Clinical manifestations and outcomes of musculoskeletal nontuberculous mycobacterial infections
To investigate the clinical manifestations and outcomes of musculoskeletal (MSK) nontuberculous mycobacterium (NTM) infections. This study was a retrospective cohort study using the Siriraj Hospital database from 2005 to 2017. Enrolled were all patients aged 15 or older who had an MSK infection with NTM identified in synovial fluid, pus, or tissue by an acid-fast bacilli stain, culture, or polymerase chain reaction. Of 1529 cases who were diagnosed with NTM infections, 39 (2.6%) had an MSK infection. However, only 28 patients met our inclusion criteria. Their mean age (SD) was 54.1 (16.1) years, and half were male. Of this cohort, 25% had previous musculoskeletal trauma, 18% prior bone and joint surgery, 14% prosthetic joint replacement, and 11% HIV infection. The median symptom duration (IQR) was 16 (37.4) weeks. The most common MSK manifestation was arthritis (61%), followed by osteomyelitis (50%), tenosynovitis (25%), and spondylodiscitis (14%). The most common organism was M. abscessus (18%), and M. kansasii (18%), followed by M. intracellulare (14%), M. marinum (14%), M. fortuitum (7%), and M. haemophilum (7%). In addition to medical treatment, most patients underwent surgery (82%), comprising debridement, osteotomy, prosthesis removal, and amputation, while 18% received only medical treatment. The treatment outcomes were complete recovery in 46%, improvement with some residual disability and deformities in 29%, and death in 3.6%. Musculoskeletal NTM infections were uncommon. Most patients had underlying joint disease or were immunocompromised hosts. Surgical management, as an adjunct to medical therapy, was necessary.
KeywordsMusculoskeletal infection Nontuberculous mycobacterium Risk factors Manifestations Outcomes
The authors gratefully acknowledge Ms. Khemajira Karaketklang of the Research and Academic Services Unit, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University for assistance with statistical analysis.
CN and WK made substantial contributions to the conception, design of the work, the acquisition, analysis, interpretation of data, drafted the work or substantively revised it, approved the submitted version and take full responsibility for the integrity of the study and the final version of the manuscript.
This study is unfunded.
Compliance with ethical standards
Conflict of interest
Author Wanruchada Katchamart and Author Chaikiat Napaumpaiporn declares that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standard (Siriraj Institutional Review Broad, COA no. Si 63812018, Approval date: October 10, 2018).
Informed consent was not obtained from all individual participants included in the study because this study is a retrospective chart review.
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