Clinical presentation and treatment outcomes of extrapulmonary nontuberculous mycobacterial infections with rapid and slow growth rates in Cali, Colombia

Clinical presentation and treatment outcomes of extrapulmonary nontuberculous mycobacterial infections with rapid and slow growth rates in Cali, Colombia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical presentation and treatment outcomes of extrapulmonary nontuberculous mycobacterial infections with rapid and slow growth rates in Cali, Colombia Natalia Ramos Ospina, Sofia Alexandra Montes-Tello, Angie Valeria Torres-Morales, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3982582/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Mar, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: The increasing prevalence of extrapulmonary nontuberculous mycobacterial (NTM) infections poses significant challenges in clinical management due to their inherent drug resistance and the need for prolonged antibiotic regimens. Although these infections are infrequent in daily clinical practice, detailed information on associated clinical outcomes is lacking in the local literature. Materials and Methods This descriptive observational study examined 17 patients with extrapulmonary NTM infection from the General Mycobacteria Registry of Fundación Valle del Lili University Hospital and reviewed a total of 391 patients between 2007 and 2021. Results A predominance of women with a history of cosmetic surgery was observed, with the skin being the most common site of involvement, especially for M. fortuitum and M. abscessus . The most commonly used treatment consisted of a combination of clarithromycin and moxifloxacin administered for approximately 4–6 months, for a cure rate of 70.5%. Conclusion The treatment regimens implemented align with the literature recommendations, and it is noteworthy that the cure rate exceeds 70%, which contrasts with what has been reported in existing research. The lack of temporal references for diagnosis and treatment is highlighted, underscoring the need for future research to address this critical aspect and improve clinical outcomes. nontuberculous mycobacteria fast-growing mycobacteria slow-growing mycobacteria extrapulmonary clinical outcome Figures Figure 1 Figure 2 INTRODUCTION NTMs are ubiquitous microorganisms found in soil and water and include approximately 190 species. They can cause diseases in individuals with underlying pulmonary conditions, advanced human immunodeficiency virus (HIV) infection, advanced age, or compromised immune systems, leading to skin and soft tissue (SST) lesions in immunocompetent individuals [ 1 , 2 ]. NTM have been identified in various sources, including water distribution systems, biofilms and aerosols within the households of NTM patients [ 2 ]. Locally, pathogenic NTM species such as M. chelonae and M. fortuitum have been detected in drinking water supplies [ 3 ]. Proper characterization of NTM infections is crucial due to the global increase in NTM infections, which are linked to genetic mutations, climate change, and immunocompromised populations [ 4 ]. Reports in Colombia document NTM infections with cutaneous involvement, often from cosmetic procedures [ 5 ]. A case series in Bogotá and Cali showed higher NTM rates among HIV-infected patients [ 4 , 6 ]. Identifying NTM strains poses several challenges, especially owing to the need for specialized laboratories and molecular testing for species confirmation, which are unevenly available in major cities. Species confirmation guides antibiotic therapy, which is critical due to NTM natural drug resistance. Guidelines recommend specific regimens based on species, with treatment adherence determining clinical outcomes [ 1 , 7 ]. Our study explored the sociodemographic and clinical characteristics, antimicrobial regimens, adverse effects, and outcomes of NTM extrapulmonary (NTM-EP) infections treated in Cali from 2007 to 2021. This study aimed to enhance the understanding of the clinical response and optimize management strategies for patients with NTM infections beyond the pulmonary system. METHODS A descriptive cross-sectional observational study was conducted by thoroughly reviewing 391 patients from the General Mycobacteria Registry of the Fundación Valle del Lili University Hospital from 2007 to 2021. Among these patients, 17 who met the criteria of NTM infection with extrapulmonary involvement, microbiological identification of NTM, and NTM treatment, were selected ( Fig. 1 ). Data collection techniques and management An active search of the institution's medical records was performed using diagnoses from the International Classification of Diseases, 10th Revision (ICD-10) related to NTM infection. Selected cases were reviewed for data, and quantitative variables were described according to their distribution. The means and standard deviations were calculated, and categorical variables were described using tables of absolute and relative frequencies. RESULTS Patient Characteristics and Clinical Presentation Thirteen patients (76%) had cutaneous lesions, seven of whom underwent cosmetic procedures as a risk factor, five of whom did not undergo cosmetic procedures, and one who suffered an injury caused by a plant, with an age range of 29 to 42 years and a median age of 38 years. A total of 76.6% of patients self-identified as mestizos, and a history of cosmetic interventions was evident in 7 (41.2%) patients, along with immunosuppressive drug therapy in 6 (35.3%) patients ( Table 1 ). Table 1 Description of patients with NTM with extrapulmonary involvement. Variable Patients (n = 17) Gender Female 13 (76,5%) Male 4 (23,5%) Age Range 61 years 4 (24,5%) Ethnicity Hispanic 13 (76,6%) Black 2 (11,7%) Others 2 (11,7%) Medical History Surgery or cosmetic procedures 7 (41,2%) Immunosuppressive Therapy 6 (35,3%) HIV infection 3 (17,6%) Type 2 Diabetes Mellitus 2 (11,7%) Bariatric surgery 1 (5,9%) Cancer 1 (5,9%) Abbreviations HIV: Human Immunodeficiency Virus, NTM: Nontuberculous mycobacteria Fever was observed in 7 (41.2%) patients, and a clinical presentation with skin involvement was noted in 13 (76%) patients ( Table 2 ). The median time between symptom onset and clinical suspicion of NTM infection was 40 days (interquartile range (IQR): 6–79), while the median time between clinical diagnosis and identification of the NTM isolate was 33 days (IQR: 14–189). Table 2 Clinical Presentation of NTM. Extrapulmonary Involvement Patients (n = 17) Soft tissues 13 (76,5%) Skin 12 (92,3%) Muscle 1 (7,7%) Lymph node 3 (17,6%) Endocardium (biological mitral valve) 1 (5,9%) Abbreviations NTM: Nontuberculous mycobacteria. NTM identification was carried out using the Speed-oligo® Mycobacteria technique in 8 patients (47.1%) and the GenoType Mycobacteria technique in another 8 patients; in one of them, the identification method used was unknown. The identified rapid-growing mycobacteria (RGMs) were the M. fortuitum complex in soft tissues and the mediastinum, the M. abscessus complex (Mab) in soft tissues and lymph nodes and M. chelonae in soft tissues and muscle. The slow-growing mycobacteria (SGM) were M. avium complex (MAI) in the lymph node, M. malmoense in the biological heart valve and M. marinum in the soft tissues ( Fig. 2 ). Sensitivity profile identification was described for 10 (58.8%) patients. One M. chelonae strain was sensitive to aminoglycosides, macrolides, fluoroquinolones, and oxazolidinones. One patient with MAI was sensitive to quinolones and aminoglycosides but resistant to fluoroquinolones. Among the five Mab strains, 100% were sensitive to aminoglycosides, macrolides, and quinolones, 60% were resistant to doxycycline, 20% were resistant to ofloxacin, and 20% had an intermediate profile of ofloxacin resistance. Among the three M. fortuitum isolates, 100% were sensitive to aminoglycosides, macrolides, and quinolones, and 66.7% were sensitive to ofloxacin. The treatment regimens used were as follows: one case of M. marinum treated with rifampicin and moxifloxacin; one case of M. malmense treated with rifampicin, moxifloxacin, and clarithromycin; two cases of M. chelonae treated with moxifloxacin and clarithromycin; two cases of MAI treated with clarithromycin and ethambutol; one of these cases was additionally treated with amikacin; all five cases of Mab were treated with clarithromycin; two cases additionally were treated with amikacin; and one case was treated with an additional antibiotic, doxycycline, linezolid, or levofloxacin. Among the six patients with M. fortuitum infection , five were treated with clarithromycin and moxifloxacin, and only one was treated with clindamycin. The duration of treatment was not related to the type of NTM; in eight (47.1%) patients, the treatment duration was 6 months, and in three (17.6%) patients, it was 4 months. Five (29.4%) patients required a treatment duration equal to or greater than 12 months according to the clinical cure criteria, and only two patients were lost to follow-up, with no information available on clinical outcome ( Table 3 ). Finally, adverse effects were observed in three (20%) patients, all of whom required modification of the antibiotic regimen: one patient withdrew from moxifloxacin due to reactive arthritis, and two patients experienced amikacin-related hearing loss and tinnitus. The most common adverse effects without requiring a change in the antibiotic regimen were gastrointestinal symptoms, particularly nausea, vomiting, and dyspepsia. Table 3 Clinical description and treatment outcomes of NTM cases. Mycobacteria Diagnosis Clinical profile Treatment and outcome Cardiovascular involvement M. malmoense. Microbiological confirmation through GenoType Mycobacterium CM/AS in blood cultures at 33 days, with no availability of DST. A 61-year-old male with dermatomyositis treated with prednisolone and rituximab, and with a biological prosthetic mitral valve due to rheumatic valvulopathy, develops fever, dyspnea, and chest pain. Endocarditis on the prosthetic aortic valve caused by NTM is diagnosed. Surgical management with valve replacement. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d + RIF 600 mg q.d for 12 months. Experiences favorable clinical evolution, with no evidence of relapse after three years of follow-up. Soft tissue involvement M. abscessus. Microbiological confirmation through GenoType Mycobacterium CM/AS in soft tissue cultures at 7 days, sensitive to AMK, MXF, and CLR. A 31-year-old female with erythema nodosum and biopolymer implants. Presents with nodular lesions at the right gluteal area. Surgical management with excision of the nodules. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d. for 4 months, discontinued due to gastrointestinal adverse events. No evidence of relapse after three years of follow-up. M. abscessus. Microbiological confirmation through Speed-oligo® Mycobacteria of intraoperative culture at 10 days, sensitive to AMK, MXF and CLR, resistant to OFL and DXC. A 31-year-old female with a history of breast augmentation surgery and replacement of breast implants one year prior, develops inflammatory changes in the surgical wound. Surgical management with removal of the implants. Pharmacological management : CLR 500 mg b.i.d + DXC 100 mg b.i.d for 6 months with early relapse. Treatment regimen was modified to LNZ 600 mg b.i.d + CLR 500 mg b.i.d for 6 months. No evidence of relapse after four years of follow-up." M. abscessus. Microbiological confirmation through Speed-oligo® Mycobacteria of soft tissue biopsy at 25 days. Sensitive to AMK, CLR, MXF, and DXC, resistant to OFL. A 35-year-old female, who after a session of mesotherapy, develops nodular lesions with purulent discharge and systemic inflammatory response. Surgical lavages. Pharmacological management : CLR 500 mg b.i.d + AMK 500 mg t.i.d for 6 months. No evidence of relapse after one year of follow-up M. abscessus. Microbiological confirmation through Speed-oligo® Mycobacteria in culture of gluteal secretion at 15 days. Sensitive to AMK, CLR, and MXF, resistant to DXC and OFL. A 28-year-old female with a history of liposuction and gluteal lipoinjection develops inflammatory changes and erythematous nodular lesions on both gluteal regions with purulent discharge 20 days after the procedure. Ambulatory treatment with ampicillin-sulbactam was administered, followed by moxifloxacin, without improvement. Surgical management with debridement. Pharmacological management : CLR 500 mg b.i.d + LVX 500 mg q.d + AMK 500 mg t.i.d for 6 months. No evidence of relapse after one year of follow-up. M. fortuitum. Microbiological confirmation through GenoType Mycobacterium CM/AS in culture of surgical wound secretion and mediastinal fluid at 34 days. Sensitive to CLR, AMK, and MXF. A 69-year-old male with a history of liver transplantation (tacrolimus and prednisolone) presents with aortic dissection, managed with ascending aorta replacement. However, he is readmitted a week later due to febrile syndrome associated with inflammatory changes in the surgical wound in the chest Surgical lavages. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d for 12 months. No evidence of relapse after three years of follow-up. M. fortuitum. Microbiological confirmation through Speed-oligo® Mycobacteria in culture of surgical wound secretion at 11 days. DST not available. A 64-year-old female with CREST syndrome and breast cancer undergoing chemotherapy and mastectomy, developed a surgical site infection managed with outpatient trimethoprim-sulfamethoxazole without improvement. She was readmitted to the emergency department due to inflammatory changes in the surgical wound and purulent discharge. Surgical lavages. Pharmacological management : MXF 400 mg q.d. + CLI 600 mg t.i.d for 4 months. No evidence of relapse after one year of follow-up. M. fortuitum. Microbiological confirmation through Speed-oligo® Mycobacteria in culture of surgical wound secretion at 13 days, sensitive to AMK, CLR, and OFL. A 64-year-old female with a history of gastric bypass surgery developed an abdominal hernia requiring surgical correction with mesh placement, which subsequently led to surgical site infection involving the organ space accompanied by fever. Surgical lavages. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d for 6 months. No evidence of relapse after one year of follow-up M. fortuitum. Microbiological confirmation through GenoType Mycobacterium CM/AS in culture of surgical wound secretion at 17 days. DST not available A 56-year-old female with a history of lipectomy, liposuction, and breast implants develops inflammatory changes in the abdominal surgical wound at the hypogastric level six months after the cosmetic procedures, associated with constitutional symptoms and evidence of subcutaneous tissue collection on ultrasound Surgical lavages. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d. The duration of treatment is unknown as the patient did not continue follow-up M. fortuitum. Microbiological confirmation through GenoType Mycobacterium CM/AS in culture of surgical wound secretion, sensitive to AMK, CLR, and OFL. A 45-year-old female with a history of HIV (HIV viral load: 1,536,776 copies/ml, CD4 count: 0% − 104 cells/ml) on ART (ABC, 3TC, NVP) and breast implants, presents with inflammatory changes in the surgical wound in the breast. Surgical lavages. Pharmacological management : CLR 500 mg b.i.d for 6 months. No evidence of relapse after two years of follow-up M. fortuitum. Microbiological confirmation through Speed-oligo® Mycobacteria in surgical wound culture at 8 days. DST not available. A 16-year-old female with a history of surgery including osteotomy of the lower jaw and right condrectomy with osteosynthesis material. One week after the procedure, she develops inflammatory changes in the surgical wound Surgical lavages. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d for 4 months. No evidence of relapse after one year of follow-up M. chelonae. Microbiological confirmation through GenoType Mycobacterium CM/AS in skin biopsy culture at 6 days, sensitive to CLR and MXF with intermediate profile for DXC. A 40-year-old female with a history of cosmetic surgery in the abdominal and gluteal regions presents with nodular, indurated, erythematous lesions with discharge in the bilateral gluteal region at three months Surgical lavages. Pharmacological management : Initially, two months with AMK, followed by CLR 500 mg b.i.d + MXF 400 mg q.d for 6 months. No evidence of relapse after five years of follow-up. M. chelonae. Microbiological confirmation through Speed-oligo® Mycobacteria in soft tissue culture at 16 days. DST not available. A 32-year-old female with a history of bariatric surgery, sarcoidosis, and SLE under rituximab therapy presents with joint pain in the hips, associated with constitutional symptoms, without a history of trauma or procedures. Gluteus major myositis and ipsilateral fascia lata involvement are confirmed without joint or bone compromise Surgical lavages. Pharmacological management : CLR 500 mg b.i.d + MXF 400 mg q.d for 12 months. The patient discontinues it and experiences a relapse after one month. Treatment is restarted for another 6 months. No evidence of relapse after five years of follow-up. M. marinum. Microbiological confirmation through GenoType Mycobacterium CM/AS in skin biopsy culture at 21 days. DST not available. A 58-year-old female with type DM2 and rheumatoid arthritis, undergoing treatment with leflunomide and rituximab, is exposed to home aquariums. She experiences trauma with a plant object on the fourth finger of the right hand, with lymphatic dissemination after three weeks. She develops a nodular, erythematous, painful lesion on the inner forearm. Surgical lavages. Pharmacological management : RIF 600 mg q.d + MXF 400 mg q.d for 6 months. No evidence of relapse after three years of follow-up. Ganglionar involvement M. avium intracellulare. Microbiological confirmation through Speed-oligo® Mycobacteria in biopsy culture at 11 days, sensitive to MXF, ETB, CLR, and AMK A 4-year-old male with a history of perinatal HIV infection under treatment with LPV/rtv-based ART associated with AZT/3TC, (HIV viral load: 451 copies/ml, CD4: 8% − 212 cells/ml), and immune thrombocytopenia (ITP), develops adenopathies without inflammatory response or constitutional symptoms. Pharmacological management : CLR 125 mg b.i.d + ETB 260 mg q.d + AMK 260 mg q.d, for 12 months. No evidence of relapse after two years of follow-up M. avium intracellulare Isolated in culture from a lymph node biopsy, identification test unknown, and DST not available A 47-year-old male with a history of HIV on ART with EFV associated with ABC/3TC (HIV viral load: 681,613 copies/ml, CD4: 1% − 28 cells/ml), who develops adenopathy in the neck and mediastinum. Pharmacological management : ETB 1200 mg q.d + CLR 500 mg b.i.d, for 6 months. No evidence of relapse after two years of follow-up M. abscessus. Microbiological confirmation through GenoType Mycobacterium CM/AS in biopsy culture at 26 days, sensitive to MXF, AMK, and CLR, with an intermediate profile for OFL and resistant to DXC. A 41-year-old female presents with polyarticular pain syndrome, inguinal lymphadenopathy, ulcerated nodular lesions on the lower limbs, associated with constitutional symptoms. A chest CT scan reveals hilar mediastinal lymphadenopathy. She is HIV-negative but has a decreased CD4 + T lymphocyte count (33% − 59 cells/mL), suggesting idiopathic CD4 T-cell lymphocytopenia. Pharmacological management : CLR 500 mg b.i.d + AMK 500 mg t.i.d. However, the latter was discontinued by the patient after one month, and she continued monotherapy with CLR for an unknown duration as she did not continue follow up. Abbreviations : 3TC: lamivudine; ABC: abacavir; AMK: amikacin; ART: antiretroviral therapy; AZT: zidovudine; B.I.D: twice a day; CLI: clindamycin; CLR: clarithromycin; DM2: type 2 diabetes mellitus; DST: drug susceptibility test; DXC: doxycycline; EFV: efavirenz; ETB: ethambutol; HIV: human immunodeficiency virus; ITP: Immune thrombocytopenic purpura; LNZ: linezolid; LPV/rtv: lopinavir/ritonavir; LVX: levofloxacin; MXF: moxifloxacin; NTM: nontuberculous mycobacteria; NVP: nevirapine; OFL: ofloxacin;; RIF: rifampicin; SLE: systemic lupus erythematosus; T.I.D: three times a day. DISCUSSION Aspects related to the presentation of NTM infection. The analysis of patients revealed NTM-EP infection in a high-complexity hospital in Cali, Colombia. Information on NTM-EP in Colombia has been limited. Cases of cutaneous infections in patients undergoing cosmetic procedures, especially those involving M. chelonae [ 8 , 9 ], Mab and M. fortuitum [ 9 , 10 ], have been reported. Valvular involvement by M. peregrinum has also been reported [ 11 ], along with involvement of the MAI, M. parascrofulaceum , M. terrae [ 12 , 13 ] and M. fortuitum [ 14 ] in the HIV population. Our study contributes to the understanding of the extrapulmonary manifestations of both RGM ( M. chelonae , Mab, M. fortuitum) and SGM ( M. malmoense , MAI and M. marinum). In most countries, local studies have estimated the incidence of NTM infection, as it is not considered a notifiable disease. The incidence reported in the United States was 0.011% [ 15 ], while in India, it ranged from 0.93% in 2011 to an increase of 1.6% in 2020 [ 16 ]. In Colombia, prevalence studies have shown a 1.5% prevalence in respiratory isolates, with M. fortuitum and Mab being the most prevalent [ 17 ], and a 5% prevalence in the HIV population [ 4 ]. In our study, the presence of M. fortuitum (46%), Mab (31%), M. chelonae (15%), and M. marinum (8%) was detected in patients with cutaneous involvement. This differs from reports in India and Japan, where M. chelonae , Mab, and M. ulcerans are the most reported isolates [ 16 , 18 ]. In China, the MAI, Mab, and M. kansasii are observed [ 19 ], and M. fortuitum is the most common [ 20 ], mostly related to trauma. MAI was identified in 67%, and M. abscessus was identified in the remaining 33%. More than half of the patients were HIV-positive, with MAI being the main isolated mycobacteria. The prevalence of MAI infection in the HIV population is estimated to be 7–12% [ 2 , 6 , 21 ], with disseminated presentation [ 2 ]. One of the sites compromised by MAI is the lymphatic system, especially the cervical, mediastinal, and intra-abdominal lymph nodes, as well as the lungs, bones, skin, soft tissues, genital ulcers, and central nervous system [ 2 ]. Colombia has become a significant destination for cosmetic surgeries, ranking ninth globally [ 22 ]. However, despite its popularity, reports indicate that a considerable number of patients seeking cosmetic procedures in Colombia are from North America, particularly the United States [ 23 ]. This raises questions about the quality of care and postoperative complications, especially concerning infectious complications. While cosmetic tourism can offer financial benefits, particularly in Colombia, where costs are often lower than those in other countries, it is crucial to weigh these costs against potential health risks, including the risk of contracting infections such as NTM. Balancing the allure of cosmetic procedures with patient safety remains a critical consideration in the burgeoning cosmetic tourism industry. Aspects related to diagnosis. Clinical suspicion guides the approach to NTM infection, with Zielh-Neelsen stains and cultures of lesions or biopsies to detect acid-fast bacilli [ 24 ]. The cultures were complemented by molecular tests such as Speed-Oligo Mycobacteria , which identifies up to 12 different species, including the M. tuberculosis complex , M. avium-intracellulare-scrofulaceum complex , M. chelonae-abscessus complex , M. fortuitum , M. kansasii , and M. gordonae [ 25 ]. In this case series, mycobacteria were identified using molecular tests, notably the Genotype MTBDR and Speed Oligo. Aspects related to drug susceptibility Drug