Fish Tank Granuloma Research Articles

A husband and wife with left hand rashes

A 60-year-old housewife from Newmarket, Cambridgeshire, UK, presented with a 3-month history of inability to flex her left second and third fingers and a painless rash (figure, A). Findings of laboratory tests were unremarkable. A biopsy of the lesions was obtained. 3 weeks later, her 64-year-old, otherwise healthy, farmer husband presented with similar lesions of his left hand (figure, B). The culture of the wife’s biopsy came back positive for Mycobacterium marinum infection (also known as “swimming pool granuloma” or “fish tank finger”). The couple owned an aquarium that they both cleaned regularly. Since they were both right-handed, they would open the aquarium with their right hand and immerse the left hand in the water. Both were treated with clarithromycin 500 mg orally twice daily, the wife for 6 months and the husband for 4 months. Both patients had complete resolution of their symptoms, and are currently in good health. M marinum is a slowly growing environmental mycobacterium, first isolated by Arsonson in 1926. Together with Mycobacterium fortuitum and Mycobacterium chelonae, the bacterium is one of the agents of fish mycobacteriosis that result in disseminated infection, emaciation, and death for more than 150 fish species. Approximately 50% of infections with known exposures are aquarium-related with the remaining related to fish or shellfish injuries, or injuries associated with saltwater or brackish water. M marinum commonly causes superficial skin infections of a sporotrichoid appearance, limited to the cooler areas of the body. The bacterium can also cause tenosynovitis of the hand, together with nine more non-tuberculous mycobacteria species, and, rarely, septic arthritis or osteomyelitis. Disseminated infection is rare.

Fish tank granuloma in a renal transplant and diabetic patient

Fish tank granuloma in a renal transplant and diabetic patient

Mycobacterium marinum Strains Can Be Divided into Two Distinct Types Based on Genetic Diversity and Virulence

Mycobacterium marinum causes a systemic tuberculosis-like disease in a large number of poikilothermic animals and is used as a model for mycobacterial pathogenesis. In the present study, we infected zebra fish (Danio rerio) with different strains of M. marinum to determine the variation in pathogenicity. Depending on the M. marinum isolate, the fish developed an acute or chronic disease. Acute disease was characterized by uncontrolled growth of the pathogen and death of all animals within 16 days, whereas chronic disease was characterized by granuloma formation in different organs and survival of the animals for at least 4 to 8 weeks. Genetic analysis of the isolates by amplified fragment length polymorphism showed that M. marinum strains could be divided in two clusters. Cluster I contained predominantly strains isolated from humans with fish tank granuloma, whereas the majority of the cluster II strains were isolated from poikilothermic species. Acute disease progression was noted only with strains belonging to cluster I, whereas all chronic-disease-causing isolates belonged to cluster II. This difference in virulence was also observed in vitro: cluster I isolate Mma20 was able to infect and survive more efficiently in the human macrophage THP-1 and the carp leukocyte CLC cell lines than was the cluster II isolate Mma11. We conclude that strain characteristics play an important role in the pathogenicity of M. marinum. In addition, the correlation between genetic variation and host origin suggests that cluster I isolates are more pathogenic for humans.

Isolamento, identificazione e sensibilità ai farmaci antimicrobici di due ceppi di Mycobacterium marinum da fish tank granuloma

Mycobacterium marinum is an emerging pathogen responsible for cutaneous infections related to the handling of domestic aquariums.Two distinct strains of M. marinum have been isolated from as many cases of fish tank granuloma. Despite the ability of both strains to grow at 37° C, the detection of their growth by the automated BACTEC 9000MB system, was delayed or not happened at all in comparison with the growth of mycobacterium culture in the Löwenstein-Jensen medium.The different antibiotic susceptibility pattern showed by M. marinum in several studies, required to perform suscepibility testing of two clinical isolates. Both strains were resistant to isoniazid, imipenem, cefoxitine, susceptible to rifampicin, ethambutol, clarithromycin, ciprofloxacin and moderately susceptible to doxycycline.

Fish tank granuloma: response to treatment with clarithromycin

Fish tank granuloma: response to treatment with clarithromycin

Fish tank granuloma--a frequently misdiagnosed infection of the upper limb.

Five patients attended the accident and emergency (A&E) department with fish tank granuloma caused by an infection with Mycobacterium marinum. All patients had forearm symptoms which were initially misdiagnosed. They...

Antimicrobial treatment of fish tank granuloma

Three patients with fish tank granuloma of the hand and forearm are reported. Each patient was treated with antimicrobial regimes which have rarely or never been previously used in this condition. Two patients responded well to treatment, one who received ciprofloxacin plus clarithromycin and another who was given clarithromycin plus ethambutol. The third patient received six different antimicrobial regimes before responding to a combination of rifabutin and ciprofloxacin. Our experience suggests that there now exist a number of effective alternatives to antimicrobials which have been traditionally used in the treatment of cutaneous Mycobacterium marinum infection.

