Abstract

Objective/Background: SSIs remain a significant cause of morbidity and mortality after surgery. One in eight patients develop SSI after exploratory laparotomies making it one of the major factors responsible for post-operative mortality and morbidity. Atypical mycobacteria are responsible for a spectrum of diseases ranging from superficial skin infections to widely disseminated systemic infections. Health care associated infections due to non-tuberculous mycobacteria is on the rise due to contaminated hospital water supplies, solutions, improperly sterilized instruments and devices. Our case is of an atypical mycobacterial infection in a patient with abdomino-thoracic trauma who underwent multiple surgeries. Case presentation: A 24 year old gentleman presented with a penetrating stab injury to the abdomen and left hemi-thorax following an assault. Patient underwent an emergency exploratory laparotomy which revealed a 4 x 4 cm defect in the left hemi-diaphragm, through which the stomach was herniating into the left thoracic cavity. During the 2nd post-operative week, patient developed empyema thorax, for which pigtail drain was placed initially and later thoracotomy with decortication and intercostal drainage were performed. Following discharge after 2 weeks, he presented with fever, body pain and pus discharge from the previously inserted intercostal drain site. Pus obtained was positive for acid fast bacilli and gene expert was negative. Atypical mycobacterial infection was diagnosed based on high index of suspicion and he received treatment for 6 months. Conclusion: This case highlights that identification of atypical mycobacterial infections in post-operative patients require a high index of suspicion. Management requires multi-drug approach and surgical intervention wherever necessary. Even with the existing sterilization techniques and preventive measure, atypical mycobacterial infection cannot be completely eliminated from a hospital set-up and hence must be considered in all nosocomial infections.

• 1.   Sinha S. Management of post-surgical wounds in general practice. Aust J Gen Pract. 2019 Sep;48(9):596-599. doi: 10.31128/AJGP-04-19-4921. PMID: 31476832.
• 2.   Chowdhury S, Bahatheq S, Alkaraawi A, et al. Surgical site infections after trauma laparotomy. An observational study from a major trauma center in Saudi Arabia. Saudi Med J. 2019;40(3):266-270. doi:10.15537/smj.2019.3.24005.
• 3.   Michael S. Phillips, C. Fordham von Reyn, Nosocomial Infections Due to Nontuberculous Mycobacteria, Clinical Infectious Diseases, Volume 33, Issue 8, 15 October 2001, Pages 1363 1374, https://doi.org/10.1086/323126.
• 4.   Pinheiro, Patrícia Yvonne Maciel, Setúbal, Sérgio and Oliveira, Solange ArtimosdePost-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro. Revista da SociedadeBrasileira de Medicina Tropical [online]. 2019, v. 52 [Accessed 26 December 2021] , e20190039. Available from: . Epub 18 July 2019. ISSN 1678-9849. https://doi. org/10.1590/0037-8682-0039-2019.
• 5.   Agência Nacional de VigilânciaSanitária. Informe Técnico No 1 - Infecção por Mycobacterium abscessus Diagnóstico e tratamento. 2007a. Available at: Available at: http://www.anvisa. gov.br/servicosaude/controle/Alertas// Informe_tecnico_1.pdf Accessed: March 11, 2018.
• 6.   T. M. Gonzalez-Santiago and L. A. Drage, “Nontuberculous mycobacteria: skin and soft tissue infections,” Dermatologic Clinics, vol. 33, no. 3, pp. 563–577, 2015.
• 7.   B. A. Brown-Elliott and R. J. Wallace, “Infections caused by Mycobacterium bovis and nontuberculous mycobacteria other than Mycobacterium avium complex,” in Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, J. E. Bennett, R. Dolin, and M. J. Blaser, Eds., pp. 2844–2852, Saunders, Philadelphia, Pa, USA, 8th edition, 2015.
• 8.   Shah AK, Gambhir RP, Hazra N, Katoch R. Non tuberculous mycobacteria in surgical wounds- a rising cause of concern?. Indian J Surg. 2010;72(3):206-210. doi:10.1007/s12262-010-0057-9
• 9.   Prabin Sharma, Laia Jimena Vazquez Guillamet, Goran Miljkovic, “Atypical Mycobacterial Infection after Abdominoplasty Overseas: A Case Report and Literature Review”, Case Reports in Infectious Diseases, vol. 2016, Article ID 3642567, 4 pages, 2016. https://doi.org/10.1155/2016/3642567.
• 10.   R. C. Lamb and G. Dawn, “Cutaneous non tuberculous mycobacterial infections,” International Journal of Dermatology, vol. 53, no. 10, pp. 1197–1204, 2014.
• 11.   D. E. Griffith, T. Aksamit, B. A. Brown-Elliott et al., “An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases,” American Journal of Respiratory and Critical Care Medicine, vol. 175, no. 4, pp. 367–416, 2007.
• 12.   C. Daley and D. Griffith, “Nontuberculous mycobacterial infections,” in Murray and Nadel’s Textbook of Respiratory Medicine, V. C. Broaddus, R. J. Mason, J. D. Ernst et al., Eds., pp. 629–645, Saunders, 6th edition, 2016.
• 13.   J. M. Swenson, R. J. Wallace Jr., V. A. Silcox, and C. Thornsberry, “Antimicrobial susceptibility of f ive subgroups of Mycobacterium fortuitum and Mycobacterium chelonae,” Antimicrobial Agents and Chemotherapy, vol. 28, no. 6, pp. 807–811, 1985.
• 14.   B. A. Brown, R. J. Wallace Jr., G. O. Onyi, V. De Rosas, and R. J. Wallace III, “Activities of four macrolides, including clarithromycin, against Mycobacterium fortuitum, Mycobacterium chelonae, and M. chelonae-like organisms,” Antimicrobial Agents and Chemotherapy, vol. 36, no. 1, pp. 180–184, 1992.
• 15.   S. H. Kasperbauer and M. A. De Groote, “The treatment of rapidly growing mycobacterial infections,” Clinics in Chest Medicine, vol. 36, no. 1, pp. 67–78, 2015.
• 16.   Chaudhuri S, Sarkar D, Mukerji R. Diagnosis and management of atypical mycobacterial infection after laparoscopic surgery. Indian J Surg. 2010;72(6):438-442. doi:10.1007/s12262-010-0164-7

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