susceptibility in NTM is crucial for effective treatment. In more than 50% of the patients studied, resistance to doxycycline and ofloxacin was identified via drug susceptibility tests. However, NTM strains were sensitive to fluoroquinolones, aminoglycosides, and macrolides in all the tests conducted. It is important to note that NTM are genetically resistant to conventional tuberculosis drugs, especially RGM. A discordance has been observed between in vitro susceptibility and in vivo treatment response, which generates controversy regarding the utility of drug susceptibility tests [ 26 ]. Drug susceptibility varies by geographic region, and correlations have been identified between the minimum inhibitory concentration (MIC) of certain drugs and specific genetic mutations in NTM. For example, mutations in the erm 41 and rrl genes confer resistance to macrolides and aminoglycosides, respectively [ 27 , 28 ]. Various resistance mechanisms have been described in different NTM species, such as efflux pumps associated with aminoglycoside resistance in M. fortuitum and the presence of proteins that protect DNA gyrase from antibiotic action in MAI [ 4 , 27 ]. M. chelonae exhibits mutations in the 23S rRNA gene that confer resistance to clarithromycin [ 27 ]. In M. marinum , resistance mechanisms, such as mutations in the rpoB gene, which encodes the beta subunit of RNA polymerase and is the target of rifampicin, are not fully understood. Given the complexity of drug resistance in NTM, prolonged drug resistance tests are recommended, along with molecular methods to detect specific genetic mutations that may influence treatment response. Discussion on pharmacological treatment aspects. The recommendations for the treatment of NTM-EP infection are limited [ 7 , 29 ]. Current clinical practice guidelines such as those from ATS/ERS/ESCMID/IDSA focus on pulmonary involvement, addressing complex NTM such as MAI, M. Kansasii, M. xenopi , and Mab in patients without cystic fibrosis and without HIV infection [ 1 ]. There is debate regarding whether stable patients with extrapulmonary involvement should receive empirical treatment or wait for susceptibility test results considering adverse events, drug interactions, and resistance [ 1 , 4 ]. The avoidance of monotherapy is recommended to prevent resistance amplification [ 1 , 2 ]. In our study, we discuss different pharmacological treatment regimens for RGM (Mab, M. chelonae, M. fortuitum ) and SGM (MAI, M. malmoense, M. marinum ) infections. Mycobacterium abscessus Our study agrees with the literature indicating that Mab skin and soft tissue infections (SSTIs) usually occur due to surgical or traumatic inoculation [ 7 , 30 ]. We observed a significant proportion of middle-aged women, with a median time of presentation after aesthetic procedures of approximately 40 days. In three patients with cutaneous manifestations of Mab susceptibility to clarithromycin, we achieved a cure without relapse using 4–6-month treatment regimens, including clarithromycin and fluoroquinolone, or clarithromycin, aminoglycoside, and fluoroquinolone, with surgery in two of three patients. However, a patient with a clarithromycin-susceptible isolate who received surgical management and clarithromycin monotherapy for 6 months experienced relapse. One patient with lymph node involvement did not continue follow-up, and 50% of patients experienced adverse events during treatment. It is important to note that Mab subspecies ( abscessus, bolletii , and massiliense ) are considered highly pathogenic, with high resistance levels and low cure rates [ 31 ]. In pulmonary treatment for Mab, a regimen of at least three drugs guided by drug susceptibility testing, including a macrolide, is recommended, even for strains with mutational or inducible ( erm gene) resistance [ 1 , 31 ]. Additionally, the utility of drugs such as cefoxitin or imipenem, linezolid, and tigecycline should be evaluated, although the treatment duration has not yet been established [ 1 , 31 ]. Minor cutaneous infections can resolve spontaneously, with or without surgical debridement, while for SSTIs, a macrolide regimen along with a parenteral drug for at least 4 months is recommended. In cases of bone infections, treatment extension to 6 months is suggested. Surgery is recommended in cases of extensive disease, abscesses, and the removal of implants or catheters [ 7 ]. Mycobacterium chelonae A patient immunosuppressed by biological therapies who developed joint involvement due to M. chelonae infection was treated for 12 months with clarithromycin combined with moxifloxacin and experienced early relapse, and a patient with an infection associated with cosmetic procedures was treated for 6 months with curative criteria and no relapse. M. chelonae infection is associated with cutaneous infections in immunocompetent patients, and in Colombia, it has been related to infections in HIV-positive individuals [ 6 , 7 , 32 ]. For mild to moderate M. chelonae infections, a two-drug regimen is recommended, and for severe infections, three drugs are suggested. Treatment should include a regimen with two intravenous drugs for 4 to 16 weeks and then two oral drugs selected according to susceptibility test results, with one of them being a macrolide if sensitive, until 12 months after sputum conversion in pulmonary involvement [ 29 ]. Drugs such as amikacin, azithromycin, clofazimine, clarithromycin, ciprofloxacin, doxycycline, imipenem, levofloxacin, linezolid, sulfamethoxazole, tigecycline, and tobramycin have demonstrated activity in human studies and in vitro microbiological activity [ 4 , 32 ]. Mycobacterium avium complex (M. intracellulare, M. chimera and M. avium (subspecies M. avium, M. paratuberculosis, M. silvaticum) In our study, two HIV patients with adenitis due to MAI were treated for 12 or 6 months. The first case involved a 4-year-old infant with perinatally acquired HIV who developed idiopathic thrombocytopenic purpura and required immunosuppressive management. At the time of NTM infection diagnosis, the patient had a CD4 + T-cell count of 212 cells/mm3, which could be related to her hematological condition. Treatment consisted of clarithromycin, ethambutol, and amikacin. The second case involved an adult HIV patient on antiretroviral therapy with a CD4 + T-cell count of 28 cells/mm3. This patient received treatment with clarithromycin and ethambutol. Both patients achieved a cure with no evidence of relapse during follow-up. For the treatment of MAI at the pulmonary level in patients with macrolide susceptibility, a three-drug treatment regimen, including a macrolide (azithromycin or clarithromycin) and ethambutol, is suggested. In cases of cavitary disease, bronchiectasis, or macrolide resistance, amikacin is added to the initial treatment for 2 to 3 months, followed by a 12-month regimen after the culture becomes negative [ 1 ]. However, up to 40% of patients may experience unfavorable outcomes, requiring modification of their treatment due to adverse events in up to 84% of cases [ 33 ]. In situations of pulmonary refractoriness, inhaled liposomal amikacin is recommended [ 1 ]. In HIV patients, MAI treatment includes the administration of clarithromycin and ethambutol, with the possibility of adding rifabutin as a third drug. In cases of severe immunosuppression (CD4 + counts less than 50 cells/mm3, bacteremia, and not receiving antiretroviral therapy), the addition of a fluoroquinolone or an aminoglycoside while maintaining treatment for 12 months is considered [ 2 ]. Mycobacterium malmoense our study presents an uncommon case of a patient with endocarditis due to M. malmoense , as most reports are related to pulmonary involvement [ 7 , 34 ]. Reports on extrapulmonary cases are limited, although lymph node, cutaneous, and articular involvement have been documented [ 7 , 35 , 36 ]. In our case, the patient underwent surgery and received a 12-month treatment including clarithromycin, moxifloxacin, and rifampicin, resulting in a cure and no relapse. M. malmoense is an SGM with inconsistencies in susceptibility testing. It is intrinsically resistant to isoniazid. For pulmonary involvement, a 12-month treatment regimen involving the use of at least three drugs, rifampicin, ethambutol, and a macrolide (clarithromycin or azithromycin), after sputum culture conversion is recommended [ 29 , 37 ]. Failure and relapse rates of 10% have been reported, with a related mortality of 4% [ 29 ]. In cases of macrolide intolerance or resistance, rifamycin or ethambutol, moxifloxacin, and clofazimine are alternatives. Intravenous amikacin can be considered for cavitary lung lesions. However, there are no specific recommendations for managing extrapulmonary involvement caused by this mycobacterium. Mycobacterium marinum A patient who developed SSTIs due to M. marinum after trauma received a 6-month regimen of moxifloxacin combined with rifampicin and achieved a cure with no evidence of relapse. M. marinum has been associated with infections in immunocompromised individuals and SSTIs in immunocompetent patients exposed to aquariums or swimming pools, known as "Fish Fancier's Finger." There is no recommendation for the management of M. marinum infection [ 4 , 38 ]. In M. marinum , there is demonstrated activity in humans for drugs such as amikacin, clarithromycin, doxycycline, ethambutol, minocycline, rifampicin, and sulfamethoxazole, and in vitro microbiological activity studies for ciprofloxacin, imipenem, isoniazid, levofloxacin, linezolid, moxifloxacin, and tedizolid [ 4 ]. The main limitation is related to the sample size, which stems from the inadequate representation of data in the target population. Despite our thorough search for cases in clinical records, many cases were excluded due to the lack of microbiological confirmation of the NTM species. However, our case series still provides valuable information on NTM-EP infections. Notably, NTMP-EP events are not subject to mandatory reporting, making it challenging to clearly define an NTM epidemiological outbreak. It is essential to recognize that certain risk interventions and sources of contamination could signal a potential epidemiological concern and that NTM infections are often mistaken for other diseases. Additionally, the identification of cases is hindered by the absence of a reference test and inadequate storage of isolates in identification laboratories, leading to a lack of availability for identification in almost half of the cases. One notable weakness identified in our study is the inability to identify the subspecies of M. fortuitum and Mab, which may exhibit distinct drug susceptibility patterns. CONCLUSIONS Patients with atypical NTM infections present with chronic, indolent clinical presentations before diagnosis, requiring antimicrobial management guided by susceptibility testing combined with two or three drugs for an extended period. In pulmonary infections, cure rates are low, with high relapse rates requiring prolonged treatments, and in the management of skin and soft tissue infections, surgical and directed pharmacological management are therapeutic options, but clinical trials are needed. In summary, while our study sheds light on NTM-EP infections, the limitations underscore the need for standardized reporting mechanisms, improved laboratory practices, and enhanced diagnostic techniques to better understand and manage these infections. Abbreviations 3TC: lamivudine ABC: abacavir AMK: amikacin ART: antiretroviral therapy AZT: zidovudine B.I.D: twice a day CLI: clindamycin CLR: clarithromycin DM2: type 2 diabetes mellitus DST: drug susceptibility test DXC: doxycycline EFV: efavirenz ETB: ethambutol HIV: human immunodeficiency virus ITP: immune thrombocytopenic purpura LNZ: linezolid LPV/rtv: lopinavir/ritonavir LVX: levofloxacin Mab: M. abscessus complex MAI: M. avium complex MXF: moxifloxacin NTM: nontuberculous mycobacteria NTM-EP: nontuberculous mycobacteria – extrapulmonary NVP: nevirapine OFL: ofloxacin RGMs: rapid-growing mycobacteria RIF: rifampicin SGM: slow-growing mycobacteria SLE: systemic lupus erythematosus SST: skin and soft tissue T.I.D: three times a day Declarations Ethical Considerations: The risk level for participants, as per Resolution 8430 of 1993 from the Ministry of Health, is minimized and acceptable. This retrospective study, involving no intervention or experimentation, received approval from the Ethics Committee for Biomedical Research of the Valle del Lili Foundation, Cali, Colombia. It entails low risk and does not necessitate informed consent since there is no intervention; it is merely a case review. Availability of data and materials: For this study, the datasets used and/or analyzed are available through the corresponding author upon reasonable request. The corresponding author can be contacted to access the relevant data supporting the findings presented in the article. This measure is taken to protect the privacy of patients and ensure compliance with relevant ethical regulations. Competing Interests: The authors declare that they have no competing interests. Funding: None Authors’ Contributions: All the authors contributed to writing, reading, and approving the submitted version of the manuscript. Acknowledgments: The authors would like to extend their gratitude to the Centro de Investigaciones Clínicas (CIC) at Hospital Universitario Fundación Valle del Lili for their invaluable contributions and support in the completion of this manuscript. References Daley, C. L., Iaccarino, J. M., Lange, C., Cambau, E., Wallace, R. J., Andrejak, C., … Winthrop, K. L. (2020). Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clinical Infectious Diseases, 71(4), e1–e36. doi: 10.1093/cid/ciaa241 Thomson, R., Tolson, C., Carter, R., Coulter, C., Huygens, F., & Hargreaves, M. (2013). Isolation of Nontuberculous Mycobacteria (NTM) from Household Water and Shower Aerosols in Patients with Pulmonary Disease Caused by NTM. Journal of Clinical Microbiology, 51(9), 3006–3011. doi: 10.1128/JCM.00899-13 Dávalos, A. F., Garcia, P. K., Montoya-Pachongo, C., Rengifo, A., Guerrero, D., Díaz-Ordoñez, L., … Ferro, B. E. (2021). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3982582","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277321925,"identity":"ba2ffb12-d619-4391-bc83-67ffe4564027","order_by":0,"name":"Natalia Ramos Ospina","email":"","orcid":"","institution":"Clinical Research Center, Fundación Valle del Lili","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"Ramos","lastName":"Ospina","suffix":""},{"id":277321926,"identity":"69cd16aa-87a0-420a-a968-24accb3799df","order_by":1,"name":"Sofia Alexandra Montes-Tello","email":"","orcid":"","institution":"Clinical Research Center, Fundación Valle del Lili","correspondingAuthor":false,"prefix":"","firstName":"Sofia","middleName":"Alexandra","lastName":"Montes-Tello","suffix":""},{"id":277321927,"identity":"e5a67052-a759-4c96-9afb-1a7531c35047","order_by":2,"name":"Angie Valeria Torres-Morales","email":"","orcid":"","institution":"Health Sciences Faculty, Universidad Icesi","correspondingAuthor":false,"prefix":"","firstName":"Angie","middleName":"Valeria","lastName":"Torres-Morales","suffix":""},{"id":277321928,"identity":"c56edbeb-fa19-4a08-86d5-1525baceefb3","order_by":3,"name":"Mabel Soraya Moreno-Turriago","email":"","orcid":"","institution":"Clinical Research Center, Fundación Valle del Lili","correspondingAuthor":false,"prefix":"","firstName":"Mabel","middleName":"Soraya","lastName":"Moreno-Turriago","suffix":""},{"id":277321929,"identity":"515f7cda-5183-497f-9182-d9abb59ef441","order_by":4,"name":"José Fernando García Goez","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIie2QvUoDQRCAZxi4aw623QMhrzCLIAghz5IQ0EbQ8kDQDQd3zRHb+Bi+QWSLNKc+QJocFrYnWCzhCjeJ2q2aTnC/Yphd+OYPIBD4g6D+zGgb+wLiPZWTVNOeXc3PCpVls4L14FyUtMK37EmyAXzO1tATvsGq+pBxOj6emYjpoF5uFFIPU1C32qPMziKJFTETMKXF8irNIUonFQx57lNOXyxW106JW6c8yl8owyMAa5ySML4WcynIKdp+o7hd5EgvWJrkwkA9dgrmaqKldxflLta23SWLm8VdY7OBjOL8vtFd33sxtSk1KnYPk+w6a8BCegSA3jZ2H1Par//OawQCgcD/4x0szFLFv0Z3WgAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Internal Medicine, Infectious Diseases Service, Fundación Valle del Lili","correspondingAuthor":true,"prefix":"","firstName":"José","middleName":"Fernando García","lastName":"Goez","suffix":""}],"badges":[],"createdAt":"2024-02-23 17:03:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3982582/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3982582/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-10681-4","type":"published","date":"2025-03-31T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":52600383,"identity":"0ec7b357-fa17-4a65-bd79-f6fcc5c70c39","added_by":"auto","created_at":"2024-03-13 12:56:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":103202,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3982582/v1/8c23a9b75a5e2bd3b12be43c.png"},{"id":52600384,"identity":"6637a853-2ffa-44b7-aa74-f2f536a3ae57","added_by":"auto","created_at":"2024-03-13 12:56:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":188401,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIsolated mycobacteria (n = 17)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.Isolatedmycobacteria.png","url":"https://assets-eu.researchsquare.com/files/rs-3982582/v1/8480fda7b7aaa13333422492.png"},{"id":80081887,"identity":"ab8130d1-895b-4c01-a97f-11c29d232b34","added_by":"auto","created_at":"2025-04-07 15:58:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1507684,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3982582/v1/1aa40268-03b8-490e-8bc5-56facfdf7f2d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical presentation and treatment outcomes of extrapulmonary nontuberculous mycobacterial infections with rapid and slow growth rates in Cali, Colombia","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNTMs are ubiquitous microorganisms found in soil and water and include approximately 190 species. They can cause diseases in individuals with underlying pulmonary conditions, advanced human immunodeficiency virus (HIV) infection, advanced age, or compromised immune systems, leading to skin and soft tissue (SST) lesions in immunocompetent individuals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. NTM have been identified in various sources, including water distribution systems, biofilms and aerosols within the households of NTM patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Locally, pathogenic NTM species such as \u003cem\u003eM. chelonae\u003c/em\u003e and \u003cem\u003eM. fortuitum\u003c/em\u003e have been detected in drinking water supplies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProper characterization of NTM infections is crucial due to the global increase in NTM infections, which are linked to genetic mutations, climate change, and immunocompromised populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Reports in Colombia document NTM infections with cutaneous involvement, often from cosmetic procedures [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A case series in Bogotá and Cali showed higher NTM rates among HIV-infected patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIdentifying NTM strains poses several challenges, especially owing to the need for specialized laboratories and molecular testing for species confirmation, which are unevenly available in major cities. Species confirmation guides antibiotic therapy, which is critical due to NTM natural drug resistance. Guidelines recommend specific regimens based on species, with treatment adherence determining clinical outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study explored the sociodemographic and clinical characteristics, antimicrobial regimens, adverse effects, and outcomes of NTM extrapulmonary (NTM-EP) infections treated in Cali from 2007 to 2021. This study aimed to enhance the understanding of the clinical response and optimize management strategies for patients with NTM infections beyond the pulmonary system.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e A descriptive cross-sectional observational study was conducted by thoroughly reviewing 391 patients from the General Mycobacteria Registry of the Fundación Valle del Lili University Hospital from 2007 to 2021. Among these patients, 17 who met the criteria of NTM infection with extrapulmonary involvement, microbiological identification of NTM, and NTM treatment, were selected \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eData collection techniques and management\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAn active search of the institution's medical records was performed using diagnoses from the International Classification of Diseases, 10th Revision (ICD-10) related to NTM infection. Selected cases were reviewed for data, and quantitative variables were described according to their distribution. The means and standard deviations were calculated, and categorical variables were described using tables of absolute and relative frequencies.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cstrong\u003ePatient Characteristics and Clinical Presentation\u003c/strong\u003e \u003cp\u003eThirteen patients (76%) had cutaneous lesions, seven of whom underwent cosmetic procedures as a risk factor, five of whom did not undergo cosmetic procedures, and one who suffered an injury caused by a plant, with an age range of 29 to 42 years and a median age of 38 years. A total of 76.6% of patients self-identified as mestizos, and a history of cosmetic interventions was evident in 7 (41.2%) patients, along with immunosuppressive drug therapy in 6 (35.3%) patients \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Description of patients with NTM with extrapulmonary involvement.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (76,5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (23,5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Range\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (11,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (35,3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (29,4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;61 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (24,5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (76,6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (11,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (11,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical History\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery or cosmetic procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (41,2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppressive Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (35,3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (17,6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType 2 Diabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (11,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBariatric surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbbreviations\u003c/b\u003e HIV: Human Immunodeficiency Virus, NTM: Nontuberculous mycobacteria\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFever was observed in 7 (41.2%) patients, and a clinical presentation with skin involvement was noted in 13 (76%) patients \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e The median time between symptom onset and clinical suspicion of NTM infection was 40 days (interquartile range (IQR): 6\u0026ndash;79), while the median time between clinical diagnosis and identification of the NTM isolate was 33 days (IQR: 14\u0026ndash;189).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Presentation of NTM.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtrapulmonary Involvement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoft tissues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (76,5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (92,3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (7,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (17,6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndocardium (biological mitral valve)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (5,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbbreviations\u003c/b\u003e NTM: Nontuberculous mycobacteria.