Mycobacterium Fortuitum Treatment & Management

  • Author: Joseph M Fritz, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Feb 26, 2010
 

Medical Care

  • Local wound care for cutaneous lesions is always appropriate. Small lesions may improve with local care and antibiotics without surgical intervention.
  • In vitro susceptibilities may not correlate with in vivo activities. Before considering major surgery, a course of at least 2 drugs may be useful, even with resistant organisms.
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Surgical Care

  • Surgical debridement of cutaneous or subcutaneous lesions, especially if the lesions are extensive, is usually required for cure.
  • Surgical debridement of ocular and bone lesions is almost always required.
  • Surgical excision of pulmonary lesions may be considered if response to therapy is lacking or if the organism is relatively resistant to antibiotics.
  • Surgical excision of lymphadenitis is the therapy of choice and is usually curative.
  • If the infection involves an implanted device, removal of the device is usually necessary for cure.
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Consultations

  • Obtain consultation with an infectious diseases specialist for diagnostic and therapeutic guidance.
  • Obtain consultation with a pulmonologist for lung lesions, for possible bronchoscopy, and for therapeutic guidance.
  • Obtain consultation with a surgeon for debridement and/or biopsy. Indwelling catheter placement may also be necessary if long-term antibiotics are to be administered.
  • Obtain consultation with a dermatologist for possible biopsy of cutaneous lesions.
  • If local expertise in NTM infections is not available, consider obtaining expert advice from a national center, such as the National Jewish Medical and Research Center in Denver, Colo, or a regional medical school, such as the Mycobacterial Disease Clinic at The University of Texas Health Center at Tyler.
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Contributor Information and Disclosures
Author

Joseph M Fritz, MD  Fellow, Division of Infectious Diseases, Washington University School of Medicine, Barnes Jewish Hospital

Joseph M Fritz, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Coauthor(s)

Keith F Woeltje, MD, PhD  Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine

Keith F Woeltje, MD, PhD is a member of the following medical societies: American College of Physicians, American Medical Informatics Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine

Disclosure: sepracor None None

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Winthrop KL, Abrams M, Yakrus M, Schwartz I, Ely J, Gillies D, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. May 2 2002;346(18):1366-71. [Medline].

  2. CDC. Nontuberculous mycobacteria reported to the Public Health Laboratory Information System by State Public Health Laboratories United States, 1993-1996. [Full Text].

  3. ATS. Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association. Am J Respir Crit Care Med. Aug 1997;156(2 Pt 2):S1-25. [Medline].

  4. Wallace RJ, Swenson JM, Silcox VA, Bullen MG. Treatment of nonpulmonary infections due to Mycobacterium fortuitum and Mycobacterium chelonei on the basis of in vitro susceptibilities. J Infect Dis. Sep 1985;152(3):500-14. [Medline].

  5. Heifets LB. Antimycobacterial drugs. Semin Respir Infect. Jun 1994;9(2):84-103. [Medline].

  6. Brown-Elliott BA, Wallace RJ, Crist CJ. Comparison of in vitro activities of gatifloxacin and ciprofloxacin against four taxa of rapidly growing mycobacteria. Antimicrob Agents Chemother. Oct 2002;46(10):3283-5. [Medline].

  7. Wallace RJ, Brown-Elliott BA, Crist CJ. Comparison of the in vitro activity of the glycylcycline tigecycline (formerly GAR-936) with those of tetracycline, minocycline, and doxycycline against isolates of nontuberculous mycobacteria. Antimicrob Agents Chemother. Oct 2002;46(10):3164-7. [Medline].

  8. ATS/IDSA: Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. Am J Respir Crit Care Med. February 2007;175:367-416. [Medline].

  9. Bhambri S, Bhambri A, Del Rosso JQ. Atypical mycobacterial cutaneous infections. Dermatol Clin. Jan 2009;27(1):63-73. [Medline].

  10. Esteban J, Ortiz-Pérez A. Current treatment of atypical mycobacteriosis. Expert Opin Pharmacother. Dec 2009;10(17):2787-99. [Medline].

  11. Griffith DE, Wallace RJ. New developments in the treatment of nontuberculous mycobacterial (NTM) disease. Semin Respir Infect. Dec 1996;11(4):301-10. [Medline].

  12. Kyle SD, Porter WM. Mycobacterium chelonae infection successfully treated with oral clarithromycin and linezolid. Br J Dermatol. Nov 2004;151(5):1101. [Medline].

  13. Porat MD, Austin MS. Bilateral knee periprosthetic infection with Mycobacterium fortuitum. J Arthroplasty. Aug 2008;23(5):787-9. [Medline].

  14. Wagner D, Young LS. Nontuberculous mycobacterial infections: a clinical review. Infection. Oct 2004;32(5):257-70. [Medline].

  15. Wallace RJ, Brown-Elliott BA, Ward SC. Activities of linezolid against rapidly growing mycobacteria. Antimicrob Agents Chemother. Mar 2001;45(3):764-7. [Medline].

 
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