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Atypical Mycobacterial Diseases Workup

  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
Updated: Feb 16, 2016

Laboratory Studies

The optimal way to diagnosis atypical mycobacteria is by performing a culture of tissue. This should be performed at multiple temperatures 25°, 37°, and 42° to ensure that the cultures grow out all possible pathogens.

The development of DNA fingerprinting technology, especially pulsed-field gel electrophoresis, has been suggested as a diagnostic tool. Polymerase chain reaction has been used to aid in diagnosing these conditions.

In HIV-positive patients, autoantibodies versus interferon-gamma should be considered as a reason for recurrence.[43]


Imaging Studies

In 1999, Erasmus et al[44] noted that the radiologic manifestations of pulmonary atypical mycobacteria infection are protean and include consolidation, cavitation, fibrosis, nodules, bronchiectasis, and adenopathy. Pulmonary atypical mycobacteria infection has 5 distinct clinicoradiologic manifestations: classic infection, nonclassic infection, nodules in patients who are asymptomatic, infection in patients with achalasia, and infection in patients who are immunocompromised. Although classic atypical mycobacteria infection may be indistinguishable from active tuberculosis, it is usually more indolent. The characteristic radiologic features of nonclassic atypical mycobacteria infection include bronchiectasis and centrilobular nodules isolated to or most severe in the lingula and the middle lobe. In patients with acquired immunodeficiency syndrome, mediastinal or hilar adenopathy is the most common radiographic finding.


Other Tests

Polymerase chain reaction is a new tool in diagnosing atypical mycobacterial infections and can even be performed on tissue specimens of the standard formalin-fixed paraffin-embedded type.[45]

The purified protein derivative test result is usually negative in infections with atypical mycobacteria.



A biopsy of the skin, the cervical nodes, and the lung can be used to diagnose atypical mycobacteria. The tissue obtained can be used for cultures of the tissue and for histopathologic examination.


Histologic Findings

Histopathologic examination of tissue can reveal tuberculoid, palisading, and sarcoidlike granulomas; a diffuse infiltrate of histiocytic foamy cells; acute and chronic panniculitis; nonspecific chronic inflammation; cutaneous abscesses; suppurative granulomas; and necrotizing folliculitis. Suppurative granulomas are the most characteristic feature in skin biopsy specimens from cutaneous atypical mycobacteria infections. The evolution of the disease and the immunologic status of the host may explain this spectrum of morphologic changes.

Some authorities note severe inflammatory lesions involved with the dermis and the hypodermis; these can have 3 main histopathologic patterns: granulomatous nodular or diffuse inflammation with mixed granulomas, prevailing abscesses with mild granulomatous reaction, and deep dermal and subcutaneous granulomatous inflammation with no neutrophil component.

Contributor Information and Disclosures

Noah S Scheinfeld, JD, MD, FAAD Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie<br/>Received income in an amount equal to or greater than $250 from: Optigenex<br/>Received salary from Optigenex for employment.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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.

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Mycobacterium marinum is an atypical mycobacteria found in water with a wide range of temperatures and salinities
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