HistoryThis section has been translated automatically.
Nontuberculous mycobacteria (NTMs) have been known almost as long as M. tuberculosis itself, but their clinical significance was not recognized until the 1950s. NTMs are facultatively humpathogenic and can become clinically relevant as opportunistic pathogens, under certain conditions, some nosocomial, even in immunocompetent individuals.
DefinitionThis section has been translated automatically.
The term "nontuberculous mycobacterioses", or "NTM" for short, refers to diseases caused by infections with nontuberculous mycobacteria. This is a heterogeneous group of more than 190 environmental mycobacteria (Daley CL et al. 2020) characterized by a wide diversity in terms of their occurrence, pathogenicity, adaptations to environmental conditions. Their relationship to the obligate pathogens of the tuberculosis complex and leprosy is reflected in the antipodal naming "nontuberculous mycobacteria." The older name "atypical mycobacteria is outdated. It was most often understood as synonymous with Mycobacterium avium complex (MAC) infection.
Most NTM live as apathogenic prokaryotes in soil or water (Adjemian J et al. 2012). They also reach household plumbing via water, where they can occur in biofilms in high bacterial counts (Schulze-Röbbecke R et al. 1992). Furthermore, NTMs can also be detected in foods such as pasteurized milk and cheese, but not in homogenized milk, among others (Leite CQ et al. 2003; Jordão Junior CM et al. 2009). The implication of these studies is that humans have constant contact with ubiquitous mycobacteria. Versch. Studies show that humans have several times more contact with NTMs than with M. tuberculosis. Nevertheless, NTMs are responsible for only 1-3% of mycobacterial disease cases. Thus, special local conditions, or defects of the local or systemic immune defense (see NTM in HIV infections) are necessary prerequisites for an infection with NTMs.
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PathogenThis section has been translated automatically.
Mycobacteria that do not produce either tuberculosis or leprosy are now referred to as non-tuberculous mycobacteria, or NTM for short. Their transmission from person to person is discussed, but is not certain.
NTMs occur mainly in dust, dirt, fresh and salt water, in birds, pigs, sheep, cattle, in milk and eggs.
ClassificationThis section has been translated automatically.
So far, more than 190 different NTM species have been discovered. In addition to NTMs that have also been detected in environmental samples, there are species, such as M. ulcerans, M. genavense, or M. haemophilum, that are significantly more host-specific than other species. M. haemophilum can cause scleritis in addition to skin afflictions (Pisitpayat P et al. 2020). Infections of birds have been described for M. genavense, but there is no evidence of spread outside this host. Mycobacterium ulcerans has been diagnosed in over 33 countries worldwide, not only in tropical areas of West Africa but also in areas with temperate non-tropical climates, including Australia and Japan. (Johnson PD et al. 2007). For M. haemophilum, water reservoirs are considered a likely source of infection.
Basically, according to the Runyon classification, NTM are divided into:
Slow-growing NTM: The list of clinically important slow-growing nontuberculous mycobacteria (NTM) is constantly expanding as new species are identified and older ones are recognized as pathogenic. Because the pathogens are ubiquitous in nature, many NTM have been isolated from ground or tap water, soil, house dust, domestic and wild animals, and birds. Most infections occur by inhalation or direct inoculation from environmental sources.
In addition to their cultural growth rate, NTMs can be classified as photochromogenic, scotochromogenic, or nonpigmented based on their pigment production. The following pathogens are of clinical relevance:
- M. arupense
- M. asiaticum
- M. avium and M. avium complex: Based on molecular biology criteria, the MAC complex is defined as a grouping of slow-growing mycobacteria. It currently consists of 12 validly published species: Mycobacterium avium*, Mycobacterium intracellulare*, Mycobacterium chimaera, Mycobacterium colombiense, Mycobacterium arosiense, Mycobacterium vulneris*, Mycobacterium boucheduronense, Mycobacterium timonens, Mycobacterium marseillnse, Mycobacterium yongoense, Mycobacterium paraintracellulare, Mycobacterium lepraemurium (van Ingen J et al. 2018).
