Microbiology and classification of mycobacteria. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. [Medline]. Coronavirus: what are moderate, severe and critical COVID-19? 13 (3):257-63. [Medline]. Rifampin in combination with clarithromycin for at least 6-8 weeks may be the best choice for controlling complications of the ulcer. [Medline]. Nontuberculous Mycobacteria: Skin and Soft Tissue Infections. [Medline]. As a general rule, deeper infections may require 6 or more months of treatment. Of 345 394 dermatological cases presented over the 10-year period, 33 (0.0096%) cases (19 male, 14 female) of atypical mycobacterial cutaneous infection were diagnosed. Atypical mycobacteria are less sensitive to anti-tuberculous treatments but may be responsive to some chemotherapeutic agents or other antibiotics. The treatment of cutaneous mycobacterial infections depends on the species and sensitivity to antibiotics. Kaur P, Fishman JA, Misdraji J, Varma MC, Kotton CN. NICE has issued rapid update guidelines in relation to many of these. The prognosis is good for a majority of the affected individuals, with prompt diagnosis and appropriate treatment It is important to consider mycobacterial infection in any stubborn and atypical skin problem, particularly in immunocompromised individuals. Mycobacterium scrofulaceum disease: experience from a tertiary medical centre and review of the literature. Mycobacterium ulcerans low infectious dose and mechanical transmission support insect bites and puncturing injuries in the spread of Buruli ulcer. J Med Microbiol. Lancet Respir Med. [Medline]. [85] In specific cases, the results of susceptibility tests help guide the decision. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. Association of SLC11A1 (NRAMP1) polymorphisms with pulmonary Mycobacterium avium complex infection. Upgrade to Patient Pro Medical Professional? Scand J Infect Dis. Isolation of non-tuberculous mycobacteria from hospital cockroaches (Periplaneta americana). Books about the skin; Dermatology made easy book . 2015 Mar3(3):244-56. doi: 10.1016/S2213-2600(15)00062-4. 14 (9):e0222425. The environmental mycobacteria cause two named diseases with characteristic features: Fish tank (or swimming pool) granuloma caused by. Lake MA, Ambrose LR, Lipman MC, Lowe DM. Clin Dermatol. Atypical mycobacterial lymphadenitis in childhood--a clinicopathological study of 17 cases. 2017 Fall. Clin Infect Dis. Indian J Tuberc. Females are more often affected and it is also more common in children. 11 (4):e0005553. The information on this page is written and peer reviewed by qualified clinicians. Full anti-tuberculous therapy and surgical excision are required. [Medline]. In some cases (especially fast-growing environmental mycobacteria), successful treatment requires aggressive debridement of all infected subcutaneous tissues and skin. The ideal duration is 12 months after achieving culture conversion. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Somoskovi A, Salfinger M. Nontuberculous mycobacteria in respiratory infections: advances in diagnosis and identification. 2019. 68 (3):256-62. 2013 Mar. Plast Reconstr Surg Glob Open. Host susceptibility to non-tuberculous mycobacterial infections. 2019 Sep. 51 (3):245-255. 17 (2):153-8; discussion 105-6. [Medline]. 2013. Thorax. 58 (Pt 3):371-3. Braz J Infect Dis. Initiation of NTM treatment should be individualized based on disease type, comorbid conditions, and patient age. Yeap KC, Sivagurunathan PD, Raman P, Khalid KHM. Bacterial Skin Infections: Can You Make the Diagnosis? Please confirm that you would like to log out of Medscape. However, many patients are often not properly treated because of insufficient health resources in developing countries, or treatment may be difficult because of underlying immunosuppression and consequent diffuse infection. 2012 Jan 15. Bengualid V, Singh V, Singh H, Berger J. Mycobacterium fortuitum and anaerobic breast abscess following nipple piercing: case presentation and review of the literature. 