Mycobacterium Fortuitum Treatment & Management

Updated: Nov 29, 2018
  • Author: Joseph M Fritz, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Treatment

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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Prevention

No specific deterrence methods are available. M fortuitum is a ubiquitous organism.

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Long-Term Monitoring

The frequency of outpatient visits is determined by the extent of the disease and whether the patient is receiving oral or intravenous therapy. Initially, at least monthly follow-up care for adverse effects is reasonable. More frequent visits may be necessary for patients with central catheters to evaluate for line infections.

Outpatients taking aminoglycoside therapy should undergo periodic (at least weekly) assessment of renal function and, possibly, antibiotic levels.

Monthly sputum cultures may be useful in patients with pulmonary disease to demonstrate the efficacy of the treatment plan.

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Further Inpatient Care

Many, if not most, patients do not require inpatient care. The duration of inpatient care is dictated by the time needed to recover from any procedures performed.

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Inpatient & Outpatient Medications

Administer antibiotics daily (see Medication).

Infrequent dosing (eg, 2-3 times/wk, as for tuberculosis) has not been evaluated and is not recommended.

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Transfer

Patients who require intravenous antibiotic therapy but who are unable to receive home intravenous therapy need to be placed in a facility capable of administering antibiotics.

Patients with refractory disease may require a referral to a specialty center (usually as an outpatient rather than as an inpatient transfer).

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