- M. bohemicum
- M. branderi
- M. celatum (mainly pulmonary infections in immunocompetent individuals; local infections of the skin)
- M. chimaera
- M. europaeum
- M. florentinum
- M. genavense (nosocomial infections in HIV infection)
- M. gordonae (typically detected in tap water, mainly pulmonary infections, occasional skin involvement)
- M. haemophilum (nodular, also ulcerative lesions, in immunocompetents as well as in immunoincompetents).
- M. heckeshornense
- M. interjectum
- M. intermedium (chronic granulomatous dermatitis, associated with exposure to a hot tub)
- M. intracellulare*(chronic granulomatous/lupoid dermatitis/Pampaloni A et al. 2020).
- M. kansasii (Pulmonary infections with M. kansasii resemble infections with M. tuberculosis in their clinical presentation. In rare cases, M. kansasii is also the etiologic agent of infantile lymphadenitis. Skin involvement is rare).
- M. cubicae
- M. lentiflavum (preferred causative agent of cervical lymphadenitis in children; complicating cosmetic surgery)
- M. malmoense (tuberculoid granuloma on the dorsum of the hand/Schmoor P et al. 2001)
- M. marinum (verrucous plaques and nodules, also sporotrichoid dissemination; swimming pool granuloma)
- M. nebraskense
- M. palustre
- M. saskatchewanse
- M. scrofulaceum (clustered in pediatric cervical lymphadenitis)
- M. shimodei
- M. simiae (usually pulmonary infections, rarely disseminated, papular or nodular skin infiltrates in bacteremia).
- M.smegmatis (artificial infections in cosmetic procedures/filler materials).
- M. szulgai (very rarely, disseminated skin lesions have been described in the setting of bacteremia in immunosuppressed patients; cervical lymphadenitis in children)
- M. terrae complex (no known dermatological relevance)
- M. ulcerans (Buruli ulcer, localized skin infection with torpid ulcers common in tropical zones; also reported in temperate Australia/Bairnsdale Ulcer and Japan. In Australia, M.ulcerans has also been detected in mosquitoes (Aedes camptorhynchus).
- M. vulneris*(belongs to the MAC complex, dermatologically not relevant)
- M. xenopi (along with MAC complex and M. kansasii, belongs to the frequent NTM in pulmonary infections; also detected in tap water)
* Belonging to the MAC complex.
- Photochromogenic NTM (pigment formation under light): M. marinum, M. kansasii .
- Scotochromogenic N TM (pigment formation without light): M. scrofulaceum, M. szulgai.
- Non-chromogenic NTM (no pigment formation): M. ulcerans ( Buruli ulcer), M. avium-intracellulare complex, M. malmoense, M. xenopi.
Fast-growing NTM: The eponymous characteristic of fast-growing mycobacteria is that they show marked growth in less than 7 days at their optimal growth temperature. This statement refers to standard culture conditions only. Fast-growing mycobacteria are clearly resistant to a wide variety of environmental conditions. Therefore, they are widely distributed (Falkinham 3rd JO 2009). In larger series of studies, fast growing NTM (RGM) from skin and soft tissue infections were found to have the following distribution pattern (Kumar C et al 2021):
- M. abscessus 38.7 %
- M. fortuitum 31.5 %
- M. chelonae 15 %
- M. chelonae/abscessus complex 9.6 %.
- M. abscessus**(outbreaks of M. abscessus complex associated with cosmetic procedures and nosocomial transmission are not uncommon).
- M. alvei
- M. aurum
- M. boenickei
- M. brumae
- M. chelonae (M. chelonae and M. fortuitum/localized clinical pictures with sprotrichoid arranged skin and soft tissue granulomas after inoculation are possible/more frequent are disseminated courses with granuloma or abscess formations with immunodeficiency)
- M. confluentis
- M.fortuitum complex**(Infection with the pathogens occurs after minor trauma, but also after medical procedures: injections, indwelling cannulas, liposuction, tattoos, acupuncture, etc . Mycobacterium fortuitum infections have also been observed after face-lift surgery).
