Mycobacterium Marinum Infection of the Skin Treatment & Management

Updated: May 24, 2017
  • Author: Kirstin Altman, MD; Chief Editor: Dirk M Elston, MD  more...
  • Print
Treatment

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. [7]

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. [29]

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

It should also be recommended to stop anti-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. [7]

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.

Next:

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. [30]

Previous
Next:

Consultations

A variety of specialists may be involved in the diagnosis and treatment, such as dermatologists, rheumatologists, and infectious disease physicians.

Previous
Next:

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. [31] It remains to be determined if supplementation with vitamin D in humans infected with M marinum will aid in clearance of the organisms.

Previous
Next:

Prevention

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

Previous