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]

Diet

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.

Medication

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Media Gallery

Photograph of Mycobacterium marinum infection lesions.

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Author

Kirstin Altman, MD Assistant Professor of Dermatology, Texas A&M Health Science Center College of Medicine

Kirstin Altman, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Texas Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Tahmina Mahmood, MD Resident Physician, Department of Dermatology, Baylor Scott and White Healthcare System

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

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

Joslyn S Kirby, MD Assistant Professor, Department of Dermatology, Milton S Hershey Penn State Medical Center

Joslyn S Kirby, MD is a member of the following medical societies: American Academy of Dermatology, Women's Dermatologic Society, International Society for Cutaneous Lymphomas, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

S Alison Basak, MD, MA Resident Physician, Department of Dermatology, Penn State Hershey Medical Center

S Alison Basak, MD, MA is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Pennsylvania Medical Society, Women's Dermatologic Society, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Ellen J Kim, MD Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania

Ellen J Kim, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Dermatology Foundation, Medical Dermatology Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Saeed Jaffer, MD, MS Assistant Clinical Professor, University of California at Los Angeles School of Medicine; Consulting Staff, Boston Dermatology

Saeed Jaffer, MD, MS is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery

Disclosure: Nothing to disclose.