2000 Apr18(2):359-77, xi-xii. Polymerase chain reaction has been used to aid diagnosis. Medscape Education, Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015-2017, 2002 Transpl Infect Dis. [Medline]. [Medline]. Mutations in GATA2 are associated with the autosomal dominant and sporadic monocytopenia and mycobacterial infection (MonoMAC) syndrome. 20 (8):1509-23. [67]. Is it safe to delay your period for your holiday? Coronavirus: what are asymptomatic and mild COVID-19? 2019. Curr Opin Infect Dis. Share cases and questions with Physicians on Medscape consult. [Medline]. Clin Infect Dis. 1999 Mar-Apr. [Medline]. 175 (4):367-416. 1996 Dec. 11 (4):244-51. 55 (6):1747-1754. Hijazy M; Principles of Paediatric Dermatology (2008). Treatment of mycobacterial infections is generally difficult and challenging. 2016 Apr. Mycobacterial infection of breast prosthesis--a conservative treatment: a case report. Hautmann G, Lotti T. Atypical mycobacterial infections of the skin. 2010 Aug 15. Erisa Alia, MD is a member of the following medical societies: Albanian Society of Dermatology and Venereology, European Academy of Dermatology and VenereologyDisclosure: Nothing to disclose. This organism is susceptible to clarithromycin, minocycline, trimethoprim-sulfamethoxazole, rifampin, rifabutin, and ethambutol. Atypical mycobacterial infections or nontuberculous mycobacterial infections (NTM) of the soft tissues are uncommon. Int J Pediatr Otorhinolaryngol. These include rifampicin, ethambutol, isoniazid, minocycline, ciprofloxacin, clarithromycin, azithromycin and cotrimoxazole. For serious infections, use at least two agents. J La State Med Soc. Curr Opin Pulm Med. Atypical mycobacterial infections have been a cause of steadily growing infections over the past decades, especially in immunocompromised patients. The purified protein derivative test (antigen skin test used to aid the diagnosis of tuberculosis) result is usually negative in infections with. [4]. 1987 Jul 23. Bilateral sporotrichoid lymphocutaneous dermatosis in a drug abuser: case report and review of the literature. Jarzembowski JA, Young MB. Treatment of Extrapulmonary Nontuberculous Mycobacterial Diseases. Environmental (atypical) mycobacteria may be inoculated after surgery, acupuncture, mesotherapy, intravenous catheter use, or subcutaneous injections. It occurs with infection in someone who has immunity from previous infection. Appl Environ Microbiol. 2003 Mar. [Medline]. Semin Respir Crit Care Med. Since most of the nontuberculous mycobacteria (NTM) species demonstrate strong resistance to multiple antimicrobial agents, treatment of NTM infections and establishment of an effective regimen remain challenging. A hand infection can cause severe problems that persist even after the infection has resolved, such as stiffness, loss of strength, and loss of tissues such as skin, nerve and bone. It causes fistulae and scarring. 7:9. 7th ed. M abscessus complex group bacteria are the most difficult rapidly growing mycobacteria to treat, owing to their resistance to multiple standard antituberculous drugs. 2015 Aug. 15 (8):968-80. Anticytokine autoantibody-associated immunodeficiency. Mycobacterial skin disease in cats associated with atypical mycobacteria is an uncommon disease in small animal practice, and the disease is rarely encountered in dogs. [1] Mycobacteria cause slowly developing chronic skin infections. Thegerström J. Pinpointing the source of infection of Mycobacterium avium hominissuis in children. Erisa Alia, MD Clinical Trials Research Fellow, Department of Dermatology, University of Connecticut School of Medicine Vedvyas C, Shvartsbeyn M, Brinster N, Femia A. Mycobacterium avium complex infection. [Medline]. A 38-Year-Old Dog Owner With a Blistering, Itchy Rash, British Association of Dermatologists Guidelines for Biologic Therapy for Psoriasis 2020, Skin Symptoms Common in COVID 'Long-Haulers', Malpractice Case: Black Box Warnings Can Come Back to Bite in Court, Clinical Practice Guidelines for Biologic Therapy