Hand and Wrist Non-Tuberculous Mycobacteria Infection in South Taiwan: A Retrospective Case Series

Abstract Background: In recent decades, the incidence of nontuberculous mycobacteria (NTM) has significantly increased in Taiwan. Compared to NTM pulmonary diseases, NTM hand and wrist infections are uncommon and can affect immunocompetent patients. Unfortunately, the optimal management remains unknown, and comprehensive studies are lacking. Objectives: Our aim was to determine the clinical features of hand and wrist NTM infections and establish protocols for treating such diseases. Materials and Methods: We included seven patients with hand and wrist NTM infections treated with surgical intervention followed by a medical regimen at a single tertiary medical center between 2008 and 2023. One patient was excluded due to dead of lymphoma before 1 year follow. Age, sex, occupation, trauma history, underlying disease, infective location, time from symptoms to surgery, debridement times, staining and microbiological results, pathological findings, interval to final microbial findings, initial medical regimen and regimen adjustments, treatment duration, recent condition, grip power, functional score, and pain score were recorded. Results: One died of lymphoma before a 1-year follow-up. In the remaining 6 patients, the median time from symptom onset to surgery was 4 months (range, 2–12 months) and the median interval before the final mycobacterium report was 39 days (range, 13–56 days). One patient tested positive for acid fast stain (AFS), while three were infected with the Mycobacterium Avium Complex (MAC) , two with Mycobacterium szulgai , one with Mycobacteroides Abscessus , and Mycobacterium kansasii . Except for Case 5, all patients experienced drug side effects and required medical adjustment. All patients except two had better functional outcomes after surgery. Conclusions: Surgical debridement followed by combination therapy may be effective in improving the outcomes and quality of life of patients with hand and wrist NTM infections. The most common identified pathogen was MAC . However, the clinical features and protocols for NTM infection management are still lacking in Taiwan. Surgeon awareness of NTM infection by improving clinical decision-making criteria, laboratory research, and multicenter controlled trials are required to improve the diagnosis and treatment of hand and wrist NTM infections.