Nontuberculous Mycobacterial Infections Masquerading as Common Clinical Conditions: A Case Series

Nontuberculous mycobacteria (NTM) are ubiquitous environmental pathogens increasingly implicated in human disease, often presenting diagnostic challenges due to their mimicry of common clinical syndromes.In recent years, there has been a rise in nosocomial postoperative wound infections caused by NTM worldwide.The early identification of these infections is often hindered by challenges in accurate detection, and the long-term treatment regimens, which can be poorly tolerated, further complicating effective management.Nontuberculous mycobacteria encompass a large variety of bacteria, with over 190 identified species, among which the Mycobacterium avium complex (MAC)-comprising Mycobacterium avium and Mycobacterium intracellulare-along with Mycobacterium abscessus, are the most prevalent in human infections.The standard treatment for MAC, the most frequently isolated NTM, involves a three-drug regimen lasting approximately 12-18 months.The ability of NTMs to form biofilms, their distinctive cell wall structure, and their expression of both acquired and intrinsic resistance mechanisms pose significant challenges to the development of new therapies targeting NTM infections.We report three cases in which NTM infections presented as a mesh-related abscess, a genitourinary infection following ureteroscopy, and perforated appendicitis with abscess formation, which were effectively managed using a combination of macrolides, fluoroquinolones, and aminoglycosides.Each case necessitated advanced diagnostic techniques beyond standard bacterial cultures, specifically acid-fast bacilli staining and the mycobacteria growth indicator tube, to distinguish NTM from tuberculosis and other typical bacterial causes.Treatment involved extended NTM-specific regimens, with modifications made to address toxicity, highlighting the necessity for personalized management strategies.These cases underscore the critical need to consider NTM in cases of persistent infections, especially in surgical or procedural settings, to enhance diagnostic precision and improve patient outcomes.