Mycobacterium marinum: A brief update for clinical purposes

Extrapulmonary Comparisons Between Mycobacterium Tuberculosis and Non-Tuberculous Mycobacteria: From Manifestations and Diagnosis to Treatment

The incidence of tuberculosis (TB) and non-tuberculous mycobacteria (NTM) diseases and the number of deaths from these diseases are steadily increasing worldwide. However, the pathologic diagnosis of NTM disease is similar to that of tuberculosis, and it is often difficult to distinguish between the two, which can lead to misdiagnosis and treatment aversion. Therefore, differentiation between the two can help in accurate diagnosis and treatment planning. This review compares the presentation, diagnosis, and treatment of common extrapulmonary sites of involvement in tuberculosis and non-tuberculous mycobacterial disease.

Cutaneous Granuloma Resulting from Mixed Infection with Mycobacterium marinum and Candida metapsilosis: A Case Report of Successful Treatment

Background

Mycobacterium marinum and Candida metapsilosis are rare pathogens that cause chronic cutaneous and soft tissue infections. Although molecular technologies have improved their diagnosis, both diseases are challenging to treat. Here, we describe the first case of cutaneous granuloma caused by concurrent M. marinum and C. metapsilosis infections.

Case Presentation

A 67-year-old male patient presented with a one-year history of painful erythematous nodules on his left ring finger after a fish stabbing. He was apparently immunocompetent and received no immunosuppressive treatment. Histopathological examination revealed infectious granuloma. Positive cultures for mycobacteria and fungi, along with molecular testing, confirmed the mixed infection with M. marinum and C. metapsilosis. Considering his old age and hepatitis B core antibody, we initiated treatment with oral clarithromycin, topical sulfadiazine silver cream (SSC), and topical nifuratel nystatin gel (NNG). Owing to adverse events, the course of clarithromycin was limited to ten days. Nonetheless, a three-month regimen of continuous topical SSC and NNG led to the complete recovery of his lesions without recurrence.

Conclusion

This is the first reported case of mixed infection with M. marinum and C. metapsilosis. The combination therapy with 10-day oral clarithromycin treatment and 3-month topical SSC and NNG successfully treated superficial infections caused by these two distinct pathogens. This case could offer a viable alternative for patients unable to endure prolonged systemic therapy. Further studies are required to verify its efficacy.

Seventeen cases of Mycobacterium marinum infection in Italy: A multicenter retrospective study

Mycobacterium marinum infection is rare, misrecognized and underdiagnosed but can cause severe clinical pictures, especially if the diagnosis is late and the patient is immunocompromised. Treatment includes long-term antibiotic therapy combined with surgical therapy when necessary. We performed a multicenter retrospective study with data from five Italian hospitals describing the epidemiological, clinical, bacteriological characteristics, and treatment outcome of subjects diagnosed with M. marinum infection. During the study period 17 subjects were enrolled. The median time from symptoms onset to diagnosis was 124 days. Thirteen out of 17 were bacteriologically confirmed cases. In all cases, expect one, at least two antibiotics were used with a median of 6 months of treatment, leading to clinical resolution. Too often, the diagnosis of M. marinum infection is delayed and it remains largely presumptive. Prospective studies and randomized controlled trials are necessary to better understand the most appropriate therapeutic regimen and duration.

Aquaculture requires special consideration in National Action Plans for Antimicrobial Resistance

Antimicrobial resistance (AMR) demands collective action to reduce and mitigate its threats. The Quadripartite collaboration of the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP) and World Organization for Animal Health (WOAH) has led development and implementation of National Action Plans (NAPs) that describe approaches each country will take to tackle AMR. All antimicrobial users and sectors should be included, and the Quadripartite encourages a One Health approach. Aquaculture has received mixed coverage in NAPs: Here, we argue why aquaculture requires special consideration. Aquaculture is a diverse, global collection of industries and activities, with heterogeneity in systems and species greatly exceeding terrestrial food-animal production, with products traded internationally in huge volumes. Almost 6 % of global total antibiotic usage is estimated to be applied in aquaculture, with per-biomass quantities in some species exceeding usage in human and terrestrial food-animals. The watery nature of aquaculture interconnects it with other One Health compartments: humans, other animals and the wider environment. Rapid industry growth challenges relatively detached stakeholders such as regulators and NAP creators to remain abreast of changing practices, whilst support capabilities and capacity, e.g., health services, typically lag behind growing needs. To integrate aquaculture effectively into next-generation NAPs, ensuring policies cover the One Health spectrum, NAP creators need to recognise the diversity of aquaculture and initiate engagement across associated value chains, especially health service providers. Disentangling the industry can assist formulation of realistic policies for heterogenous contexts and identify pathways to implementation. Resource allocation must be appropriate and include relevant government departments, whilst improved ways to track and monitor AMR, including those international activities that impact AMR domestically, through suitable data collection are key to monitoring and evaluating policies. Better NAPs are crucial to addressing AMR and this coordinated global approach provides our best opportunity for success.

