Journal of the Formosan Medical Association
Volume 105, Issue 5 , Pages 370-376, 2006

Abdominal Nontuberculous Mycobacterial Infection in a University Hospital in Taiwan from 1997 to 2003

  • Liang-Wen Ding

      Affiliations

    • Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taipei, Taiwan
    • Department of Internal Medicine, Taipei, Taiwan
    • ,
  • Chih-Cheng Lai

      Affiliations

    • Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taipei, Taiwan
    • Department of Internal Medicine, Taipei, Taiwan
    • ,
  • Li-Na Lee

      Affiliations

    • Department of Internal Medicine, Taipei, Taiwan
    • Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Po-Ren Hsueh

      Affiliations

    • Department of Internal Medicine, Taipei, Taiwan
    • Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr. Po-Ren Hsueh, Departments of Internal Medicine and Laboratory Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 100, Taiwan

Received 23 June 2005; received in revised form 15 September 2005; accepted 4 October 2005.

Article Outline

Background/Purpose

Abdominal nontuberculous mycobacterial infection is a rare condition. Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis is the most common manifestation of infection due to nontuberculous mycobacteria (NTM). There are limited data on the clinical manifestations of nontuberculous mycobacterial infection. This study investigated the diagnostic features, clinical presentation, mycobacteriology, treatment and outcome of all abdominal NTM infections treated over a 7-year period at a major teaching hospital in Taiwan.

Methods

The medical records of all patients with a diagnosis of abdominal NTM infection from January 1997 through to December 2003 were retrospectively reviewed.

Results

All 11 patients with abdominal NTM infections identified during the 7-year period were included. Among these patients, six were male and five were female, with a mean age of 64.5 years. The disease manifested as peritonitis (9 patients, 82%), splenic abscess (1, 9%), or perirenal abscess (1, 9%). Most patients (73%) had underlying malignancy, most often hepatoma (45%). Immunocompromised status (liver cirrhosis, malignancy, acquired immunodeficiency syndrome) was noted in 10 patients (91%). None of our patients who developed NTM peritonitis had received CAPD. The peritoneal fluid appearance varied considerably, with no particular predominance of clear, turbid, bloody, or chylous findings. Rapidly growing mycobacteria were the major etiology (46%) of abdominal NTM infection, and Mycobacterium abscessus played a major role (27%). Overall, eight patients died, and only one patient survived longer than 1 year. Seven patients (64%) died before diagnosis.

Conclusion

Abdominal NTM infection is frequently overlooked because of its rarity and nonspecific symptoms, with consequent delays in diagnosis and treatment. In immunocompromised patients with ascites from any cause (liver cirrhosis, malignant ascites, etc.), NTM peritonitis should be considered early in the differential diagnosis of symptoms including fever, abdominal pain and weight loss. The poor prognosis of abdominal NTM infection appears to be related to the severity of underlying conditions, most often malignancy.

Key Words:  abdominal infection , nontuberculous mycobacteria , peritonitis , Taiwan

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PII: S0929-6646(09)60132-7

doi:10.1016/S0929-6646(09)60132-7

Journal of the Formosan Medical Association
Volume 105, Issue 5 , Pages 370-376, 2006

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