[Non-tuberculous mycobacterial infections of the hand and wrist: a retrospective review of five cases from a single centre].
OBJECTIVE
A suggestion for a graduated diagnostic and therapeutic approach for patients with a suspected infection with non-tuberculous mycobacteria (NTM) of the hand and wrist is made.


METHODS
Between March 2003 and February 2007, 2 women and 3 men with an average age of 64 years were treated for an NTM infection of the hand and wrist. 4 patients had a tenosynovitis of the wrist. In 1 patient both wrists were involved. 1 patient had a granuloma of the index finger. The patients' charts, the operation reports, histological and bacteriological findings and the antibiogram were evaluated.


RESULTS
An inoculating trauma was identified in four patients. Intraoperatively rice bodies were present in the 4 patients with a tenosynovitis of the wrist. Histological findings showed acid-fast bacilli in 2 patients and chronic inflammatory reaction with/without granuloma (3/2) in 5 patients. Species identification was based on PCR and microbiological culture and revealed in three patients slow growing species (M. malmoense, M. nonchromogenicum, M. szulgai) and in two patients M. marinum (intermediate growth rate). Therapy consisted of immediate postoperative empirical combined drug treatment followed by antibiogram-based therapy. All patients showed healing of the infection at the final follow-up at an average of 25.2 months (range: 15-44 months) postoperatively.


CONCLUSIONS
Consideration of non-tuberculous mycobacteria in the differential diagnosis in cases of localised tenosynovitis is paramount for diagnosis. Treatment based on graduated diagnostic steps, surgery and drugs (empirical followed by directed drugs) can achieve favourable clinical outcomes.
Universitätsklinik für Unfallchirurgie, AKH-Wien, Währinger Gürtel 18-20, Vienna, Austria. irena.krusche-mand1@meduniwien.ac.at
I
I
Krusche-Mandl
A
A
Decramer
J
J
Boltuch-Sherif
E
E
Vlieghe
C
C
Brands
D
D
Vandenberghe
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000601:surgery*; D019910:Mycobacterium marinum; D009170:Nontuberculous Mycobacteria; D009894:Opportunistic Infections / Q000175:diagnosis / Q000601:surgery; D013717:Tenosynovitis / Q000175:diagnosis / Q000601:surgery*; D014946:Wound Infection / Q000175:diagnosis / Q000601:surgery*; D014954:Wrist Injuries / Q000175:diagnosis / Q000601:surgery*
D000900:Anti-Bacterial Agents