Imagine the following case scenario: In October 2017, an otherwise healthy 42-year-old Hispanic woman presents reporting an approximately 6-week history of a nonhealing wound on her left upper calf. She reports being from Galveston, Texas, the epicenter of Hurricane Harvey when it made landfall. Her small, single-story home was flooded and partially collapsed, trapping her inside for 3 days until shewas rescued and evacuated. She suffered minor injuries, mostly inthe form of cuts and abrasions to her arms and legs. At a local hospital, her wounds were cleaned and dressed, and she was given a tetanus booster. Two weeks later, the wound had slightly expanded and began emitting purulent debris. A bacterial culture of the purulent debris was obtained, and the patient was given a 7-day course of oral clindamycin. The culture results later returned negative. A physical examination in your office reveals a solitary abscess. The patient endorses slight tenderness around the calf wound but otherwise feelswell without fever.
This example scenario demonstrates the importance of recognizing nontuberculous mycobacteria (NTM) as a potential cause of flooding disaster-associated infections. NTM are mildly acid-fast bacilli that are ubiquitous in water and soil (Kang et al., 2019).They can cause indolent infections in healthy individuals, particularlywhen traumatic wounds are exposed to contaminated water,but are often more severe in immunocompromised individuals.Cutaneous disease in the United States and Europe is usually from M. marinum, M. chelonae, M. abscessus, or M. fortuitum (Kang et al., 2019).Flooding disasters create distinct environments that further increase the risk of atypical wound infections (Bandino et al., 2015). This is due to traumatic open wounds, contamination from sewage and wastewater, vigorous churning of soil that contains atypical pathogens, and stagnant water.