鱼刺伤肉芽肿四例分析

报道4例鱼刺伤所致肉芽肿,患者均为老年女性,均有鱼类接触史,皮疹特点均为暗红色丘疹、结节,其中一例伴有上肢串珠样皮下结节。组织病理示感染性肉芽肿。虽然微生物感染证据缺乏,但诊断考虑非结核分枝杆菌感染,予利福平、克拉霉素行经验性治疗有效。     

T-SPOT检测阳性的游泳池肉芽肿三例

报道3例游泳池肉芽肿。患者均有鱼刺刺伤史，皮损特点为暗红色结节、斑块成线状排列。组织病理示感染性肉芽肿。T-SPOT检测均为阳性。使用利福平和克拉霉素治疗预后好转。     

鱼刺伤肉芽肿二例

报道2例鱼刺伤肉芽肿患者。2例患者均有鱼类接触史、组织病理示感染性肉芽肿、结核分枝杆菌γ-干扰素体外释放定量试验(TB-IGRA)阳性、结核感染T细胞γ干扰素升高、海分枝杆菌qPCR阳性。结合其病史、组织病理、TB-IGRA、海分枝杆菌qPCR等确诊为鱼刺伤肉芽肿。2例患者均予以克拉霉素缓释片、利福平胶囊治疗后痊愈。     

游泳池肉芽肿56例临床病理分析

【摘要】 目的 探讨游泳池肉芽肿的临床病理特征。方法 回顾性分析2018年1月至2021年1月天津市中医药研究院附属医院56 例游泳池肉芽肿的临床及病理特点。结果 56例患者中,男16例,女40例,平均年龄 60.84 岁。水产从业人员及居民日常烹饪中处理受感染的鱼或海产品是本组病例感染的主要暴露方式（31/56）,平均潜伏期4.58周,平均诊断时间为3.19个月;56例患者皮损均位于上肢,以红斑、丘疹结节为主,有时表现为脓疱、溃疡、肉芽肿或疣状斑块。单发孤立性皮损11例,36例表现为孢子丝菌病串珠样皮损,6例表现为双侧串珠样皮损。组织病理学上除4例无特异性改变外,52例患者表现为感染性肉芽肿,其中37例出现特征性的渗出坏死,中央为不等量的纤维素样渗出或坏死物,其内或周边伴随大量中性粒细胞、组织细胞及多核巨细胞浸润。56例病原微生物宏基因组DNA测序均检测到海分枝杆菌序列。结论 天津地区游泳池肉芽肿以老年女性患病为主,处理受感染的鱼或海产品是最主要的暴露方式,组织病理可表现为特征性的渗出坏死性肉芽肿。     

偶发分枝杆菌致感染性肉芽肿一例

患者,男,41岁。躯干、双侧大腿上部散在触痛性结节、斑块54天。发病前有大腿外伤史及河水接触史。皮肤组织病理检查示:真皮深部感染性肉芽肿改变。细菌培养及菌落DNA PCR测序示偶发分枝杆菌。患者行全外显子测序未发现免疫、感染相关突变,综上诊断为偶发分枝杆菌感染性肉芽肿。给予左氧氟沙星、克拉霉素、脓肿切开、穿刺引流等,病情好转。     

游泳池肉芽肿1例

患者男,45岁。更换鱼缸水后双上肢出现多发性红色结节,呈线状分布,可自行破溃,病理提示慢性肉芽肿性反应,按照游泳池肉芽肿治疗,1月后皮损明显消退。结合病理、临床表现、治疗结果,游泳池肉芽肿诊断成立。     

海分枝杆菌致游泳池肉芽肿

报告1例海分枝杆菌致游泳池肉芽肿。患者女,66岁。右手背及手腕结节1个月,有右拇指鱼刺刺伤史。皮肤科检查:右手背一淡紫红色结节,直径约4 cm,高出皮面,其上干燥、脱屑,中央破溃伴黄色脓液,质韧,边界不清;右手腕一淡红色结节,稍高出皮面,直径约8 mm,界不清,无压痛。皮损组织病理检查:表皮大致正常,真皮内可见中性粒细胞性脓疡形成,外围淋巴细胞及组织细胞浸润,偶见多核巨细胞。抗酸染色及结核感染T细胞斑点试验(T-SPOT.TB)均阳性,微生物培养及16 S测序示海分枝杆菌。诊断:游泳池肉芽肿。     