- M. goodii (catheter-associated bacteremia has been demonstrated).
- M. holsaticum
- M. immunogenum (mainly skin infections e.g. after cosmetic procedures and surgery)
- M. iranicum
- M. margeritense
- M. mucogenicum
- M. peregrinum
- M. phocaicum
- M. septicum (skin infections caused by M. septicum have been reported after cosmetic surgery)
- M. smegmatis (described in association with various cosmetic procedures, among others. Wang CJ et al. 2022)
- M. thermoresistible
EtiopathogenesisThis section has been translated automatically.
While NTM may be detectable in the sputum or stool of asymptomatic individuals (colonization), almost only patients with massive immunodeficiency and less than < 50 CD4 cells/µl become ill. In the pre-HAART era, this was as high as 40% of AIDS patients.
In the meantime, NTM infections in HIV-infected patients have become rather rare as a result of sufficient thefrapic measures of HIV infection. In the past, NTM infections in HIV-infected patients were almost always disseminated.
NTM infections in immunocompetent persons mostly occur as localized forms. Thus as pulmonary infections, as osteomyelitides (spine! Joints!), as lymphadenopathies, as skin manifestations in the form of inflammatory plaques and nodules (see below swimming pool granuloma) or melting, subcutaneously localized "scrophular" abscesses.
Of etiopathogenetic note are NTMs that occur in patients with primary immunodeficiencies that affect intrinsic imm unity. These immunodeficiency syndromes are grouped under the term MSMD, "Mendelian susceptibility to mycobacterial diseases" (MSDM). MSMD refer to rare, autosomal dominant or autosomal recessive or X-linked recessive (monogenic) immunodeficiency syndromes caused by molecular defects in the IL12 / IFNγ-dependent signaling pathway (Casanova JL 2001).
DiagnosticsThis section has been translated automatically.
Histology, PCR, culture from tissue biopsy.
LaboratoryThis section has been translated automatically.
The AP is often elevated. In case of newly occurring anemia and constitutional symptoms, infection with atypical mycobacteria should always be considered.
HistologyThis section has been translated automatically.
Tuberculoid and sarcoid palisade granulomas, with multinucleated giant cells, accompanied by a diffuse infiltrate of lymphocytes, gronulocytes, and histiocytic foam cells are demonstrable. Usually signs of acute and chronic panniculitis.
Differential diagnosisThis section has been translated automatically.
TherapyThis section has been translated automatically.
Individual skin lesions can be excised; in the case of uncomplicated lymph node involvement, lymph node extirpation may be performed. If deep infections and fistula tracts develop, incision and drainage, usually combined with antibiosis.
The individual mycobacteria respond differently to the tuberculostatic drugs (see Tuberculostatics), prior determination of resistance is therefore essential. Long-term treatment (sometimes up to 2 years) necessary. The duration of therapy should be continued for some time even after clinical healing.
In case of disseminated infestation, antibiotic combination treatments are necessary. Since patients are often immunosuppressed, these cases are life-threatening.
For general therapy regimens, see Tables 2 and 3. For specific dosages in chemotherapeutic treatment, see below, depending on the clinical picture. Appropriate drugs include:
Imipenem 1 g i.v. every 6 h.
Levofloxacin 500 mg i.v. or p.o. 1x/day.
Clarithromycin 500 mg p.o. 2x/day.
Doxycycline 100 to 200 mg p.o. 1x/day
Cefoxitin 2 g i.v. every 6 to 8 h
Amikacin 10 to 15 mg/kg i.v. 1x/day.
Combination therapy with at least 2 drugs that have in vitro activity is recommended. Duration of therapy averages 24 months and may be longer if the infected foreign body remains in the body. Amikacin is usually included for the first 3 to 6 months of therapy. Infections caused by M. abscessus and M. chelonae are usually resistant to most antibiotics and have been shown to be extremely difficult or impossible to cure.
TablesThis section has been translated automatically.
Differentiation of common ubiquitous mycobacteria according to their treatability with conventional tuberculostatics (according to Fätkenheuer/Diehl/Schrappe).