Tenosynovitis due to mycobacteria other than tuberculosis: a hazard of water sports and hobbies

Tenosynovitis is defined as inflammation of a tendon sheath. In established cases it often presents as painful swelling associated with gradual loss of movement and palpable synovial thickening with nodularity and crepitus in the affected tendons. The cause of such inflammation may include autoimmune phenomena as in rheumatoid arthritis, bacterial infection and in the following cases, mycobacterial infection with mycobacteria other than tuberculosis (MO-l-f). Infections of soft tissue and joints with MOTT have been previously described (14) in addition to pulmonary and other extra-pulmonary sites. Mycobacterium marinum infection has been identified as a hazard of leisure pursuits (5,6) and cutaneous mycobacteriosis (7,8) such as ‘fish tank granuloma’. This organism is less often reported involving deeper tissues such as the tendon sheaths in tenosynovitis (9,lO). Mycobacterium kansasii has been reported in pulmonary disease (11,12) but is much less often implicated in chronic bone and joint infection, especially of the wrist and hand (1,13). Both organisms share similar microbiological characteristics; both are slow growing photochromogens (M. marinum optimally cultures at 30°C; M. kansasii at 37°C) (14). These organisms have been isolated from both domestic and environmental water sources (15-17) and can be difficult to demonstrate on direct staining (1). Both organisms share sensitivities to rifampicin and resistance to pyrazinamide, and choice of an optimal second therapeutic agent can be difficult.

Skin Diseases of the Hands and Feet.

In brief A variety of dermatologic problems affect the hands and feet of active patients, often producing significant pain and disability. Traumatic disorders include friction blisters, calcaneal petechiae, subungual hemorrhage, and plezogenic papules. Infectious disorders include hot tub folliculitis, swimming pool granuloma, tinea pedis, warts, and herpetic whitlow. Athletic shoe dermatitis is a common allergic disorder, and hand eczema is a common disorder with a strong hereditary component. Prompt diagnosis and treatment can minimize morbidity. Some traumatic disorders can be prevented.

Mycobacterium marinum cutaneous infections acquired from occupations and hobbies.

Non-tuberculous mycobacterial (NTB) infections are not commonly diagnosed in Thailand. The dissertation of reported cases among 10 published reports of 44 cases within 20 years revealed only six cases of cutaneous infections in which M. marinum was not included. The proven cases of M. marinum infection were studied at the Institute of Dermatology, Bangkok from 1981 to 1990. The clinical data, histopathology, tuberculin test, chest x-ray, and treatments were recorded. M. marinum skin infection accounted for 18 cases (81.8% of NTB skin infection), 10 men and 8 women. A history of preceding trauma occurred in 11 cases (61.1%), most of which were negligible wounds or minor abrasions. Twelve cases (66.7%) were in contact with organisms in their occupations and hobbies associated with fish and water exposure. Eighteen cases of M. marinum cutaneous infection acquired from occupations and hobbies were reported. The term "M. marinum cutaneous infection" or "M. marinum granuloma" instead of swimming pool granuloma or fish tank granuloma was proposed. According to this study, cotrimoxazole was the most appropriate drug for the treatment of M. marinum cutaneous infection.

Cutaneous Mycobacterium marinum infection ("swimming pool granuloma").

Cutaneous Mycobacterium marinum infection ("swimming pool granuloma").

Infection and disease due to the environmental mycobacteria

Saprophytic mycobacteria are widely distributed in the environment and contact between them and man is unavoidable. Immunologically effective contact is responsible for cross-reactivity to tuberculin and there is increasing evidence that it also profoundly affects the nature of subsequent responses to BCG vaccination and to infection by the tubercle and leprosy bacilli. Some environmental mycobacteria occasionally cause overt disease. Two species, Mycobacterium ulcerans and M. marinum, cause characteristic named diseases: Buruli ulcer and swimming pool granuloma respectively. Other species cause pulmonary and non-pulmonary lesions that resemble those of tuberculosis. Disease often, but not always, occurs in individuals with predisposing factors such as damaged lungs or immunosuppressive disorders including AIDS. Diagnosis rests on the isolation and identification of the causative species and treatment is based on antituberculous therapy for extended periods or combinations of various other drugs. In contrast to tuberculosis, the incidence of these diseases appears to be on the increase in the Western world and they merit serious consideration.

