Mycobacterium marinum infection in humans occurs mainly as a granulomatous infection after exposure of traumatized skin to contaminated water. It is usually confined to the skin and soft tissue. Disseminated disease involving other organs rarely occurs in immunocompetent patients. Here, we report a case of disseminated M. marinum infection involving not only the cutaneous tissue, but also the lung of a male patient with uncontrolled diabetes and a previous history of steroid injection who was employed by a deep-water fishery.
Diabetes Mellitus* ; Fisheries ; Humans ; Lung* ; Male ; Mycobacterium marinum* ; Mycobacterium* ; Skin ; Steroids ; Water

Mycobacterium marinum infection in humans occurs mainly as a granulomatous infection after exposure of traumatized skin to contaminated water. It is usually confined to the skin and soft tissue. Disseminated disease involving other organs rarely occurs in immunocompetent patients. Here, we report a case of disseminated M. marinum infection involving not only the cutaneous tissue, but also the lung of a male patient with uncontrolled diabetes and a previous history of steroid injection who was employed by a deep-water fishery.
Diabetes Mellitus* ; Fisheries ; Humans ; Lung* ; Male ; Mycobacterium marinum* ; Mycobacterium* ; Skin ; Steroids ; Water

No abstract available.
Mycobacterium marinum* ; Mycobacterium* ; Polymerase Chain Reaction*

BACKGROUND: As the immunocompromised population has increased in recent years, the number of cutaneous nontuberculous mycobacterial (NTM) infections has also risen. However, since this affliction has no pathognomonic clinical or histological features, the diagnosis and treatment of cutaneous NTM infections are often delayed. OBJECTIVE: The aim of this study was to investigate the microbiological, clinical, and histological findings of cutaneous NTM infections. METHODS: We reviewed medical records and histologic slides of 10 patients diagnosed with cutaneous NTM infections confirmed by culture or polymerase chain reaction. RESULTS: All patients except one were immunocompetent, and 5 of 10 patients had preceding factors including trauma, liposuction, and intralesional triamcinolone injection. Microbiologically, of the 10 infections, 5 were caused by Mycobacterium marinum, 3 by Mycobacterium fortuitum, and 1 each by Mycobacterium chelonae and Mycobacterium ulcerans, respectively. Of the 5 patients with M. marinum, 2 had a fish-related job and 1 reared fish at a home aquarium. The most common clinical presentation was erythematous nodules (7/10). Histologically, irregular acanthosis (4/10), mixed cell infiltrate of lymphocytes, histiocytes, neutrophils (9/10), suppurative granuloma (7/10), microcysts lined by neutrophils (5/10), fibrosis (4/10), and panniculitis (7/10) were identified. CONCLUSION: We found microcysts lined by neutrophils in 50% of the samples and considered this finding to be a diagnostic marker of NTM infection. These clinicopathologic features will assist clinicians in diagnosing NTM infection more rapidly and accurately.
Diagnosis ; Fibrosis ; Granuloma ; Histiocytes ; Humans ; Lipectomy ; Lymphocytes ; Medical Records ; Mycobacterium chelonae ; Mycobacterium fortuitum ; Mycobacterium marinum ; Mycobacterium ulcerans ; Neutrophils ; Nontuberculous Mycobacteria ; Panniculitis ; Polymerase Chain Reaction ; Triamcinolone

Mycobacterium marinum is an atypical mycobacterium (ATM) and is an uncommon cause of skin and soft tissue infections associated with contact with contaminated water. Diagnosis is often delayed when only a conventional identification method is used. PCR amplification and direct sequencing is recently available method for rapid identification of ATM. We report a case of M. marinum infection identified by PCR and sequencing. A 56-year-old female was referred for multiple erythematous nodules on both forearms which appeared two months ago. Skin biopsy showed suppurative granulomatous inflammation, and AFB culture showed nontuberculous Mycobacteria. PCR and sequencing were performed, and the obtained sequences were compared to the database using BLAST. The sequences of 16S rRNA and rpoB could not differentiate between M. marinum and M. ulcerans, showing 100% homology to both. Identification was possible using the sequences of the tuf and hsp65 genes, showing both 100% homology to M. marinum, while 99.8%, 99.7% to M. ulcerans. The patient was treated with clarithromycin, rifampicin, and ethambutol for 6 months.
Biopsy ; Clarithromycin ; Ethambutol ; Female ; Forearm ; Humans ; Inflammation ; Middle Aged ; Mycobacterium ; Mycobacterium Infections, Nontuberculous ; Mycobacterium marinum ; Nontuberculous Mycobacteria ; Polymerase Chain Reaction ; Rifampin ; Skin ; Soft Tissue Infections