20例鱼刺伤肉芽肿临床、病理及分子生物学检测分析

目的:分析鱼刺伤肉芽肿患者的临床特点、病理及分子生物学检测情况。方法:对我院门诊确诊的20例鱼刺伤肉芽肿患者临床资料进行回顾性分析。结果:20例患者中16例(80%)患者发病前有外伤史且与水产品或水有接触,4例(20%)无明显诱因;所有患者皮损发生于上肢,17例患者单侧发病,3例双侧发病;临床表现以原发皮疹、浅表破溃或多发结节为主。20例患者病理组织检查者均提示感染性肉芽肿;TB-IGRA阳性率为70%。17例(85%)患者于治疗后6个月内痊愈,1例治疗10个月后痊愈,2例正在随访中。结论:本文中患者海分枝杆菌感染多与日常接触水产品有关;临床以单侧发病为主;TB-IGRA阳性检出率高。     

游泳池肉芽肿一例及文献复习

报道一例游泳池肉芽肿并相关文献复习。患者,女,40岁。右手中指溃烂、手背多发性结节伴疼痛3个月,皮损及周围皮肤皮温不高,常规抗感染治疗无效,有右手中指鱼刺划伤史。结核菌纯蛋白衍生物（PPD）试验（-）,皮损真菌镜检（-）,真菌培养及抗酸染色（-）,组织病理示非特异性炎症。抗真菌治疗无效,给予抗分枝杆菌感染治疗3个月后痊愈。     

从外伤后细菌性致死性肉芽肿到巴拉姆希阿米巴感染：20年研究体会

【摘要】 1960—1990年间，一些中国皮肤科医师注意到少数临床表现为面部皮肤肉芽肿性炎症的患者最终死于脑炎。2001年高天文医师总结了此类患者的临床和病理特点，将其命名为外伤后细菌性致死性肉芽肿，当时初步认为可能由痤疮丙酸杆菌感染所致。2018年证实该病为皮肤和脑组织巴拉姆希阿米巴感染。本文总结中国皮肤科医师对巴拉姆希阿米巴感染的研究历程及其临床、病理特点和治疗方法。     

The fate of 20 sea breams : Mycobacterium marinum infection

Cutaneous infections with Mycobacterium marinum are rare. They also are known as swimming pool or fish tank granulomas. Often the history of contact with contaminated water associated with microtrauma of the upper extremities leads to the correct diagnosis. Since chlorination of swimming pools has become standard, cases of swimming pool granuloma have become rare. Contact with fish tanks now is the most common route of infection. Positive culture of skin biopsy leads to the correct diagnosis. Moxifloxacin in combination with other antibiotics is often effective.     

Fish tank granuloma: misdiagnosed as cutaneous leishmaniasis

Mycobacterium marinum is an atypical mycobacterium that causes a skin infection known as fish tank granuloma or swimming pool granuloma affecting people who are exposed to aquatic environments. In general, it is managed medically with antimicrobials and variable treatment protocols. Here, we report a Saudi gentleman who acquired this infection in Thailand and was misdiagnosed as cutaneous leishmaniasis. After establishing the correct diagnosis, treatment with minocycline and trimethoprim‐sulfamethoxazole resulted in rapid healing.     

MYCOBACTERIUM MARINUM CUTANEOUS INFECTIONS ACQUIRED FROM OCCUPATIONS AND HOBBIES

Background. Nontuberculous mycobacterial (NTB) infections are not commonly diagnosed in Thailand. The dissertation of reported cases among 10 published reports of 44 cases within 20 years revealed only six cases of cutaneous infections in which M. marinum was not included. Methods. The proven cases of M. marinum infection were studied at the Institute of Dermatology, Bangkok from 1981 to 1990. The clinical data, histopathology, tuberculin test, chest x-ray, and treatments were recorded. Results. M. marinum skin infection accounted for 18 cases (81.8% of NTB skin infection), 10 men and 8 women. A history of preceding trauma occurred in 11 cases (61.1%), most of which were negligible wounds or minor abrasions. Twelve cases (66.7%) were in contact with organisms in their occupations and hobbies associated with fish and water exposure. Conclusions. Eighteen cases of M. marinum cutaneous infection acquired from occupations and hobbies were reported. The term “M. marinum cutaneous infection” or “M. marinum granuloma” instead of swimming pool granuloma or fish tank granuloma was proposed. According to this study, cotrimoxazole was the most appropriate drug for the treatment of M. marinum cutaneous infection.     