Relatively sensitive mycobacteria
Relatively resistant mycobacteria
M. kansasii: RMP + INH + EMB or SM
M. avium complex
M. marinum: RMP + EMB
M. szulgai: RMP + EMB + ETA or SM
M. xenopi: INH + RMP + SM
Clinic and therapy of common infections with atypical mycobacteria
Soil, dust and water, biosynthetic surfaces (e.g., silicone tubing, indwelling venous cannula).
Predominantly pulmonary, rarely extrapulmonary manifestations.
Combination with RMP + INH + EMB + levofloxacin or SM for several months to 2 years. Success also described with kanamycin, clarithromycin, or minocycline.
On the skin variable e.g. abscess formation; localized oropharyngeal infection among others; disseminated infections in immunosuppressive patients.
In case of circumscribed foci, additional surgical procedure.
M. marinum (swimming pool granuloma)
Sea, lake, rivers, swimming pool, fountains, aquariums.
Usually spontaneous healing within 1-2 years. If necessary, excision or incision with drainage, cryosurgery, electric snare. If necessary, cotrimoxazole, tetracycline, minocycline. If persistent, RMP + EMB.
2-3 weeks after contact Appearance of circumscribed skin changes in the form of a livid nodule, plaques, or verrucous lesions. Ulcerations are possible. Asymptomatic or painful skin lesions.
M. ulcerans (Buruli ulcer)
Minor injuries e.g. thorn pricks, insect bites, mainly in water-rich subtropical areas.
Excision and plastic coverage. Therapeutic trial with cotrimoxazole + SM. If necessary, additional local heat therapy and hyperbaric therapy. Spontaneous healing after years.
Approximately 3 months after contact, a subcutaneous swelling develops, which expands and possibly ulcerates. Extension to entire limb possible (painless!), patient otherwise feels well.
M. chelonei (M. fortuitum-chelonei complex)
Water (including tap water), soil, dust.
Pulmonary, rarely cutaneous manifestations.
Therapy of choice for circumscribed processes is excision in toto. The pathogen responds well to erythromycin. Agents such as clarithromycin, cefocitin, amikacin, doxycycline, sulfamethoxazole alone or in combination are sometimes described as successful. When in doubt, antituberculous drug therapy. No specific regimen known. Spontaneous cure possible.
Transmission frequently after minor injuries, surgery, punctures, indwelling venous cannulae.
On the skin as dermal deep red subcutaneous nodules, possibly with ulceration or abscess formation or elevated erythematous keratotic plaques. Dissemination may occur with immunosuppression.
M. avium-intracellulare (M. avium complex).
Occurs in dust, dirt, fresh and salt water, in birds, pigs, sheep, cattle, in milk and eggs.
Pulmonary, rarely extrapulmonary.
Circumscribed lesions are excised. In disseminated infestation: clarithromycin + rifabutin + EMB, clofazimine.
Granulomatous synovitis, panniculitis. On the skin, subcutaneous nodules. In immunosuppressive patients, possibly dissemination. Primary skin infections have been described sporadically.
Milk, oysters, soil, and water. Occurs in children (1-3 yr) and immunosuppressed patients. Sources of infection are often unclear.
Cutaneous manifestations, lymph node involvement.
Lymphadenitis: excision of affected lym node areas is curative. If extensive, excision, incision if necessary, and drainage combined with systemic treatment. Clarithromycin + EMB + rifabutin.
Typical (cervical) lymphadenitis with also long-standing asymptomatic plaques or sporotrichoid nodules. Disseminated forms in immunosuppression.
Cutaneous manifestations, lymph node involvement.
For circumscribed changes, lymph nodes and affected skin are surgically removed. If persistent, RMP + EMB + ETA or SM.
Typical is (cervical) lymphadenitis with appearance of nodules and plaques on the skin.
Note(s)This section has been translated automatically.
LiteratureThis section has been translated automatically.
- Abdoulaye S et al (2014) Mycobacterium ulcerans Disease with Unusual Sites Not to Be Ignored. Dermatol Res Pract 2014:639374.
