A Cluster of Nontuberculous Mycobacterial Tenosynovitis Following Hurricane Relief Efforts. (2nd November 2020)

• Record Type: Journal Article
• Authors: Turner, Nicholas A; Sweeney, Mollie I; Xet-Mull, Ana M; Storm, Jeremy; Mithani, Suhail K; Jones, David B; Miles, Jeremy J; Tobin, David M; Stout, Jason E
• Is Part Of: Clinical infectious diseases. Volume 72:Number 12(2021)
• Page Start: e931
• Page End: e937
• Publication Date: 2020-11-02
• Subjects: Mycobacterium arupense -- Mycobacterium heraklionense -- Mycobacterium terrae complex -- Mycobacterium intracellulare -- tenosynovitis; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1665
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Nontuberculous mycobacteria (NTM) are a rare cause of infectious tenosynovitis of the upper extremity. Using molecular methods, clinical microbiology laboratories are increasingly reporting identification down to the species level. Improved methods for speciation are revealing new insights into the clinical and epidemiologic features of rare NTM infections. Methods: We encountered 3 cases of epidemiologically linked upper extremity NTM tenosynovitis associated with exposure to hurricane-damaged wood. We conducted whole-genome sequencing to assess isolate relatedness followed by a literature review of NTM infections that involved the upper extremity. Results: Despite shared epidemiologic risk, the cases were caused by 3 distinct organisms. Two cases were rare infections caused by closely related but distinct species within the Mycobacterium terrae complex that could not be differentiated by traditional methods. The third case was caused by Mycobacterium intracellulare . An updated literature review that focused on research that used modern molecular speciation methods found that several species within the M. terrae complex are increasingly reported as a cause of upper extremity tenosynovitis, often in association with environmental exposures. Conclusions: These cases illustrate the importance of molecular methods for speciating phenotypically similar NTM, as well as the limitations of laboratory-based surveillance in detecting point-source outbreaks when the source is environmental and may involve multiple organisms. Abstract : Molecular methods have improved speciation of nontuberculous mycobacteria (NTM), revealing new insights into clinical and epidemiologic behaviors. Here, we describe a cluster of epidemiologically linked, yet molecularly unrelated NTM infections of the upper extremity, accompanied by an updated literature review.