Medical Management for the Treatment of Nontuberculous Mycobacteria Infection of the Parotid Gland: Avoiding Surgery May Be Possible (original) (raw)
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Non-tuberculous mycobacterial infection of the parotid gland in an immunosuppressed adult
Journal of Medical Microbiology, 2008
Infections of the parotid gland with non-tuberculous mycobacteria (NTM) are rarely described. Here, we report on an infection of the parotid gland caused by Mycobacterium avium and give a literature-based overview about this entity. In the light of a global increase of mycobacterial infections, unusual manifestations have to be considered and should be included in the differential diagnosis when dealing with solid lesions of uncertain aetiology in the head and neck region.
Nontuberculous Mycobacterial Infections of the Head and Neck
Archives of Otolaryngology - Head and Neck Surgery, 1994
Non-tuberculous mycobacterial infections of the hand are difficult to treat and require a long time before remission. But how long should we wait to see an improvement? To answer this question, the published scientific literature was reviewed in English, French and German. Tuberculosis, arthritis and osteomyelitis cases were excluded. A total of 241 non-tuberculous mycobacterial hand infections in 38 scientific publications were retrieved. Most were case reports or series. The median age of the patients was 58 years and one third was female. Patients were immunocompromised in 17 episodes. The most common species were Mycobacterium marinum in 198 episodes (82%), followed by M. chelonae in 13 cases (5%). There were no cases of mixed infection. Most infections were aquatic in origin and community-acquired, and were treated with a combination of surgical debridement and long-duration systemic combination antibiotic therapy (14 different regimens; no local antibiotics) for a median duration of 6 months. The median number of surgical procedures was 2.5 (range 1-5). Clinical success was not immediate: a median period of 3 months (range 2-6) was necessary before the first signs of improvement were observed. The majority (173 cases; 76%) remained entirely cured after a median follow-up time of 1.7 years (range, 1-6). Only two microbiological recurrences occurred (1%). However, 49 patients (21%) had long-term sequelae such as pain, stiffness and swelling. The approach of long-duration antibiotic treatment in combination with repeated surgery for mycobacterial soft tissue infections of the hand leads to few recurrences. However, clinical success is not immediate and may take up to 3 months. Type of study.-Therapeutic study: systematic review of level III studies. Level of evidence.-III.
Nontuberculous mycobacterial adenitis in children: Diagnostic and therapeutic management
American Journal of Otolaryngology, 2003
We reviewed a series of 45 patients affected by nontuberculous mycobacterial adenitis of the neck observed in the Ear, Nose, and Throat Institute of S. Orsola-Malpighi Hospital-Bologna over a 20-year period between 1981 and 2001. The mean age was 5.5 years. Patients were tested by using the differential Mantoux test, which was the principal diagnostic tool in the case of atypical mycobacterial infections. Forty-two patients were surgically treated by total excision of infected nodes, whereas parotidectomy with sparing of facial nerve was performed in those 3 cases with intraparotid nodes involvement. In all cases, the histopathological diagnosis was tubercular granulomatous lymphadenitis. The culture growth of nontuberculous mycobacteria was positive in 13 cases with a marked prevalence of the avium-intracellular germs. The disease was eradicated in all patients. The diagnostic and therapeutic management of nontuberculous mycobacterial adenitis is discussed in this retrospective study.
BMC Infectious Diseases
Background: Soft tissue or skin infections due to nontuberculous mycobacteria (NTM) have been reported frequently and are mostly associated with trauma or cosmetic interventions like plastic surgery. However, infection with NTM as a result of a dental procedure have rarely been described and the lack of clinical suspicion and a clear clinical manifestation makes diagnosis challenging. Case presentation: We report on three patients with a facial cutaneous sinus tract of dental origin, due to an infection with respectively Mycobacterium fortuitum, M. abscessus and M. peregrinum. The infection source was the dental unit waterlines (DUWLs), which were colonized with NTM. Conclusions: Water of the DUWL can pose a health risk. This report emphasizes the need for quality control and certification of water flowing through DUWLs, including the absence of NTM. Our report also shows the need for a rapid recognition of NTM infections and accurate laboratory diagnosis in order to avoid long-term ineffective antibiotic treatment.
A B S T R A C T Nontuberculous mycobacterial (NTM) adenitis of the head and neck region is well-described in healthy children, most commonly presenting under the age of 5 years. Extrac-ervicofacial NTM adenitis is less common. We present a case of NTM inguinal adenitis in a 2-year-old girl, followed by a systematic review of the literature. A previously healthy girl, aged 2 years and 9 months, who lived on a ranch in northern New Mexico was seen by her primary care provider with a 3-week history of a right-sided inguinal swelling. She had cut her right foot several weeks prior and frequently played in the animal pastures barefoot. No erythema, fever, or pain was present. Initial examination was concerning for an inguinal adenitis. Five-day courses of amoxicillin–clavulanate, followed by trimethoprim-sulfamethoxazole failed to improve her condition. Ultrasonography at this time revealed matted lym-phadenopathy. Six and 10 days after her ultrasound, she underwent fine-needle aspiration (FNA) of the involved lymph nodes, which produced negative Gram stains and sterile bacterial cultures. Following the last FNA, a thick, cream-colored discharge was noted from the aspiration site, and she developed violaceous discoloration over the region. The site remained nontender, and she was otherwise well. Two weeks after the last aspiration, she underwent a third FNA, which was sent for acid-fast bacillus (AFB) stain and culture. AFB stains were positive, and her culture ultimately grew