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Nonmarinum, Nontuberculous Mycobacterial Infections of the Upper Extremity: A Multi-Institutional Descriptive Report
Kevin J Renfree1, Kelly L Scott1, Thomas M Polveroni2
1Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ.
The Journal of Hand Surgery
|May 31, 2022
Summary
Nonmarinum nontuberculous mycobacterial infections (NTMI) of the upper extremity are often misdiagnosed, leading to delayed treatment. Early diagnosis and appropriate management, including debridement and prolonged antibiotics, are crucial for better patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Nonmarinum nontuberculous mycobacterial infections (NTMI) affecting the upper extremity present diagnostic challenges.
- These infections can lead to significant morbidity if not promptly identified and treated.
Purpose of the Study:
- To analyze demographic factors in upper extremity NTMI.
- To assess diagnostic and prognostic values of preoperative tests.
- To identify factors influencing disease recurrence and patient outcomes.
Main Methods:
- Retrospective review of 76 patients with culture-proven upper extremity NTMI from two academic centers.
- Analysis based on pathogen type (rapid vs. slow-growing) and patient immune status.
- Extraction of patient demographics, clinical presentation, treatment, and outcomes.
Main Results:
- The mean patient age was 59 years, with 65% males; 48% had a preceding injury.
- Immunosuppressed patients (41%) experienced longer treatment durations, more complications, and higher recurrence rates.
- One-third of all patients experienced complications or recurrence, necessitating debridement, with 4 requiring amputation.
Conclusions:
- Upper extremity NTMI are frequently misdiagnosed, delaying appropriate care.
- Early suspicion in cases of chronic swelling, lesions, or septic arthritis is vital.
- Diagnosis requires tissue biopsy for histopathology and microbiological analysis; specialist consultation is recommended. Treatment involves debridement and prolonged antibiotics, with a high incidence of adverse reactions.
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