Mycobacterium marinum: Difference between revisions
Ostermayer (talk | contribs) |
ClaireLewis (talk | contribs) |
||
| (10 intermediate revisions by 2 users not shown) | |||
| Line 3: | Line 3: | ||
*Bacteria that causes "fish tank Granuloma" | *Bacteria that causes "fish tank Granuloma" | ||
*Can infect both immunocompetent and immunocompromised hosts | *Can infect both immunocompetent and immunocompromised hosts | ||
*M. marinum is generally not found in chlorinated swimming pools<ref>Slany M et al. Mycobacterium marinum infections in humans and tracing of its possible environmental sources. Can J Microbiol. 2012. 58(1): 39-44</ref> | |||
===Risk Factors=== | ===Risk Factors=== | ||
*Aquarium workers and enthusiasts | *Aquarium workers and enthusiasts | ||
| Line 12: | Line 12: | ||
[[File:Fish_Tank_Granuloma_picture_1.jpg|thumb|Fish tank granuloma. <ref>Ryan, J and Bryant G. "Fish tank granuloma - a frequently misdiagnosed infection of the upper limb." J Accid Emerg Med. 1997 Nov; 14(6): 398–400.</ref>]] | [[File:Fish_Tank_Granuloma_picture_1.jpg|thumb|Fish tank granuloma. <ref>Ryan, J and Bryant G. "Fish tank granuloma - a frequently misdiagnosed infection of the upper limb." J Accid Emerg Med. 1997 Nov; 14(6): 398–400.</ref>]] | ||
[[File:Fish_tank_granuloma_4.png|thumb|Fish tank granuloma spreading via lymphatic channels.]] | [[File:Fish_tank_granuloma_4.png|thumb|Fish tank granuloma spreading via lymphatic channels.]] | ||
*Solitary to multiple superficial red nodules or plaques in exposed areas | *Solitary to multiple superficial red [[rash|nodules]] or plaques in exposed areas | ||
**Lesions on the hands and fingers if works with aquariums, or the knees and elbows in swimmers | **Lesions on the hands and fingers if works with aquariums, or the knees and elbows in swimmers | ||
*Ascending lymphangitis that resembles [[ | *Ascending [[lymphangitis]] that resembles [[sporotrichosis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{SSTI DDX}} | {{SSTI DDX}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis in ED | *Clinical diagnosis in ED | ||
*Can be aided by histopathology | *Can be aided by histopathology | ||
*If there is an affected joint it is important to evaluate for a [[septic arthritis]] | |||
*If there are draining wounds consider imaging and evaluate for [[osteomyelitis]] | |||
==Management== | ==Management== | ||
# Long-term antibiotic therapy | #Long-term antibiotic therapy (2-18 weeks) | ||
#*Monotherapy with [[doxycycline]], [[clarithromycin]], [[bactrim]], or [[minocycline]]<ref>Petrini, B; "Mycobacterium Marinum: ubiquitous Agent of Waterborne Granulomatous Skin Infections." European Journal of Clinical Microbiology and Infectious Diseases. October 2006, Volume 25, Issue 10, pp 609-613</ref><ref>Rallis, E; Koumantaki-Mathioudaki, E; "Treatment of Mycobacterium Marinum Cutaneous Infections." Expert Opinion on Pharmacotherapy. Volume 8, Issue 17, 2007</ref> | #*Monotherapy with [[doxycycline]], [[clarithromycin]], [[bactrim]], or [[minocycline]]<ref>Petrini, B; "Mycobacterium Marinum: ubiquitous Agent of Waterborne Granulomatous Skin Infections." European Journal of Clinical Microbiology and Infectious Diseases. October 2006, Volume 25, Issue 10, pp 609-613</ref><ref>Rallis, E; Koumantaki-Mathioudaki, E; "Treatment of Mycobacterium Marinum Cutaneous Infections." Expert Opinion on Pharmacotherapy. Volume 8, Issue 17, 2007</ref> | ||
#*Secondary to drug high levels of drug resistance, may require dual drug therapy | #*Secondary to drug high levels of drug resistance, may require dual drug therapy | ||
# Warm compresses (bacterium is heat-sensitive) | #Warm compresses (bacterium is heat-sensitive) | ||
==Disposition== | ==Disposition== | ||
*Unless the patient has evidence of sepsis, severe pain, or has other severe complicating medical problems, outpatient treatment is acceptable. | |||
==Clinical Course== | |||
*M marinum infection may result in non-healing ulcers or a septic arthritis. | |||
*Aggressive or long standing . marinum infection may cause severe osteomyelitis requiring surgical debreedment | |||
==See Also== | ==See Also== | ||
| Line 35: | Line 41: | ||
==External Links== | ==External Links== | ||
*[https://a816-health30ssl.nyc.gov/sites/nychan/Lists/AlertUpdateAdvisoryDocuments/Mycobacterium%20marinum%20outbreak.pdf NYC Chinatown M. marinum outbreak] | |||
==References== | ==References== | ||
| Line 40: | Line 47: | ||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Dermatology]] | ||
Latest revision as of 22:59, 27 September 2019
Background
- Atypical Mycobacterium species found in fresh or salt water (cold or warm)
- Bacteria that causes "fish tank Granuloma"
- Can infect both immunocompetent and immunocompromised hosts
- M. marinum is generally not found in chlorinated swimming pools[1]
Risk Factors
- Aquarium workers and enthusiasts
- Swimming
- Handling of contaminated water
Clinical Features
Fish tank granuloma. [2]
- Solitary to multiple superficial red nodules or plaques in exposed areas
- Lesions on the hands and fingers if works with aquariums, or the knees and elbows in swimmers
- Ascending lymphangitis that resembles sporotrichosis
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Evaluation
- Clinical diagnosis in ED
- Can be aided by histopathology
- If there is an affected joint it is important to evaluate for a septic arthritis
- If there are draining wounds consider imaging and evaluate for osteomyelitis
Management
- Long-term antibiotic therapy (2-18 weeks)
- Monotherapy with doxycycline, clarithromycin, bactrim, or minocycline[3][4]
- Secondary to drug high levels of drug resistance, may require dual drug therapy
- Warm compresses (bacterium is heat-sensitive)
Disposition
- Unless the patient has evidence of sepsis, severe pain, or has other severe complicating medical problems, outpatient treatment is acceptable.
Clinical Course
- M marinum infection may result in non-healing ulcers or a septic arthritis.
- Aggressive or long standing . marinum infection may cause severe osteomyelitis requiring surgical debreedment
See Also
External Links
References
- ↑ Slany M et al. Mycobacterium marinum infections in humans and tracing of its possible environmental sources. Can J Microbiol. 2012. 58(1): 39-44
- ↑ Ryan, J and Bryant G. "Fish tank granuloma - a frequently misdiagnosed infection of the upper limb." J Accid Emerg Med. 1997 Nov; 14(6): 398–400.
- ↑ Petrini, B; "Mycobacterium Marinum: ubiquitous Agent of Waterborne Granulomatous Skin Infections." European Journal of Clinical Microbiology and Infectious Diseases. October 2006, Volume 25, Issue 10, pp 609-613
- ↑ Rallis, E; Koumantaki-Mathioudaki, E; "Treatment of Mycobacterium Marinum Cutaneous Infections." Expert Opinion on Pharmacotherapy. Volume 8, Issue 17, 2007