Mycobacterium marinum is an uncommon cause of skin and soft-tissue infection. The diagnosis of M. marinum infection is often delayed when only a conventional tissue culture method is used. PCR-restriction fragment length polymorphism (RFLP) analysis using the novel region of the rpoB gene is now available for the rapid identification of Mycobacteria. We report a case of hand infection caused by M. marinum that was identified by PCR-RFLP analysis. The PCR-RFLP assay is a specific and rapid method for the identification of Mycobacteria that facilitates the early diagnosis of non-tuberculous Mycobacterium infection.
Early Diagnosis ; Hand ; Mycobacterium ; Mycobacterium Infections ; Mycobacterium marinum ; Skin ; Tenosynovitis

Mycobacterium marinum is an uncommon cause of skin and soft-tissue infection. The diagnosis of M. marinum infection is often delayed when only a conventional tissue culture method is used. PCR-restriction fragment length polymorphism (RFLP) analysis using the novel region of the rpoB gene is now available for the rapid identification of Mycobacteria. We report a case of hand infection caused by M. marinum that was identified by PCR-RFLP analysis. The PCR-RFLP assay is a specific and rapid method for the identification of Mycobacteria that facilitates the early diagnosis of non-tuberculous Mycobacterium infection.
Early Diagnosis ; Hand ; Mycobacterium ; Mycobacterium Infections ; Mycobacterium marinum ; Skin ; Tenosynovitis

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.
Female ; *Hand/radiography ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mycobacterium Infections, Nontuberculous/*diagnosis/etiology/radiography ; Mycobacterium avium-intracellulare Infection/*diagnosis/etiology/radiography ; *Mycobacterium marinum ; Surgical Wound Infection/complications ; Tenosynovitis/diagnosis/*microbiology/radiography ; Wound Infection/complications

Mycobacterium marinum (M. marinum) is a nontuberculosis mycobacterium that is normally associated with cutaneous lesions. Most cases occur after an individual has suffered minor trauma in association with contaminated fresh or salt water. In immunocompromised patients, M. marinum can cause osteomyelitis, synovitis and/or disseminated infection, which can be mistaken for rheumatoid arthritis (RA) or remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Therefore, precise history taking and specimen culture are very important for early diagnosis and appropriate treatment. We report an unusual case of septic polyarthritis due to M. marinum that was diagnosed by culture and improved with antibiotic therapy.
Arthritis ; Arthritis, Rheumatoid ; Early Diagnosis ; Edema ; Immunocompromised Host ; Mycobacterium ; Mycobacterium Infections, Nontuberculous ; Mycobacterium marinum ; Osteomyelitis ; Synovitis

BACKGROUNDAn increasing incidence of disease caused by nontuberculous mycobacteria (NTM) is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai.

METHODSAll NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system.

RESULTSA total of 21,221 specimens were cultured, of which 4868 (22.94%) grew acid fast bacilli (AFB), and 248 (5.09%) of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae (26.7%), followed by M. fortuitum (15.4%), M. kansasii (14.2%), M. avium-intracellulare complex (13.1%) and M. terrae (6.9%). The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. gordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance.

CONCLUSIONSThe prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.

Antitubercular Agents ; pharmacology ; China ; epidemiology ; Drug Resistance, Bacterial ; Mycobacterium ; drug effects ; physiology ; Mycobacterium Infections ; epidemiology ; microbiology ; Mycobacterium chelonae ; drug effects ; physiology ; Mycobacterium fortuitum ; drug effects ; physiology ; Mycobacterium kansasii ; drug effects ; physiology ; Mycobacterium marinum ; drug effects ; physiology ; Mycobacterium xenopi ; drug effects ; physiology ; Nontuberculous Mycobacteria ; drug effects ; physiology ; Prevalence