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Suggest Treatment For Mycobacterial Infection Post Surgery
Question: Hello sir,
My mother's age is 48. In december 2015 she had her uterus removed and umbilical hernia repaired in a single surgery. After about a month of this surgery pus started leaking from her naval area where the incision was made. Subsequently she had to be reoperated as there was massive pus formation which had engulfed the mesh used to repair her hernia , so the mesh was taken out and a lot of skin and muscle got infected so there was no skin to stitch after the surgery also. the surgeon who reoperated her told us that the two surgeries performed together at the first place should never have been done together at once , moreover infection from surgical instruments further deteriorated her condition. Post this second surgery the tests showed that she had a typical mycobacterial infection so she was given clarithomycin for 6 months. So in those 6 months her surgical wound healed with proper dressing and by having clarithomycin . But after she left the medicine for a month again a lump formed with pus in it. So we rushed to the surgeon on 8th november again and he suggested a drain out via surgery but we insisted on having medicines for her so he said she must have AKT - 4 (medicine for TB) for 3 months and may have to continue for upto a year. We are all so worried so we consulted some other physician also who advised us to undergo some tests which shows tuberculosis positive (M TB IGRA) and high C reactive protien . this physician also suggested that AKT 4 may not work as he suspects mycobacterium chelnoe and he again asked mom to eat claribid and zanocen . We are totally perplexed as to what to do. that lump has burst and there is pus leaking again with a massive sensation of itching in the area and currently she is taking AKT 4 and azithromycin 500mg daily. Her puss has gone for testing . My mother has TB twice before all this. Once in her lungs at the age of 13 and in her neck gland in 2009. She is also diabetic .
My mother's age is 48. In december 2015 she had her uterus removed and umbilical hernia repaired in a single surgery. After about a month of this surgery pus started leaking from her naval area where the incision was made. Subsequently she had to be reoperated as there was massive pus formation which had engulfed the mesh used to repair her hernia , so the mesh was taken out and a lot of skin and muscle got infected so there was no skin to stitch after the surgery also. the surgeon who reoperated her told us that the two surgeries performed together at the first place should never have been done together at once , moreover infection from surgical instruments further deteriorated her condition. Post this second surgery the tests showed that she had a typical mycobacterial infection so she was given clarithomycin for 6 months. So in those 6 months her surgical wound healed with proper dressing and by having clarithomycin . But after she left the medicine for a month again a lump formed with pus in it. So we rushed to the surgeon on 8th november again and he suggested a drain out via surgery but we insisted on having medicines for her so he said she must have AKT - 4 (medicine for TB) for 3 months and may have to continue for upto a year. We are all so worried so we consulted some other physician also who advised us to undergo some tests which shows tuberculosis positive (M TB IGRA) and high C reactive protien . this physician also suggested that AKT 4 may not work as he suspects mycobacterium chelnoe and he again asked mom to eat claribid and zanocen . We are totally perplexed as to what to do. that lump has burst and there is pus leaking again with a massive sensation of itching in the area and currently she is taking AKT 4 and azithromycin 500mg daily. Her puss has gone for testing . My mother has TB twice before all this. Once in her lungs at the age of 13 and in her neck gland in 2009. She is also diabetic .
Brief Answer:
Suspicious of Atypical mycobacterial infection.
Detailed Answer:
Dear XXXXXXX Hi & Welcome.
Thanks for approaching healthcare magic for your concerns.
I have gone through the history and I am sorry to know the sequence of events that led to her present condition.
I am of the opinion that she seems to have acquired atypical mycobacterial infection caused by a Non-TB bacteria called Mycobacterium chelonae which most commonly causes skin infection, subcutaneous abscess, or a disseminated disease. Disseminated infection is often associated with abdominal surgeries involving prostheses such as mesh in presence of diabetes.
Interferon Gamma Release Assay or high C-Reactive Protein are diagnostic of latent tuberculosis infection. However, a positive IGRA or high C Reactive protein result may not necessarily indicate TB infection, but can also be caused by infection with non-tuberculous mycobacteria like Mycobacterium chelonae/abscessus.
