Clinical Analysis On Three Cases Of Cutaneous Mycobacterium Abscessus Infection And Literature Review

Objective: The clinical manifestations and histopathological results of cutaneous mycobacterium abscessus infection lack of specificity,and the treatment process is rarely resistant and complicated.Therefore,the paper aims to enrich the knowledge of the diagnosis and treatment of the disorder.Methods: we summarized three cases of cutaneous mycobacterium abscessus infection admitted to the department of dermatology,the First Hospital of China Medical University.In the meantime,we reviewed relevant literature and collected 67 cases of cutaneous mycobacterium abscessus infection by searching domestic and foreign databases,,in terms of age,gender,clinical manifestations,histopathological results,diagnosis,treatment and prognosis.Results: All the patients had histories of trauma and presented with erythema,nodulars,and deep ulceration.They had been treated with conventional antibotics,without improvement.Additionally,the histopathological results all revealed granulomatous inflammation.Both the results of mycobacterium culture and molecular identification were positive.All the patients were treated with several antibotics and changed every other day.After 6 months of treatment,the skin lesions basically subsided.The 70 cases collected were as follows:1.Age and sex distribution of onset: There were 18 males(27.1%)and 62 emales(72.9%);The mean age of onset was 44.67±17.81 years;2.Risk factors and inducement: 19 patients(27%)had histories of cosmetic surgeries before onset;18 patients(26%)had histories of surgical operations;3patients had histories of tattooing;7 patients(10%)had no histories of trauma but worked as gardeners or spas;17 patients(24%)showed no definite inducement,no contact with aquatic animals,aquatic products or soil.Most patients did not have a clear time between exposure to the trigger and the onset of the disease.3.Clinical manifestations: The trunks(38.6%)were the most commonly accumulated sites of infection.Erythema(76%)were the most common lesions and sporotrichosis along lymphatic vessels was found in 2 cases(2.9%).There were 10 cases(14.3%)of disseminated MABc infection involving skin infection.4.Histopathological results: Majority findings showed granulomatous inflammatory changes in histopathology,while the patients of immunocom promise revealed suppurative inflammation in histopathology.Furthermore,acid-fast staining rate is not high,and only 14 of 26 cases were positive.After general bacterial culture,82.3% of M.abscessus strains were found,and 95.2% were identified as positive by PCR DNA sequencing.5.A definitive diagnosis mainly relies on isolation and culture of pathogens.If culture fails,we can consider PCR DNA sequencing.Among the collected patients,64 were positive and 36 were positive for molecular biology.6.Treatment and prognosis: Among the collected cases,6 cases had a good prognosis with single drug therapy,58 patients were treated with 2-4 antibiotics combined,and 2 patients were not treated with antibiotics and received surgical debridement treatment.40 patients received antibiotic therapy combined with surgical debridement.2 patients died of sepsis and majoity patients recovered with a good prognosis.Conclusion:1.Cutaneous MABc infection is most likely to occur in medical cosmetic surgery in private institutions or with a history of trauma.Simultaneously,polluted water and soil are risk factors.Additionally,disseminated MABc infection is likely to occur in the patients with immunocom promise.2.There are no specities in clinical manifestation or histopathological results of Cutaneous MABc infection,to a large extent,which are based on the disorder process and immune function ststus.Moreover,biopsies should be taken on multiple sites and multiple times for complexed diseases patients.3.For patients with inducement and related risk factors,we should isolate and identify the pathogen as soon as possible after the failure of conventional antibiotic treatment.4.A definitive diagnosis mainly relies on isolation and culture of pathogens.If culture fails,we can consider PCR DNA sequencing.5.If conventional anti-infective therapy is ineffective,bacterial culture and PCR molecular identification should be performed as soon as possible.The diagnosis should be confirmed to avoid delay in diagnosis and treatment.6.Mycobacterium abscessus is highly resistant during treatment,and drug susceptibility tests should be performed as soon as possible after the diagnosis is made.Treatment is generally used in combination with 2-3 antibiotics,combined with surgery ifnecessary.