eMedicine Specialties > Dermatology > Mycobacterial Infections
Mycobacterium Marinum Infection of the Skin
Updated: Sep 8, 2006
Introduction
Background
Mycobacterium marinum is an atypical Mycobacterium found in salt and fresh water. M marinum is the most common atypical Mycobacterium to cause infection in humans. Infection occurs following primary inoculation of a skin abrasion or puncture and manifests as a localized granuloma or sporotrichotic lymphangitis. Diagnosis and treatment are often delayed because of a lack of suspicion for mycobacterial involvement, ie, versus more common bacterial pathogens.
Pathophysiology
M marinum infection occurs following trauma to an extremity that is in contact with an aquarium, salt water, or marine animals such as fish or turtles. Exposure to M marinum via swimming pools is rare because most pools are chlorinated.
The pathogen is classified in Runyon group 1 and is a photochromogen, which means it produces yellow pigment when cultured and exposed to light. Culture growth occurs over 7-21 days and is optimal at 25-32°C (77-89.6°F) because the organism is adapted to infect ectotherms, such as fish. Endotherms, such as humans, also can be infected; however, the cooler extremities are affected more often than central sites. Systemic infection, usually in the context of an immunocompromised host, has been reported. This indicates that the organism is capable of adapting to grow in conditions closer to 37°C.
After inoculation into the host tissues via an abrasion or other wound, the mycobacteria are phagocytosed by macrophages. Inside the macrophage, they are able to interrupt the formation of the phagolysosome, which would kill the organisms. The mycobacteria then escape the lysosome and can move intracellularly and extracellularly via actin-based motility. This may contribute to cell-to-cell spread.
Studies have revealed 2 pathophysiologically and genetically (ie, via amplified restriction-based polymorphism analysis) distinct populations of M marinum. One group can infect humans and causes acutely lethal disease in fish, while a second group cannot infect humans and causes chronic progressive disease in fish.
Frequency
United States
Infections caused by M marinum are rare but well described in the literature. The estimated annual incidence is 0.27 cases per 100,000 adult patients. Of the approximately 150 cases described, most are case reports of cutaneous infection; however, some describe osteomyelitis, tenosynovitis, arthritis, and disseminated infection. Nosocomial infection has never been described.
International
Infection occurs worldwide, most commonly in individuals with occupational and recreational exposure to fresh or salt water.
Mortality/Morbidity
The disease typically remains localized and does not cause significant morbidity in patients who are immunocompetent. Cases reported in patients who are severely immunocompromised have resulted in disseminated infection involving the bone marrow and viscera and may result in death.
Race
No racial predilection is apparent.
Sex
No sexual predilection has been noted.
Age
M marinum infection has been reported in persons of every age group; however, it appears to be rare in the pediatric population.
Clinical
History
- Patients at risk include anglers, oyster workers, swimmers, aquarium workers, and individuals with aquariums in their homes.
- 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.
Physical
- An erythematous or bluish 0.5- to 3-cm papule or nodule develops at the inoculation site, which is the upper extremity in 90% of cases. 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.
- 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.
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.
More on Mycobacterium Marinum Infection of the Skin |
 Overview: Mycobacterium Marinum Infection of the Skin |
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| Treatment & Medication: Mycobacterium Marinum Infection of the Skin |
| Follow-up: Mycobacterium Marinum Infection of the Skin |
| References |
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References
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Further Reading
Keywords
tropical fish tank granuloma, fish tank granuloma, M marinum, Mycobacterium, Mycobacterium marinum, mycobacteria, acid-fast mycobacteria, saltwater infection, freshwater infection, marine infection, marine bacteria, water-borne bacteria, water-borne bacterial infection