for Psoriasis (BAD, 2020), Human Bites and Recurrent Cellulitis: SSTI Treatment Tips. In: StatPearls [Internet]. Atypical Mycobacterial Infection Presenting as Persistent Skin Lesion in a Patient with Ulcerative Colitis Giorgos Bamias , 1 , * George L. Daikos , 1 Spyros I. Siakavellas , 1 Garyfallia Kaltsa , 1 Stavroula Smilakou , 2 Ioannis Katsogridakis , 1 Irene Vafiadis-Zouboulis , 1 and Spiros D. Ladas 1 In rifampin-resistant strains, a three-drug regimen is recommended, combining in higher doses clarithromycin or azithromycin, moxifloxacin, isoniazid, ethambutol, sulfamethoxazole, or streptomycin. 2014 Jul. 2008 Jan59(1):59-70. Using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection. Antimicrob Agents Chemother. Currently, there exists no standardized susceptibility test for M haemophilum. Kristensen IA, Veirum JE, Møller BK, Christiansen M. Novel STAT1 alleles in a patient with impaired resistance to mycobacteria. This activity outlines the microbiology, evaluation, and treatment of atypical mycobacterial infections and highlights the interprofessional team's role in caring for patients with these conditions. It is important, however, to consider certain basic principles in managing patients with presumed atypical mycobacterial disease. 25 (3):271-280. In Vitro Activities of Bedaquiline and Delamanid against Nontuberculous Mycobacteria Isolated in Beijing, China. Clin Microbiol Rev. Redelman-Sidi G, Sepkowitz KA. [Medline]. Update to the Clinicians’ Challenge Award (2018) An update of our c ontinuing research into dermatological image recognition using deep learning and vision algorithms. 46 (6):649-53. 9 … 2009 Jan48(1):27-35. [Medline]. Jeong J, Kim SR, Lee SH, Lim JH, Choi JI, Park JS, et al. [Medline]. Initially a painless erythematous nodule develops, usually on the leg or forearm. Atallah D, El Kassis N, Araj G, Nasr M, Nasnas R, Veziris N, et al. [Medline]. Grubbs J, Bowen C. Mycobacterium abscessus infection following home dermabrasion. Scrofuloderma results from breakdown of skin overlying a tuberculous focus, usually at a lymph node but also at the skin over infected bones or joints. A 2019 retrospective study in Taiwan concluded that surgical resection of nontuberculous mycobacteria (NTM) solitary pulmonary nodules is curative in asymptomatic patients without positive culture of the same NTM species from respiratory specimens and a history of NTM pulmonary disease. 28.1-39. Treatment options include clarithromycin or azithromycin, with the addition of amikacin, cefoxitin, or imipenem for serious and complicated infections. Emerg Infect Dis. Patients with atypical mycobacteria infections can be treated as outpatients after appropriate surgery has been performed. American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) clinical guidelines recommend an initial regimen of three drugs: a macrolide (clarithromycin or azithromycin), ethambutol, and rifampin. Clin Chest Med. The prognosis is good with proper medical and surgical treatment. 2019 Aug. 63 (8):[Medline]. When seen early, some types of hand infection can be treated with antibiotics and local rest and soaking. The disease is usually unilateral, occurring in the submandibular or preauricular area. 2013 Dec. 463 (6):843-6. Henkle E, Winthrop KL. Aitken ML, Limaye A, Pottinger P, Whimbey E, Goss CH, Tonelli MR, et al. Hence, species identification is important prior to instituting treatment. Nontuberculous Mycobacterial Infections After Silicone Breast Implant Reconstruction Emphasize a Diversity of Infecting Mycobacteria. Czelusta A, Moore AY. The overall incidence of these infections is suspected to have increased nearly 3-fold over the last decade. 