So, in view of the explanation given above and the fact that your mom had suffered from TB twice, let her continue taking AKT4 and Azithromycin till the culture and sensitivity tests of the pus are available.
Then based on the results of pus test, the most appropriate antibiotic would be prescribed by her doctor to eradicate the infection.
Hope the advice given above would be useful to your mom.
However, do reply if you have any follow up query.
Wishing your mom a very smooth and quick recovery.
Take care.
Suspicious of Atypical mycobacterial infection.
Detailed Answer:
Dear XXXXXXX Hi & Welcome.
Thanks for approaching healthcare magic for your concerns.
I have gone through the history and I am sorry to know the sequence of events that led to her present condition.
I am of the opinion that she seems to have acquired atypical mycobacterial infection caused by a Non-TB bacteria called Mycobacterium chelonae which most commonly causes skin infection, subcutaneous abscess, or a disseminated disease. Disseminated infection is often associated with abdominal surgeries involving prostheses such as mesh in presence of diabetes.
Interferon Gamma Release Assay or high C-Reactive Protein are diagnostic of latent tuberculosis infection. However, a positive IGRA or high C Reactive protein result may not necessarily indicate TB infection, but can also be caused by infection with non-tuberculous mycobacteria like Mycobacterium chelonae/abscessus.
So, in view of the explanation given above and the fact that your mom had suffered from TB twice, let her continue taking AKT4 and Azithromycin till the culture and sensitivity tests of the pus are available.
Then based on the results of pus test, the most appropriate antibiotic would be prescribed by her doctor to eradicate the infection.
Hope the advice given above would be useful to your mom.
However, do reply if you have any follow up query.
Wishing your mom a very smooth and quick recovery.
Take care.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you for your advice we shall abide by the same. I just had a few more questions. as u know that the lump that had formed burst about a week ago and most of the pus has drained out but some of it still keeps leaking. She has been using betadine solution for dressing of the area . Please suggest something for the itching sensation she feels in the area. Also, i would like to ask is AKT 4 enough dosage for her? her weight is 68 kgs and height 5 feet 3 inches. also if in case the cuture reports confirm mycobacterium chelonae will she have to discontinue AKT and just be on antibiotics or she should be given a combination of two ?
thank u
thank u
Brief Answer:
Kindly find the details below
Detailed Answer:
Dear XXXXXXX Hi
Thanks for your reply, noted its contents.
1. For the relief of itching sensation Calamine lotion or Cortisone cream can be applied over the affected area. If there is no relief with these medicaments she may be given less sedating oral antihistamines like Cetrizine once daily.
2. One kit of AKT4 contains four different antibiotics like Ethambutol, Isoniazid, Pyrazinamide, and Rifampicin are commonly prescribed as an initially for the treatment of tuberculosis for 2-3 months depending upon the severity of the disease. The dose prescribed for your mother is adequate.
3. If the culture yields the growth of mycobacterium chelonae, in my opinion she should be given the antibiotics based on the culture and sensitivity.
Hope these answer your queries.
Thanks and regards.
Kindly find the details below
Detailed Answer:
Dear XXXXXXX Hi
Thanks for your reply, noted its contents.
1. For the relief of itching sensation Calamine lotion or Cortisone cream can be applied over the affected area. If there is no relief with these medicaments she may be given less sedating oral antihistamines like Cetrizine once daily.
2. One kit of AKT4 contains four different antibiotics like Ethambutol, Isoniazid, Pyrazinamide, and Rifampicin are commonly prescribed as an initially for the treatment of tuberculosis for 2-3 months depending upon the severity of the disease. The dose prescribed for your mother is adequate.
3. If the culture yields the growth of mycobacterium chelonae, in my opinion she should be given the antibiotics based on the culture and sensitivity.
Hope these answer your queries.
Thanks and regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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