- Adjemian J et al (2012) Spatial clusters of nontuberculous mycobacterial lung disease in the United States. Am J Respir Crit Care Med 186: 553-558.
- Alcaide F et al. (2010) Infecciones cutáneas y de partes blandas por micobacterias no tuberculosas [Cutaneous and soft skin infections due to non-tuberculous mycobacteria]. Enferm Infecc Microbiol Clin Suppl 1:46-50.
- American Thoracic Society (1987). Mycobacterioses and the acquired immunodeficiency syndrome. Joint position paper of the American Thoracic Society and the Centers for Disease Control. Am Rev Respir Dis 136: 492-496.
- Andrejak C et al (2010) Nontuberculous pulmonary mycobacteriosis in Denmark: incidence and prognostic factors. Am J Respir Crit Care Med 181: 514-552.
- Andréjak C et al (2013) Chronic respiratory disease, inhaled corticosteroids and risk of nontuberculous mycobacteriosis. Thorax 68: 256-262
- Aubry A et al (2002) Sixty-three cases of Mycobacterium marinum infection: clinical features, treatment, and antibiotic susceptibility of causative isolates. Arch Intern Med 162: 1746-1752.
- Brown-Elliott BA et al (2012) Antimicrobial susceptibility of nontuberculous mycobacteria from eye infections. Cornea 31: 900-906
- Casanova JL (2001). Mendelian susceptibility to mycobacterial infection in man. Swiss Med Wkly 131:445-454.
- Chan ED et al (2013) Underlying host risk factors for nontuberculous mycobacterial lung disease. Sem Respir Crit Care Med 34: 110-123.
- Chatzikokkinou P et al (2015) Disseminated cutaneous infection with Mycobacterium chelonae in a renal transplant recipient. Cutis 96:E6-9.
- Colombo RE et al (2010) Familial clustering of pulmonary nontuberculous mycobacterial disease. Chest 137: 629-634
- Daley CL (2009) Nontuberculous mycobacterial disease in transplant recipients: early diagnosis and treatment. Curr Opin Organ Transplant 14: 619-624.
- Daley CL et al (2020) Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J 56:2000535.
- Dodiuk-Gad R et al (2007) Nontuberculous mycobacterial infections of the skin: A retrospective study of 25 cases. J Am Acad Dermatol 57:413-420.
- Düzgünes N et al. (1991) Treatment of mycobacterium avium-intracellulare complex infection in beige mice with free and liposome-encapsulated streptomycin: role of liposome type and duration of treatment. J Infect Dis 164: 143-151
- Edson RS et al (2006) Mycobacterium intermedium granulomatous dermatitis from hot tub exposure. Emerg Infect Dis 12:821-823.
- Edson RS et al. (2006) Mycobacterium intermedium granulomatous dermatitis from hot tub exposure. Emerg Infect Dis 12:821-823.
- Fabri M (2015) Atypical mycobacterioses, JDDG 13 (Suppl.1): 7-8.
- Fätkenheuer G et al (1995) Clinic and therapy of ubiquitous mycobacterioses. Internist 36: 987-994
- Ferreira J et al (2012) Mycobacterium marinum: an increasingly common opportunistic infection in patients on infliximab. Am J Gastroenterol 107: 1268-1269.
- Fonda-Pascual P et al (2018) Penile Mycobacterium avium complex spindle cell pseudotumor. Indian J Dermatol Venereol Leprol. 84:199-202.
- Franco-Paredes C et al. (2018) Cutaneous Mycobacterial Infections.Clin Microbiol Rev 32. pii: e00069-18. doi: 10.1128/CMR.00069-18.
- Fritscher LG et al (2011) Nontuberculous mycobacterial infection as a cause of difficult-to-control asthma: a case-control study. Chest 9: 23-27
- Gonzalez-Santiago TM et al (2015) Nontuberculous mycobacteria: skin and soft tissue infections. Dermatol Clin. 33:563-577.
- Griffith DE et al (2007) An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 175: 367-416.
