Dermatologic Manifestations of Mycobacterium Marinum Infection of the Skin Clinical Presentation

  • Author: Joslyn S Kirby, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 25, 2011
 

History

Patients at risk include anglers (commercial, recreational), oyster workers, swimmers, aquarium workers, and individuals with aquariums in their homes. Infection has also been reported following natural disasters involving the ocean.[6]

Patients may present with a papule, nodule, or ulcer at the site of trauma and a history of exposure to nonchlorinated water 2-3 weeks earlier. Patients may give a history of a papule or nodule that subsequently ulcerated and/or (1) signs of the infection spreading up the finger or hand or (2) involvement of the local joint or tendons. Over a period of months, localized cutaneous disease can spread to soft tissues.

Localized pain and induration are common. Fever, lymphadenopathy, and systemic infection are rare, with the exception of in immunosuppressed patients.

Next

Physical

An erythematous or bluish 0.5- to 3-cm papule or nodule develops at the inoculation site. Ulceration can occur later, and subsequent lesions may be present along the path of lymphatic drainage of the extremity. This occurs in 25-50% of patients and is termed sporotrichotic spread.

The upper extremity is the inoculation site in 90% of cases.

Lymphadenopathy may be present.

Patients may have deeper involvement, with tenosynovitis, bursitis, septic arthritis, and osteomyelitis of the underlying bone. Dissemination to the bone marrow and abdominal viscera is rare.

If diagnosis is delayed, the infections can mimic rheumatoid arthritis, gout, trauma-related tenosynovitis, foreign body, deep fungal infections, or malignancy.

Previous
Next

Causes

The cause is infection with M marinum. Exposure of traumatized skin to affected aqueous environments (fish tanks) is the leading predisposing factor. Individuals who are consistently exposed to the organism are more likely to develop the infection. Hosts who are immunocompromised are also at increased risk.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Joslyn S Kirby, MD  Assistant Professor, Department of Dermatology, Milton S Hershey Penn State Medical Center

Joslyn S Kirby, MD is a member of the following medical societies: American Academy of Dermatology, International Society for Cutaneous Lymphomas, Pennsylvania Academy of Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ellen J Kim, MD  Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Ellen J Kim, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Dermatology Foundation, Medical Dermatology Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Saeed Jaffer, MD, MS  Assistant Clinical Professor, University of California at Los Angeles School of Medicine, Consulting Staff, Boston Dermatology

Saeed Jaffer, MD, MS is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Terry L Barrett, MD  Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas

Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Kent ML, Watral V, Wu M, Bermudez LE. In vivo and in vitro growth of Mycobacterium marinum at homoeothermic temperatures. FEMS Microbiol Lett. Apr 2006;257(1):69-75. [Medline].

  2. Clay H, Volkman HE, Ramakrishnan L. Tumor necrosis factor signaling mediates resistance to mycobacteria by inhibiting bacterial growth and macrophage death. Immunity. Aug 15 2008;29(2):283-94. [Medline].

  3. Salvana EM, Cooper GS, Salata RA. Mycobacterium other than tuberculosis (MOTT) infection: an emerging disease in infliximab-treated patients. J Infect. Dec 2007;55(6):484-7. [Medline].

  4. Levesque BG, Sandborn WJ. Mycobacterium marinum infection in the setting of antitumor necrosis factor alpha therapy for Crohn's disease. Inflamm Bowel Dis. Jun 2011;17(6):1443-4. [Medline].

  5. Doedens RA, van der Sar AM, Bitter W, Scholvinck EH. Transmission of Mycobacterium marinum from fish to a very young child. Pediatr Infect Dis J. Jan 2008;27(1):81-3. [Medline].

  6. Appelgren P, Farnebo F, Dotevall L, Studahl M, Jonsson B, Petrini B. Late-onset posttraumatic skin and soft-tissue infections caused by rapid-growing mycobacteria in tsunami survivors. Clin Infect Dis. Jul 15 2008;47(2):e11-6. [Medline].