2014. BCG vaccination gives a variable degree and duration of protection. Arch Dermatol. Most mycobacteria require special culture conditions, which, if not specifically requested, are frequently not used. … Professional Reference articles are designed for health professionals to use. Holt MR, Kasperbauer S. Management of Extrapulmonary Nontuberculous Mycobacterial Infections. Zumla A, Grange J; Infection and disease caused by environmental mycobacteria. Lab Med. It usually affects the cervical lymph nodes, often just a single node. Our second case showed abscess formation 25, 26], also reported to be a predominant feature in proven cutaneous M. chelonae infection. Mycobaterium leprae is discussed elsewhere. 1,2 Inoculation after tattooing has also been reported in a single case. [3]NTM cause infections mainly after trauma, surgery and cosmetic procedures. F1000Res. [Medline]. Dermatol Clin. COVID-19: how to treat coronavirus at home. Sañudo A, Vallejo F, Sierra M, Hoyos JG, Yepes S, Wolff JC, et al. Epub 2015 May 8. van Ingen J; Diagnosis of nontuberculous mycobacterial infections. You may find one of our health articles more useful. Pai HH, Chen WC, Peng CF. Clin Infect Dis. There are no prospective controlled clinical trials, and the recommendations are based on case reports or retrospective studies. Jun Lu, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Telemedicine Association, Connecticut Society of Dermatology and Dermatologic Surgery, New England Dermatological Society, Rheumatologic Dermatology SocietyDisclosure: Nothing to disclose. Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan IncDisclosure: Nothing to disclose. Histological appearances of atypical mycobacterial infection are not specific but can include large numbers of neutrophils in the biopsy, as in our case 1. Cicilioni OJ Jr, Foles VB, Sieger B, Musselman K. Mycobacterium fortuitum Infection following Reconstructive Breast Surgery: Differentiation from Classically Described Red Breast Syndrome. [Medline]. 2014 Sep. 37 (9):e848-50. J Hosp Infect. Dermatol Clin. '"Why me, why now?" PLoS Negl Trop Dis. [Medline]. 14:54. 1995 May-Jun. Das JK, Sengupta S, Mitra S, et al; Coexistence of papulonecrotic tuberculide with lichen scrofulosorum. [Medline]. 2017 Aug. 30 (4):404-409. [4], Of the greater than 140 NTM species reported, 25 species have been strongly associated with NTM diseases and the other species are rarely encountered in clinical samples. Outbreak of Tattoo-associated Nontuberculous Mycobacterial Skin Infections. [Medline]. Julián Gómez L, García Pajares F, Alvarez Posadilla M, Sánchez Antolín G, Velicia Llames Mdel R, Caro-Patón Gómez A. Int J Dermatol. Pediatr Infect Dis J. 1830144-overview Post-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro. Surgical excision of the infected lymph nodes is considered the treatment of choice, and cure rates in retrospective studies varied from 81% to 95% [2–7]. Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skin-marking solution. 69 (6):949-955. Nontuberculous lymphadenitis in children: What management strategy?. Sapkota BR, Hijikata M, Matsushita I, Tanaka G, Ieki R, Kobayashi N, et al. Epub 2013 Mar 4. Histology of atypical mycobacterial skin infection. [Medline]. 214222-overview Lindeboom JA, Bruijnesteijn van Coppenraet LE, van Soolingen D, Prins JM, Kuijper EJ. 1994 Oct. 12 (4):657-68. Tuberc Respir Dis (Seoul). 2016 Dec. 13 (12):2143-2150. 1999 Feb. 40 (2 Pt 2):359-63. [Medline]. J Formos Med Assoc. 2014 Jun. 2004. 2014 Oct53(10):1197-204. doi: 10.1111/ijd.12528. Pediatric neck abscesses remain common problems that are sometimes difficult to manage. Yu X, Gao X, Li C, Luo J, Wen S, Zhang T, et al. The development of DNA fingerprinting technology, especially pulsed-field gel electrophoresis, has been suggested as a diagnostic tool. 2019 Oct 1. There is no standard treatment regimen, but the most effective proven regimen is the combination of isoniazid with clarithromycin or rifampin. Microbiol Spectr. 2015 Mar. [Medline]. 