Human Tsukamurella infections - Clinical spectrum, diagnosis, antimicrobial resistance, and treatment outcomes: A review.

Tsukamurella species are rare environmental aerobic actinomycetes that are increasingly recognized as opportunistic human pathogens, particularly among immunocompromised patients and those with indwelling medical devices. This review aims to summarize the clinical spectrum, diagnostic methodologies, patterns of antimicrobial resistance, and treatment outcomes associated with human Tsukamurella infections. A narrative review of published case reports, case series, and microbiological studies was conducted, emphasizing clinical manifestations, laboratory identification, antimicrobial susceptibility, and therapeutic interventions. The available evidence indicates that catheter-related bloodstream infections are the most frequently reported presentations; however, pulmonary, ocular, cutaneous, endocardial, central nervous system, peritoneal, and prosthetic joint infections have also been documented. Diagnosis remains challenging, as Tsukamurella can be misidentified by conventional methods; precise identification often necessitates advanced techniques such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S ribosomal ribonucleic acid (16S rRNA) gene sequencing. Successful management typically involves prolonged targeted antimicrobial therapy and the removal of infected devices. In conclusion, Tsukamurella is an under-recognized pathogen, and standardized diagnostic and susceptibility-testing protocols, along with larger clinical studies, are essential to enhance patient management.