Infections à Mycobacterium abscessus : épidémiologie, aspects cliniques et traitement

Among nontuberculous mycobacteria, Mycobacterium abscessus, and also two closely related species, M. massiliense and M. bolletii, are emergent opportunistic agents in humans, causing respiratory, cutaneo-mucous, bone or disseminated infections. Respiratory infections are the most common infections, frequently severe and usually occurring on underlying lung disease (particularly cystic fibrosis) but can occur without predisposing factor, generally in elderly Caucasian women with specific morphologic features. M. abscessus is resistant to most antibiotics. Treatment of M. abscessus consists of an oral agent, clarithromycin, initially combined with two parenteral agents, cefoxitin and amikacin. Concerning infections with a low bacterial load, like skin and soft tissue infections, treatment is efficient. At the opposite, in respiratory infections (with high bacterial load) prolonged triple therapy is required, eradication of the mycobacteria is often not obtained and side effects are common.