Isolation and identification of non-tuberculous mycobacteria from aquarium fish in Ilam, Iran

Non-tuberculous mycobacteria (NTM) are among the most important pathogens in wild, captive, marine, and freshwater fish species. So, it is important to consider fish as the primary source of infection for aquarium fish and humans. The present study analyzed the occurrence of NTM in aquarium fish in Ilam, west of Iran. In total, 50 samples of infected fish were collected from different aquariums. Following initial sample processing, sediment of each sample was inoculated into Lowenstein-Jensen and Herrold egg media. The positive colonies were investigated with, growth rate, pigmentation, colony morphology, niacin accumulation, nitrate reduction, catalase activity, urease activity, and arylsulfatase activity. Also, molecular identification was carried out by sequencing of heat shock protein 65 kD gene (hsp65) sequence analysis. According to our results, NTM were isolated from 13 samples (26%), comprising 6 (46.2%) rapid growing, and 7 (53.8%) slow growing mycobacteria. In addition, Mycobacterium marinum was the most common NTM isolated in ornamental fish, which is potentially dangerous for both fish and humans. In conclusion, the current study indicates that ornamental fish play a significant role as a source of NTM.

Semisynthesis, Structure Elucidation and Anti-Mycobacterium marinum Activity of a Series of Marine-Derived 14-Membered Resorcylic Acid Lactones with Interesting Ketal Groups

The incidence of Mycobacterium marinum infection is on the rise; however, the existing drug treatment cycle is lengthy and often requires multi-drug combination. Therefore, there is a need to develop new and effective anti-M. marinum drugs. Cochliomycin A, a 14-membered resorcylic acid lactone with an acetonide group at C-5' and C-6', exhibits a wide range of antimicrobial, antimalarial, and antifouling activities. To further explore the effect of this structural change at C-5' and C-6' on this compound's activity, we synthesized a series of compounds with a structure similar to that of cochliomycin A, bearing ketal groups at C-5' and C-6'. The R/S configuration of the diastereoisomer at C-13' was further determined through an NOE correlation analysis of CH3 or CH2 at the derivative C-13' position and the H-5' and H-6' by means of a 1D NOE experiment. Further comparative 1H NMR analysis of diastereoisomers showed the difference in the chemical shift (δ) value of the diastereoisomers. The synthetic compounds were screened for their anti-microbial activities in vitro. Compounds 15-24 and 28-35 demonstrated promising activity against M. marinum, with MIC90 values ranging from 70 to 90 μM, closely approaching the MIC90 of isoniazid. The preliminary structure-activity relationships showed that the ketal groups with aromatic rings at C-5' and C-6' could enhance the inhibition of M. marinum. Further study demonstrated that compounds 23, 24, 29, and 30 had significant inhibitory effects on M. marinum and addictive effects with isoniazid and rifampicin. Its effective properties make it an important clue for future drug development toward combatting M. marinum resistance.

Fishy story: paradoxical reaction associated with Mycobacterium marinum

Paradoxical reactions occur when an infection has acute worsening in response to antibiotic therapy. Here, we describe a patient with chronic cutaneous ulcerative lymphangitis that acutely worsened following initiation of antibiotic therapy. The infection was caused by Mycobacterium marinum, a species which has not previously been associated with paradoxical reaction in immunocompetent persons. In this case report, we describe our patient's diagnosis and management, review the management of Mycobacterium marinum infection, and discuss paradoxical reactions in mycobacterial disease.

