuitum and M. chelonae. An immunosuppressive condition was present in 52% of patients and iatrogenic trauma (prior surgery, medical procedure, tattooing) was the source of infection in the majority of cases [14].…”