eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Marinum: Follow-up

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

Follow-up

Further Outpatient Care

  • Patients with M marinum infection are treated in an outpatient setting.
  • Follow-up visits with patients should be scheduled weekly until they begin to respond to therapy and then biweekly until the infection is fully cured.

Inpatient & Outpatient Medications

  • Continue combination therapy or monotherapy 1-2 months after the infection resolves.

Transfer

  • Transfer to other facilities is unnecessary.
  • Refer patients with M marinum infection to an infectious diseases physician or a dermatologist in an outpatient clinical setting.

Deterrence/Prevention

  • People who work near salt water should take precautions to avoid abrasions, trauma, or bites from fish and marine animals.
  • People who work in aquariums should wear gloves if they are cleaning tanks or expect to encounter trauma to their hands or feet.
  • If abrasions or bites occur, cleanse the skin with an antibacterial preparation and dress with an appropriate bandage.

Complications

  • Persistent ulceration or suppuration
  • Osteomyelitis
  • Tenosynovitis
  • Arthritis
  • Disseminated infection
  • Amputation of involved digit

Prognosis

  • With treatment, M marinum infection carries an excellent prognosis. A study from France reported cure in 87% of cases. Treatment failure was significantly related to deeper-structure involvement and ulcerative skin lesions but not to acquired antimicrobial resistance.
  • Clinical presentations and outcomes of M marinum infections in patients with HIV infection did not differ from those in patients without HIV infection.

Patient Education

  • Patients with M marinum infection are not infectious and are cured with proper treatment.
  • Educate people who work near salt water to cleanse their skin with an antibacterial preparation and to dress abrasions or bites with an appropriate bandage.

Miscellaneous

Medicolegal Pitfalls

  • Failure to accurately identify M marinum as the causative agent: M marinum infection may be mistaken for sporotrichosis or other causes of nodular ascending lymphangitis.
  • Failure to obtain appropriate biopsy samples and skin lesion cultures to determine appropriate therapy

Special Concerns

  • M marinum infections in patients with AIDS may result in dissemination to the bone marrow, liver, spleen, and lung.3 This infection may be difficult to detect in this setting and may be confused with M tuberculosis.
  • M marinum infections may disseminate in patients receiving infliximab therapy.4
  • M marinum infections do not respond to conventional antituberculosis agents, such as isoniazid, pyrazinamide, para-aminosalicylic acid, and streptomycin.
 


More on Mycobacterium Marinum

Overview: Mycobacterium Marinum
Differential Diagnoses & Workup: Mycobacterium Marinum
Treatment & Medication: Mycobacterium Marinum
Follow-up: Mycobacterium Marinum
Multimedia: Mycobacterium Marinum
References
[ CLOSE WINDOW ]

References

  1. Barr KL, Lowe L, Su LD. Mycobacterium marinum infection simulating interstitial granuloma annulare: a report of two cases. Am J Dermatopathol. Apr 2003;25(2):148-51. [Medline].

  2. Awais A, Tam CS, Kontoyiannis D, et al. Rapid resolution of Mycobacterium marinum chronic skin infection during lenalidomide therapy for chronic lymphocytic leukemia. Clin Infect Dis. Apr 1 2008;46(7):e69-71. [Medline].

  3. Kishihara Y, Nakashima K, Nukina H, et al. [Two cases of acquired immunodeficiency syndrome with disseminated non-tuberculous mycobacterial infection]. Kansenshogaku Zasshi. Dec 1993;67(12):1223-7. [Medline].

  4. Rallis E, Koumantaki-Mathioudaki E, Frangoulis E, Chatziolou E, Katsambas A. Severe sporotrichoid fish tank granuloma following infliximab therapy. Am J Clin Dermatol. 2007;8(6):385-8. [Medline].

  5. Adhikesavan LG, Harrington TM. Local and disseminated infections caused by Mycobacterium marinum: an unusual cause of subcutaneous nodules. J Clin Rheumatol. Jun 2008;14(3):156-60. [Medline].

  6. Aubry A, Chosidow O, Caumes E, et al. Sixty-three cases of Mycobacterium marinum infection: clinical features, treatment, and antibiotic susceptibility of causative isolates. Arch Intern Med. Aug 12-26 2002;162(15):1746-52. [Medline].

  7. Barton A, Bernstein RM, Struthers JK, et al. Mycobacterium marinum infection causing septic arthritis and osteomyelitis. Br J Rheumatol. Nov 1997;36(11):1207-9. [Medline].

  8. Bartralot R, Garcia-Patos V, Sitjas D, et al. Clinical patterns of cutaneous nontuberculous mycobacterial infections. Br J Dermatol. Apr 2005;152(4):727-34. [Medline].

  9. Bråbäck M, Riesbeck K, Forsgren A. Susceptibilities of Mycobacterium marinum to gatifloxacin, gemifloxacin, levofloxacin, linezolid, moxifloxacin, telithromycin, and quinupristin-dalfopristin (Synercid) compared to its susceptibilities to reference macrolides and quinolones. Antimicrob Agents Chemother. Apr 2002;46(4):1114-6. [Medline].