Mycobacterium marinum hand infection: a case report and literature review

Mycobacterium marinum, a photochromogenic, slow-growing mycobacterium, thrives in both marine and freshwater environments. Optimal growth occurs between 25°C and 35°C, with survival becoming challenging above 37°C. Typically, M. marinum enters the body via skin abrasions, often leading to infections of the upper extremities. Diagnosis of M. marinum infection is frequently challenging and delayed due to the difficult pathogen identification. At present, a standardized treatment protocol has yet to be established. Presented herein is a case study detailing an infection of the right hand's middle finger caused by M. marinum. Notably, his occupation as a chef, handling fish and seafood post-injury, was a significant factor. Histological examination of the skin biopsy and positive acid-fast staining were consistent with a diagnosis of mycobacterial infection. Pathological examination confirmed a skin infection with infectious granuloma, and tissue section acid-fast staining revealed acid-fast bacill. Cultures on Columbia blood agar yielded rough, flattened, yellow-fleshy colonies after 10 days, which was identified as M. marinum through 16S rRNA sequencing. The patient responded well to a 3-month regimen of oral moxifloxacin (0.4 qd) and linezolid (0.6 qd), resulting in rash resolution and pain relief, with no recurrence observed for 1-year follow-up. This report presents the first documented acid-fast staining images of M. marinum tissue sections and colony morphology photographs, offering an in-depth view of M. marinum's morphological characteristics. It aims to enhance awareness of M. marinum infections, underscore the necessity for clinicians to delve into patient histories, and provide a review of the clinical manifestations, diagnostic techniques, therapeutic approaches, and pathogenic mechanisms associated with M. marinum.

High-mortality epizootic Mycobacterium ulcerans ecovar Liflandii in a colony of Zaire Dwarf Clawed Frogs (Hymenochirus boettgeri)

Mycobacterium ulcerans ecovar Liflandii (MuLiflandii) was identified as the causative agent of mycobacteriosis in a research colony of Zaire dwarf clawed frogs (Hymenochirus boettgeri) at the University of Michigan. Clinical presentation included lethargy, generalized septicemia, cutaneous granulomas, coelomic effusion, and acute mortality. Identification of the mycobacterial species was based on molecular, microbiological, and histopathologic characteristics. These findings indicate that MuLiflandii is a primary cause of morbidity and mortality in Zaire dwarf clawed frogs and should be considered in the differential diagnosis of sepsis and coelomic effusion in amphibians. Mycobacterial speciation is important given the variability in pathogenesis within the family Mycobacteriaceae and the implications for both animal and human health as potential zoonoses. The Zaire dwarf clawed frog is a species common in the pet trade, and these findings provide consideration for this pathogen as a potentially important public health concern. This is the first report of MuLiflandii infection in the genus Hymenochirus and illustrates the diagnostic challenges of differentiating among both mycolactone-producing mycobacteria and Mycobacterium marinum. Furthermore, we demonstrate the utility of environmental sampling for this pathogen within the tank system, suggesting this mode of sampling could replace the need for direct frog surveillance.

Activation of host nucleic acid sensors by Mycobacterium: good for us or good for them?

Although the importance of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) sensors in controlling viral infection is well established, their role in promoting an effective immune response to pathogens other than viruses is less clear. This is particularly true for infections with mycobacteria, as studies point to both protective and detrimental roles for activation of nucleic acid sensors in controlling a mycobacterial infection. Some of the contradiction likely stems from the use of different model systems and different mycobacterial species/strains as well as from which nucleic acid sensors were studied and what downstream effectors were evaluated. In this review, we will describe the different nucleic acid sensors that have been studied in the context of mycobacterial infections, and how the different studies compare. We conclude with a section on how nucleic acid sensor agonists have been used therapeutically and what further information is needed to enhance their potential as therapeutic agents.

Characterization of microbial contamination in agricultural soil: A public health perspective

Soil is widely recognized as a reservoir of microbial contaminants including antibiotic resistance genes (ARGs) and human bacterial pathogens (HBPs), which are major public health concerns. Although the risks associated with soil safety in different soil habitats have been studied, the results are not comprehensive. In this study, dryland soils used for vegetable, corn, and soybean planting, and submerged soils used for rice planting and crab farming were collected and subjected to metagenomic sequencing to characterize HBPs, ARGs, and virulence factor genes (VFGs). The results showed that submerged soils had a higher abundance of HBP than dryland soils. In addition, the submerged soil microbiome acquired significantly higher levels of high-risk ARGs than the dryland soil microbiome and these ARGs were mainly assigned to bacA, sul1, and aadA genes submerged. Network analysis revealed that 11 HBPs, including Yersinia enterocolitica, Vibrio cholerae, Escherichia coli, and Leptospira interrogans, were high-risk because of their close association with ARGs, VFGs, and mobile genetic elements (MGEs). Procrustes and network analyses showed that HBPs and ARGs were more closely linked in submerged soil. This study confirms that submerged field has higher ecological environment risk and human health risk than dryland soil.

