游泳池肉芽肿5例分析

报告5例游泳池肉芽肿,患者均有水源性接触史,皮损特点均为暗红色丘疹、结节,沿淋巴管扩散。组织病理示肉芽肿性炎,但微生物学感染证据常缺乏。治疗药物选用利福平、乙胺丁醇和克拉霉素。该文对患者临床表现、实验室检查及预后做出分析,并对微生物学感染证据的相关情况展开讨论,总结游泳池肉芽肿的诊断要点,即通过鱼或水源接触史、临床表现、组织病理及病原体查找确诊。     

海鲈鱼刺伤引发的海分枝杆菌感染四例临床分析

对2019年10月30日至2019年11月25日我院确诊的4例海分枝杆菌感染患者的临床资料进行回顾性分析。4例患者（男1例,女3例）,发病年龄39～60岁,均被海鲈鱼刺伤后发病,表现为手部和上肢的浸润性结节,病理呈感染性肉芽肿改变,皮损组织培养出非典型分枝杆菌,克拉霉素联合利福平、乙胺丁醇治疗有效。     

美容注射术后皮肤脓肿分枝杆菌感染临床分析

对2018年12月至2019年12月我院确诊的7例皮肤脓肿分枝杆菌感染患者的临床资料进行回顾性分析。本文患者均在非正规医院行美容注射术,术后注射部位都发生脓肿分枝杆菌感染。7例患者均为多发皮损,且为美容注射后发病,表现为红斑、结节、脓肿、溃疡。病理呈感染性肉芽肿改变。6例皮损组织脓液培养结果为脓肿分枝杆菌,1例行组织PCR扩增提示脓肿分枝杆菌感染。诊断为皮肤脓肿分枝杆菌感染。给予克拉霉素、利福平、左氧氟沙星治疗,皮损均消退,随访半年无复发。     

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。     

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。     

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。     

穴位埋线致脓肿分枝杆菌感染北大核心CSCD

报告1例穴位埋线致脓肿分枝杆菌感染。患者女,34岁。因躯干与四肢红斑、结节伴痒痛1个月余就诊。患者1个月前至非医疗机构行穴位埋线后埋线部位出现结节、脓肿,脓液抗酸染色阳性,组织病理学检查呈感染性肉芽肿改变,分枝杆菌培养阳性,DNA测序符合脓肿分枝杆菌,诊断为脓肿分枝杆菌感染。予以利福平、莫西沙星、克拉霉素抗感染治疗1年,脓肿消退遗留色素沉着和瘢痕。     

免疫抑制治疗患者罹患皮肤非结核分枝杆菌感染二例

患者1，皮肤多处结节、溃疡伴发热1个月余，皮损组织病理提示感染性肉芽肿，分子生物学检查为嗜血分枝杆菌感染，予环丙沙星、克拉霉素、异烟肼治疗1年后治愈，该患者2016年诊断为系统性红斑狼疮、Ⅵ型狼疮性肾炎，予腹膜透析、糖皮质激素及免疫抑制剂长期治疗。患者2，双下肢溃疡伴疼痛3个月，皮损组织病理提示感染性肉芽肿，分子生物学检查为鸟分枝杆菌感染，未治疗。3个月后复诊，病情加重，予乙胺丁醇、克拉霉素、利福平治疗，目前正在随访中。该患者7年前因“慢性肾衰竭”行同种异体肾移植术，术后规律服用他克莫司胶囊、吗替麦考酚酯片、糖皮质激素。对于长期应用免疫抑制剂和糖皮质激素的患者出现皮肤结节、脓肿和溃疡时，应考虑到皮肤NTM感染的可能。     

游泳池肉芽肿一例

报告1例游泳池肉芽肿。患者男,51岁,右手指肿胀、丘疹5月,手臂皮下结节2月。皮损组织病理学改变为伴角化过度和棘层肥厚的混合性炎症反应、感染性肉芽肿及上皮样结节改变。PPD试验（++）,PCR检测分支杆菌65kdhsp基因阳性。利福平和复方新诺明联合治疗取得较好疗效。     

游泳池肉芽肿三例北大核心CSCD

例1女,40岁,右手及前臂结节斑块2个月,否认外伤史,但从事热带鱼销售。体检示右手手指、腕、肘关节旁暗红色结节斑块,右上肢多发串珠样皮下结节。例2女,48岁,左手及前臂结节斑块2个月。发病前有清洗热带鱼鱼缸及过滤网外伤史。体检示左手、腕、前臂及上臂散在暗紫红色斑块及无痛性皮下结节。例3男,39岁,双手指散在结节3个月。否认外伤史但爱好热带鱼养殖。体检双手指间关节伸侧散在暗红色黄豆大结节。实验室检查：3例皮损组织反复真菌学检查均为阴性。组织病理提示混合炎症细胞浸润的感染性肉芽肿改变。结核菌素纯蛋白衍生物（PPD）试验均为阳性。例1和例2活检组织分离出海分枝杆菌,例3分枝杆菌培养阴性。3例均诊断为游泳池肉芽肿。分别给予利福平和克拉霉素为主的抗非典型分枝杆菌治疗,1—3个月后皮损完全消退,总疗程2～5个月不等。停药后随访3—12个月均无复发。     

