OBJECTIVETo explore the etiological factors of hand special chronic infections and their relationship with tuberculosis, and to give evidence for clinical diagnosis as well as treatments.

METHODSFrom 2002 to 2004 pathologic inspection, acid-fast stain, bacterial cultication, mycobacterial cultivation were performed in all 29 cases of hand special chronic infections.

RESULTSAll cases showed granulomatous lesions in pathological appearance, 2 positive in acid-fast stain, 12 positive in bacteria cultivation, and 1 nocardiosis, 1 staphylococcus epidermidis, 7 M.marinum, 1 M.tuberculosis, 1 M.fortuitum, 1 M.kansasii.

CONCLUSIONSNon-tuberculo-mycobacterium (NTM) especially M.marinum are far more important as the major factor than tuberculosis and other bacterial in hand special chronic infections. Bacteria cultivation should be routine examined for all cases.

Adult ; Aged ; Chronic Disease ; Combined Modality Therapy ; Diagnosis, Differential ; Female ; Hand Dermatoses ; diagnosis ; therapy ; Humans ; Male ; Middle Aged ; Mycobacterium Infections, Nontuberculous ; diagnosis ; therapy ; Mycobacterium marinum ; Retrospective Studies ; Tuberculosis, Cutaneous ; diagnosis ; therapy

A clinical and histopathologic study was done on 48 cases of cutaneous tuberculosis among 43, 209 out-patients in Dermatologic department of Korea t.Jniversity Hospital during the period of 15 years and 9 mont4s from January, 1969 to September, 1984. These 48 cases were consistent with skin tuberculosis in histologic and clinicalI finc1ings, The result were summarized as follows: ]. The incidence of skin tuberculosis was 0 I 1 g among 43, 209 cases of outpatients. 2. Localized type of skin tuberculosis was 3. 2 times more frequent than disseminated type. Frequent skin tuberculosis was lupus vulgaris (57 3%), erythema induratum (12, 5%), tuberculosis verrucosa cutis(8.3%) and lupus milaris disseminatus faciei (8. 3%). 4, The ratio between male and fenmle was 1: l. 1. 5 The ages of onset were variable according to the types of skin tuberculosis. but 45 8% of all cases developed in the age group between 10 and 29 years. Seasonal incidences of skin tuberculosis were 52. 1% in spring, 85%, in winter, 18. 8% in summer, 4, 2%, in autumn. 7 In histopathologic findings, there were tubercle or tubrculoid structures in all cases and typical tubercle structures were observed in 18.8% The ratio of accordance between the histopathologic diagnosis and clinicopa thologic diagnosis was 81.3%.
Diagnosis ; Erythema Induratum ; Humans ; Incidence ; Korea ; Lupus Vulgaris ; Male ; Outpatients ; Seasons ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.
Arthritis, Rheumatoid ; Bronchial Diseases ; Female ; Humans ; Lung Diseases ; Methotrexate ; Mycobacterium ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Tuberculosis, Pulmonary

Objective: To understand the etiological characteristics and drug susceptibility of Mycobacterium thermoresistibile and Mycobacterium elephantis isolated from a cow with mastitis and provide evidence for the prevention and control of infectious mastitis in cows. Methods: The milk sample was collected from a cow with mastitis, which was pretreated with 4% NaOH and inoculated with L-J medium for Mycobacterium isolation. The positive cultures were initially identified by acid-fast staining and multi-loci PCR, then Mycobacterium species was identified by the multiple loci sequence analysis (MLSA) with 16S rRNA, hsp65, ITS and SodA genes. The drug sensitivity of the isolates to 27 antibiotics was tested by alamar blue assay. Results: Two anti-acid stain positive strains were isolated from the milk of a cow with mastitis, which were identified as non-tuberculosis mycobacterium by multi-loci PCR, and multi-loci nucleic acid sequence analysis indicated that one strain was Mycobacterium thermoresistibile and another one was Mycobacterium elephantis. The results of the drug susceptibility test showed that the two strains were resistant to most antibiotics, including rifampicin and isoniazid, but they were sensitive to amikacin, moxifloxacin, levofloxacin, ethambutol, streptomycin, tobramycin, ciprofloxacin and linezolid. Conclusions:Mycobacterium thermoresistibile and Mycobacterium elephantis were isolated in a cow with mastitis and the drug susceptibility spectrum of the pathogens were unique. The results of the study can be used as reference for the prevention and control the infection in cows.
Animals ; Anti-Bacterial Agents/pharmacology* ; Antitubercular Agents/pharmacology* ; Cattle ; Drug Resistance, Bacterial ; Female ; Humans ; Mastitis, Bovine/microbiology* ; Microbial Sensitivity Tests ; Milk/microbiology* ; Mycobacterium/isolation & purification* ; Mycobacterium Infections/veterinary* ; Mycobacterium tuberculosis/drug effects* ; Nontuberculous Mycobacteria/isolation & purification* ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/genetics*

Managing chronic cough is diagnostically challenging especially in primary care. This case report highlights the difficulties experienced in approaching a case of chronic cough from a primary care perspective. The discussion also involves the clinical significance and treatment dilemma of M. fortuitum chelonae complex that was isolated from the sputum cultures of an elderly woman who presented with chronic cough for more than a year.
Mycobacterium Infections, Nontuberculous ; Mycobacterium fortuitum ; Primary Health Care

