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Clinical characteristics and the diagnostic role of molecular tests in musculoskeletal infections caused by nontuberculous Mycobacterium: a single-center experience

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Abstract

Purpose

We retrospectively investigated NTM musculoskeletal infections to understand the clinical characteristics as well as the diagnostic performance of molecular tests as a useful supplementary test.

Methods

A retrospective cohort study was conducted from January 2016 to December 2019. Intraoperative specimens for culture and pathological analysis were obtained during surgery under sterile conditions. AdvanSure TB/NTM real-time PCR (LG Life Sciences, Seoul, Korea) and PCR-reverse blot hybridization assay (REBA, REBA Myco-ID; YD Diagnostics, Yongin, Republic of Korea) was performed directly from tissue specimens for the rapid and accurate identification of 20 mycobacterial species.

Results

A series of 24 patients was identified during the study period. Agricultural/aquatic exposure were predisposing factors in 9 patients, trauma in 4 patients, but no predisposing host factor was identified for 11 patients. Twenty-two patients presented with tenosynovitis and two with arthritis with substantial delays between initial presentation of symptoms and microbiologic diagnosis, with a median of 147 days (range 5–396 days). Pathologic tissue examination of musculoskeletal NTM infections was positive for chronic granulomatous inflammation in 18 cases. Fifteen were positive in the culture study, and nine were positive only in the molecular study using tissue specimens. All 6 M. ulcerans/M. marinum isolates were identified only by PCR.

Conclusions

This study is an important reminder that NTM infections should be a part of the differential diagnosis in patients with chronic musculoskeletal infections refractory to regular treatment. Although molecular test cannot replace the conventional smear and culture methods, it can be used as a useful supplementary test especially in diagnosing M. marinum infection.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapseong-dong, Masanhoewon-gu, Changwon, Gyeongsangnam, Republic of Korea

    Cheon Hoo Jeon, Si-Ho Kim, Yu-Ji Lee & Yu Mi Wi

  2. Department of Internal Medicine, Kangbook Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Hae Suk Cheong

  3. Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea

    Dong Hee Kim

  4. Department of Dermatology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea

    Eun Phil Heo

Authors
  1. Cheon Hoo Jeon
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  2. Si-Ho Kim
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  4. Dong Hee Kim
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  5. Yu-Ji Lee
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  7. Yu Mi Wi
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Corresponding author

Correspondence to Yu Mi Wi.

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Conflict of interest

The authors have no conflicts of interest relevant to this article to report.

Ethics approval

The present study protocol was reviewed and approved by the Institutional Review Board of Samsung Changwon Hospital (approval No. SCMC 2020-06-011). Informed consent was waived because of the retrospective nature of the study.

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All authors have approved the publication of the manuscript.

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Cite this article

Jeon, C.H., Kim, SH., Cheong, H.S. et al. Clinical characteristics and the diagnostic role of molecular tests in musculoskeletal infections caused by nontuberculous Mycobacterium: a single-center experience. Infection 50, 981–987 (2022). https://doi.org/10.1007/s15010-022-01780-4

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  • DOI: https://doi.org/10.1007/s15010-022-01780-4

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