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNTM identification was carried out using the \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e technique in 8 patients (47.1%) and the \u003cem\u003eGenoType Mycobacteria\u003c/em\u003e technique in another 8 patients; in one of them, the identification method used was unknown. The identified rapid-growing mycobacteria (RGMs) were the \u003cem\u003eM. fortuitum complex\u003c/em\u003e in soft tissues and the mediastinum, the \u003cem\u003eM. abscessus\u003c/em\u003e complex (Mab) in soft tissues and lymph nodes and \u003cem\u003eM. chelonae\u003c/em\u003e in soft tissues and muscle. The slow-growing mycobacteria (SGM) were \u003cem\u003eM. avium\u003c/em\u003e complex (MAI) in the lymph node, \u003cem\u003eM. malmoense\u003c/em\u003e in the biological heart valve and \u003cem\u003eM. marinum\u003c/em\u003e in the soft tissues \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSensitivity profile identification was described for 10 (58.8%) patients. One \u003cem\u003eM. chelonae\u003c/em\u003e strain was sensitive to aminoglycosides, macrolides, fluoroquinolones, and oxazolidinones. One patient with MAI was sensitive to quinolones and aminoglycosides but resistant to fluoroquinolones. Among the five Mab strains, 100% were sensitive to aminoglycosides, macrolides, and quinolones, 60% were resistant to doxycycline, 20% were resistant to ofloxacin, and 20% had an intermediate profile of ofloxacin resistance. Among the three \u003cem\u003eM. fortuitum\u003c/em\u003e isolates, 100% were sensitive to aminoglycosides, macrolides, and quinolones, and 66.7% were sensitive to ofloxacin.\u003c/p\u003e \u003cp\u003eThe treatment regimens used were as follows: one case of \u003cem\u003eM. marinum\u003c/em\u003e treated with rifampicin and moxifloxacin; one case of \u003cem\u003eM. malmense treated\u003c/em\u003e with rifampicin, moxifloxacin, and clarithromycin; two cases of \u003cem\u003eM. chelonae\u003c/em\u003e treated with moxifloxacin and clarithromycin; two cases of MAI treated with clarithromycin and ethambutol; one of these cases was additionally treated with amikacin; all five cases of Mab were treated with clarithromycin; two cases additionally were treated with amikacin; and one case was treated with an additional antibiotic, doxycycline, linezolid, or levofloxacin. Among the six patients with \u003cem\u003eM. fortuitum infection\u003c/em\u003e, five were treated with clarithromycin and moxifloxacin, and only one was treated with clindamycin.\u003c/p\u003e \u003cp\u003eThe duration of treatment was not related to the type of NTM; in eight (47.1%) patients, the treatment duration was 6 months, and in three (17.6%) patients, it was 4 months. Five (29.4%) patients required a treatment duration equal to or greater than 12 months according to the clinical cure criteria, and only two patients were lost to follow-up, with no information available on clinical outcome \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFinally, adverse effects were observed in three (20%) patients, all of whom required modification of the antibiotic regimen: one patient withdrew from moxifloxacin due to reactive arthritis, and two patients experienced amikacin-related hearing loss and tinnitus. The most common adverse effects without requiring a change in the antibiotic regimen were gastrointestinal symptoms, particularly nausea, vomiting, and dyspepsia.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical description and treatment outcomes of NTM cases.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMycobacteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical profile\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTreatment and outcome\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCardiovascular involvement\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. malmoense.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in blood cultures at 33 days, with no availability of DST.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 61-year-old male with dermatomyositis treated with prednisolone and rituximab, and with a biological prosthetic mitral valve due to rheumatic valvulopathy, develops fever, dyspnea, and chest pain. Endocarditis on the prosthetic aortic valve caused by NTM is diagnosed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical management with valve replacement. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e: CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d\u0026thinsp;+\u0026thinsp;RIF 600 mg q.d for 12 months.\u003c/p\u003e \u003cp\u003eExperiences favorable clinical evolution, with no evidence of relapse after three years of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSoft tissue involvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. abscessus.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in soft tissue cultures at 7 days, sensitive to AMK, MXF, and CLR.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 31-year-old female with erythema nodosum and biopolymer implants. Presents with nodular lesions at the right gluteal area.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical management with excision of the nodules.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e: CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d. for 4 months, discontinued due to gastrointestinal adverse events. No evidence of relapse after three years of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. abscessus.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e of intraoperative culture at 10 days, sensitive to AMK, MXF and CLR, resistant to OFL and DXC.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 31-year-old female with a history of breast augmentation surgery and replacement of breast implants one year prior, develops inflammatory changes in the surgical wound.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical management with removal of the implants.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e: CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;DXC 100 mg b.i.d for 6 months with early relapse. Treatment regimen was modified to LNZ 600 mg b.i.d\u0026thinsp;+\u0026thinsp;CLR 500 mg b.i.d for 6 months. No evidence of relapse after four years of follow-up.\"\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. abscessus.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e of soft tissue biopsy at 25 days. Sensitive to AMK, CLR, MXF, and DXC, resistant to OFL.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 35-year-old female, who after a session of mesotherapy, develops nodular lesions with purulent discharge and systemic inflammatory response.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e: CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;AMK 500 mg t.i.d for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after one year of follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. abscessus.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e in culture of gluteal secretion at 15 days. Sensitive to AMK, CLR, and MXF, resistant to DXC and OFL.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 28-year-old female with a history of liposuction and gluteal lipoinjection develops inflammatory changes and erythematous nodular lesions on both gluteal regions with purulent discharge 20 days after the procedure. Ambulatory treatment with ampicillin-sulbactam was administered, followed by moxifloxacin, without improvement.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical management with debridement. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e: CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;LVX 500 mg q.d\u0026thinsp;+\u0026thinsp;AMK 500 mg t.i.d for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after one year of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. fortuitum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in culture of surgical wound secretion and mediastinal fluid at 34 days. Sensitive to CLR, AMK, and MXF.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 69-year-old male with a history of liver transplantation (tacrolimus and prednisolone) presents with aortic dissection, managed with ascending aorta replacement. However, he is readmitted a week later due to febrile syndrome associated with inflammatory changes in the surgical wound in the chest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e: CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d for 12 months. No evidence of relapse after three years of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. fortuitum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e in culture of surgical wound secretion at 11 days. DST not available.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 64-year-old female with CREST syndrome and breast cancer undergoing chemotherapy and mastectomy, developed a surgical site infection managed with outpatient trimethoprim-sulfamethoxazole without improvement. She was readmitted to the emergency department due to inflammatory changes in the surgical wound and purulent discharge.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eMXF 400 mg q.d. + CLI 600 mg t.i.d for 4 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after one year of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. fortuitum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e in culture of surgical wound secretion at 13 days, sensitive to AMK, CLR, and OFL.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 64-year-old female with a history of gastric bypass surgery developed an abdominal hernia requiring surgical correction with mesh placement, which subsequently led to surgical site infection involving the organ space accompanied by fever.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after one year of follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. fortuitum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in culture of surgical wound secretion at 17 days. DST not available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 56-year-old female with a history of lipectomy, liposuction, and breast implants develops inflammatory changes in the abdominal surgical wound at the hypogastric level six months after the cosmetic procedures, associated with constitutional symptoms and evidence of subcutaneous tissue collection on ultrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages. \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d. The duration of treatment is unknown as the patient did not continue follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. fortuitum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in culture of surgical wound secretion, sensitive to AMK, CLR, and OFL.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 45-year-old female with a history of HIV (HIV viral load: 1,536,776 copies/ml, CD4 count: 0% \u0026minus;\u0026thinsp;104 cells/ml) on ART (ABC, 3TC, NVP) and breast implants, presents with inflammatory changes in the surgical wound in the breast.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 500 mg b.i.d for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after two years of follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. fortuitum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e in surgical wound culture at 8 days. DST not available.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 16-year-old female with a history of surgery including osteotomy of the lower jaw and right condrectomy with osteosynthesis material. One week after the procedure, she develops inflammatory changes in the surgical wound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d for 4 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after one year of follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. chelonae.