Atypical Mycobacterial Diseases Treatment & Management

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 2, 2011
 

Medical Care

Infections with atypical mycobacteria can be treated with a variety of antibiotics. Clarithromycin has shown good efficacy against a broad range of atypical mycobacteria, but some organisms are resistant, and proper sensitivities must be obtained.

Effective treatment of M kansasii infection can usually be accomplished with a rifampin-based regimen, or a rifabutin-based regimen can be used for patients who are HIV seropositive and receiving antiretroviral therapy.

Jousse-Joulin et al[33] described skin and joint infection by M chelonae treated with rescue treatment with interferon gamma.

Han et al[34] analyzed clinical and microbiologic features of 115 cases involving rapidly growing mycobacteria isolated at the University of Texas M.D. Anderson Cancer Center from 2000-2005. Antimicrobial susceptibility test results demonstrated that M abscessus was the most resistant species and that Mycobacterium mucogenicum was most susceptible.

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Surgical Care

A combined therapeutic approach, including surgical drainage, debridement, and prolonged (>3 mo) treatment with combined antimicrobial agents, has been used in some cases of atypical mycobacteria.

In some cases based on clinical assessment, successful treatment requires aggressive debridement of all infected subcutaneous tissues and skin.

Split-thickness skin grafting has been successfully used to cover large wounds. Grafting did not appear to foster recurrent infection.

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Consultations

Consultations with infectious disease specialists, surgeons, dermatologists, and pulmonary specialists may be necessary.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Specialty Editor Board

Takeji Nishikawa, MD  Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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