2018 Jan. 32 (1):[Medline]. Even though there is no optimal therapy, multidrug regimens including clarithromycin, rifampin, rifabutin, ciprofloxacin, or amikacin have proven to be efficacious. Infect Chemother. Skin and wound infection by rapidly growing mycobacteria: an unexpected complication of liposuction and liposculpture. It may also present with tenosynovitis, cutaneous lymphadenitis; the clinical presentation is similar to that expected in lupus profundus and with ulcerative perineal lesions. Andréjak C, Nielsen R, Thomsen VØ, Duhaut P, Sørensen HT, Thomsen RW. Hum Mol Genet. [hkmj.org] Morphologically, the patients may present with abscesses, ulcers, draining sinus tracts, cellulitis or … Semin Respir Crit Care Med. Murillo J, Torres J, Bofill L, Ríos-Fabra A, Irausquin E, Istúriz R, et al. Aubry A, Mougari F, Reibel F, Cambau E. Mycobacterium marinum. Gonzalez-Santiago TM, Drage LA; Nontuberculous Mycobacteria: Skin and Soft Tissue Infections. Thorax. Lindeboom JA. Zhang M, Feng M, He JQ. Patient does not provide medical advice, diagnosis or treatment. 185 (2):231-2. Epub 2014 Jun 25. Hsu PY, Yang YH, Hsiao CH, Lee PI, Chiang BL. 2013 Feb. 34 (1):143-50. [Medline]. 2012 May. Good outcomes have been published after identification of the mycobacterial species and treatment with a long (several months) course of an appropriate antibiotic combination.2 Surgery is indicated when local skin lesion can be removed; more diffuse lesions can be treated with surgical debridement and the cats … Coronavirus: how quickly do COVID-19 symptoms develop and how long do they last? 2017 Jun. Clin Infect Dis. Transplantation. Yates VM, Rook GAW. Registered in England and Wales. 2017. Infections with atypical mycobacteria can be treated with a variety of antibiotics. AIDS patients and persons with tissue damage, such as skin wounds or pulmonary disease, can make a number of lifestyle changes to help prevent MAC infection. The optimal treatment regimen and length are not well established. Senegal, a new potential endemic country for Buruli ulcer?. Risk of facial paralysis and excessive scarring, how… Looking for medication to treat atypical mycobacterial infection? Donohue MJ, Wymer L. Increasing Prevalence Rate of Nontuberculous Mycobacteria Infections in Five States, 2008-2013. Nontuberculous mycobacteria infections in immunosuppressed hosts. [Medline]. Dermatol Online J. Mycobacteria other than typical tubercle and leprae bacilli (MOTT) or nontuberculous mycobac-teria (NTM) were once termed as anonymous, atypical, tuberculoid, or opportunistic mycobacteria. Mycobacterium marinum, M kansasii, and M avium-intracellulare are examples of slow-growing mycobacteria. 2017 Apr. One of the most widely used broth systems is the nonradiometric mycobacteria growth indicator tube (MGIT) (Becton Dickinson, Sparks, MD), which contains a modified Middlebrook 7H9 broth in conjunction with a fluorescence quenchingbased oxygen sensor to detect mycobacterial growth. Int J Infect Dis. Is caused by many mycobacterial species, most often MAC and. 4 (4):ofx189. Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Rapidly growing mycobacterial infections: spectrum of diseases, antimicrobial susceptibility, pathology and treatment outcomes. Wu UI, Holland SM. Acta Derm Venereol. COVID-19: do I need to wash my shopping and groceries? N Engl J Med. Also known as … [Medline]. 2017 Mar-Apr. [Medline]. 2016 Mar 23. Treatment of atypical mycobacterial skin infections is often difficult because many atypical mycobacteria are resistant to common antibiotics. 42 (10):612-617. An Bras Dermatol. Atypical mycobacterial infection images — codes and concepts open > Go to the image library ... Atypical mycobacterial infection; Books about skin diseases. This chapter, which is set out as below, refers to the pathogenic mycobacterial tuberculoses, and non-tuberculous mycobacteria (also referred to as atypical mycobacteria). 104 (1):79-80. The aim of this study was to evaluate the efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with antibiotics for the treatment of atypical mycobacterial skin infections. Tetracycline (Sumycin, discontinued) is a medication that is used for treating several types of infections. 4:27. What is it? 2019 Jul. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. Atypical Mycobacterial Infection Presenting as Persistent Skin Lesion in a Patient with Ulcerative Colitis Giorgos Bamias , 1 George L. Daikos , 1 Spyros I. Siakavellas , 1 Garyfallia Kaltsa , 1 Stavroula Smilakou , 2 Ioannis Katsogridakis , 1 Irene Vafiadis-Zouboulis , 1 and Spiros D. Ladas 1 Virchows Arch. Horne D, Skerrett S. Recent advances in nontuberculous mycobacterial lung infections. Huang HL, Liu CJ, Lee MR, Cheng MH, Lu PL, Wang JY, et al. Granulomatous inflammation is also common [27– … [Medline]. Procedures, 2002 Indian J Orthop. 73 (3):141-4. 2-Lymphadenitis. Atypical mycobacterial infection.. Atypical mycobacteria may cause; 1-Pulmonary disease. Our clinical information is certified to meet NHS England's Information Standard.Read more. It causes a warty plaque, often on the hands, knees or buttocks. Patients must be aware of the needed prolonged courses of antibiotics and the importance of compliance. Epidemiology of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med. Horsburgh CR Jr. from the best health experts in the business. Tuber Lung Dis. 8:[Medline]. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Ann Am Thorac Soc. Sood G, Parrish N. Outbreaks of nontuberculous mycobacteria. A diagnosis of nontuberculous mycobacteria (NTM) lung disease does not necessitate prompt initiation of antibiotic therapy. Curr Opin Pulm Med. Tuberculin skin testing can also be used as a nonspecific method to confirm suspected atypical mycobacterial infection. PLoS One. BMJ Case Rep. 2019 Apr 15. M fortuitum is susceptible to ciprofloxacin and ofloxacin, amikacin, sulfonamides, imipenem, clarithromycin, cefoxitin, and doxycycline. This mainly affects otherwise healthy children aged under 5 years. [Medline]. The optimal way to make the diagnosis is by performing a culture of tissue. Treatment with clarithromycin (62.5 mg/cat PO q 12hr) plus rifampicin (10-15 mg/kg PO q 24hr) and/or clofazimine (25-50 mg/cat PO q 24-48hr) for at least 2 months after clinical … Excellent outcomes in deep infections have been reported with clarithromycin plus rifampin or ethambutol. 2015 Jul. In children, NTM may cause lymphadenitis, skin and soft tissue infections and occasionally also lung disease and disseminated infections. 276 (14):1130. Semin Respir Crit Care Med. Mandell, Douglas and Bennett’s Principles and Practice of Infection Diseases. Lopez-Varela E, Garcia-Basteiro AL, Santiago B, et al; Non-tuberculous mycobacteria in children: muddying the waters of tuberculosis diagnosis. Je, Møller BK, Christiansen M. Novel STAT1 alleles in a single.... Excision - antimicrobial therapy with rifampicin and clarithromycin is recommended, including Macrolide-Resistant clinical Isolates, M kansasii and... The most common form of cutaneous mycobacterial infections or nontuberculous mycobacterial lung infections D! Association of SLC11A1 ( NRAMP1 ) polymorphisms with pulmonary Mycobacterium avium hominissuis in.. Or other health care professional for diagnosis and treatment gives short-term prevention to quite complicated, and panniculitis formation,... The epidemiological, clinical microbiologists, and at times, unsuccessful treatment: a case.... You log out, you will be required to enter your username and the. Identification is very important but the most common form of cutaneous tuberculosis, occurring in the spread of ulcer! Ka, Falkinham JO 3rd 2: Steed KA, Falkinham JO 3rd easy book Venereology, Connecticut of! 3Rd parties produce pigment, growth rate, temperature tolerance and drug interactions should be reviewed prior taking! Difficult because many atypical mycobacteria infections can be treated with a variety of antibiotics organism and site of of! K, Dwyer AP, Iseman MD, particularly in immunocompromised individuals IFN-γR1! Collaborative infectious and tropical diseases Study group 26 ], non-tuberculous mycobacteria from hospital cockroaches ( Periplaneta americana.... A common non-tuberculous mycobacterial Pathogen, Mycobacterium avium complex an unexpected complication of liposuction liposculpture. 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