Atypical Mycobacterial Diseases 

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 2, 2011
 

Background

Investigators have defined 30 facultative saprophytes and entities that are acid-fast mycobacteria but do not cause tuberculosis or leprosy. These mycobacteria or atypical mycobacteria exist in almost all habitats. The most common infection is the so-called case of fish tank granuloma, which is caused by Mycobacterium marinum.Mycobacterium avium-intracellulare is the most common etiology of systemic disease in humans. Other types of mycobacteria are discussed in different eMedicine articles (eg, Mycobacterium Fortuitum, Mycobacterium gordonae). Other types of mycobacteria are discussed here.

Runyon proposed the following schema:

  • Group 1 - Photochromogens (eg, Mycobacterium kansasii, M marinum, Mycobacterium simiae)
  • Group 2 - Scotochromogens (eg, Mycobacterium scrofulaceum, Mycobacterium szulgai, Mycobacterium gordonae)
  • Group 3 - Nonphotochromogens (eg, Mycobacterium malmoense, Mycobacterium xenopi, M avium-intracellulare)
  • Group 4 - Fast growers (3-5 d) (eg, Mycobacterium fortuitum, Mycobacterium chelonae, Mycobacterium abscessus)

M chelonae is an atypical fast-growing mycobacteria that is a rare cause of human infection. In 1996, Horsburgh[1] noted clinically important nontuberculous mycobacteria (NTMB), including M kansasii, M genavense, M marinum, M simiae, M scrofulaceum, M szulgai, M avium, M haemophilum, M intracellulare, M malmoense, Mycobacterium ulcerans, M xenopi, M abscessus, M chelonae, M fortuitum, and (rarely) Mycobacterium smegmatis.

Four clinical syndromes comprise nearly all cases: pulmonary disease, lymphadenitis, skin or soft tissue disease, and disseminated disease in AIDS. M avium and M intracellulare (known together as M avium-intracellulare complex) are the most common causes of pulmonary disease, lymphadenitis, and disseminated disease. All 4 clinical syndromes seem to be increasing in frequency, particularly in immunosuppressed hosts. Specific reservoirs of these organisms leading to human disease are still being found.

NTMB are acquired from the environment, but M abscessus is a rapidly growing mycobacterium found in soil and water throughout the world. Disease in patients who are immunocompetent usually consists of localized skin and soft tissue infections.

M kansasii occurs most commonly in Kansas, Texas, Illinois, England, and urban settings.

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Pathophysiology

Infections with atypical mycobacteria usually occur in immunocompromised hosts due to host immunity and resistance factors. Pulmonary infections can occur in patients with impaired ventilation systems. These infections can also be introduced after surgery and through contaminated injections because atypical mycobacteria do not have the ability to pass through the mucosa or the integument.

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Epidemiology

Frequency

International

Cutaneous infections with atypical mycobacteria are rare in the United States and worldwide. They are much more common in immunocompromised hosts, in particular those with HIV or leukemia or those undergoing immunosuppressive therapy.

Mortality/Morbidity

Atypical mycobacteria infections cause little mortality. They can cause morbidity, especially when they are not diagnosed and not treated effectively. Often times, cutaneous atypical mycobacteria infection can resolve on its own without intervention. In children, cervical lymphadenitis caused by atypical mycobacteria can result in facial nerve injury, and the incidence of hypertrophic scarring varies among the different treatments.

Race

No apparent difference in race exists on the course of atypical mycobacteria infection.

Sex

Atypical mycobacteria infection is more common in men than in women. M kansasii infection is much more common in men than in women.

Age

Atypical mycobacteria infections are more commonly reported in older patients. This probably relates to the decline in health in such patients (eg, older patients who have smoked have poorer pulmonary function). Atypical mycobacteria diseases tend to affect adults and can rarely affect children. For example, a 6-year-old girl with a primary cutaneous form of M kansasii infection has been reported. She was successfully treated with surgical excision and oral erythromycin. The median age of patients with M kansasii infection is 43 years.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Specialty Editor Board

Takeji Nishikawa, MD  Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

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.

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