Dermatologic Manifestations of Mycobacterium Marinum Infection of the Skin Workup

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

Laboratory Studies

Culture is the criterion standard method of identification. Cultures are specific but not sensitive. Cultures may be positive in only 70-80% of cases.[9] Cultures at 25-32°C (77-89.6°F) may grow nonmotile acid-fast bacilli in 7-21 days. The organisms are photochromogens (Runyon group 1), producing yellow pigment only when exposed to light. No niacin or nitrate production occurs; urease is produced, but the organism is a weak producer of catalase at 25°C (77°F).[10]

If culture results are negative but the history and clinical findings are consistent with M marinum infection, then treatment should still be strongly considered; additionally, performing a biopsy on the lesion may help identify the organisms.

Polymerase chain reaction (PCR) studies of tissue are quick to perform and are increasingly being used to help distinguish the exact Mycobacterium species involved.[11] However, errors of identification have been reported when using PCR.[12, 13]

An enzyme-linked immunospot assay for interferon-gamma has been developed for Mycobacterium tuberculosis. Patients with infection by M marinum may also have a positive result with this test.[14]

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Imaging Studies

Consider obtaining imaging studies (plain radiography, CT scanning, or MRI) if tenosynovitis, osteomyelitis, or deep infection is suspected.[15]

MRI may show exuberant tenosynovitis; however, unlike with purulent tenosynovitis, the underlying muscles and bony structures are rarely involved.

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Other Tests

Mycobacteriophages are viruses that infect Mycobacterium. They are currently commercially available but are still being refined as a tool to rapidly identify the specific species in mycobacterial infections. They are also being developed as a future modality for diagnosis and treatment of these infections.[16]

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Procedures

Biopsy samples from cutaneous lesions or from intra-articular tissue should be obtained for histopathologic analysis. Acid-fast preparations, such as Ziehl-Neelsen and Fite stains, reveal acid-fast bacilli.

Surgical drainage of skin lesions often is unnecessary; however, if a deeper infection is diagnosed, drainage may be indicated.

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Histologic Findings

The histopathologic findings vary depending on the duration of the lesion sampled and on the degree of granuloma formation.

Early lesions show a nonspecific mixed inflammatory infiltrate, but acid-fast stains typically reveal bacilli. Established lesions display characteristic tuberculoid granulomas, often containing a stellate abscess.

Abscess formation can vary from absent to marked.

Granulomas can vary from poorly formed, consisting of epithelioid histiocytes and lymphocytes with few multinucleated giant cells, to fully formed granulomas with numerous multinucleated giant cells, although caseation is rare.[17]

A lichenoid and granulomatous infiltrate has also been reported with M marinum infection.[7]

The epidermis frequently demonstrates papillomatosis, hyperkeratosis, and an acute inflammatory infiltrate, with or without ulceration.

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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

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