Seven Mycobacterium fortuitum Post-Procedural Wound Infections Identified in India

During a one-year period at a tertiary care center in Eastern India, seven patients with post-procedural wound infections were identified with culture-confirmed M. fortuitum.

Eastern India Study Identifies Mycobacterium fortuitum Post-Procedural Infections

Rapidly growing nontuberculous mycobacteria, particularly Mycobacterium fortuitum, drive chronic post-procedural skin and soft tissue infections. A hospital-based cross-sectional observational study conducted between September 2024 and August 2025 in the Department of Microbiology in collaboration with the Departments of General Surgery and Obstetrics & Gynaecology at a tertiary care teaching hospital in Eastern India evaluated patients presenting with clinically suspected chronic or persistent post-procedural wound infections.

The study protocol was approved by the Institutional Ethics Committee, and written informed consent was obtained from all participants before enrolment. Delayed clinical suspicion and limited microbiological investigations frequently result in underdiagnosis, especially within resource-limited settings.

Specialized Laboratory Techniques Identify Mycobacterial Infections

Identifying these mycobacterial infections demands specialized laboratory techniques. Each specimen was initially subjected to Gram staining, Ziehl-Neelsen staining, and routine aerobic bacterial culture.

Seven Mycobacterium fortuitum Post-Procedural Wound Infections Identified in India — Photo: sciencedirect.com

Individual patient histories in the Eastern India case series illustrate varied clinical presentations. Among the seven patients, the cohort included both female and male individuals with distinct prior procedures performed in settings such as local nursing homes. One patient was a 38-year-old woman with no reported comorbidities who developed multiple discharging sinuses one month after an ovarian cystectomy at a private hospital, experiencing symptoms for four months before diagnosis. Examination showed multiple draining sinus tracts near the operative site. Another patient was a 40-year-old woman with no reported comorbidities who presented with pain and a discharging sinus three months after symptoms began, starting one week after a total abdominal hysterectomy with bilateral salpingo-oophorectomy performed at a local nursing home.

Lumbar Spinal Surgery Infection Involving Mycobacterium senegalense

Rapidly growing nontuberculous mycobacteria also surface in complex surgical environments. Researchers Boyan Su, Huifang Zhang, Haozhe Ding, Adilijiang Aihemaitiniyazi, Dan Lei, and Guihuai Wang described a 54-year-old immunocompetent man who developed an afebrile lumbar surgical-wound infection following an instrumented L1 schwannoma resection. Two independently collected deep-incisional wound swabs yielded isolates identified as Mycobacterium senegalense by MALDI-TOF MS without molecular confirmation.

Laboratory evaluations for the lumbar surgical patient showed C-reactive protein was mildly elevated at 25 mg/L, while the erythrocyte sedimentation rate remained normal at 10 mm/h. With the hardware retained, the clinical team utilized limited debridement, wound care, and multidrug therapy. Although oral therapy stopped after 11 weeks—short of the planned six-month course due to a morbilliform rash—the patient achieved clinical and magnetic resonance imaging resolution at 22 months post-surgery.

Evaluating Treatment Outcomes

Across the documented cohort in Eastern India, all patients received prolonged combination antimicrobial therapy, with one patient requiring surgical debridement, and every individual achieved complete clinical healing during follow-up. For the ovarian cystectomy patient, treatment included azithromycin, doxycycline, and levofloxacin, leading to lesion healing.

Authors of the investigations emphasize that isolation of these pathogens highlights the necessity of maintaining a high index of clinical suspicion when managing patients with persistent, non-healing postoperative wounds. This is especially critical when routine bacterial cultures return negative results or patients exhibit a poor response to conventional antibacterial therapy, as early mycobacterial culture and species-level identification remain essential to guiding clinical management and preventing diagnostic delays.

Increased awareness among surgeons, clinicians, and infection control teams, alongside effective communication with microbiology laboratories, may facilitate earlier recognition, guide clinical management, and improve the prevention of healthcare-associated rapidly growing nontuberculous mycobacterial infections.

Readers suspecting a persistent or chronic postoperative wound infection should consult qualified medical professionals or infectious disease specialists for appropriate diagnostic evaluation and personalized clinical care.