B69-22 Bone and Joint Infections Caused by Non-Tuberculous Mycobacteria: Review of the Literature Reveals Some Expected and Unexpected Findings

Abstract Background Osteoarticular non-tuberculous mycobacteria (NTM) infections are comprised of case reports and series. We undertook a systematic review of the literature reporting osteoarticular NTM infections to determine if there are patterns that link specific NTM species to specific types of osteoarticular infections. Methods We used the PubMed database using the key words of non-tuberculous mycobacteria with “bone” or “joint” infections. We also included cases of “tenosynovitis” due to NTM. We reviewed the bibliography of the articles for additional published reports. We then tabulated for each subject their age, gender, the specific bone and/or joint involved, the NTM species involved, and underlying risk factor / mode of infection. Results A total of 286 cases of osteoarticular infections were reported in the literature. Osteoarticular NTM infections were reported in 172 males (ages 3 to 87 years) and 113 females (ages 7 to 86) with one case of unknown age and gender. The NTM species responsible for osteoarticular infections included: (i) slow-growing mycobacteria: M. marinum (72 cases), M. avium complex (52 cases), M. haemophilum (31 cases), M. genavense (22 cases), M. xenopi (21 cases), M. kansasii (20 cases), M. aubagnense (1 case), M. gordonae (1 case), M. scrofulaceum (1 case), M. simiae (1 case), M. terrae (1 case); (ii) rapid-growing mycobacteria: M. abscessus group (26 cases), M. fortuitum (18 cases), M. chelonae (5 cases), M. houstonsense (3 cases), M. flavescens (1 case), M. phlei (1 case), M. senegalense (1 case), M. massiliense (1 case), M. smegmatis (1 case); (iii) multi-species (3 cases); (iv) unspecified NTM species (3 cases). Major sites of NTM bone infections involved: (i) appendicular bones in 74 cases; (ii) axial skeleton (skull, vertebrae, rib cage) in 92 cases; (iii) 7 in both appendicular and axial bones; and (iv) 29 cases with unspecified bone sites. Of the 286 osteoarticular cases, 84 involved joints only, 171 involved bones only, and 31 involved both joints and bones. Five articles that reported case series of osteoarticular NTM infections without more detailed information were not included in the above analyses. Conclusion M. marinum osteoarticular infections were the most common, especially with hand trauma. M. haemophilum was the second most common NTM to cause osteoarticular infections, occurring mainly in immunosuppressed patients. M. xenopi osteoarticular infections involved the vertebrae in 95% of the reported cases and was also mostly associated with immunosuppression. A limitation of this review is publication bias. This abstract is funded by: None