title: Identification and treatment of nontuberculous Mycobacterium sinusitis.
abstract: BACKGROUND
  The purpose of this study was to identify the incidence of atypical Mycobacterium identified by routine sinus cultures and review the recent literature on management.
  
  
  METHODS
  A retrospective case series was performed in a tertiary academic  hospital. A retrospective case series of all patients treated with atypical Mycobacterium rhinosinusitis from 2005 to 2010 was performed. Cases were identified from a prospective database of 676 endoscopically guided sinus cultures.
  
  
  RESULTS
  Eight patients with atypical  Mycobacterium sinusitis were identified. There were five women and three men. Median age was 63 years (range, 55-71 years). All patients had prior endoscopic sinus surgery a median of 14 months (range, 0.8-162 months) before a positive culture result. Species identified  included Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium avium complex. Chief presenting symptoms were postnasal discharge (88%), followed by decreased smell and taste (63%), and facial pain/pressure (38%). Patients were  treated based on sensitivity results with long-term oral antibiotics for at least 2 months based on improvements on endoscopy. Median follow-up for patients in this study after treatment was 1.3 years (range, 0.6-4.6 years).
  
  
  CONCLUSIONS
  In this study, atypical mycobacteria  were identified in <1% of sinus cultures. Prolonged, culture-directed antibiotic therapy remains the mainstay of treatment when there is clinical evidence of infection. Previous endoscopic sinus surgery may represent a risk factor for colonization and subsequent infection. Further research  is necessary to determine the optimal treatment duration and management to prevent disease relapse.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of California-Los Angeles, School of Medicine, Los Angeles, California 90095-1624, USA. jeffsuh@mednet.ucla.edu
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Suh
authors.forename: Vijay R
authors.initials: VR
authors.lastname: Ramakrishnan
authors.forename: Bobby
authors.initials: B
authors.lastname: Tajudeen
authors.forename: Christine
authors.initials: C
authors.lastname: Reger
authors.forename: David W
authors.initials: DW
authors.lastname: Kennedy
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005157:Facial Pain / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D000857:Olfaction Disorders / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D012852:Sinusitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D013651:Taste Disorders / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents