Soft Tissue Infection Caused by Rapid Growing Mycobacterium following Medical Procedures: Two Case Reports and Literature Review

Non-tubecrulosis mycobacterium infections were increasingly reported either pulmonary or extrapulmonary in the past decades. In Taiwan, we noticed several reports about the soft tissue infections caused by rapid growing mycobacterium such as Mycobacterium abscessus, Mycobacterium chelonae, on newspaper, magazines, or the multimedia. Most of them occurred after a plastic surgery, and medical or non-medical procedures. Here, we reported two cases of these infections following medical procedures. We also discussed common features and the clinical course of the disease, the characteristics of the infected site, and the treatment strategy. The literatures were also reviewed, and the necessity of the treatment guidelines was discussed.     

针灸致脓肿分枝杆菌感染一例

患者女,59岁,因躯干结节、斑块伴疼痛2月余,于2014年10月至我院就诊。体检：一般情况尚可,各系统检查无特殊。皮肤科检查：背部、臀部散在数个蚕豆大小红色结节及鸽蛋大小斑块,质地较硬,部分结节破溃,见稀薄浆液性分泌物渗出（图1）,诊断为疖肿。给予口服头孢克洛,外用金黄散,但结节继续增大,部分融合成浸润性斑块,未见破溃。斑块、结节处组织病理：表皮大致正常,真皮浅层毛细血管周围少量炎症细胞浸润,真皮下方及皮下脂肪内纤维组织增生,另见较多嗜酸性粒细胞、淋巴细胞及组织细胞浸润（图2）……     

Cutaneous Mycobacterium massiliense Infection of the Sole of the Feet

Mycobacterium massiliense which is recognized as a separate species from M. abscessus is little known regarding its clinical patterns and the response to treatment. We present a case of a localized cutaneous infection due to M. massiliense of the sole associated with acupuncture. M. massiliense was identified via polymerase chain reaction-hybridization analysis. We treated the patient with single-drug therapy consisting of clarithromycin for 4 months and the patient showed a significant response to this treatment.     

Extensive Infection of Face by Mycobacterium chelonae: An Unusual Presentation

Mycobacterium chelonae is a rapidly growing mycobacteria, causes cutaneous, soft tissue, and rarely lung infections. Here we present a rare case of extensive infection of face at multiple sites by Mycobacterium chelonae, with an unusual presentation, diagnosed by using conventional methods.     

A Pediatric Case of Atypical Mycobacterium avium Infection of the Skin

We report a case of cutaneous atypical mycobacteriosis in a 12-year-old healthy girl due to Mycobacterium avium. The cutaneous symptoms were three well-defined subcutaneous nodules on both buttocks and on the posterior surface of the left thigh. One had a fistulous opening on the skin surface. Histopathological examination revealed epithelioid cell granulomas surrounded by dense lymphocytic infiltration and acid-fast bacteria were seen with modified periodic acid-carbol fuchsin staining. Using Ogawa's medium at 37°C, acid-fast bacteria were isolated from the biopsied specimen and identified by the DNA-DNA hybridization method as Mycobacterium avium. In drug susceptibility test, these were resistant to all antituberculous drugs. Oral administration of minocycline 100 mg/day for two months had little effect on the two remaining lesions, which were therefore excised. Based upon reported cases of Mycobacterium avium complex, we considered that our pediatric patient with multiple intradermal or subcutaneous nodules on the buttocks and the thigh exhibited the characteristic symptoms of M. avium infection.     

Cutaneous Mycobacterium fortuitum Infection: Successfully Treated with Amikacin and Ofloxacin Combination

Cutaneous infections caused by atypical mycobacteria are uncommon and the diagnosis can be missed unless there is strong clinical suspicion supported by laboratory confirmation. We report a case of chronic discharging sinus caused by Mycobacterium fortuitum in a young healthy immunocompetent individual. The patient recovered completely following amikacin and ofloxacin therapy.     

Mycobacterium abscessus skin infection after tattooing - Case report

Mycobacterium abscessus is a rapidly growing mycobacterium that has been affecting people undergoing invasive procedures, such as videosurgery and mesotherapy. This bacterium has global distribution, being found in numerous niches. The frequency of published reports of infection by rapidly growing mycobacteria associated with tattooing procedures has increased in recent years. However, in Brazil there were no case reports of M. abscessus after tattooing in the literature until now. In this paper, we describe the case of a patient with a nine-month history of lesion on a tattoo site. The diagnosis of infection with Mycobacterium abscessus was established by correlation between dermatological and histopathological aspects, culture and molecular biology techniques. The patient had significant improvement of symptoms with the use of clarithromycin monotherapy.     