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in skin biopsy culture at 6 days, sensitive to CLR and MXF with intermediate profile for DXC.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 40-year-old female with a history of cosmetic surgery in the abdominal and gluteal regions presents with nodular, indurated, erythematous lesions with discharge in the bilateral gluteal region at three months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages. \u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eInitially, two months with AMK, followed by CLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after five years of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. chelonae.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e in soft tissue culture at 16 days. DST not available.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 32-year-old female with a history of bariatric surgery, sarcoidosis, and SLE under rituximab therapy presents with joint pain in the hips, associated with constitutional symptoms, without a history of trauma or procedures. Gluteus major myositis and ipsilateral fascia lata involvement are confirmed without joint or bone compromise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d for 12 months. The patient discontinues it and experiences a relapse after one month. Treatment is restarted for another 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after five years of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. marinum.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in skin biopsy culture at 21 days. DST not available.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 58-year-old female with type DM2 and rheumatoid arthritis, undergoing treatment with leflunomide and rituximab, is exposed to home aquariums. She experiences trauma with a plant object on the fourth finger of the right hand, with lymphatic dissemination after three weeks. She develops a nodular, erythematous, painful lesion on the inner forearm.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgical lavages.\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eRIF 600 mg q.d\u0026thinsp;+\u0026thinsp;MXF 400 mg q.d for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after three years of follow-up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGanglionar involvement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. avium intracellulare.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eSpeed-oligo\u0026reg; Mycobacteria\u003c/em\u003e in biopsy culture at 11 days, sensitive to MXF, ETB, CLR, and AMK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 4-year-old male with a history of perinatal HIV infection under treatment with LPV/rtv-based ART associated with AZT/3TC, (HIV viral load: 451 copies/ml, CD4: 8% \u0026minus;\u0026thinsp;212 cells/ml), and immune thrombocytopenia (ITP), develops adenopathies without inflammatory response or constitutional symptoms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 125 mg b.i.d\u0026thinsp;+\u0026thinsp;ETB 260 mg q.d\u0026thinsp;+\u0026thinsp;AMK 260 mg q.d, for 12 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after two years of follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. avium intracellulare\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIsolated in culture from a lymph node biopsy, identification test unknown, and DST not available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 47-year-old male with a history of HIV on ART with EFV associated with ABC/3TC (HIV viral load: 681,613 copies/ml, CD4: 1% \u0026minus;\u0026thinsp;28 cells/ml), who develops adenopathy in the neck and mediastinum.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eETB 1200 mg q.d\u0026thinsp;+\u0026thinsp;CLR 500 mg b.i.d, for 6 months.\u003c/p\u003e \u003cp\u003eNo evidence of relapse after two years of follow-up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eM. abscessus.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMicrobiological confirmation through \u003cem\u003eGenoType Mycobacterium\u003c/em\u003e CM/AS in biopsy culture at 26 days, sensitive to MXF, AMK, and CLR, with an intermediate profile for OFL and resistant to DXC.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA 41-year-old female presents with polyarticular pain syndrome, inguinal lymphadenopathy, ulcerated nodular lesions on the lower limbs, associated with constitutional symptoms. A chest CT scan reveals hilar mediastinal lymphadenopathy. She is HIV-negative but has a decreased CD4\u0026thinsp;+\u0026thinsp;T lymphocyte count (33% \u0026minus;\u0026thinsp;59 cells/mL), suggesting idiopathic CD4 T-cell lymphocytopenia.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePharmacological management\u003c/span\u003e:\u003c/p\u003e \u003cp\u003eCLR 500 mg b.i.d\u0026thinsp;+\u0026thinsp;AMK 500 mg t.i.d. However, the latter was discontinued by the patient after one month, and she continued monotherapy with CLR for an unknown duration as she did not continue follow up.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: 3TC: lamivudine; ABC: abacavir; AMK: amikacin; ART: antiretroviral therapy; AZT: zidovudine; B.I.D: twice a day; CLI: clindamycin; CLR: clarithromycin; DM2: type 2 diabetes mellitus; DST: drug susceptibility test; DXC: doxycycline; EFV: efavirenz; ETB: ethambutol; HIV: human immunodeficiency virus; ITP: Immune thrombocytopenic purpura; LNZ: linezolid; LPV/rtv: lopinavir/ritonavir; LVX: levofloxacin; MXF: moxifloxacin; NTM: nontuberculous mycobacteria; NVP: nevirapine; OFL: ofloxacin;; RIF: rifampicin; SLE: systemic lupus erythematosus; T.I.D: three times a day.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cb\u003eAspects related to the presentation of NTM infection.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe analysis of patients revealed NTM-EP infection in a high-complexity hospital in Cali, Colombia. Information on NTM-EP in Colombia has been limited. Cases of cutaneous infections in patients undergoing cosmetic procedures, especially those involving \u003cem\u003eM. chelonae\u003c/em\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], Mab and \u003cem\u003eM. fortuitum\u003c/em\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], have been reported. Valvular involvement by \u003cem\u003eM. peregrinum\u003c/em\u003e has also been reported [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], along with involvement of the MAI, \u003cem\u003eM. parascrofulaceum\u003c/em\u003e, \u003cem\u003eM. terrae\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and \u003cem\u003eM. fortuitum\u003c/em\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] in the HIV population. Our study contributes to the understanding of the extrapulmonary manifestations of both RGM (\u003cem\u003eM. chelonae\u003c/em\u003e, Mab, \u003cem\u003eM. fortuitum)\u003c/em\u003e and SGM (\u003cem\u003eM. malmoense\u003c/em\u003e, MAI and \u003cem\u003eM. marinum).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIn most countries, local studies have estimated the incidence of NTM infection, as it is not considered a notifiable disease. The incidence reported in the United States was 0.011% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], while in India, it ranged from 0.93% in 2011 to an increase of 1.6% in 2020 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In Colombia, prevalence studies have shown a 1.5% prevalence in respiratory isolates, with \u003cem\u003eM. fortuitum\u003c/em\u003e and Mab being the most prevalent [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and a 5% prevalence in the HIV population [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, the presence of \u003cem\u003eM. fortuitum\u003c/em\u003e (46%), Mab (31%), \u003cem\u003eM. chelonae\u003c/em\u003e (15%), and \u003cem\u003eM. marinum\u003c/em\u003e (8%) was detected in patients with cutaneous involvement. This differs from reports in India and Japan, where \u003cem\u003eM. chelonae\u003c/em\u003e, Mab, and \u003cem\u003eM. ulcerans\u003c/em\u003e are the most reported isolates [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In China, the MAI, Mab, and \u003cem\u003eM. kansasii\u003c/em\u003e are observed [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and \u003cem\u003eM. fortuitum\u003c/em\u003e is the most common [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], mostly related to trauma.\u003c/p\u003e \u003cp\u003eMAI was identified in 67%, and \u003cem\u003eM. abscessus\u003c/em\u003e was identified in the remaining 33%. More than half of the patients were HIV-positive, with MAI being the main isolated mycobacteria. The prevalence of MAI infection in the HIV population is estimated to be 7\u0026ndash;12% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], with disseminated presentation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. One of the sites compromised by MAI is the lymphatic system, especially the cervical, mediastinal, and intra-abdominal lymph nodes, as well as the lungs, bones, skin, soft tissues, genital ulcers, and central nervous system [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eColombia has become a significant destination for cosmetic surgeries, ranking ninth globally [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, despite its popularity, reports indicate that a considerable number of patients seeking cosmetic procedures in Colombia are from North America, particularly the United States [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This raises questions about the quality of care and postoperative complications, especially concerning infectious complications. While cosmetic tourism can offer financial benefits, particularly in Colombia, where costs are often lower than those in other countries, it is crucial to weigh these costs against potential health risks, including the risk of contracting infections such as NTM. Balancing the allure of cosmetic procedures with patient safety remains a critical consideration in the burgeoning cosmetic tourism industry.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAspects related to diagnosis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eClinical suspicion guides the approach to NTM infection, with Zielh-Neelsen stains and cultures of lesions or biopsies to detect acid-fast bacilli [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The cultures were complemented by molecular tests such as \u003cem\u003eSpeed-Oligo Mycobacteria\u003c/em\u003e, which identifies up to 12 different species, including the \u003cem\u003eM. tuberculosis complex\u003c/em\u003e, \u003cem\u003eM. avium-intracellulare-scrofulaceum complex\u003c/em\u003e, \u003cem\u003eM. chelonae-abscessus complex\u003c/em\u003e, \u003cem\u003eM. fortuitum\u003c/em\u003e, \u003cem\u003eM. kansasii\u003c/em\u003e, and \u003cem\u003eM. gordonae\u003c/em\u003e [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In this case series, mycobacteria were identified using molecular tests, notably the \u003cem\u003eGenotype MTBDR\u003c/em\u003e and \u003cem\u003eSpeed Oligo.