eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Marinum: Differential Diagnoses & Workup

Author: Alexandre Lacasse, MD, MSc, Fellow in Infectious Diseases, University of Tennessee at Memphis
Coauthor(s): Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee; Raphael J Kiel, MD, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Infectious Diseases Division, William Beaumont Hospital
Contributor Information and Disclosures

Updated: Jan 16, 2009

Differential Diagnoses

Anthrax
Mycobacterium Kansasii
Blastomycosis
New World cutaneous leishmaniasis
Coccidioidomycosis (Infectious Diseases)
Nocardiosis
Cryptococcosis
Sporotrichosis
Histoplasmosis
Staphylococcus aureus soft-tissue infection
Melioidosis
Streptococcus pyogenes soft-tissue infection
Mycobacterium Chelonae
Trauma (eg, self-induced trauma in an intravenous drug abuser)
Mycobacterium Fortuitum
Ulceroglandular tularemia

Workup

Laboratory Studies

  • M marinum is a nonmotile acid-fast bacillus (AFB) that grows in 2-3 weeks, with optimum growth on Lowenstein-Jensen medium at 30°C. Laboratory personnel should be notified in advance since AFB cultures are mostly carried at higher temperatures.
  • M marinum is a photochromogen (Runyon group 1), producing a yellow pigment when exposed to light.
  • M marinum produces urease and catalase (weakly) but does not produce niacin or nitrate.
  • Polymerase chain reaction (PCR) amplification techniques using Mycobacterium genus-specific primers can be used to diagnose M marinum infection directly in the biopsy sample.

Imaging Studies

  • First, obtain radiography of the affected area to evaluate for underlying osteomyelitis.
  • Obtain either MRI or CT scanning of the affected area if tenosynovitis or deeper infection is suspected, including osteomyelitis if the screening radiography findings are unrevealing. This would also be indicated in patients with prosthetic material from a previous injury.

Procedures

  • Surgical drainage of skin lesions is often unnecessary. Deeper-structure infection may require surgical debridement.

Histologic Findings

Younger lesions show epidermal hyperkeratosis, a mixed inflammatory response, or, possibly, frank suppuration. Older lesions may present as organized granuloma. Caseation is uncommon. The organisms are acid-fast and may have a transverse banding pattern.

More on Mycobacterium Marinum

Overview: Mycobacterium Marinum
Differential Diagnoses & Workup: Mycobacterium Marinum
Treatment & Medication: Mycobacterium Marinum
Follow-up: Mycobacterium Marinum
Multimedia: Mycobacterium Marinum
References
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References

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Further Reading

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Keywords

Mycobacterium marinum infection, M marinum infection, fish tank granuloma, swimming pool granuloma, fish fancier's finger

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Contributor Information and Disclosures

Author

Alexandre Lacasse, MD, MSc, Fellow in Infectious Diseases, University of Tennessee at Memphis
Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee
Michael Gelfand, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Southern Medical Association
Disclosure: Nothing to disclose.

Raphael J Kiel, MD, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Infectious Diseases Division, William Beaumont Hospital
Raphael J Kiel, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Geriatrics Society
Disclosure: Nothing to disclose.

Medical Editor

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

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