Consensus guidelines for diagnosis and management of cutaneous non-tuberculous mycobacterial infections by Special Interest Group (SIG) – Skin Neglected Tropical Diseases (NTDs), IADVL Academy
Tarun Narang, Sushruta Kathuria, Parul Verma, Rajwinder Singh, Mandira Varma-Basil, Sheetanshu Kumar, Arpita Nibedita Rout, M Ramam, Ramesh V, Archana Singal, Pratibha Narang, Chandra Sekhar Sirka, Jyoti Bajpai, Abhishek Bhardwaj, Shagufta Rather, Manisha Balai, Sunil DograBackground
Non tuberculous mycobacterial (NTM) infections are a heterogenous group of infections caused by more than 200 species of mycobacteria other than M. tuberculosis complex and M. leprae . The existing guidelines for treatment of NTM infections focus primarily on pulmonary infection. This consensus statement has been formulated for the diagnosis and management of cutaneous NTM infections (excluding M. marinum and M. ulcerans ).
Objectives
The aim was to develop consensus guidelines for diagnosis and management of cutaneous NTM infections in situations where the organism is identified with known drug susceptibility pattern, and when treatment has to be given empirically.
Methods
The modified DELPHI method was used for developing the guidelines. Agreement by 3 75% experts was considered as consensus. The panel consisted of nine experts including dermatologists, internists and microbiologists. Initially, 50 statements based on Likert scale were drafted and internally and externally validated. Three rounds were conducted, first two were sent by mail and the third was a live discussion on an online platform.
Results
Consensus was met on 33 statements which have been discussed in this article. The statement focusses on four key areas: clinical features, diagnostic criteria, investigations and specific and empirical treatment plans. Clinical diagnostic criteria have been agreed upon.
Limitations
The statement is based on collective experience of experts rather than real-time data. Hence, it should be interpreted as a guideline.
Conclusion
The consensus statement provides a guideline for dermatologists to identify and diagnose NTM infections. It also provides a step-by-step approach to treating NTM infection when identification of the organism becomes difficult, due to the nature of the disease or due to lack of facilities.