Environmental Sources and Transmission of Nontuberculous Mycobacteria

The field of environmental nontuberculous mycobacteria (NTM) is benefiting from a new era of genomics that has catapulted our understanding of preferred niches, transmission, and outbreak investigations. The ability to forecast environmental features that promote or reduce environmental NTM prevalence will greatly improve with coordinated environmental sampling and by elevating the necessity for uniform disease notifications. Studies that synergize environmental biology, isolate notifications, and comparative genomics in prospective, longitudinal studies, particularly during climate changes and weather events, will be useful to solve longstanding NTM public health quandaries.

Mycobacterium marinum: A Case-Based Narrative Review of Diagnosis and Management

Skin and soft tissue infections caused by non-tuberculous mycobacteria are occurring more frequently in recent years. However, chronic skin and soft tissue lesions present a challenge for clinicians, as the diagnostic work-up and definitive diagnosis require knowledge and available laboratory resources. We present here the case of a 66-year-old male patient who presented with painful abscess-like nodules on his right hand and forearm, which worsened after treatment with an anti-TNF-a agent. The fluid specimen taken from the lesion was positive for mycobacteria according to the acid-fast stain. Mycobacterium marinum was identified, first by next-generation sequencing and finally grown on culture, after eight weeks. Acknowledging the complexity of diagnosing and managing infections by non-tuberculous mycobacteria, and especially Mycobacterium marinum, we provide a review of the current epidemiology, clinical characteristics, diagnosis and management of Mycobacterium marinum infection.

Molecular epidemiology of nontuberculous mycobacteria isolated from tuberculosis-suspected patients

It is a growing problem around the world to deal with nontuberculous mycobacteria infection (NTM), but its clinical significance is still largely unknown. This study aims to investigate the epidemiology of NTM infections from various clinical samples and determine their clinical significance. From December 2020 to December 2021, 6125 clinical samples were collected. In addition to phenotypic detection, genotypic detection through multilocus sequence typing (hsp65, rpoB, and 16S rDNA genes) and sequencing was also conducted. Records of patients were consulted for clinical information, such as symptoms and radiological findings. Of the 6,125 patients, 351 (5.7%) were positive for acid-fast bacteria (AFB). Out of 351 AFB, 289 (82.3%) and 62 (17.7%) subjects were identified as M. tuberculosis complex (MTC) and NTM strains, respectively. Isolates of Mycobacterium simiae and M. fortuitum were the most frequent, followed by isolates of M. kansasii and M. marinum. We also isolated M. chelonae, M. canariasense, and M. jacuzzii, which are rarely reported. Symptoms (P = 0.048), radiographic findings (P = 0.013), and gender (P = 0.039) were associated with NTM isolates. M. Fortuitum, M. simiae, and M. kansasii presented with bronchiectasis, infiltration, and cavitary lesions most frequently, while cough was the most common symptom. In conclusion, Mycobacterium simiae and M. fortuitum were presented in seventeen and twelve NTM isolates from the collected samples. There is evidence that NTM infections in endemic settings may contribute to the dissemination of various diseases and the control of tuberculosis. In spite of this, further research is needed to evaluate the clinical significance of NTM isolates.

Comparative Evaluation of LAMP and Nested PCR for the Rapid Diagnosis of Mycobacterium marinum Infection

Purpose

Culture of Mycobacterium marinum is very time-consuming, taking several weeks to produce positive results. Seeking rapid and sensitive diagnostic methods for diagnosis can greatly improve patient treatment. Our study aimed to compare the rapid diagnostic abilities of polymerase chain reaction (PCR), nested PCR and loop mediated isothermal amplification (LAMP) of detecting M. marinum in skin samples from patients with M. marinum infection.

Methods

A total of 6 M. marinum strains and 6 skin samples with definite diagnosis of M. marinum infection were included in the study. We optimized LAMP performance for detection of M. marinum genomic DNA and confirmed the specificity of the primers. Then, the sensitivity of the LAMP and nested PCR assays were assessed by M. marinum strains and clinical samples.

Results

Nested PCR was 10-fold more sensitive than the LAMP assay by serial dilution of M. marinum DNA. PCR positive samples were all positive by LAMP detection of 6 clinical M. marinum strains. Out of 6 clinical skin specimens confirmed as M. marinum infection, 0 (0%), 3 (50%), 3 (50%), and 4 (66.6%) were positive by PCR, nested PCR, LAMP and culture. The LAMP shared the same sensitivity than nested PCR in M. marinum strains and clinical samples, but it was easy to perform and faster than nested PCR assay.

Conclusion

Compared with conventional PCR, LAMP and nested PCR are more sensitive and have a higher detection rate of M. marinum in clinical skin specimens. The LAMP assay proved to be more suitable for rapid diagnosis of M. marinum infection in a shorter time, especially in resource-limited settings.