Chronic granulomatous infection of the skin and soft tissue by nontuberculous mycobacteria in patients with normal immune system is rarely reported. This case was about a child patient, with normal immune system, whose lower leg was lacerated after a slip down in the Philippines and it was previously treated at a hospital in the Philippines. After a couple of surgical debridement of the wound, the cause of the soft tissue infection was found to be a combined infection of nontuberculous mycobacteria and mycobacterium tuberculosis. We present a case that has been rare in Korea, but common overseas.
Child ; Debridement ; Humans ; Immune System ; Korea ; Leg ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Philippines ; Skin ; Soft Tissue Infections

Atypical mycobacteria, widely distributed in nature, are opportunistic infection strain, rare pathogen in immunocompetent patients. Recently, the increase of invasive cosmetic treatment and surgery has increased the infection of atypical mycobacteria. We report a case of cutaneous infection by Mycobacterium fortuitum and Mycobacterium intracellulare that occurred after a fat graft. A 62-year-old female patient presented painful, erythematous nodules and purulent discharge on her face after a fat graft. A skin biopsy and culture were performed. Polymerase chain reaction-hybridization to identify mycobacterium other than tuberculosis revealed M. fortuitum and M. intracellulare. The patient was treated with clarithromycin, rifampicin, and ethambutol for 1 month after excision and drainage of pus, after which the skin lesions improved. In cases of refractory cutaneous infection after an invasive cosmetic procedure, atypical mycobacterial infection should be suspected.
Biopsy ; Clarithromycin ; Coinfection* ; Drainage ; Ethambutol ; Female ; Humans ; Middle Aged ; Mycobacterium avium Complex* ; Mycobacterium fortuitum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Rifampin ; Skin ; Suppuration ; Transplants* ; Tuberculosis

Few recent reports have indicated that Mycobacterium massiliense causes various infections including respiratory infection. However, there is scarce information on the clinical significance, natural history of the infection, and therapeutic strategy. This report describes a case of an immunocompetent old man infected by M. massiliense that causes acute respiratory failure. In light of the general courses of non-tuberculous mycobacterium infections, rapid progression and fatality are very rare and odd. In addition, we discuss the biological and pathological properties of M. massiliense with the review of cases reported previously including our fatal one.
Light ; Mycobacterium ; Mycobacterium Infections ; Mycobacterium Infections, Nontuberculous ; Natural History ; Respiratory Insufficiency

We report the first Korean case of lung diseases caused by Mycobacterium abscessus subsp. bolletii in a previously healthy male, except for a previous history of pulmonary tuberculosis and bronchiectasis. All serial isolates are identified as M. abscessus subsp. bolletii by multi-locus sequence analysis based on the hsp65, rpoB, and 16S rRNA fragments. At the genetic level, the isolate has the erm(41) gene with a T28 sequevar, associated with clarithromycin resistance, and no rrl mutation. The isolate is resistant to clarithromycin. Although the symptoms and radiographic findings have improved after combination of antibiotics, the follow-up sputum cultures are persistently positive.
Anti-Bacterial Agents ; Bronchiectasis* ; Clarithromycin ; Follow-Up Studies ; Humans ; Lung Diseases* ; Lung* ; Male ; Mycobacterium Infections, Nontuberculous ; Mycobacterium* ; Nontuberculous Mycobacteria ; Sequence Analysis ; Sequence Analysis, DNA ; Sputum ; Tuberculosis, Pulmonary

INTRODUCTION: In the Philippines, a diagnosis of pulmonary tuberculosis  is  very  common  especially  in  the  presence of sputum findings positive for Acid Fast Bacilli (AFB).  But it should be kept in mind that not all Mycobacterium are tuberculosis(TB).A  previous  study  done  at  the  University of Santo Tomas (UST) Hospital from 2003 to 2009 showed a 2.17% incidence of Mycobacterium other than tuberculosis (MOTT). However, due to its growing correlation with the Human Immunedeficiency Virus (HIV), updated incidence rates  are  warranted.Likewise,the importance of culture in  the  right  diagnosis  of  diseases  should  always  be  emphasized.
OBJECTIVES: The study aimed to determine the incidence of  MOTT  in  a  tertiary  hospital  in  Manila  among  patients  suspected of having TB. 
MATERIALS AND METHODS: This is a retrospective study done at the UST Hospital, a quality-assured referral center for TB in  Manila,  with  a  TB  Directly  Observed  Short  Course  (TB-DOTS) Clinic. Laboratory records of specimens submitted for  culture  and  sensitivity  studies  for  Mycobacterium tuberculosis  (MTB)  for  which  isolates  of  MOTT  grew,  using  BACTECTM(Becton-Dickinson)  method  and  Mycobacteria  Growth  Indicator  Tube  (MGITTM),  from  January  2003  to  December 2014, were reviewed.
RESULTS: A total of 6,886 specimens were submitted for MTB culture and sensitivity studies. Results showed 157 cases of MOTT with an incidence of 2.28%. Majority of the specimens with MOTT were from pulmonary sources (85%), most common of which was from sputum. Non pulmonary sources (15%) were mostly from urine, cerebro-spinal, and gastrointestinal tract. were isolated for MOTT. These find-ings are consistent with the previous local available data. Correct identification of this organism influence eventual decisions for treatment.
CONCLUSION: The incidence of positive culture for MOTT in our institution remains to be low. However, there is an increasing trend in the number of specimens which are turning out to be positive for MOTT. A future study on the correlation with the patients' clinical profile is recommended.

Human ; Mycobacterium Tuberculosis ; Sputum ; Tertiary Care Centers ; Philippines ; Tuberculosis, Pulmonary ; Tuberculosis ; Hiv Infections ; Gastrointestinal Tract