title: Non-tuberculous mycobacterial infection of the musculoskeletal system: pattern of infection and efficacy of combined surgical/antimicrobial treatment.
abstract: Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal tissue is a rare disease. An early and accurate diagnosis is often difficult because of the indolent clinical course and difficulty of isolating pathogens. Our goal was to determine the clinical features of musculoskeletal NTM infection and to present the treatment outcomes. A total of 29 patients (nine females, 20 males between 34 and 85 years old, mean age 61.7 years; 34 to 85) with NTM infection of the musculoskeletal system between 1998 to 2011 were identified and their treatment retrospectively analysed. Microbiological studies demonstrated NTM in 29 patients: the isolates were Mycobacterium intracellulare in six patients, M. fortuitum in three, M. abscessus in two and M. marinum in one. In the remaining patients we failed to identify the species. The involved sites were the hand/wrist in nine patients the knee in five patients, spine in four patients, foot in two patients, elbow in two patients, shoulder in one, ankle in two patients, leg in three patients and multiple in one patient. The mean interval between the appearance of symptoms and diagnosis was 20.8 months (1.5 to 180). All patients underwent surgical treatment and antimicrobial medication according to our protocol for chronic musculoskeletal infection: 20 patients had NTM-specific medication and nine had conventional antimicrobial therapy. At the final follow-up 22 patients were cured, three failed to respond to treatment and four were lost to follow-up. Identifying these diseases due the initial non-specific presentation can be difficult. Treatment consists of surgical intervention and adequate antimicrobial therapy, which can result in satisfactory outcomes.
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Park
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J O
authors.initials: JO
authors.lastname: Yoon
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Chang
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Kim
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Chun
authors.affiliation: University of Ulsan, Asan Medical Centre, School of Medicine, Department of Orthopaedic Surgery, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: I H
authors.initials: IH
authors.lastname: Jeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial; Musculoskeletal system; Nontuberculous mycobacteria; Pattern of Infection; Surgical; Treatment