- Iseman MD (2011) Mycobacterial infections in the era of modern biologic agents. Am J Med Sci 341: 278-280
- Johnson PD et al (2007) Mycobacterium ulcerans in mosquitoes captured during outbreak of Buruli ulcer, southeastern Australia. Emerg Infect Dis 13:1653-1660.
- Jordão Junior CM et al. (2009) Detection of nontuberculous mycobacteria from water buffalo raw milk in Brazil. Food Microbiol 26: 658-661.
- Jurairattanaporn N et al (2020) Mycobacterium haemophilum skin and soft tissue infection in a kidney transplant recipient: A case report and summary of the literature. Transpl Infect Dis 22:e13315.
- Kendall BA et al (2013) Update on the epidemiology of pulmonary nontuberculous mycobacterial infections. Sem Respir Crit Care Med 34: 87-94.
- Kim RD et al (2008) Pulmonary nontuberculous mycobacterial disease. Prospective study of a distinct preexisting syndrome. Am J Respir Crit Care Med 178: 1066-1074.
- Kirk O et al (2000) Infections with Mycobacterium tuberculosis and Mycobacterium avium among HIV-infected patients after the introduction of highly active antiretroviral therapy. EuroSIDA Study Group JD. Am J Respir Crit Care Med 162: 865-872.
- Kump PK et al (2013) A case of opportunistic skin infection with Mycobacterium marinum during adalimumab treatment in a patient with Crohn's disease. J Crohns Colitis 7: e15-18.
- Kumar C et al (2021) Skin and soft-tissue infections due to rapidly growing mycobacteria: An overview. Int J Mycobacteriol 10:293-300.
- Lamb SR et al (2004) Disseminated cutaneous infection with Mycobycterium chelonae in a patient with steroid-dependent rheumatoid arthritis. Clin Exper Dermatol 29: 254-257
- LeBlanc PM et al (2012) Tattoo ink-related infections--awareness, diagnosis, reporting, and prevention. N Engl J Med 367: 985-987.
- Leite CQ et al (2003) Isolation and identification of mycobacteria from livestock specimens and milk obtained in Brazil. Mem Inst Oswaldo Cruz 98: 319-323.
- Lewis FM et al (2003) Fish tank exposure and cutaneous infections due to Mycobacterium marinum: tuberculin skin testing, treatment, and prevention. Clin Infect Dis 37: 390-397
- Mahaisavariya P et al (2003) Nontuberculous mycobacterial skin infections: clinical and bacteriological studies. J Med Assoc Thai 86:52-60.
- McGarvey J et al (2002) Pathogenesis of nontuberculous mycobacteria infections. Clin Chest Med 23: 569-583.
- Mello RB et al (2020) Cutaneous infection by Mycobacterium lentiflavum after subcutaneous injection of lipolytic formula. An Bras Dermatol 95: 511-513.
- Olivier KN et al (2003) Nontuberculous mycobacteria in Cystic Fibrosis Study Group. Nontuberculous mycobacteria. I: multicenter prevalence study in cystic fibrosis. Am J Respir Crit Care Med 167: 828-834.
- Paech V et al (2002) Remission of cutaneous Mycobacterium haemophilum infection as a result of antiretroviral therapy in a human immunodeficiency virus--infected patient. Clin Infect Dis 34: 1017-1019
- Palenque E (2000) Skin disease and nontuberculous atypical mycobacteria. Int J Dermatol 39: 659-666.
- Pampaloni A et al (2020) Skin and soft tissue infection by Mycobacterium intracellulare in an immunocompetent patient. IDCases 19:e00720.
- Phillips MS et al (2001) Nosocomial infections due to nontuberculous mycobacteria. Clin Infect Dis 33: 1363-1374.
- Phillips P et al (2005) Nontuberculous mycobacterial immune reconstitution syndrome in HIV-infected patients: spectrum of disease and long-term follow-up. Clin Infect Dis 41: 1483-1497
- Pisitpayat P et al (2020) Mycobacterium haemophilum scleritis: two case reports and review of literature. BMC Ophthalmol 20:378.
