Mycobacterium Marinum Infection Research Articles

Mycobacterium marinum infections of the hand and wrist. Results of conservative treatment in twenty-four cases.

Mycobacterium marinum infections of the hand and wrist. Results of conservative treatment in twenty-four cases.

Tetracyclines in therapy of Mycobacterium marinum infections

Tetracyclines in therapy of Mycobacterium marinum infections

Antigen-specific T-cell anergy in progressive Mycobacterium marinum infection in humans.

The cellular immune responses of 12 patients with culture-proved Mycobacterium marinum infection involving deep tissues were studied. Of the 12 patients, 11 failed to respond to M. marinum antigens. All of the patients had, however, normal blastogenic responses to concanavalin A, phytohemagglutinin, pokeweed mitogen, and the antigens tetanus toxoid and Candida albicans. In contrast, 9 of 14 healthy fishermen responded to the M. marinum antigens with significant in-vitro blastogenesis. Infection of deep tissues with M. marinum is associated with antigen-specific T-cell anergy to M. marinum antigens.

Tetracyclines in Therapy of Mycobacterium marinum Infections

To the Editor. —The editorial Mycobacterium marinumInfections: A Problem of Recognition, Not Therapy? by Brown and Sanders1that appeared in the May 1987 issue of theArchiveswas in response to our article Therapy ofMycobacterium marinumInfections: Use of Tetracyclines vs Rifampin that appeared a year earlier.2As we feel that the editorial distorts what we said in our article, and as readers unfortunately did not have the opportunity to compare the editorial comments with our article in the same issue, we wished to make the following statements: Prior to our article, problems with tetracycline therapy had not been emphasized. Two of the four patients described were clearly tetracycline treatment failures, and the other two were unimproved after two weeks of treatment. In the face of other alternatives (eg, rifampin, sulfamethoxazole and trimethoprim), it seemed prudent to offer the suffering patient alternative agents, and we believed

Mycobacterium marinum infection of the hand and wrist. Results of conservative treatment in twenty-four cases.

Inadequate débridement, extensive scarring, and breakdown of the wound have been commonly encountered after surgical débridement has been employed as the initial treatment of infection with Mycobacterium marinum involving the deep structures of the hand. Because of our disappointment with the results of this form of treatment, from 1982 to 1986 we treated twenty-four patients who had such an infection with rifampicin and ethambutol after a diagnostic biopsy was done. Surgical treatment was deferred until it was determined that the infection had not been controlled by the chemotherapy. The clinical outcome for these patients could be divided into three patterns: eleven patients (Group I) had a good result with no complications, three patients (Group II) had delayed healing of the wound, and ten patients (Group III) did not have a good response to conservative treatment and required one or more surgical débridements. Complications were sometimes associated with use of the drugs, and loss of visual acuity was a concern in three patients. In twenty-one (87 per cent) of the patients, at follow-up the function of the treated hand was equal to that of the other hand. Persistent pain, a discharging sinus, and previous local injection of steroids were unfavorable prognostic factors. If these factors are present, surgical débridement is advised.

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

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

Mycobacterium marinum infections of the hand

Fifteen patients had culture proven Mycobacterium marinum infections of the hand; 11 had injured their hands while fishing in water around Long Island. No patient had type I lesions (verrucal), six patients had type II lesions (subcutaneous granulomas), and nine patients had type III lesions (deep). Histologic examination showed noncaseating granulomas in all cases. A specific defect in the patients' lymphocytes ability to respond to M. marinum antigens was identified. A combination of surgery and tetracycline provided effective treatment. Follow-up averaged 2 1/2 years.

Failure of Doxycycline Treatment in Aquarium-associated Mycobacterium marinum Infections

Two cases of aquarium-associated Mycobacterium marinum infections are described. Neither was cured by the initial therapy consisting of surgical excision followed by doxycycline treatment. Both strains of M. marinum were shown to be resistant to doxycycline. In one patient the lesions were subsequently healed with cotrimoxazole. The other patient, a 12-year-old girl with sporotrichoid spread of the lesions on the lower arm, failed to respond satisfactorily to a combination of rifampicin and ethambutol despite favourable effect in vitro of both drugs. Nine months after the initial treatment, the infection was finally cured with renewed surgery followed by additional chemotherapy with rifampicin and ethambutol. No signs of immunological disorder could be detected in the patient. Increased awareness of the possibility of tetracycline resistance of M. marinum is advocated. A combination of adequate chemotherapy and surgical intervention may be required at least in complicated cases.

An unusually aggressive Mycobacterium marinum hand infection

An unusually aggressive Mycobacterium marinum infection of the hand that progressed despite surgical and medical treatment is presented. The infection progressed over a 3-week period after the patient had surgical treatment and received isoniazid (INH), rifampin, and ethambutol hydrochloride. The patient had a collar-button abscess, destruction of the metacarpophalangeal (MCP) joint capsule, flexor and extensor tenosynovitis, and metacarpal and proximal phalanx bone destruction at the MCP joint and metacarpal shaft. Although atypical mycobacterial infections of the hand are usually indolent but persistent, this Mycobacterium marinum hand infection progressed rapidly, even with surgical and medical treatment. A judgment was made to perform an index ray amputation. With a more complete excision of the infected tissue, there was a higher probability of controlling this severe infection. The patient was treated with antituberculosis medications for 6 months and is doing well 1 year after the operation.

