Retrospective study of Mycobacterium marinum skin infections

BACKGROUND: Although infection by Mycobacterium marinum is well reported in the literature, there have been few epidemiologic studies. The purpose of this study was to review the epidemiology of patients with cutaneous M. marinum infection over a 3-year period at the National Skin Centre in Singapore. METHODS: Patients with a diagnosis of cutaneous M. marinum infection, confirmed histologically, were collated from computerized data from 1995 to 1997. Thirty-eight patients were diagnosed as having cutaneous M. marinum infection based on history, and clinical and histologic features. RESULTS: Out of the 38 cases of M. marinum infection, there were 30 men and eight women. The age range was 14-85 years (mean: 44.7 years). The duration of disease ranged from 1 to 132 months (mean: 19 months). Thirteen patients (34.2%) had fish rearing as a hobby and four patients (10.5%) had occupational exposure to fish. Twelve patients (31.5%) gave a history of trauma to the disease site. All patients had biopsies of the lesions. All showed infective granulomas/granulomatous inflammation on histology. Acid-fast bacilli were identified in five out of 38 patients (13.2%) and mycobacteria were isolated in one out of 35 patients (2.9%). Nineteen patients received treatment with cotrimoxazole-trimethoprim alone, three with minocycline alone, five with minocycline and cotrimoxazole-trimethoprim, seven with various combinations of drugs, one with excision, and three defaulted treatment. The duration of treatment ranged from 4 to 38 weeks (mean: 14.9 weeks). Twenty-six patients (68.4%) showed clinical improvement, two (5.3%) had no response, and 10 (26.3%) were lost to follow-up. None of the patients worsened with treatment. The follow-up period ranged from 1 to 20 months (mean: 6.8 months). CONCLUSIONS: The diagnosis of cutaneous M. marinum infection is mainly clinical, with supporting evidence from histologic features and the response to therapy. Risk factors include a history of trauma and water/fish-related hobbies or occupations. There is a poor yield of positive isolates in our experience; however, empirical treatment usually produces a good clinical response. In future, the polymerase chain reaction (PCR) technique may become more widely available as a rapid, sensitive, and specific means of diagnosis.     

Mycobacterium marinum skin infections mimicking cutaneous leishmaniasis

Ten cases of skin infection due to Mycobacterium marinum are reported from Israel. Most of the infections were contracted in natural bathing pools at Ein Feshka on the shores of the Dead Sea, south of Jericho. The lesions closely resembled those of cutaneous leishmaniasis prevalent in this region. The condition does not seem to have been detected previously in the Middle East.     

Mycobacterium marinum with associated bursitis.

BACKGROUND: Mycobacterium marinum infections have been reported for over 50 years, mostly in association with trauma in the setting of water exposure. OBJECTIVE: The differential diagnosis for nodules in a sporotrichoid distribution with simultaneous bursitis is discussed. Mycobacterium marinum treatment regimens for skin and joint involvement are reviewed. METHODS: Mycobacterium marinum was identified by skin tissue culture with Lowenstein-Jensen medium at 32 degrees C. Histopathologic findings support mycobacterial infection. RESULTS: Bursitis and nodules resolved in the first 2 months of a 6-month course of minocycline treatment. CONCLUSION: Bursitis is an extremely rare but significant complication of M. marinum.     

Mycobacterium marinum infections acquired from tropical fish tanks

Mycobacterium marinum is reported for the first time in New Zealand. Three cases of infection on the hands of tropical fish fanciers are described with details of treatment. Probable sources of the organism were investigated and possible explanations for its presence in New Zealand are discussed.     

Mycobacterium marinum infection complicating Crohn's disease, treated with infliximab

Tumour necrosis factor-alpha inhibitors including infliximab are often used to treat a number of recalcitrant medical conditions. These agents are increasingly associated with infections, particularly mycobacterial infections. We report sporotrichoid spread of Mycobacterium marinum in a 37-year-old woman with Crohn's disease, who had been receiving infliximab infusions for 2 years. An infection had spread up the right leg, after she had been swimming on holiday in the Canary Islands. M. marinum was cultured from the lesions and also identified by PCR on formalin-fixed tissue. To our knowledge, this is the first report of M. marinum occurring in a patient receiving infliximab.     

Mycobacterium marinum infection.

Contaminated water in swimming pools or tropical fish aquaria is the usual source of Mycobacterium marinum skin infection. Many patients give a history of preceding minor skin trauma. Successful culture of the organism from biopsy confirms the diagnosis. Spontaneous resolution frequently occurs, but, where treatment is considered necessary, a trimethoprim-sulphamethoxazole regime has proved extremely effective.     

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).     

Kutane Infektion mit Mycobacterium marinum

Zusammenfassung Wir berichten über 2 Patienten mit einer kutanen Mycobacterium-marinum-Infektion. Nach kultureller Erregerisolation kam es unter systemischer Kombinationstherapie mit Rifampicin und Clarithromycin innerhalb von 3 Monaten zu einer deutlichen Verbesserung des Hautbefundes.     

Mycobacterium marinum with different responses to second-generation tetracyclines

BACKGROUND: Persistent cutaneous infections with Mycobacterium marinum can follow exposure of injured skin to contaminated water or fish, and can be treated with second-generation tetracyclines in addition to other antimicrobials. Due to the rarity of this infection, there are few data comparing the different treatment alternatives. METHODS: We report a patient with culture-proven M. marinum who was treated with two different second-generation tetracyclines. RESULTS: Our patient failed a 4-week trial of doxycycline, but responded rapidly to minocycline. CONCLUSION: This case suggests that, despite a similar mechanism, pharmacokinetics, and even sensitivity, these two agents may differ in their effectiveness against strains of M. marinum.     

Amikacin treatment for Mycobacterium marinum infection

This report describes a case of Mycobacterium marinum skin infection. A granulomatous plaque on the dorsum of the left hand of a 71-year-old man who kept a tank of tropical fish was followed by erythema and induration on the left forearm of the lymphocutaneous type. The lesion was successfully treated with 6 weeks of administration of amikacin (28 intramuscular injections) a total of 3500 mg. The isolated M. marinum strain was sensitive in vitro to amikacin at 0.78 μg/ml. Furthermore, another 15 clinical strains of M. marinum showed high sensitivity in vitro to this drug (93% of the 16 strains were sensitive to between 0.78 and 1.56 μg/ml).