- Rupp J et al (2011) Infections with nontuberculous mycobacteria in patients with immunodeficiencies. Pneumologe 8: 402-407
- Schmoor P et al (2001) Infection cutanée à Mycobacterium malmoense chez une malade immunocompétente [Mycobacterium malmoense cutaneous infection in an immunocompetent patient]. Ann Dermatol Venereol 128:139-40.
- Schoenfeld N et al.(2016) Recommendations of the German Central Committee. Pneumology 70: 250-276
- Schulze-Röbbecke R et al (1992) Occurrence of mycobacteria in biofilm samples. Tuber Lung Dis 73: 141-144
- Silva DLFD et al (2020) Atypical cutaneous mycobacteriosis caused by M. fortuitum acquired in domestic environment. An Bras Dermatol. 95:390-391.
- Sizaire V et al. (2006) Mycobacterium ulcerans infection: control, diagnosis, and treatment. Lancet Infect Dis 6:288-296.
- Street ML et al (1991) Nontuberculous mycobacterial infections of the skin. J Am Acad Dermatol 24: 208-215.
- Thomson RM (2010) Changing epidemiology of pulmonary nontuberculous mycobacteria infections. Emerg Infect Dis 16: 1576-1583.
- To K et al (2020) General Overview of Nontuberculous Mycobacteria Opportunistic Pathogens: Mycobacterium avium and Mycobacterium abscessus. J Clin Med 9:2541.
- Tortoli E (2006) The new mycobacteria: an update. FEMS Immunol Med Microbiol 48: 159-178.
- Tribuna C et al (2015) Pulmonary Kaposi sarcoma and disseminated Mycobacterium genavense infection in an HIV-infected patient. BMJ Case Rep bcr2015211683.
- Turenne CY (2019) Nontuberculous mycobacteria: Insights on taxonomy and evolution. Infect Genet Evol 72:159-168.
- Uslu U et al. (2019) Skin and Soft Tissue Infections Caused by Mycobacterium chelonae: More Common Than Expected? Acta Derm Venereol 99:889-893.
- van Ingen J et al. (2018) A definition of the Mycobacterium avium complex for taxonomical and clinical purposes, a review. Int J Syst Evol Microbiol 68:3666-3677.
- Wang CJ et al. (2022) Mycobacterium smegmatis skin infection following cosmetic procedures: report of two cases. Clin Cosmet Investig Dermatol 15:535-540.
- Walsh DS et al (2011) Buruli ulcer: advances in understanding Mycobacterium ulcerans infection. Dermatol Clin 29: 1-8
- Winthrop KL et al (2002) An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med 346: 1366-1371
- Winthrop KL et al (2009) Nontuberculous mycobacteria infections and anti-tumor necrosis factor-alpha therapy. Emerg Infect Dis 15: 1556-1561.
- Winthrop KL et al (2010) Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease. Am J Respir Crit Care Med 182: 977-982.
- Wölfer LU (2009) Atypical mycobacterioses of the skin. Act Dermatol 35: 295-299
- Xu X et al (2019) Chronic Mycobacterium avium skin and soft tissue infection complicated with scalp osteomyelitis possibly secondary to anti-interferon-γ autoantibody formation. BMC Infect Dis 19:203.
Incoming links (14)Atypical mycobacterioses; Cutaneous botryomycosis ; Disseminated sporotrichosis; Hiv infection; Infectious diseases of the skin; Mycobacteria other than tubercle bacilli (mott); Mycobacterium fortuitum complex; mycobacterium intracellulare; Nontuberculous Mycobacteria; nontuberculous mycobacterioses; ... Show all
Outgoing links (36)Buruli ulcer; Cervical lymphadenopathy in children ; Cutaneous mycobacterium spindle cell pseudotumor ; Cutaneous tuberculosis (overview); M. abscessus; Mendelian susceptibility to mycobacterial diseases; Mycobacteria; Mycobacterium avium; Mycobacterium avium Complex ; Mycobacterium celatum; ... Show all
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