Nontuberculous mycobacterial infections of the face and neck--practical considerations

Cervicofacial nontuberculous mycobacterial (NTM) infections are a diagnostic and therapeutic dilemma which may be encountered by the Otolaryngologist. A review of the world's literature indicates that these infections are being diagnosed more frequently and that they far outnumber cervical infections by Mycobacterium tuberculosis. The organisms are ubiquitous. The portal of entry may be through a small defect in the skin or mucosa. They rarely, if ever, cause serious systemic illness. Diagnosis is by culture of the organism, however, cultures are usually not available at the time the patient is treated. Treatment, then, must be based on the results of skin tests, examination of pus and tissue, a "typical clinical presentation," and elimination of other diseases. The differential diagnosis is extensive. This review reports 21 patients with proven or suspected NTM infections of the face and neck. Eight of these patients were treated by traditional methods utilizing completed excision and, in some cases, drug therapy. Eleven were treated by curettage alone, and two more by curettage and drugs. The results were excellent by all of these forms of treatment. These findings support the proposition that curettage is a simple, safe, and effective method of treatmenting cervicofacial NTM infections and should be utilized as the primary treatment in all suspected or proven cases of this disease. The method dose not exclude other forms of treatment being utilized if they should be required.