4 Cases Report Of Cutaneous Nontuberculous Mycobacterial Infections And Domestic Literatures Meta Study

Objective To investigate the clinical features, diagnostic approach and therapeutic regimen of cutaneous nontuberculous mycobacterial(NTM) infections, and to provide references for cutaneous NTM infections in clinical practice.Methods Clinical data were retrospectively analyzed in 4 cases with cutaneous NTM infections, which were form inpatients of The First Affiliated Hospital of Fujian Medical University dermatological department from January 2013 to December 2015. While pertinent literature from the Chinese National Knowledge Infrastructure database(CNKI), VIP Database and Wanfang Data between 2013 and 2015 were reviewed and statistically analyzed.Results Total of 4 cases including three male and one female, aged 4-48 years old were reported in our study. 4 patients were misdiagnosed or diagnosed indefinite at other hospitals, clinical course was 2 months to more than 1 year. About the location of rash, 1 case on face and cervical region, 1 case on hand and arm, 1 case on penis, and 1 case on both sides of the lower abdomen, anterior superior spine and thigh; The rash were pleomorphic, 4 cases had nodules, 3 cases had ulcers, 1 case had invasive erythema, papules and pustules, 1 case had cyst and blister. Etiology examinations in 4 patients were negative for infectious organisms including bacteria and fungus. The pathological changes of tissues in 4 cases were characterized by infectious granuloma, while acid-fast stain was negative. Cutaneous NTM infections were diagnosed in 4 cases. 4 patients were treated by orally rifampicin, clarithromycin and levofloxacin, and the course was varying from 2 months to 6 months. 30 cases of cutaneous NTM infections had been reported in the CNKI, VIP and Wanfang databases, only 17 cases with complete clinical data. According to reports in the literature and case in our hospital, a total of 21 patients who suffered from cutaneous NTM infections were collected and comprehensively summarized. 85.71% of cases occurred in young and middle-aged, and 71.43% of patients with a history of traumatic injury or surgery. 47.62% the rash on limbs, and 38.10% on the chest and abdomen relating to surgery. 52.38% of cases had infectious granulomas in histologic changes, 33.33% acid-fast stain were positive, 33.33% had PCR sequencing, and 33.33% could not identify the NTM. Treatment was mainly using anti-tuberculosis drugs and sensitive antimicrobial chemotherapy. 61.91% of patients had anti-TB drugs such as rifampin and ethambutol, 80.95% selected clarithromycin or azithromycin, and 42.85% with levofloxacin, moxifloxacin or amikacin. 52.38% of the treatment course was 3 to 6 months. 20 patients had significantly remission, the cure rate was 95.24%, while only 1 case had recurrence after six months of follow-up.Conclusions 1. Cutaneous NTM infections used to appear mostly in young and middle-aged with the history of local trauma or surgery. The most common cause of it include M. marinum, M. abscessus and M. haemophilum. 2. The lesions good hair at the limbs and other daily exposed parts of the skin and soft tissue, expressing a variety of rash. The development of the disease is slow, and the symptoms are mild. 3. Histopathological features are infectious granuloma mostly. 4. The rate of acid fast staining and tissue culture is not so high, and the technique of PCR is hard to popularize, therefore, the microbiology diagnosis is difficult. 5. Most of the NTM are sensitive to anti tuberculosis drugs, macrocyclic lactones and fluoroquinolone. Therefore, these drugs are a better choice for empirical treatment.