海分枝杆菌感染二例并文献复习

报道2例海分枝杆菌感染并复习相关文献。患者1,男,25岁。右侧拇指红肿破溃伴疼痛1个月。患者2,女,54岁。左侧大拇指及手背手腕红斑结节伴疼痛2个月。2例患者均有鱼扎伤病史,常规抗感染治疗无效,最终诊断为游泳池肉芽肿,给予抗分枝杆菌感染治疗3个月后痊愈。     

Unusual cutaneous dissemination of a tropical fish tank granuloma

A patient with an unusual disseminated tropical fish tank granuloma is presented. The infection manifested first as red, subcutaneous nodules of the right hand and forearm. During subsequent days and weeks, nodules appeared on the left arm, on the ventral and dorsal thorax, on one leg, and the face. The diagnosis was based on, in addition to the history and the clinical aspects, a positive reaction to intracutaneous testing with a specific Mycobacterium marinum antigen and on the histologic examination of biopsy specimens. The larger nodules were treated with excision. Smaller nodules disappeared spontaneously after the larger ones had been surgically removed.     

鱼刺伤肉芽肿10例临床分析

回顾分析2019年1月至2020年5月我院10例鱼刺伤肉芽肿的临床资料及治疗效果。10例患者中,男3例,女7例,平均发病年龄49岁;3例从事与海产相关的厨师职业,5例有鱼类或海鲜刺伤史;1例有菜刀切伤史,1例有手部外伤史。皮损主要表现为上肢红斑、结节,伴破溃结痂。3例患者皮损局限于手部,其余患者皮损沿淋巴管播散。所有患者组织病理检查见上皮样肉芽肿或炎性细胞浸润的非特异性表现。所有患者菌落或皮损组织DNA检测海分枝杆菌qPCR阳性。对皮损局限于手部的3例患者给予米诺环素50 mg,每日2次,平均疗程（4.67±2.08）个月,均痊愈。对6例播散性患者给予利福平150~600 mg联合克拉霉素500 mg每日1次,1例失访,5例痊愈,平均疗程（4.80±1.48）个月。对1例肝功能异常播散性患者给予多西环素100 mg,每日2次,9个月治愈。     

Mycobacterium marinum infection

A 49-year-old man presented with nodules on his right hand after a history of Mycobacterium marinum infection recently treated with rifampin and clarithromycin. The patient has an aquarium with Betta fish (Siamese fighting fish).     

鱼刺伤致腱鞘炎二例

鱼刺伤肉芽肿是因鱼刺伤后被海分枝杆菌感染引起的肉芽肿性损伤，上肢是最常见的感染部位。通常情况下，所报道的病例多表现为皮肤表面的结节、红斑。累及肌腱、骨骼、关节等深部结构较为少见。现报道因海分枝杆菌感染导致的腱鞘炎两例。     

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。     

Cutaneous infections due to atypical mycobacteria

Atypical mycobacteria are environmental saprophytes. Occasionally they may enter human skin through injuries and cause localized infection. Papules, nodules, plaques, ulcers and panniculitis-like lesions are common manifestations. Disseminated infection occurs in immunocompromised patients. Evidence of mycobacterial infection can be obtained by tissue specimens, culture being most important for diagnosis. Because many mycobacteria only grow on special media and at special temperatures it is crucial that clinical suspicion is raised so correct testing is performed. Buruli ulcer caused by M. ulcerans is the most prevalent atypical mycobacteriosis worldwide; its occurrence is restricted to tropical areas. In European countries fish tank granuloma caused by M. marinum is most commonly observed. M. avium-complex, M. kansasii und rapidly growing mycobacteria of M. fortuitum-complex are other atypical mycobacteria that can cause cutaneous infection. Treatment is difficult because many atypical mycobacteria are resistant to common antibiotics.     

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.     

Hautinfektionen durch atypische Mykobakterien

Atypical mycobacteria are environmental saprophytes. Occasionally they may enter human skin through injuries and cause localized infection. Papules, nodules, plaques, ulcers and panniculitis-like lesions are common manifestations. Disseminated infection occurs in immunocompromised patients. Evidence of mycobacterial infection can be obtained by tissue specimens, culture being most important for diagnosis. Because many mycobacteria only grow on special media and at special temperatures it is crucial that clinical suspicion is raised so correct testing is performed. Buruli ulcer caused by M. ulcerans is the most prevalent atypical mycobacteriosis worldwide; its occurrence is restricted to tropical areas. In European countries fish tank granuloma caused by M. marinum is most commonly observed. M. avium-complex, M. kansasii und rapidly growing mycobacteria of M. fortuitum-complex are other atypical mycobacteria that can cause cutaneous infection. Treatment is difficult because many atypical mycobacteria are resistant to common antibiotics.