Mycobacterium terrae: Case reports, literature review, and in vitro antibiotic susceptibility testing

Mycobacterium terrae infection can cause debilitating disease that is relat ively resistant to antibiotic therapy. Two cases are presented, and data fr om an additional 52 reports from the literature are reviewed. Tenosynovitis of the upper extremity, often following trauma, was the most commonly repo rted presentation (59% of cases), with pulmonary disease occurring in an ad ditional 26% of cases, Underlying medical problems were absent (44%) or not reported (28%) in 72% of the cases. One-half of the patients with upper ex tremity tenosynovitis were treated with local or systemic corticosteroids, before microbiological identification. Only one-half of the patients with t enosynovitis who were followed up for 6 months had clinical improvement or were cured. The other one-half of the patients required repeated debridemen t, tendon extirpation, or amputation. The best antimicrobial therapy for M. terrae infection is unknown but might include a macrolide antibiotic plus ethambutol and one other effective drug for at least 12 months after clinic al response. Parenteral treatment with an aminoglycoside and surgery may be useful in selected cases.