Mycobacterium Marinum Infection of the Skin Treatment & Management

Updated: Mar 24, 2022
  • Author: Kirstin Altman, MD; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

Treatment is usually medical in nature, using bacteriocidal agents. The duration of therapy is empiric, with the recommendations to continue therapy for 4-6 weeks following clinical resolution of the lesions. Treatment of some infections may last as long as 25 months or longer. [10]

Effective antimicrobials include tetracyclines, fluoroquinolones, macrolides, sulfonamides, and others.

Drug resistance varies and has been reported with all classes of antibiotic treatment listed above. Combination therapy is used for cases with documented antimicrobial resistance or those not responding to single-agent therapy. [37]

Spontaneous resolution has been reported. Treatment with radiation, cryotherapy, and heat probes has been reported.

It should also be recommended to stop anti-tumor necrosis factor (TNF) therapy or other immunosuppressive therapy during the course of antibiotics when M marinum infection occurs in patients treated with these medications. Despite the small number of cases described, it appears that the lesions may progress if these medications are not discontinued. [10]

See Medication for further discussion of single- and combination-agent therapies.

Patients can be treated in an outpatient setting and should be seen frequently until they begin to respond to therapy, then less frequently until the infection is fully cured. Patients may benefit from seeing an infectious disease physician in an outpatient setting.


Surgical Care

Surgical drainage of skin lesions is usually unnecessary.

Infection of deep structures such as the tendon sheaths, joint space, or bone should be managed with the help of a surgeon. Debridement of necrotic tissues of the synovium, tendon sheaths, and/or bone may be needed to control infection in spite of appropriate systemic antibiotic therapy. Amputations are rarely necessary. [38]



In an in vitro experimental M marinum model, the activated form of vitamin D (1α,25-dihydroxyvitamin D3) reduced M marinum survival through increased intracellular and extracellular levels of cathelicidin antimicrobial peptides. [39] It remains to be determined if supplementation with vitamin D in humans infected with M marinum will aid in clearance of the organisms.