Mycobacterium Fortuitum Clinical Presentation

Updated: Nov 18, 2019
  • Author: Sami M Akram, MD, MHA, RDMS; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Presentation

History

Patients who developed M fortuitum infection related to breast implants presented with breast pain or tenderness after an average incubation period of 9 months. [7]

In a cohort of 40 patients with pulmonary M fortuitum infection, common presenting symptoms included sputum (68.6%), hemoptysis (51.4%), cough (45.7%), and gastroesophageal disease (22.9%). Underlying lung disease and smoking were common predisposing factors. [8] Fever, weight loss, and night sweats are less frequent in pulmonary M fortuitum infection than in M tuberculosis infection.

In tattoo-associated M fortuitum infections, a nonpruritic papular eruption occurred 1-2 weeks after the tattoo procedure. [11] Clustering of cases may occur. [5] Patients with cutaneous disease may develop a nonhealing skin ulcer.

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Physical

No findings are pathognomonic of M fortuitum infection. Physical findings depend on the infection site, as follows:

  • Eye: Keratitis or corneal ulcers may be present.
  • Lungs: Rales or rhonchi may be present.
  • Heart: Valvular murmur with endocarditis may be present.
  • Abdomen: Diffuse tenderness with peritonitis may be present (eg, a patient undergoing peritoneal dialysis). [12]
  • Skin: Ulcerative skin lesions and/or subcutaneous nodules may be present. Deeper infections may lead to draining fistulas. [13, 11] Various other skin lesions may be present, including cellulitis, nonhealing ulcers, nodular lesions, chronic nodular lesions, verrucous lesions, and/or lymphadenitis. [7]
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Causes

Risk factors for M fortuitum infection include the following:

  • Trauma or injection - Skin lesions, subcutaneous lesions, ocular lesions, and osteomyelitis.
  • Immunosuppression - Development of infection is driven by the environmental exposure and not by an immunocompromised state. However, infections may be deeper and more extensive in persons who are immunocompromised.
  • Disseminated disease, especially in patients with AIDS or in those who use corticosteroids
  • Lung disease - M fortuitum is a common colonizer that can cause transient infection. [6] Chronic infections may occur in individuals with underlying achalasia or gastroesophageal disorders. [8]
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Complications

Lung involvement in individuals with underlying structural lung disease is frequently debilitating.

Skin lesions and subsequent debridement may be disfiguring.

Antibiotic monotherapy is ineffective and leads to drug resistance.

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