Disseminated folliculitis by Mycobacterium fortuitum in an immunocompetent woman

Mycobacterium fortuitum is a non-tuberculous fast-growing mycobacterium which is frequently acquired from environmental sources such as soil and water. Since it is an opportunist pathogen, it is associated with trauma, surgery or immunodeficiency. The current report describes a case of Mycobacterium fortuitum-caused disseminated lesions on the skin of an immunocompetent patient.     

脓肿分枝杆菌致全身播散性皮肤感染一例

目的 报道1例罕见的全身播散性脓肿分枝杆菌皮肤感染.方法 对患者作全面临床检查.应用流式细胞仪检测患者细胞免疫水平,同时进行组织病理检查、组织培养.用PCR-RFIJP、基因测序方法对分离自患者皮损的分枝杆菌做鉴定.结果 患者女,22岁,1年多前,无明显诱因面颈部出现对称性红斑,并在此基础上渐出现丘疹、结节和斑块,逐渐扩展至躯干四肢;患者CD4⁺T细胞低于正常,HIV抗体检测阴性.对皮损进行两次多管体外培养,3～5天后,Löwenstein-Jensen培养基上(37℃和32℃)出现阳性菌落.PCR-RFLP比较分析发现,临床分离株的酶切(BstEⅡ和HaeⅢ)图谱与脓肿分枝杆菌的酶切图谱相符合;对临床分离株的hsp65、16S rRNA基因进行了序列分析,发现该二序列与脓肿分枝杆菌同源性最接近,分别是99.75%和100%.予以患者口服利福平、异烟肼、左氧氟沙星、克拉霉素,胸腺肽肌内注射,2个月后皮损明显好转.复查该患者的免疫状况,CD4⁺T细胞已在正常范围;6个月后颈部、躯干及四肢皮损基本痊愈.结论 结合表型特征、DNA酶切图谱和序列分析,临床分离株符合脓肿分枝杆菌;抗生素联合化疗辅以免疫调节剂综合治疗有效.     

面部脓肿分枝杆菌感染2例

报告2例美容注射手术后面部感染脓肿分枝杆菌.例1.女,32岁.肉毒素注射1周后面部出现多发脓肿.例2.女,35岁.面部自体脂肪填充术2周后注射部位出现多发性脓肿.通过对2例患者脓液行各项检查鉴定出脓肿分枝杆菌,证实2例患者均为脓肿分枝杆菌感染.例1治疗3个月后基本痊愈,例2仍在随访中.     

美容注射术后皮肤脓肿分枝杆菌感染临床分析

对2018年12月至2019年12月我院确诊的7例皮肤脓肿分枝杆菌感染患者的临床资料进行回顾性分析。本文患者均在非正规医院行美容注射术,术后注射部位都发生脓肿分枝杆菌感染。7例患者均为多发皮损,且为美容注射后发病,表现为红斑、结节、脓肿、溃疡。病理呈感染性肉芽肿改变。6例皮损组织脓液培养结果为脓肿分枝杆菌,1例行组织PCR扩增提示脓肿分枝杆菌感染。诊断为皮肤脓肿分枝杆菌感染。给予克拉霉素、利福平、左氧氟沙星治疗,皮损均消退,随访半年无复发。     

肺炎克雷伯杆菌致皮肤感染1例

患者男,43岁。大腿、臀部环形红斑、糜烂半年。右侧大腿内侧及臀部出现少量红斑、丘疹,伴瘙痒,并出现表皮坏死、溃疡。血WBC 5.79×109/L,N0.574,L0.345,Hb 151g/L,PLT139×109/L。皮损组织病理检查提示慢性炎症改变。多次治疗效果欠佳,行皮损分泌物细菌培养示肺炎克雷伯杆菌感染。予庆大霉素8万u/d肌注共3天,口服头孢克肟片200mg/d,同时予庆大霉素溶液湿敷,3次/d。治疗后病情明显好转。     

脓肿分枝杆菌临床分离株药物敏感性初探

目的:分析脓肿分枝杆菌临床分离株对常用抗生素的体外药物敏感性.方法:临床菌株分离自2019年9月至2021年6月就诊于陆军军医大学大坪医院皮肤科的脓肿分枝杆菌皮肤软组织感染患者,用微量肉汤稀释法检测其对克拉霉素、阿奇霉素、阿米卡星、莫西沙星、环丙沙星、米诺环素、美罗培南、利奈唑胺、异烟肼、利福平、头孢西丁的最小抑菌浓度...     