\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eAspects related to drug susceptibility\u003c/h3\u003e\n\u003cp\u003eDrug susceptibility in NTM is crucial for effective treatment. In more than 50% of the patients studied, resistance to doxycycline and ofloxacin was identified via drug susceptibility tests. However, NTM strains were sensitive to fluoroquinolones, aminoglycosides, and macrolides in all the tests conducted. It is important to note that NTM are genetically resistant to conventional tuberculosis drugs, especially RGM. A discordance has been observed between \u003cem\u003ein vitro\u003c/em\u003e susceptibility and \u003cem\u003ein vivo\u003c/em\u003e treatment response, which generates controversy regarding the utility of drug susceptibility tests [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDrug susceptibility varies by geographic region, and correlations have been identified between the minimum inhibitory concentration (MIC) of certain drugs and specific genetic mutations in NTM. For example, mutations in the \u003cem\u003eerm\u003c/em\u003e 41 and \u003cem\u003errl\u003c/em\u003e genes confer resistance to macrolides and aminoglycosides, respectively [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Various resistance mechanisms have been described in different NTM species, such as efflux pumps associated with aminoglycoside resistance in \u003cem\u003eM. fortuitum\u003c/em\u003e and the presence of proteins that protect DNA gyrase from antibiotic action in MAI [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. \u003cem\u003eM. chelonae\u003c/em\u003e exhibits mutations in the 23S rRNA gene that confer resistance to clarithromycin [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In \u003cem\u003eM. marinum\u003c/em\u003e, resistance mechanisms, such as mutations in the \u003cem\u003erpoB\u003c/em\u003e gene, which encodes the beta subunit of RNA polymerase and is the target of rifampicin, are not fully understood. Given the complexity of drug resistance in NTM, prolonged drug resistance tests are recommended, along with molecular methods to detect specific genetic mutations that may influence treatment response.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDiscussion on pharmacological treatment aspects.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe recommendations for the treatment of NTM-EP infection are limited [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Current clinical practice guidelines such as those from ATS/ERS/ESCMID/IDSA focus on pulmonary involvement, addressing complex NTM such as MAI, \u003cem\u003eM. Kansasii, M. xenopi\u003c/em\u003e, and Mab in patients without cystic fibrosis and without HIV infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. There is debate regarding whether stable patients with extrapulmonary involvement should receive empirical treatment or wait for susceptibility test results considering adverse events, drug interactions, and resistance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The avoidance of monotherapy is recommended to prevent resistance amplification [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, we discuss different pharmacological treatment regimens for RGM (Mab, \u003cem\u003eM. chelonae, M. fortuitum\u003c/em\u003e) and SGM (MAI, \u003cem\u003eM. malmoense, M. marinum\u003c/em\u003e) infections.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMycobacterium abscessus\u003c/strong\u003e \u003cp\u003eOur study agrees with the literature indicating that Mab skin and soft tissue infections (SSTIs) usually occur due to surgical or traumatic inoculation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. We observed a significant proportion of middle-aged women, with a median time of presentation after aesthetic procedures of approximately 40 days. In three patients with cutaneous manifestations of Mab susceptibility to clarithromycin, we achieved a cure without relapse using 4\u0026ndash;6-month treatment regimens, including clarithromycin and fluoroquinolone, or clarithromycin, aminoglycoside, and fluoroquinolone, with surgery in two of three patients. However, a patient with a clarithromycin-susceptible isolate who received surgical management and clarithromycin monotherapy for 6 months experienced relapse. One patient with lymph node involvement did not continue follow-up, and 50% of patients experienced adverse events during treatment.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIt is important to note that Mab subspecies (\u003cem\u003eabscessus, bolletii\u003c/em\u003e, and \u003cem\u003emassiliense\u003c/em\u003e) are considered highly pathogenic, with high resistance levels and low cure rates [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In pulmonary treatment for Mab, a regimen of at least three drugs guided by drug susceptibility testing, including a macrolide, is recommended, even for strains with mutational or inducible (\u003cem\u003eerm\u003c/em\u003e gene) resistance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Additionally, the utility of drugs such as cefoxitin or imipenem, linezolid, and tigecycline should be evaluated, although the treatment duration has not yet been established [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Minor cutaneous infections can resolve spontaneously, with or without surgical debridement, while for SSTIs, a macrolide regimen along with a parenteral drug for at least 4 months is recommended. In cases of bone infections, treatment extension to 6 months is suggested. Surgery is recommended in cases of extensive disease, abscesses, and the removal of implants or catheters [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMycobacterium chelonae\u003c/strong\u003e \u003cp\u003eA patient immunosuppressed by biological therapies who developed joint involvement due to \u003cem\u003eM. chelonae\u003c/em\u003e infection was treated for 12 months with clarithromycin combined with moxifloxacin and experienced early relapse, and a patient with an infection associated with cosmetic procedures was treated for 6 months with curative criteria and no relapse. \u003cem\u003eM. chelonae\u003c/em\u003e infection is associated with cutaneous infections in immunocompetent patients, and in Colombia, it has been related to infections in HIV-positive individuals [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFor mild to moderate \u003cem\u003eM. chelonae\u003c/em\u003e infections, a two-drug regimen is recommended, and for severe infections, three drugs are suggested. Treatment should include a regimen with two intravenous drugs for 4 to 16 weeks and then two oral drugs selected according to susceptibility test results, with one of them being a macrolide if sensitive, until 12 months after sputum conversion in pulmonary involvement [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Drugs such as amikacin, azithromycin, clofazimine, clarithromycin, ciprofloxacin, doxycycline, imipenem, levofloxacin, linezolid, sulfamethoxazole, tigecycline, and tobramycin have demonstrated activity in human studies and \u003cem\u003ein vitro\u003c/em\u003e microbiological activity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003e\u003cem\u003eMycobacterium avium\u003c/em\u003e complex \u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003e(M. intracellulare, M. chimera and M. avium (subspecies M. avium, M. paratuberculosis, M. silvaticum)\u003c/span\u003e\u003c/strong\u003e \u003cp\u003eIn our study, two HIV patients with adenitis due to MAI were treated for 12 or 6 months. The first case involved a 4-year-old infant with perinatally acquired HIV who developed idiopathic thrombocytopenic purpura and required immunosuppressive management. At the time of NTM infection diagnosis, the patient had a CD4\u0026thinsp;+\u0026thinsp;T-cell count of 212 cells/mm3, which could be related to her hematological condition. Treatment consisted of clarithromycin, ethambutol, and amikacin. The second case involved an adult HIV patient on antiretroviral therapy with a CD4\u0026thinsp;+\u0026thinsp;T-cell count of 28 cells/mm3. This patient received treatment with clarithromycin and ethambutol. Both patients achieved a cure with no evidence of relapse during follow-up.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFor the treatment of MAI at the pulmonary level in patients with macrolide susceptibility, a three-drug treatment regimen, including a macrolide (azithromycin or clarithromycin) and ethambutol, is suggested. In cases of cavitary disease, bronchiectasis, or macrolide resistance, amikacin is added to the initial treatment for 2 to 3 months, followed by a 12-month regimen after the culture becomes negative [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, up to 40% of patients may experience unfavorable outcomes, requiring modification of their treatment due to adverse events in up to 84% of cases [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In situations of pulmonary refractoriness, inhaled liposomal amikacin is recommended [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn HIV patients, MAI treatment includes the administration of clarithromycin and ethambutol, with the possibility of adding rifabutin as a third drug. In cases of severe immunosuppression (CD4\u0026thinsp;+\u0026thinsp;counts less than 50 cells/mm3, bacteremia, and not receiving antiretroviral therapy), the addition of a fluoroquinolone or an aminoglycoside while maintaining treatment for 12 months is considered [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMycobacterium malmoense\u003c/strong\u003e \u003cp\u003eour study presents an uncommon case of a patient with endocarditis due to \u003cem\u003eM. malmoense\u003c/em\u003e, as most reports are related to pulmonary involvement [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Reports on extrapulmonary cases are limited, although lymph node, cutaneous, and articular involvement have been documented [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In our case, the patient underwent surgery and received a 12-month treatment including clarithromycin, moxifloxacin, and rifampicin, resulting in a cure and no relapse.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eM. malmoense\u003c/em\u003e is an SGM with inconsistencies in susceptibility testing. It is intrinsically resistant to isoniazid. For pulmonary involvement, a 12-month treatment regimen involving the use of at least three drugs, rifampicin, ethambutol, and a macrolide (clarithromycin or azithromycin), after sputum culture conversion is recommended [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Failure and relapse rates of 10% have been reported, with a related mortality of 4% [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In cases of macrolide intolerance or resistance, rifamycin or ethambutol, moxifloxacin, and clofazimine are alternatives. Intravenous amikacin can be considered for cavitary lung lesions. However, there are no specific recommendations for managing extrapulmonary involvement caused by this mycobacterium.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMycobacterium marinum\u003c/strong\u003e \u003cp\u003eA patient who developed SSTIs due to \u003cem\u003eM. marinum\u003c/em\u003e after trauma received a 6-month regimen of moxifloxacin combined with rifampicin and achieved a cure with no evidence of relapse. \u003cem\u003eM. marinum\u003c/em\u003e has been associated with infections in immunocompromised individuals and SSTIs in immunocompetent patients exposed to aquariums or swimming pools, known as \"Fish Fancier's Finger.\" There is no recommendation for the management of \u003cem\u003eM. marinum\u003c/em\u003e infection [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In \u003cem\u003eM. marinum\u003c/em\u003e, there is demonstrated activity in humans for drugs such as amikacin, clarithromycin, doxycycline, ethambutol, minocycline, rifampicin, and sulfamethoxazole, and \u003cem\u003ein vitro\u003c/em\u003e microbiological activity studies for ciprofloxacin, imipenem, isoniazid, levofloxacin, linezolid, moxifloxacin, and tedizolid [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe main limitation is related to the sample size, which stems from the inadequate representation of data in the target population. Despite our thorough search for cases in clinical records, many cases were excluded due to the lack of microbiological confirmation of the NTM species. However, our case series still provides valuable information on NTM-EP infections. Notably, NTMP-EP events are not subject to mandatory reporting, making it challenging to clearly define an NTM epidemiological outbreak. It is essential to recognize that certain risk interventions and sources of contamination could signal a potential epidemiological concern and that NTM infections are often mistaken for other diseases.