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Nontuberculous mycobacterial osteomyelitis.

Abstract
Osteomyelitis caused by nontuberculous mycobacteria (NTM) can have severe consequences and a poor prognosis. Physicians therefore need to be alert to this condition, especially in immunocompromised patients. Although the pathogenesis of NTM osteomyelitis is still unclear, studies in immunodeficient individuals have revealed close relationships between NTM osteomyelitis and defects associated with the interleukin-12-interferon-γ-tumor necrosis factor-α axis, as well as human immunodeficiency virus infection, various immunosuppressive conditions, and diabetes mellitus. Culture and species identification from tissue biopsies or surgical debridement tissue play crucial roles in diagnosing NTM osteomyelitis. Suitable imaging examinations are also important. Adequate surgical debridement and the choice of appropriate, combined antibiotics for long-term anti-mycobacterial chemotherapy, based on in vitro drug susceptibility tests, are the main therapies for these bone infections. Bacillus Calmette-Guerin vaccination might have limited prophylactic value. The use of multiple drugs and long duration of treatment mean that the therapeutic process needs to be monitored closely to detect potential side effects. Adequate duration of anti-mycobacterial chemotherapy together with regular monitoring with blood and imaging tests are key factors determining the recovery outcome in patients with NTM osteomyelitis.
AuthorsSheng Bi, Fei-Shu Hu, Hai-Ying Yu, Kai-Jin Xu, Bei-Wen Zheng, Zhong-Kang Ji, Jun-Jie Li, Mei Deng, Hai-Yang Hu, Ji-Fang Sheng
JournalInfectious diseases (London, England) (Infect Dis (Lond)) Vol. 47 Issue 10 Pg. 673-85 ( 2015) ISSN: 2374-4243 [Electronic] England
PMID25915177 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
Chemical References
  • Tumor Necrosis Factor-alpha
  • Interleukin-12
  • Interferon-gamma
Topics
  • Adult
  • Diabetes Complications
  • Diabetes Mellitus
  • Disease Susceptibility
  • HIV (pathogenicity)
  • Humans
  • Immunocompromised Host
  • Interferon-gamma (immunology)
  • Interleukin-12 (immunology)
  • Mycobacterium Infections, Nontuberculous (etiology, microbiology, therapy)
  • Nontuberculous Mycobacteria (pathogenicity)
  • Osteomyelitis (etiology, microbiology, therapy)
  • Tumor Necrosis Factor-alpha (immunology)

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