Postoperative wound infection by nontuberculous mycobacteria; case series in Dhaka Medical College Hospital of Bangladesh

Abstract

The incidence of nontuberculous mycobacterial (NTM) infections after operations is increasing in Bangladesh but data regarding clinical presentation, diagnosis, treatment, and prognosis after treatment are lacking. In this case series, three patients having persistent serous discharge from incision wound after operation were studied. Discharge from wounds were collected, wet film microscopy was performed for pus cells and fungus, Gram stain, Ziehl-Neelsen (ZN) stain, culture in routine culture media and Lowenstein-Jensen (LJ) media, Xene-Xpert for mycobacterium tuberculosis (MTB), polymerase chain reaction (PCR) for NTM were done. NTM-positive patients were treated initially for 6 weeks with four drugs regimen (clarithromycin 500 mg 12 hourly, ciprofloxacin 500 mg 12 hourly, linezolid 400 mg 12 hourly, and amikacin 500 mg 12 hourly), followed by 5 months with three drugs regimen (clarithromycin 500 mg 12 hourly, ciprofloxacin 500 mg 12 hourly, and linezolid 400 mg 12 hourly) as a maintenance dose. Cessation of discharge occurred within 3-4 weeks after starting treatment, and the wounds were healed.

Keywords: Bangladesh; Dhaka Medical College Hospital; acid‐fast bacilli (AFB); nontuberculous mycobacteria (NTM); postoperative wound infection.

FIGURE 1

High‐magnification microscopic picture showing the presence of acid‐fast bacilli in wound discharge on Ziehl‐Neelsen stain (100×).

FIGURE 2

Culture on blood agar media yielded growth of NTM on Day 4.

FIGURE 3

Discharging sinus 3 months after operation when the patient came to the microbiology department.

FIGURE 4

Healed lesion after 6 months of getting treatment.