Cutaneous Mycobacterium massiliense Infection Caused by Skin Coining ‘Gua Sha’ in Korean Healthy Female

Nontuberculous mycobacteria are ubiquitous environmental organisms that are rare pathogens in immunocompetent individuals. However, cutaneous nontuberculous mycobacteria infections have been increasingly associated with invasive procedures, including surgery, liposuction, filler injection, intramuscular injection, mesotherapy, piercing, acupuncture, and cupping therapy. Herein, we report the first case of cutaneous nontuberculous mycobacteria infection caused by the East-Asian traditional treatment ‘Gua Sha’, also known as scraping, coining or spooning in English. A 35-year-old healthy female presented with widespread, painful skin nodules and pustules on her upper and lower extremities that had developed after Gua Sha treatment for body contouring. Histopathologic examination of the lesions revealed granulomatous inflammation in the dermis and the culture isolates were identified as Mycobacterium massiliense with molecular identification. The patient was successfully treated with intermittent incision and drainage of persistent nodules and oral clarithromycin based on antimicrobial susceptibility testing. We recommend implementation of a standard safety protocol for Gua Sha practitioners to minimize the risk of infection transmission.     

Buruli ulcer: Advances in understanding Mycobacterium ulcerans infection

Buruli ulcer (BU), caused by the environmental organism Mycobacterium ulcerans and characterized by necrotizing skin and bone lesions, poses important public health issues as the third most common mycobacterial infection in humans. Pathogenesis of M ulcerans is mediated by mycolactone, a necrotizing immunosuppressive toxin. First-line therapy for BU is rifampin plus streptomycin, sometimes with surgery. New insights into the pathogenesis of BU should improve control strategies.     

A Case of Fulminant Varicella Infection with Purpura Fulminans,Hepatitis, and Rhabdomyolysis

Varicella zoster virus causes varicella which is a common disease. Generally it is self-limiting, and treatment is often unnecessary, but severe or life-threatening complications are rarely seen. We report a case of fulminant varicella complicating with purpura fulminans, hepatitis, and probable rhabdomyolysis in a previously healthy child.     

Allergic Urticaria: A Case Report of Rare Skin Allergy with a Common Mouthwash

Chlorhexidine is a widely used antiseptic and disinfectant in medical and non-medical environments. Compared to its ubiquitous use, allergic contact dermatitis from chlorhexidine has rarely been reported and so its sensitization rate seems to be low. Chlorhexidine has been used for more than 50 years but it was only in the last two decades, that reports of immediate- type reactions to chlorhexidine were seen. Reactions ranging from localized urticaria to anaphylactic shock and hypersensitivity reactions, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions, and photosensitivity reactions, began to appear more frequently. However the prevalence of contact urticaria and anaphylaxis due to chlorhexidine remains to be unknown. In this case report we have reported a case of urticaria due to oral use of chlorhexidine. The adverse reaction was confirmed by a skin prick test.     

Onychomycosis Caused by Chaetomium globosum

Onychomycosis is usually caused by dermatophytes, but some nondermatophytic molds and yeasts are also associated with invasion of nails. The genus Chaetomium is a dematiaceous nondermatophytic mold found in soil and plant debris as a saprophytic fungus. We report the first Korean case of onychomycosis caused by Chaetomium globosum in a 35-year-old male. The patient showed brownish-yellow discoloration and subungual hyperkeratosis on the right toenails (1st and 5th) and left toenails (1st and 4th). Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud''s dextrose agar (SDA) without cycloheximide slants showed the same fast-growing colonies, which were initially velvety white then turned to dark gray to brown. However, there was no growth of colony on SDA with cycloheximide slants. Brown-colored septated hyphae, perithecia and ascospores were shown in the slide culture. The DNA sequence of internal transcribed spacer region of the clinical sample was a 100% match to that of C. globosum strain ATCC 6205 (GenBank accession number {"type":"entrez-nucleotide","attrs":{"text":"EF524036.1","term_id":"146706231","term_text":"EF524036.1"}}EF524036.1). We confirmed C. globosum by KOH mount, colony, and light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical amorolfine 5% nail lacquer for 3 months.     

Identification of Cutaneous Mycobacterium massiliense Infections Associated with Repeated Surgical Procedures

Mycobacterium massiliense, an emerging pathogen that is increasingly reported as a causative agent in infections occurring during medical procedures, is difficult to be identified using conventional methods. Here we report the case of a cutaneous M. massiliense infection that was associated with repeated surgical procedures and that was identified via a comparative sequence analysis of rpoB and hsp65. The patient showed a substantial response to treatment with a combination of antimicrobial therapies consisting of clarithromycin, amikacin, and cefoxitin for 6 months.