Nontuberculous mycobacterial osteomyelitis.
Osteomyelitis caused by nontuberculous mycobacteria (NTM) can have severe consequences and a poor prognosis. Physicians therefore need to be alert to this condition, especially in immunocompromised patients. Although the pathogenesis of NTM osteomyelitis is still unclear, studies in immunodeficient individuals have revealed close relationships between NTM osteomyelitis and defects associated with the interleukin-12-interferon-γ-tumor necrosis factor-α axis, as well as human immunodeficiency virus infection, various immunosuppressive conditions, and diabetes mellitus. Culture and species identification from tissue biopsies or surgical debridement tissue play crucial roles in diagnosing NTM osteomyelitis. Suitable imaging examinations are also important. Adequate surgical debridement and the choice of appropriate, combined antibiotics for long-term anti-mycobacterial chemotherapy, based on in vitro drug susceptibility tests, are the main therapies for these bone infections. Bacillus Calmette-Guerin vaccination might have limited prophylactic value. The use of multiple drugs and long duration of treatment mean that the therapeutic process needs to be monitored closely to detect potential side effects. Adequate duration of anti-mycobacterial chemotherapy together with regular monitoring with blood and imaging tests are key factors determining the recovery outcome in patients with NTM osteomyelitis.
From the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University , Hangzhou , China.
Sheng
S
Bi
Fei-Shu
FS
Hu
Hai-Ying
HY
Yu
Kai-Jin
KJ
Xu
Bei-Wen
BW
Zheng
Zhong-Kang
ZK
Ji
Jun-Jie
JJ
Li
Mei
M
Deng
Hai-Yang
HY
Hu
Ji-Fang
JF
Sheng
D000328:Adult; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D004198:Disease Susceptibility; D006678:HIV / Q000472:pathogenicity; D006801:Humans; D016867:Immunocompromised Host; D007371:Interferon-gamma / Q000276:immunology; D018664:Interleukin-12 / Q000276:immunology; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology / Q000382:microbiology* / Q000628:therapy*; D009170:Nontuberculous Mycobacteria / Q000472:pathogenicity*; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology* / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
D014409:Tumor Necrosis Factor-alpha; D018664:Interleukin-12; D007371:Interferon-gamma
Osteomyelitis; diabetes mellitus; nontuberculous mycobacteria