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An Update on

Atypical Mycobacteria

Erin Lowe, DO, PGY-4

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DISCLOSURES?

NONE

JOKES?

PLENTY

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1999

• Don’t get into strangers’ cars

• Don’t meet people from the internet

2019

• Literally summon strangers from the internet

to get into their car

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

DIAGNOSIS (skin biopsy, left index finger):

MYCOBACTERIAL INFECTION (ACID FAST ROD-SHAPED ORGANISM) with

associated suppurative and granulomatous inflammation, granulation tissue, foreign

body reaction and fibrosis

ACID FAST STAIN confirms the presence of ACID FAST ROD-SHAPED ORGANISM

keeping with a diagnosis of a MYCOBACTERIAL INFECTION

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ACID FAST STAINS: Ziehl-Neelsen, Fite,

Kinyuon’s

1. Mycobacterium tuberculosis

2. Mycobacterium leprae

3. Atypical mycobacterioses

+/- Nocardia

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This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

Mycobacterium marinum

• Primary contact

• Aquatic environments

• Single lesion or sporotrichoid

lymphocutaneous nodules

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Mycobacterium avium complex

• AIDS patients

• Pulmonary infection m/c

• Disseminates to skin

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M. abscessus, M. chelonae, M. fortuitum = RGM

• Infection after trauma, surgery, or procedure

– Liposuction

– Implants

– Tattoo, Acupunture

– Pedicures

– Botox, Filler

– CO2 Laser

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Work-up for a suspected Atypical Mycobacteria infection

LAB STUDIES

• CBC

• CMP

• HIV

• PPD

• QuantiFERON-TB Gold

TISSUE STUDIES

• Fresh tissue culture

• AFB PCR identification

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Fresh tissue culture

1. Fluorochrome smear

2. AFB culture

- Grow at 30°, 37°, and 42° Celcius

- 6-8 weeks

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publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

TREATMENT WHILE YOU WAIT?

• Clarithromycin 500mg PO QD

• +/- a tetracycline

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Phillips RC, et al. Cutaneous nontuberculosis mycobacteria infections: A retrospective case series of 78 patients

from the Texas Gulf Coast region. JAAD. 2019, April.

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publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this

publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.

PEARLS…

• Atypical mycobacteria are ubiquitous

• They are usually acquired through environmental exposure

• The microorganism is resistant to the standard levels of chlorination,

therefore it can be found in tap water

• There have been no reports of spread via person-to-person contact

• You’re in for the long haul

• Get ID and your local TB clinic involved

• Sometimes it’s best to cut these out

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publication represent those of the author(s) do not necessarily represent the official views of HCA or any of its affiliated entities.