Dermatologic Manifestations of Mycobacterium Marinum Infection of the Skin Medication

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

Medication Summary

The mainstay of therapy for infection by M marinum is antimicrobials, including antibiotics and antimycobacterials.

The organism is sensitive to rifampin plus ethambutol, tetracyclines (minocycline [MCN],[20] doxycycline [DCN]), trimethoprim-sulfamethoxazole (TMP-SMZ), clarithromycin,[21] and fluoroquinolones (ciprofloxacin, ofloxacin, sparfloxacin). Resistance to doxycycline and rifampin has been reported but is rare.[22]

Antimicrobials are administered singly or in combination.[18] Single-agent therapy may be sufficient in uncomplicated infection of the skin; however, combination therapy is used when more extensive infection is treated. Combination antimycobacterial agents include the following:

  • Rifampin and ethambutol: This combination is regarded as highly effective therapy, especially for severe disease or in patients with impaired immune systems.
  • Streptomycin, ethambutol, and isoniazid
  • Clarithromycin, alone or in combination: This agent has shown the most efficacy of the macrolide antibiotics. One case report discusses the use of azithromycin in combination with ethambutol. Erythromycin has not demonstrated efficacy for treating M marinum infections.

Combining rifabutin or rifampin with macrolide antibiotics is not recommended because of the decreased efficacy of the macrolide and the increased levels of rifabutin or rifampin.

Most strains of M marinum have been found to be resistant to medications typically used for Mycobacterium tuberculosis, including isoniazid, streptomycin, pyrazinamide, and para-aminosalicylic acid.[16] In contrast, ethambutol is effective in combination with antimycobacterial or antibiotics, but not as a single agent.

The duration of therapy is empiric; multiple sources recommend extended therapy for 4-6 weeks following clinical resolution of lesions.[18]

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Antimicrobial agents

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Therapy must be taken regularly and continued for a sufficient period.

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Rifampin (Rifadin, Rimactane)

 

Found to be effective as monotherapy and is successful when given in combination with another antimicrobial. Inhibits DNA-dependent bacterial RNA but not mammalian RNA polymerase. Cross-resistance may occur. Treat for 6-9 mo or until 6 mo have elapsed from conversion to negative results from sputum culture.

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Ethambutol (Myambutol)

 

Only effective when combined with another antimicrobial agent, preferably rifampin. Diffuses into actively growing mycobacterial cells (eg, tubercle bacilli). Impairs cell metabolism by inhibiting synthesis of one or more metabolites, which, in turn, causes cell death. No cross-resistance demonstrated. Mycobacterial resistance is common with previous therapy.

Minocycline (Dynacin, Minocin) or Doxycycline (Doryx, Vibramycin)

 

Effective monotherapy; however, strains of M marinum resistant to doxycycline but sensitive to minocycline have been reported. Also treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma species.

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Trimethoprim and sulfamethoxazole (Bactrim, Septra)

 

Several case reports have shown effectiveness of this drug. Reports indicate that it can help eradicate organisms unresponsive to either antituberculars or tetracyclines. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

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Clarithromycin (Biaxin)

 

Cases of organisms resistant to conventional antitubercular therapy have responded to clarithromycin but not erythromycin. Use of azithromycin has not been reported. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Has bactericidal activity against atypical Mycobacterium species (eg, M marinum).

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Ciprofloxacin (Cipro)

 

Fluoroquinolones are effective alone or in combination with other medications to eradicate M marinum. Inhibits bacterial DNA synthesis and, consequently, growth.

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Levofloxacin (Levaquin)

 

For treatment of tuberculosis and some atypical mycobacterial infections in combination with rifampin and other antituberculosis agents.

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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].

 
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