Mycobacterium marinum infection in gnotobiotic nu/nu mice pretreated with cyclophosphamide and silica

Germfree nude mice (NMRJ — nu/nu) and germfree nu/+ mice were infected with Mycobacterium marinum in the footpad test. After pretreatment with 400 mg/kg cyclophosphamide, significantly higher amounts of M. marinum were reached in the footpad and in the liver. On the other hand, the yield of M. marinum could not be elevated by in vivo inhibition of macrophages with silica.

Therapy of Mycobacterium marinum Infections

We describe four patients with Mycobacterium marinum infections who did not respond to two- to six-week courses of therapy with tetracycline, minocycline, and doxycycline. All four patients had prompt responses to therapy with either rifampin alone (two patients) or rifampin in combination with ethambutol. Results of antimicrobial sensitivity tests may be helpful in guiding therapy. Rifampin may be the drug of choice for treatment of these infections.

Opportunistic mycobacterial infections.

Infections with nontuberculous Mycobacterium species have been recognized with increasing frequency in recent years, particularly among patient who are immunosuppressed, have prior lung disease, or have undergone invasive procedures and operations. The infections may be self-limited and mild, as in cases of Mycobacterium marinum infection, or disseminated and life-threatening, as in some cases of M. intracellulare infection. Diagnosis of these infections can present a problem, both because the organisms can be difficult to grow in the laboratory and because they are found in the environment. Furthermore, distinguishing infection from colonization is often difficult. Therapy is complicated because many of the isolates are resistant to antituberculosis drugs, and the results of susceptibility testing with other drugs do not necessarily correlate with therapeutic responses. In addition, the epidemiology of such infections is difficult to study because of the lack of definitive markers.

Mycobacterium marinum infection confused with sporotrichosis

Mycobacterium marinum infection confused with sporotrichosis

Mycobacterium marinum infection of the skin in Japan.

ABSTRACTBased on several reviews in Japanese dermatological journals, seventy‐five cases of bacteriologically confirmed Mycobacterium marinum infection of the skin from 1969 through 1980 have been accumulated. These 75 cases accounted for 82% of all reported cases of atypical mycobacterial infections of the skin in Japan (1).The following features were noted: Approximately half of the cases were occupationally related to fish handling; the other half occurred among fish tank hobby enthusiasts. The clinical presentation usually suggested sporotrichosis, with the majority of the skin eruptions appearing on the hand and 96 % being unilateral. Minocycline is recommended as the drug of choice.

Pulmonary Infiltrates and Eosinophilia From Minocycline

To the Editor.— A variety of drugs has been implicated as causes of pulmonary infiltrates with peripheral eosinophilia. Ho et al 1 described two patients in whom administration of a tetracycline antibiotic was associated with diffuse skin rash and pulmonary infiltrates with eosinophilia. Report of a Case.— A 55-year-old woman was given oral minocycline hydrochloride (100 mg twice a day) in December 1982 for treatment of a cutaneous Mycobacterium marinum infection. Approximately four weeks later, the skin lesions had resolved but she experienced fever, chills, night sweats, and fatigue. The minocycline therapy was discontinued and she was admitted to the hospital. Her temperature was 40 °C. On auscultation, breath sounds were decreased and fine crackles were heard over both lung bases. Admission chest x-ray film showed diffuse bilateral fine reticulonodular infiltrates involving all lobes but most prominent in the lung bases. The WBC count was 12,900/cu mm with 22% eosinophils; an

Mycobacterium marinum infection of the hand involving deep structures

Five patients with Mycobacterium marinum infection of the hand involving deep structures were seen recently. Four of them were fishermen. Hydrocortisone injection or simple incision and drainage led to worsening of the infection. The clinical presentation, operative finding, and histopathologic and microbiologic features were quite similar in all five patients. Extensive debridement and therapy with ethambutol and rifampin led to satisfactory results in four patients while biopsy and therapy in the fifth patient seemed to offer another form of acceptable treatment.

Sporotrichoid mycobacterial infection: Case report and review

A patient with a sporotrichoid Mycobacterium marinum infection was successfully treated with minocycline hydrochloride. The subject of sporotrichoid mycobacterial infection is reviewed.

Effects of treatment with muramyl dipeptide on resistance to Mycobacterium leprae and Mycobacterium marinum infection in mice

Studies were carried out to determine whether treatment of mice with the synthetic adjuvant muramyl dipeptide (MDP) afforded resistance to infection with Mycobacterium leprae or M. marinum in mice. Regardless of the timing, dose, or route of administration, there was no evidence that treatment with MDP or 3 of its analogs (desMDP, abuMDP, valMDP) enhanced resistance to food pad infection with M. leprae or M. marinum. In parallel studies, systemic treatment with Proprionibacterium acnes failed to protect against either M. leprae or M. marbium. Administration of P. acnes locolly into the foot pad afforded marginal resistance to M. marinum when injected prior to infection. Local treatment with P. acnes afforded marked rsistance to growth of M. leprae, even when administered months after infection.

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

Acute haematogenous osteomyelitis in infancy and childhood.

Chronic osteomyelitis is recognised as a very old disease, but acute osteomyelitis appears to have been understood only in the last 50 or so years. Until the latter part of the nineteenth century, acute osteomyelitis was only rarely recognised, except as a complication of open fractures or local sepsis. According to Wilensky (1927) the term osteomyelitis was probably coined by Nelaton in 1844. Acute osteomyelitis has always been a serious disease because of the risk to the life of the patient as well as its tendency to chronicity and recurrence. Recent improvements in surgical care and chemotherapy have made it less