History

M marinum infection often follows abrasions to an extremity occurring in nonchlorinated water. Fishermen, oyster workers, swimmers, and aquarium workers are predisposed to infection.

M marinum has an incubation period of approximately 2-3 weeks

A mildly tender papule or nodule initially appears at the site of trauma, slowly enlarges, and then suppurates or ulcerates.

The localized lesion can grow slowly over several months.

Localized pain and induration are common.

Further nodular lesions may develop along the lymphatic channels, resulting in ascending nodular lymphangitis.

Regional lymphadenitis and systemic symptoms are uncommon.

Contiguous spread to deeper structures (eg, tendons, joints, or even bones) occurs in up to one third of individuals with M marinum infection.

Physical

In individuals with M marinum infection, a papule or bluish nodule develops at the inoculation site. Suppuration or ulceration appears at a later stage.

An ascending nodular lymphangitis develops in 25-50% of infected patients. This entity also is seen in other infectious etiologies, especially sporotrichosis, New World cutaneous leishmaniasis, nocardiosis, ulceroglandular form of tularemia, infections with other nontuberculous mycobacteria (eg, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium kansasii), various fungal infections (blastomycosis, histoplasmosis, cryptococcosis, coccidioidomycosis) and several pyogenic bacteria (Staphylococcus aureus, Streptococcus pyogenes, Burkholderia pseudomallei, Bacillusanthracis).

An upper extremity is affected in nearly 90% of persons with M marinum infection, mostly on the hands. See the image below.

Photograph of Mycobacterium marinum infection.

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Deeper involvement, with tenosynovitis, septic arthritis, and osteomyelitis of the underlying bone, may be evident on examination.

Most patients with M marinum infection have a tuberculin skin test result between 5-9 mm of induration.

M marinum infection may present similarly to interstitial granuloma annulare.^[4]

Causes

Infection is caused by inoculation with M marinum. Individuals at an increased risk for infection include the following:

Fishermen and fish-processing workers
Saltwater aquarium maintenance personnel
Home aquarium owners
Immunocompromised individuals

Complications

Potential complications include the following:

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

Differential Diagnoses

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Media Gallery

Photograph of Mycobacterium marinum infection.
Photograph of Mycobacterium marinum infection.

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Author

Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

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 Health Science Center College of Medicine

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, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai

Aaron E Glatt, MD, MACP, FIDSA, FSHEA is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, 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, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Klaus-Dieter Lessnau, MD, FCCP Former 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 Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Raphael J Kiel, MD Associate Professor of Medicine, Wayne State University School of Medicine; Associate Professor of Medicine, Oakland University William Beaumont School of Medicine; Consulting Staff, Infectious Diseases Division, William Beaumont Hospital; Consulting Staff, Infectious Diseases Division Providence 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.

Alexandre Lacasse, MD, MSc Internal Medicine Faculty, Assistant Director, Medicine Clinic, Infectious Disease Consultant, St Mary's Health Center

Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.