\u003c/p\u003e \u003cp\u003eAdditionally, the identification of cases is hindered by the absence of a reference test and inadequate storage of isolates in identification laboratories, leading to a lack of availability for identification in almost half of the cases. One notable weakness identified in our study is the inability to identify the subspecies of \u003cem\u003eM. fortuitum\u003c/em\u003e and Mab, which may exhibit distinct drug susceptibility patterns.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003ePatients with atypical NTM infections present with chronic, indolent clinical presentations before diagnosis, requiring antimicrobial management guided by susceptibility testing combined with two or three drugs for an extended period. In pulmonary infections, cure rates are low, with high relapse rates requiring prolonged treatments, and in the management of skin and soft tissue infections, surgical and directed pharmacological management are therapeutic options, but clinical trials are needed.\u003c/p\u003e \u003cp\u003eIn summary, while our study sheds light on NTM-EP infections, the limitations underscore the need for standardized reporting mechanisms, improved laboratory practices, and enhanced diagnostic techniques to better understand and manage these infections.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e3TC: lamivudine\u003c/p\u003e\n\u003cp\u003eABC: abacavir\u003c/p\u003e\n\u003cp\u003eAMK: amikacin\u003c/p\u003e\n\u003cp\u003eART: antiretroviral therapy\u003c/p\u003e\n\u003cp\u003eAZT: zidovudine\u003c/p\u003e\n\u003cp\u003eB.I.D: twice a day\u003c/p\u003e\n\u003cp\u003eCLI: clindamycin\u003c/p\u003e\n\u003cp\u003eCLR: clarithromycin\u003c/p\u003e\n\u003cp\u003eDM2: type 2 diabetes mellitus\u003c/p\u003e\n\u003cp\u003eDST: drug susceptibility test\u003c/p\u003e\n\u003cp\u003eDXC: doxycycline\u003c/p\u003e\n\u003cp\u003eEFV: efavirenz\u003c/p\u003e\n\u003cp\u003eETB: ethambutol\u003c/p\u003e\n\u003cp\u003eHIV: human immunodeficiency virus\u003c/p\u003e\n\u003cp\u003eITP: immune thrombocytopenic purpura\u003c/p\u003e\n\u003cp\u003eLNZ: linezolid\u003c/p\u003e\n\u003cp\u003eLPV/rtv: lopinavir/ritonavir\u003c/p\u003e\n\u003cp\u003eLVX: levofloxacin\u003c/p\u003e\n\u003cp\u003eMab: M. abscessus complex\u003c/p\u003e\n\u003cp\u003eMAI: M. avium complex\u003c/p\u003e\n\u003cp\u003eMXF: moxifloxacin\u003c/p\u003e\n\u003cp\u003eNTM: nontuberculous mycobacteria\u003c/p\u003e\n\u003cp\u003eNTM-EP: nontuberculous mycobacteria \u0026ndash; extrapulmonary\u003c/p\u003e\n\u003cp\u003eNVP: nevirapine\u003c/p\u003e\n\u003cp\u003eOFL: ofloxacin\u003c/p\u003e\n\u003cp\u003eRGMs: rapid-growing mycobacteria\u003c/p\u003e\n\u003cp\u003eRIF: rifampicin\u003c/p\u003e\n\u003cp\u003eSGM: slow-growing mycobacteria\u003c/p\u003e\n\u003cp\u003eSLE: systemic lupus erythematosus\u003c/p\u003e\n\u003cp\u003eSST: skin and soft tissue\u003c/p\u003e\n\u003cp\u003eT.I.D: three times a day\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations:\u0026nbsp;\u003c/strong\u003eThe risk level for participants, as per Resolution 8430 of 1993 from the Ministry of Health, is minimized and acceptable. This retrospective study, involving no intervention or experimentation, received approval from the Ethics Committee for Biomedical Research of the Valle del Lili Foundation, Cali, Colombia. It entails low risk and does not necessitate informed consent since there is no intervention; it is merely a case review.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eFor this study, the datasets used and/or analyzed are available through the corresponding author upon reasonable request. The corresponding author can be contacted to access the relevant data supporting the findings presented in the article. This measure is taken to protect the privacy of patients and ensure compliance with relevant ethical regulations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding:\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u003c/strong\u003e All the authors contributed to writing, reading, and approving the submitted version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors would like to extend their gratitude to the Centro de Investigaciones Cl\u0026iacute;nicas (CIC) at Hospital Universitario Fundaci\u0026oacute;n Valle del Lili for their invaluable contributions and support in the completion of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDaley, C. 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Journal of Infection and Chemotherapy, 25(2), 117\u0026ndash;123. https://doi.org/10.1016/j.jiac.2018.10.010\u003c/li\u003e\n\u003cli\u003eda Mata-Jard\u0026iacute;n, O., Angulo, A., Rodr\u0026iacute;guez, M., Fern\u0026aacute;ndez-Figueiras, S., \u0026amp; de Waard, J. H. (2020). Drug susceptibility patterns of rapidly growing mycobacteria isolated from skin and soft tissue infections in Venezuela. European Journal of Clinical Microbiology \u0026amp; Infectious Diseases, 39(3), 433\u0026ndash;441. https://doi.org/10.1007/s10096-019-03740-7 \u003c/li\u003e\n\u003cli\u003eLange, C., B\u0026ouml;ttger, E. C., Cambau, E., Griffith, D. E., Guglielmetti, L., Van Ingen, J., \u0026hellip; Daley, C. (2022). Consensus management recommendations for less common nontuberculous mycobacterial pulmonary diseases. The Lancet Infectious Diseases, 22(7), e178\u0026ndash;e190. doi: 10.1016/S1473-3099(21)00586-7\u003c/li\u003e\n\u003cli\u003eFord, M. B., Okulicz, J. F., Salinas, J. R., \u0026amp; Kiley, J. L. (2023). Epidemiology, clinical characteristics, and outcomes of nontuberculous mycobacterial skin, soft tissue, and bone infections from a single center over a 10-year period. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 33, 100403. doi: 10.1016/j.jctube.2023.100403\u003c/li\u003e\n\u003cli\u003eCheng, L., Zhang, Q., Lou, H., Shen, X., Qu, Q., Cao, J., \u0026hellip; Sun, Q. (2023). Effectiveness and safety of regimens containing linezolid for treatment of Mycobacterium abscessus pulmonary Disease. Annals of Clinical Microbiology and Antimicrobials, 22(1), 106. doi: 10.1186/s12941-023-00655-2\u003c/li\u003e\n\u003cli\u003eGaudencio, M., Carvalho, A., Bert\u0026atilde;o, M. I., Barreiro, I., Bessa, M. I., \u0026amp; Gon\u0026ccedil;alves, A. (2021). Mycobacterium chelonae Cutaneous Infection: A Challenge for an Internist. European Journal of Case Reports in Internal Medicine. https://doi.org/10.12890/2021_003013 \u003c/li\u003e\n\u003cli\u003eAliberti, S., Blasi, F., Burgel, P.-R., Calcagno, A., Fl\u0026oslash;e, A., Grogono, D., \u0026hellip; Loebinger, M. R. (2024). \u003cem\u003eMycobacterium avium\u003c/em\u003e complex pulmonary disease patients with limited treatment options. ERJ Open Research, 10(1), 00610\u0026ndash;02023. doi: 10.1183/23120541.00610-2023\u003c/li\u003e\n\u003cli\u003eEspinosa-del-Barrio, L., Boira, I., Esteban, V., \u0026amp; Chiner, E. (2023). Mycobacterium malmoense Infection in a Patient With Adult Cystic Fibrosis: A Case Report. Archivos de Bronconeumolog\u0026iacute;a, 59(8), 540\u0026ndash;541. doi: 10.1016/j.arbres.2023.03.021\u003c/li\u003e\n\u003cli\u003eBoudon, A., Opota, O., \u0026amp; Dan, D. (2022). A refractory tenosynovitis of the wrist: a case report. Journal of Medical Case Reports, 16(1), 75. doi: 10.1186/s13256-022-03278-x\u003c/li\u003e\n\u003cli\u003eEsteban, J., \u0026amp; Navas, E. (2018). Treatment of infections caused by nontuberculous mycobacteria. Enfermedades Infecciosas y Microbiolog\u0026iacute;a Cl\u0026iacute;nica, 36(9), 586\u0026ndash;592. https://doi.org/10.1016/j.eimc.2017.10.008\u003c/li\u003e\n\u003cli\u003eYan, M., Brode, S. K., \u0026amp; Marras, T. K. (2023). Treatment of the Less Common Nontuberculous Mycobacterial Pulmonary Disease. Clinics in Chest Medicine, 44(4), 799\u0026ndash;813. doi: 10.1016/j.ccm.2023.06.011\u003c/li\u003e\n\u003cli\u003eLopez, M., Croley, J., \u0026amp; Murphy, K. D. (2017). Atypical Mycobacterial Infections of the Upper Extremity: Becoming More Atypical? HAND, 12(2), 188\u0026ndash;192. doi: 10.1177/1558944716642764\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nontuberculous mycobacteria, fast-growing mycobacteria, slow-growing mycobacteria, extrapulmonary, clinical outcome","lastPublishedDoi":"10.21203/rs.3.rs-3982582/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3982582/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThe increasing prevalence of extrapulmonary nontuberculous mycobacterial (NTM) infections poses significant challenges in clinical management due to their inherent drug resistance and the need for prolonged antibiotic regimens. Although these infections are infrequent in daily clinical practice, detailed information on associated clinical outcomes is lacking in the local literature.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003e This descriptive observational study examined 17 patients with extrapulmonary NTM infection from the General Mycobacteria Registry of Fundaci\u0026oacute;n Valle del Lili University Hospital and reviewed a total of 391 patients between 2007 and 2021.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA predominance of women with a history of cosmetic surgery was observed, with the skin being the most common site of involvement, especially for \u003cem\u003eM. fortuitum\u003c/em\u003e and \u003cem\u003eM. abscessus\u003c/em\u003e. The most commonly used treatment consisted of a combination of clarithromycin and moxifloxacin administered for approximately 4\u0026ndash;6 months, for a cure rate of 70.5%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe treatment regimens implemented align with the literature recommendations, and it is noteworthy that the cure rate exceeds 70%, which contrasts with what has been reported in existing research. The lack of temporal references for diagnosis and treatment is highlighted, underscoring the need for future research to address this critical aspect and improve clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Clinical presentation and treatment outcomes of extrapulmonary nontuberculous mycobacterial infections with rapid and slow growth rates in Cali, Colombia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-13 12:56:03","doi":"10.21203/rs.3.rs-3982582/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-24T08:50:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-23T09:07:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-08T19:59:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b33b71d5-f2d4-475b-b165-7f6251dee192","date":"2024-04-08T01:43:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d0988325-36ca-43c5-ac99-15c7e6ad0e46","date":"2024-04-03T20:11:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145d1071-a99b-4de1-8881-0806cbac4133","date":"2024-04-02T22:50:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-18T19:07:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-15T09:57:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-08T09:43:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-08T09:43:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-02-23T16:55:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d866610d-ec49-4b92-a660-bcf2c132a56d","owner":[],"postedDate":"March 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T15:58:08+00:00","versionOfRecord":{"articleIdentity":"rs-3982582","link":"https://doi.org/10.1186/s12879-025-10681-4","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-03-31 15:56:50","publishedOnDateReadable":"March 31st, 2025"},"versionCreatedAt":"2024-03-13 12:56:03","video":"","vorDoi":"10.1186/s12879-025-10681-4","vorDoiUrl":"https://doi.org/10.1186/s12879-025-10681-4","workflowStages":[]},"version":"v1","identity":"rs-3982582","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3982582","identity":"rs-3982582","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}