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Atypic non-tuberculous mycobacterial infection in immunocompetent ENT patients
Introduction Mycobacterium gordonae is a saprophytic bacterium which is spread in water and earth. Primary infections in the ENT area in immunocompetent patiens are extremely rare and can be detected today with molecularbiological methods in suspected tissue. We will present our experience with this special cases.
Methods Analysis oft two cases with Mycobacterium gordonae infection in a cervical lymph node (female 31 years) and the paranasal sinuses (male 42 years) related to the medical history, CT and MRI scans, histological and molecularbiological /RT-PCR) findings, therapy and outcome.
Results The female patients suffered from an abcsess in a cervical lymphnode and wath operated on by surgical removeal oft he infectious tissue. The male patient was treatde by functional endonasal surgery of the bilaterally affected ethmoid and maxillary sinuses. In both cases in the routine histological evaluation a granulomatous infection with giant cells but without necrosis or vasculatis was seen. The additional moleculabiological analyis (RT-PCR) revealed a positive DNA result for Mycobacterium gordonae in the tissue but was negative for other mycobacteria. The patients were treated with a combination of antimicrobiological agents over several months.
Conclusion As shown in our investigation and also reported in the literature primary infections in the ENT area in immunocompetent patiens with Mycobacterium gordonae are extremely rare. Suspected tissue with a granulomatous infection should be analysed by PCR to detect these subspecies of the mycobacterial complex. So other granulomatousis as Wegeners disease or sarcoidosis can be excluded. The detection oft he bacterial affection is of therapeutical relevance for the patients.
10 June 2020 (online)
© Georg Thieme Verlag KG
Stuttgart · New York