Original article
Increased Incidence of Cutaneous Nontuberculous Mycobacterial Infection, 1980 to 2009: A Population-Based Study

https://doi.org/10.1016/j.mayocp.2012.06.029Get rights and content

Abstract

Objectives

To determine the incidence and clinical characteristics of cutaneous nontuberculous mycobacterial (NTM) infection during the past 30 years and whether the predominant species have changed.

Patients and Methods

Using Rochester Epidemiology Project data, we identified Olmsted County, Minnesota, residents with cutaneous NTM infections between January 1, 1980, and December 31, 2009, examining the incidence of infection, patient demographic and clinical features, the mycobacterium species, and therapy.

Results

Forty patients (median age, 47 years; 58% female [23 of 40]) had positive NTM cultures plus 1 or more clinical signs. The overall age- and sex-adjusted incidence of cutaneous NTM infection was 1.3 per 100,000 person-years (95% CI, 0.9-1.7 per 100,000 person-years). The incidence increased with age at diagnosis (P=.003) and was higher in 2000 to 2009 (2.0 per 100,000 person-years; 95% CI, 1.3-2.8 per 100,000 person-years) than in 1980 to 1999 (0.7 per 100,000 person-years; 95% CI, 0.3-1.1 per 100,000 person-years) (P=.002). The distal extremities were the most common sites of infection (27 of 39 patients [69%]). No patient had human immunodeficiency virus infection, but 23% (9 of 39) were immunosuppressed. Of the identifiable causes, traumatic injuries were the most frequent (22 of 29 patients [76%]). The most common species were Mycobacterium marinum (17 of 38 patients [45%]) and Mycobacterium chelonae/Mycobacterium abscessus (12 of 38 patients [32%]). In the past decade (2000-2009), 15 of 24 species (63%) were rapidly growing mycobacteria compared with only 4 of 14 species (29%) earlier (1980-1999) (P=.04).

Conclusion

The incidence of cutaneous NTM infection increased nearly 3-fold during the study period. Rapidly growing mycobacteria were predominant during the past decade.

Section snippets

Patients and Methods

After approval by the institutional review boards of Olmsted Medical Center and Mayo Clinic, we collected inpatient and outpatient medical records of residents of Olmsted County from the Rochester Epidemiology Project (REP). The REP is an informatics tool that indexes medical diagnoses made at health care facilities (clinics, hospitals, and nursing homes) or during autopsies for all residents of Olmsted County.

Using the REP database, we retrieved all the medical records for Olmsted County

Results

A search of the REP database yielded 360 medical records of patients identified as having any form of NTM infection. Records were excluded if infections (1) were not cutaneous or (2) did not meet the inclusion criteria of positive growth in culture concomitant with 1 or more correlated clinical signs. Forty cases of definite SSTI caused by NTM were reviewed and analyzed.

Infections were recorded in 23 female patients (58%) and 17 male patients (43%). The median age of the 40 patients was 47

Discussion

The results of this study show that in Olmsted County, the incidence of cutaneous NTM infection in 2000 to 2009 (2.0 per 100,000 person-years) was nearly 3-fold higher than that in 1980 to 1999 (0.7 per 100,000 person-years). This finding provides population-based data to substantiate the presumed increased incidence of cutaneous NTM infection. This report based case definition on culture and clinical data rather than on laboratory results alone.10

During the entire study period, M marinum was

Conclusion

The incidence of cutaneous NTM infection has increased nearly 3-fold in Olmsted County during the past 30 years, from 0.7 per 100,000 person-years between 1980 and 1999 to 2.0 per 100,000 person-years between 2000 and 2009. There was no significant difference between males and females in the rate of NTM infection, although the incidence did increase with age. The RGM infections made up the greatest proportion of cases in the latter third of the study's time frame, caused all cases of infection

References (43)

  • R. Wolf et al.

    A tattooed butterfly as a vector of atypical

    Mycobacteria. J Am Acad Dermatol

    (2003)
  • K.P. Redbord et al.

    Atypical Mycobacterium furunculosis occurring after pedicures

    J Am Acad Dermatol

    (2006)
  • E. Tortoli

    Clinical manifestations of nontuberculous mycobacteria infections

    Clin Microbiol Infect

    (2009)
  • B.A. Brown-Elliott et al.

    Infections Caused by Nontuberculous Mycobacteria

    (2005)
  • E.H. Runyon

    Identification of mycobacterial pathogens utilizing colony characteristics

    Am J Clin Pathol

    (1970)
  • E.J. Fisher et al.

    Infection with mycobacterium abscessus after Mohs micrographic surgery in an immunocompetent patient

    Dermatol Surg

    (2005)
  • P.J. Sniezek et al.

    Rapidly growing mycobacterial infections after pedicures

    Arch Dermatol

    (2003)
  • R. Jogi et al.

    Therapy of nontuberculous mycobacterial infections

    Dermatol Ther

    (2004)
  • L. Hall et al.

    Evaluation of the MicroSeq system for identification of mycobacteria by 16S ribosomal DNA sequencing and its integration into a routine clinical mycobacteriology laboratory

    J Clin Microbiol

    (2003)
  • D.P. O'Brien et al.

    Nontuberculous mycobacterial disease in northern Australia: a case series and review of the literature

    Clin Infect Dis

    (2000)
  • J.T. van Dissel et al.

    Rapidly growing mycobacteria: emerging pathogens in cosmetic procedures of the skin

    Clin Infect Dis

    (2009)
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    Grant Support: This study was made possible by the Rochester Epidemiology Project (Principal Investigators: Walter A. Rocca, MD, MPH, and Barbara P. Yawn, MD, MSc). Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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