Mycobacterium other than Tuberculosis -MOTT infection

What is mycobacterium other than Tuberculosis ( also termed as  MOTT environmental mycobacteria/ atypical mycobacterium ) usually  coming from floor dust or overhead tank) . Nonhealing stitch line a sinus with dirty discharge in any kind of surgery which d not respond to conventional antibiotics?? C/S negative. Discharge imitating 1 -3 month post operative non healing stitch line a     sinus with dirty discharge. Specimen for gene expert sent Xpert plus..

All investigations are normal including culture & sensitivity. But AFB stain from stain & culture is positive .She is also having fever 99-100F daily. What should I do further?

 Because AFB positive it seems to be a case of atypical mycobacterium or fungal infection. But symptoms and signs are in favour of tuberculosis

 Not to initiate  Att , this is MOT- mycobacterium other than Tuberculosis, Please give Clarithromycin – ( say Bioclar ) and do alt day dressing with debridement. This happens due to contamination of surgical instruments in Cidex where w also keep our endoscope and sharp instruments.

Discharge from that side and two non healing small ulcers. Daily discharge about 3-5 ml.

 H2o2 and  chlorine water can be used.

 

 At times sinuous tract needs exploration n excision. Definitely explore the sinus and give Clarithromycin for at least 2 weeks with debridement, if the sinus is subcutaneous it's MOT

 MOTT(Mycobact other than Tuberculosis)  treatment needs macrolide like Clarithromycin ..for at least for 6 weeks months

 

In   to be very sure whether it is MOT or mycobacterium one can put the biopsy specimen for gene expert ..

When one  give it for two weeks it starts improving and one is almost certain about the diag &  have time to conform diagnosis then only give it for a longer time
No ATT .

A)     MOTT treatment( Mycobact other than Tuberculosis ) should be offered only after culture/Bactec culture report.

 

B)     Second thing most common sensitive drugs are amikacin/Clarithromycin/linezolid.

 

C)    The third thing duration of treatment should be at  least for 6 months. Chances of relapse on 6  months  treatment rare ; if possible in b/w cultures should be done  but treatment should always culture guided. Members opinion

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