Musculoskeletal problems caused by Non tuberculous mycobacterial infection
What musculoskeletal problems can be caused by Non tuberculous mycobacterial infection?
Unlike MTB, “atypical” NTM do not spread human to human. They are natural inhabitants of our environment; their portal of entry is either through direct inoculation or through hematogenous spread after ingestion or inhalation in the susceptible host. They have a propensity to involve the tendons and joints of the hands. In fact, 50% affect the hands, while only 20% affect the knees. Polyarticular disease and involvement of the spine are much less common.
- Rapid growers: M. abscessus complex, M. fortuitum , M. chelonae
- Infection usually follows trauma or surgical procedures leading to direct inoculation.
- Due to inherent drug resistance, combination antimycobacterial therapy and surgical resection is key to treatment.
- Most often HIV-associated: M. haemophilum , M. avium complex (MAC), and M. kansasii
- Most likely to cause vertebral osteomyelitis: MAC, M. xenopi , M. fortiutum , and M. abscessus .
- Mycobacterium marinum : an aquatic organism that is an occupational hazard of oyster shuckers and aquarium enthusiasts. Tenosynovitis of the hands or wrist is the classic presentation, although synovitis and osteomyelitis have been reported. May also present as a chronic draining wound to the hand.
- M. bovis : may cause vertebral osteomyelitis in patients treated with intravesicular BCG for bladder cancer.
- M. ulcerans : Buruli ulcer: mainly in West Africa, but also rarely identified in South America, Mexico, Australia, Papua New Guinea. Occurs in immunocompetent hosts. Starts as a painless nodule, most frequently on an extremity, over days to weeks the nodule breaks down to a slowly progressive ulceration. About 13% infections associated with osteomyelitis.
- M. chimaera : organism within MAC associated with the global outbreak of postoperative infections related to contaminated heater cooler units used in cardiothoracic surgery. Related musculoskeletal infections include sternal or vertebral osteomyelitis.