Diagnosis And Treatment Of Non - Tuberculous Mycobacterial Diseases

Objective Take the group of patients of diseases named cutaneous nontuberculous mycobacterial(NTM) infections as object of the study, and get to know the clinical features, the susceptible strains of this kind of disease and related diagnostic and treatment informations preliminary.Methods All retrospective patients diagnosed with cutaneous NTM disease between January 1,2011 and December 31,2014 in the outpatient department of the Institute of Dermatology, Chinese Academy of Medical Sciences (CAMS) were examined for diagnosis, patient demographic, clinical features, pathological manifestation. By tissue culture, biochemical test, acid fast staining and molecular biological method, which including using universal primer Hsp65 and special primer 16sRNA.to PCR or combined with PCR-RFLP and sequencing it to compare with the known sequence. The patients accepted antibiotics regimens according to the results of susceptibility testing. Observe their response and follow them up.Results This study included 25 cutaneous NTM patients (13females and 12 males) with anaverge age of 52.7 years. The upper limbs were the most common sites of infection (60%). The nodularlesions were the most common skin lesions (76%). Traumatic injuries (24%) were the most frequent cause of infection.20% of the patients had immunosuppressive conditions.32% of the patients live in the coastal regions.24% of the patients work near water. Pathologic examinations showed infectious granuloma changes with 70.83% of the samples, negative acid fast staining results in 9 patients (36%).12.5% of the samples showed formation of small abscess. All the species can grew in the mediums and positive results of smear acid fast staining. PCR or combining with PCR-RFLP the bacterial strains of the 25 patients and sequence the DNA. The results of the identification of the species showed the proportions of M. marinum, M.abscessus, M. haemophilum, M. intracellulare, M. szulgai, M. parascrofulaceum, M. shigaense, M.colombiense, M. conceptionense, M.chelonae, M. kumamotonense is 36%,12%,12%,8%,8%,4%,4%,4%, 4%,4%,4%, including 11 kinds of species.9.09%,27.27%,36.36% and 27.27% of the mycobacteria belonged to Runyon â…  to â…£ separately. Slow growth mycobacteria covered 72.72%.25 patients all accepted antibiotic regimens.64% of the patients were cured and 24% of the patients continued being treated.Conclusions The most patients were middle and aged people. Lesions most tended to happen in the upper limbs and nodular lesions were in the majority. Trauma and immunosuppressive conditions might be the possible causes. Infectious granuloma was the most common feature of pathology. Combining tissue culture with molecular biological method can identify the common or rare NTM accurately. M.marinum, M.abscessus and M.haemophilumwere the most three common species in the group. Susceptibility testing can improve the treatement reponce. Pay attention to the side-effects of the drugs.