盐酸多西环素治疗游泳池肉芽肿9例临床分析

目的分析游泳池肉芽肿的临床特点及应用盐酸多西环素治疗的疗效。方法回顾性分析2012年1月-2017年12月期间本院皮肤科门诊游泳池肉芽肿患者的临床资料,总结单独口服盐酸多西环素治疗效果。结果共收集9例患者,男4例,女5例,平均年龄(47.89±5.99)岁,平均病程(10.33±6.60)个月。所有皮损均累及上肢,5例皮损为局限性肉芽肿样斑块(Ⅰ型),4例皮损呈孢子丝菌病样沿淋巴管播散(Ⅱ型)。8例全程单一服用多西环素治疗,1例因胃肠道不适换用左氧氟沙星治疗。所有患者全部治愈,治愈平均时间是(2.28±0.67)个月。结论Ⅰ型和Ⅱ型游泳池肉芽肿可以单独使用盐酸多西环素治愈。     

凝集试验检测游泳池肉芽肿患者血清中抗海分支杆菌抗体

目的：探讨凝集试验协助诊断游泳池肉芽肿的可能性。方法：用直接凝集试验和间接凝集试验检测了3例游泳池肉芽肿患者血清中的抗海分支杆菌抗体。结果：3例患者血清中均可测出抗海分支杆菌抗体，正常人血清中检测不出该抗体，加入抗人球蛋白可使检测敏感性提高，结论：游泳池肉芽肿患者血清中有抗海分支杆菌抗体，可以用凝集试验检测，协助疾病的诊断。     

Disseminated Mycobacterium marinum infection with extensive cutaneous eruption and bacteremia in an immunocompromised patient

Mycobacterium marinum can cause fish tank granuloma (or swimming pool or aquarium granuloma) in immunocompetent patients. Dissemination of Mycobacterium marinum-infection is a rare condition which occurs mainly in immunocompromised patients and can be life-threatening. We report the case of an 87-year-old woman who was treated with oral corticosteroids for polymyalgia rheumatica for many years and developed erythema nodosum-like lesions on the right forearm and arthritis of the right wrist. By increasing the steroid dosage and adding methotrexate only short-term remission was achieved. Seven months later painful erythematous nodules occurred on all extremities which became necrotic, ulcerative and suppurative. Ziehl-Neelsen staining revealed acid-fast bacilli and Mycobacterium marinum was cultured from skin biopsies, blood, and urine. The critically ill patient was treated with clarithromycin and ethambutol resulting in a dramatic improvement of the general condition. After four months, doxycycline had to be added because of new skin lesions. This case illustrates the impact of Mycobacterium marinum infection in immunocompromised patients.     

游泳池肉芽肿2例报告

报告2例游泳池肉芽肿，均为鱼类饲养者，表现类似淋巴管型孢子丝菌病，病理呈感染性肉芽肿及结核样结节改变，皮损处组织经低温培养分离出分枝杆菌，利福平与复方新诺明联合治疗有效。疗程需3－6个月，作者提出本病有三种皮肤损害类型。     

皮肤非结核分枝杆菌感染1例

患者男,31岁,从事污水排放设备修理。左手指、手背及上肢相继出现结节3个月。发病前工作中左手中指曾被擦破,后出现肿胀,当地医院予抗感染半个月,但左手中指肿胀无改善,且左手背部相继出现7个蚕豆大结节,无疼痛,伴轻度瘙痒。饲养多种鱼类。皮损组织病理示:感染性肉芽肿改变,部分呈结核样肉芽肿结构。真菌培养阴性,分支杆菌培养和抗酸染色均阴性。诊断:皮肤非结核分枝杆菌感染;游泳池肉芽肿?予口服利福平、乙胺丁醇和克拉霉素治疗4个月,痊愈。