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- Jyotsna Bhattacharya, MD*
- Sindhu Mohandas, MBBS*
- David L. Goldman, MD†
- *Department of Pediatric Infectious Diseases and
- †Department of Pediatrics and Microbiology and Immunology, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
AUTHOR DISCLOSURE
Drs Bhattacharya, Mohandas, and Goldman have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- AFB:
- acid-fast bacillus
- CF:
- cystic fibrosis
- HAART:
- highly active antiretroviral therapy
- HIV:
- human immunodeficiency virus
- IFN-γ:
- interferon-γ
- IGRA:
- interferon-γ release assay
- IRIS:
- immune reconstitution inflammatory syndrome
- MAC:
- Mycobacterium avium complex
- MALDI-TOF:
- matrix-assisted laser desorption/ionization–time of flight
- NTM:
- nontuberculous mycobacteria
- RGM:
- rapidly growing mycobacteria
- SGM:
- slowly growing mycobacteria
- SSTI:
- skin and soft tissue infection
Education Gaps
Outbreaks of nontuberculous mycobacterial infections have been increasingly reported following cosmetic procedures performed abroad. Failure to recognize this association can lead to inappropriate or delayed therapy. (1)
The emergence of drug resistance in specific species of nontuberculous mycobacteria infections (especially Mycobacterium abscessus) complicates medical therapy. Appropriate treatment of these infections involves the identification of a specific species and drug resistance testing. (2)
Objectives
After completing this article, readers should be able to:
Recognize the major clinical features associated with nontuberculous mycobacteria (NTM) infections in children.
Recognize that NTM infections are a potential risk related to medical tourism for cosmetic surgery.
Understand the strengths and weaknesses of currently available diagnostic methods.
Plan the appropriate management of NTM infections based on the specific clinical presentation and mycobacterial species.
Introduction
Nontuberculous mycobacteria (NTM) include all mycobacteria other than Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium leprae. Children are constantly exposed to NTM, yet clinical signs of infection are unusual. NTM exist primarily in the environment, causing human disease as opportunistic pathogens in the appropriate clinical context. Lymphadenitis is far and away the most common manifestation of NTM disease in children. Other, less common, manifestations include skin and soft tissue infections (SSTIs), lung infections, and disseminated disease. Since the last review of NTM disease in Pediatrics in Review, (3) several important developments have occurred, including changes in the epidemiology and treatment, which are reviewed herein.
Microbiology and Classification
Currently there are more than 170 recognized NTM species, although a limited number of species cause human disease. It survives inside amoeba, and the traits that promote this process may also allow for successful macrophage infection. (4 …
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