Pathology

The lowered index of suspicion on the part of clinicians, occasioned by the decrease in the number of cases of syphilis seen in practice in comparison with former times, has combined with a reduction in emphasis on the disease in medical school curricula to produce an increase in number of biopsies taken for diagnostic purposes from unrecognized early lesions of the disease. Also contributing to this problem are the diagnostic difficulties generated by the appearance of increasing numbers of exotic extragenital chancres, a phenomenon that is the natural consequence of the new sexual adventurousness among heterosexuals and the high incidence of the disease among male homosexuals noted in recent years. Biopsies are being submitted under cover of a wide variety of mistaken clinical diagnoses—psoriasis, lichen planus, pityriasis rosea, Kaposi's sarcoma, sarcoidosis, swimming pool granuloma, drug eruptions, leukemia cutis, mycosis fungoides, carcinoma, and many others. It is, therefore, incubent upon pathologists dealing with this material to be more aware than ever that their clinical colleagues are having difficulties along these lines.

Disseminated Cutaneous Mycobacterium marinum Infection

Since Mycobacterium marinum (balnei) infection in man was first described by Linnell and Norden, 1 numerous cases have been reported, usually in the form of swimming pool granuloma. 2 The disease has also been described as a generalized infection in immunocompromised hosts. 3,4 We present a case of generalized cutaneous M marinum in an immunologically normal infant. Report of a Case A 16-month-old girl was seen at the University of Michigan Hospital, Ann Arbor, with a two-month history of pimplelike lesions on her lower extremities. She had been seen by her local physician, examined several times with repeatedly negative cultures for bacteria, and was treated with various one- to two-week courses of oral antibiotics, including erythromycin ethylsuccinate plus sulfisoxazole, cephalexin, dicloxacillin, and erythromycin. An inpatient course of intravenous methicillin also produced no resolution. History disclosed that the patient was the product of a normal gestation and delivery. She was in

Fish tank granuloma

A case of fish tank granuloma is presented. A lesional biopsy sample yielded growth of Mycobacterium marinum on Löwenstein's medium. Treatment with cotrimoxazole was successful.

Cryosurgery for Benign and Malignant Skin Lesions

The Foster "Froster" unit is a new and simplified liquid nitrogen system for use in dermatologic cryosurgery. The details of its operation are described and its use in various benign, premalignant, and malignant lesions is discussed. In malignant lesions, not only type, but frequently location, is important when deciding whether to use cryosurgery as the first, alternate, or adjunctive choice of therapy. Benign and premalignant lesions which respond best are sebaceous hyperplasia, dermatofibromas, actinic keratoses, leukoplakias, lentigines, and certain seborrheic keratoses and verrucae. Initial promising results have been reported in cases of swimming pool granuloma and chromoblastomycosis. Application of the described technics in one's clinical practice must depend primarily on the level of knowledge of skin lesions and on the degree of skill attained in cryosurgical methods.

An atypical mandibular tumor caused by Mycobacterium balnei

A 12-year-old boy presented a submandibular tumor which contained acid-fast bacilli in the pus. The microorganisms were classified as “anonymous” tubercle bacilli, Mycobacterhan balnei. The patient also showed a positive Pirquet reaction. Diagnosed as tuberculosis of the cervical lymph glands, the tumor was treated with streptomycin, PAS and isoniazid with good effect. Mycobacterium balnei occurs frequently in swimming pools causing “swimming pool granulomas”.

Disease in children due to mycobacteria other than Mycobacterium tuberculosis.

An intensive search for cases of atypical mycobacteriosis in children less than 17 years of age was made. Two large groups of cases have been reported: swimming pool granulomas due to Mycobacterium marinum, and superficial adenitis predominantly cervical and due chiefly to organisms of Runyon Groups II and III. As in adults, disseminated disease is uncommon. Details of 12 cases of generalized disease and 7 cases of chronic osteomyelitis are presented. Six cases of meningitis are reported. In contrast to adults in whom pulmonary disease is the most common form of infection, very few documented cases have been reported in children. Most of the reported cases in children apparently represent disease at the portal of entry.

Swimming pool granuloma due to Mycobacterium scrofulaceum

Swimming pool granuloma due to Mycobacterium scrofulaceum

Swimming Pool Granuloma due to Mycobacterium scrofulaceum

To the Editor.— Mycobacterium marinum (balnei)is known to produce granulomatous infections of the skin. Usually, the suspected source of the infection is either a swimming pool or an aquarium.1,2Mycobacterium scrofulaceumis capable of producing the scrofula syndrome in children (cervical adenitis),3but a search of the literature reveals no reports of granulomatous lesions of the skin due to this organism. Under conditions of reduced resistance,M scrofulaceuminfections have become disseminated with fatal results.4-6Patients with chronic pulmonary disease have been known to yield high colony counts ofM scrofulaceumover long periods of time, but this is rare.4 Generally, this organism is not a pathogen and it is frequently found on cultures from sputum and gastric washings.3Mycobacterium scrofulaceumis a group II schotochrome according to Runyon's classification of the atypical mycobacteria. It is widely distributed in nature and has been isolated