  10. Edelstein H. Mycobacterium marinum skin infections. Report of 31 cases and review of the literature. Arch Intern Med. Jun 27 1994;154(12):1359-64. [Medline].

  11. El-Etr SH, Subbian S, Cirillo SL, et al. Identification of two Mycobacterium marinum loci that affect interactions with macrophages. Infect Immun. Dec 2004;72(12):6902-13. [Medline].

  12. Ena P, Sechi LA, Saccabusi S, et al. Rapid identification of cutaneous infections by nontubercular mycobacteria by polymerase chain reaction-restriction analysis length polymorphism of the hsp65 gene. Int J Dermatol. Aug 2001;40(8):495-9. [Medline].

  13. Enzensberger R, Hunfeld KP, Elshorst-Schmidt T, et al. Disseminated cutaneous Mycobacterium marinum infection in a patient with non-Hodgkin's lymphoma. Infection. Dec 2002;30(6):393-5. [Medline].

  14. Farooqui MA, Berenson C, Lohr JW. Mycobacterium marinum infection in a renal transplant recipient. Transplantation. Jun 15 1999;67(11):1495-6. [Medline].

  15. Forsgren A. Antibiotic susceptibility of Mycobacterium marinum. Scand J Infect Dis. 1993;25(6):779-82. [Medline].

  16. Galdiero M, Finamore E, Galdiero E, et al. A case of granulomatous skin lesions caused by Mycobacterium marinum in the Campania region. New Microbiol. Jan 2005;28(1):89-92. [Medline].

  17. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. Feb 15 2007;175(4):367-416. [Medline].

  18. Harth M, Ralph ED, Faraawi R. Septic arthritis due to Mycobacterium marinum. J Rheumatol. May 1994;21(5):957-60. [Medline].

  19. Hartmark-Hill JR, Kanodia AK, Frey KA. 53-year-old man with a swollen finger. Mayo Clin Proc. Feb 2008;83(2):217-20. [Medline].

  20. Horowitz EA, Sanders WE. Other Mycobacterium Species. In: Mandell G, Bennett J, Dolin R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:2264-73.

  21. Iijima S, Saito J, Otsuka F. Mycobacterium marinum skin infection successfully treated with levofloxacin. Arch Dermatol. Aug 1997;133(8):947-9. [Medline].

  22. Johnston JM, Izumi AK. Cutaneous Mycobacterium marinum infection ("swimming pool granuloma"). Clin Dermatol. Jul-Sep 1987;5(3):68-75. [Medline].

  23. Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med. Jun 1 1993;118(11):883-8. [Medline].

  24. Lewis FM, Marsh BJ, von Reyn CF. Fish tank exposure and cutaneous infections due to Mycobacterium marinum: tuberculin skin testing, treatment, and prevention. Clin Infect Dis. Aug 1 2003;37(3):390-7. [Medline].

  25. Petrini B. Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections. Eur J Clin Microbiol Infect Dis. Oct 2006;25(10):609-13. [Medline].

  26. Ramakrishnan L. Images in clinical medicine. Mycobacterium marinum infection of the hand. N Engl J Med. Aug 28 1997;337(9):612. [Medline].

  27. Rhomberg PR, Jones RN. In vitro activity of 11 antimicrobial agents, including gatifloxacin and GAR936, tested against clinical isolates of Mycobacterium marinum. Diagn Microbiol Infect Dis. Feb 2002;42(2):145-7. [Medline].

  28. Roddy K, Kao G, Dawn M, et al. The arthritic fisherman. Am J Med. Apr 2008;121(4):287-9. [Medline].

  29. Ryan JM, Bryant GD. Fish tank granuloma--a frequently misdiagnosed infection of the upper limb. J Accid Emerg Med. Nov 1997;14(6):398-400. [Medline].

  30. Saadatmand B, Poulton JK, Kauffman CL. Mycobacterium marinum with associated bursitis. J Cutan Med Surg. Apr 1999;3(4):218-20. [Medline].

  31. Shih JY, Hsueh PR, Chang YL, et al. Osteomyelitis and tenosynovitis due to Mycobacterium marinum in a fish dealer. J Formos Med Assoc. Nov 1997;96(11):913-6. [Medline].

  32. Sokol DK, Azzarelli B, Smith RR, et al. Primary intravascular lymphomatosis associated with Mycobacterium marinum. J Neuroimaging. Jan 1998;8(1):47-9. [Medline].

  33. Tan HH, Chan RK. Atypical mycobacterium infection with sporotrichoid spread in a patient with human immunodeficiency virus. Ann Acad Med Singapore. Nov 1999;28(6):846-8. [Medline].

  34. Vazquez JA, Sobel JD. A case of disseminated Mycobacterium marinum infection in an immunocompetent patient. Eur J Clin Microbiol Infect Dis. Oct 1992;11(10):908-11. [Medline].

  35. Weitzul S, Eichhorn PJ, Pandya AG. Nontuberculous mycobacterial infections of the skin. Dermatol Clin. Apr 2000;18(2):359-77, xi-xii. [Medline].

  36. Wendt JR, Lamm RC, Altman DI, et al. An unusually aggressive Mycobacterium marinum hand infection. J Hand Surg [Am]. Sep 1986;11(5):753-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.