  7. S Breza T Jr, Magro CM. Lichenoid and granulomatous dermatitis associated with atypical mycobacterium infections. J Cutan Pathol. Jul 2006;33(7):512-5. [Medline].

  8. Lam A, Toma W, Schlesinger N. Mycobacterium marinum arthritis mimicking rheumatoid arthritis. J Rheumatol. Apr 2006;33(4):817-9. [Medline].

  9. Gluckman SJ. Mycobacterium marinum. Clin Dermatol. May-Jun 1995;13(3):273-6. [Medline].

  10. Bhambri S, Bhambri A, Del Rosso JQ. Atypical mycobacterial cutaneous infections. Dermatol Clin. Jan 2009;27(1):63-73. [Medline].

  11. Mahaisavariya P, Chaiprasert A, Manonukul J, Khemngern S, Tingtoy N. Detection and identification of Mycobacterium species by polymerase chain reaction (PCR) from paraffin-embedded tissue compare to AFB staining in pathological sections. J Med Assoc Thai. Jan 2005;88(1):108-13. [Medline].

  12. Ho MH, Ho CK, Chong LY. Atypical mycobacterial cutaneous infections in Hong Kong: 10-year retrospective study. Hong Kong Med J. 2006/January;12:21-6.

  13. Nolte O, Haag H, Hafner B. A mutation in the 65,000 Dalton heat shock protein gene, commonly used for molecular identification of non-tuberculous mycobacteria, leads to the misidentification of Mycobacterium malmoense as Mycobacterium marinum. Mol Cell Probes. Aug 2005;19(4):275-7. [Medline].

  14. Lai CC, Tan CK, Lin SH, Liu WL, Liao CH, Huang YT, et al. Diagnostic value of an enzyme-linked immunospot assay for interferon-? in cutaneous tuberculosis. Diagn Microbiol Infect Dis. May 2011;70(1):60-4. [Medline].

  15. Wongworawat MD, Holtom P, Learch TJ, Fedenko A, Stevanovic MV. A prolonged case of Mycobacterium marinum flexor tenosynovitis: radiographic and histological correlation, and review of the literature. Skeletal Radiol. Sep 2003;32(9):542-5. [Medline].

  16. Rybniker J, Kramme S, Small PL. Host range of 14 mycobacteriophages in Mycobacterium ulcerans and seven other mycobacteria including Mycobacterium tuberculosis--application for identification and susceptibility testing. J Med Microbiol. Jan 2006;55:37-42. [Medline].

  17. Travis WD, Travis LB, Roberts GD, Su DW, Weiland LW. The histopathologic spectrum in Mycobacterium marinum infection. Arch Pathol Lab Med. Dec 1985;109(12):1109-13. [Medline].

  18. Rallis E, Koumantaki-Mathioudaki E. Treatment of Mycobacterium marinum cutaneous infections. Expert Opin Pharmacother. Dec 2007;8(17):2965-78. [Medline].

  19. Bhatty MA, Turner DP, Chamberlain ST. Mycobacterium marinum hand infection: case reports and review of literature. Br J Plast Surg. Mar 2000;53(2):161-5. [Medline].

  20. Cummins DL, Delacerda D, Tausk FA. Mycobacterium marinum with different responses to second-generation tetracyclines. Int J Dermatol. Jun 2005;44(6):518-20. [Medline].

  21. Dodiuk-Gad R, Dyachenko P, Ziv M, et al. Nontuberculous mycobacterial infections of the skin: A retrospective study of 25 cases. J Am Acad Dermatol. Sep 2007;57(3):413-20. [Medline].

  22. Parrish N, Luethke R, Dionne K, Carroll K, Riedel S. Case of Mycobacterium marinum infection with unusual patterns of susceptibility to commonly used antibiotics. J Clin Microbiol. May 2011;49(5):2056-8. [Medline].

  23. Janik JP, Bang RH, Palmer CH. Case reports: successful treatment of Mycobacterium marinum infection with minocycline after complication of disease by delayed diagnosis and systemic steroids. J Drugs Dermatol. Sep-Oct 2005;4(5):621-4. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.