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Tsiolakkis G, Liontos A, Filippas-Ntekouan S, Matzaras R, Theodorou E, Vardas M, Vairaktari G, Nikopoulou A, Christaki E. Mycobacterium marinum: A Case-Based Narrative Review of Diagnosis and Management. Microorganisms 2023; 11:1799. [PMID: 37512971 PMCID: PMC10384600 DOI: 10.3390/microorganisms11071799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
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.
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Affiliation(s)
- Giorgos Tsiolakkis
- Department of Internal Medicine, Nicosia General Hospital, Nicosia 2029, Cyprus
| | - Angelos Liontos
- 1st Division of Internal Medicine & Infectious Diseases Unit, University General Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Str. Niarchou, 45500 Ioannina, Greece
| | - Sempastian Filippas-Ntekouan
- 1st Division of Internal Medicine & Infectious Diseases Unit, University General Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Str. Niarchou, 45500 Ioannina, Greece
| | - Rafail Matzaras
- 1st Division of Internal Medicine & Infectious Diseases Unit, University General Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Str. Niarchou, 45500 Ioannina, Greece
| | | | - Michail Vardas
- School of Medicine, University of Cyprus, Nicosia 2029, Cyprus
| | | | - Anna Nikopoulou
- Department of Internal Medicine, G. Papanikolaou General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Eirini Christaki
- 1st Division of Internal Medicine & Infectious Diseases Unit, University General Hospital of Ioannina, Faculty of Medicine, University of Ioannina, Str. Niarchou, 45500 Ioannina, Greece
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Davies E, Wieboldt J, Stanley T, Maeda Y, Smyth M, Stanley S, Mcclean M, Evans W, Funston C, Millar BC, Goldsmith CE, Moore JE. Isolation and identification of ‘Mycobacterium angelicum’ from a patient with type II respiratory failure: suggested reporting guidelines to molecular clinical laboratories. Br J Biomed Sci 2019. [DOI: 10.1080/09674845.2012.12069140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E. Davies
- Departments of Microbiology, Causeway Hospital, Coleraine, Co. Londonderry
| | - J. Wieboldt
- Departments of Respiratory Medicine, Causeway Hospital, Coleraine, Co. Londonderry
| | - T. Stanley
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - Y. Maeda
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - M. Smyth
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - S. Stanley
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - M. Mcclean
- Northern Ireland Mycobacterium Reference Laboratory, Department of Medical Microbiology, Royal Group of Hospitals
| | - W. Evans
- Department of Microbiology, Antrim Area Hospital, Co. Antrim
| | - C. Funston
- Department of Microbiology, Antrim Area Hospital, Co. Antrim
| | - B. C. Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - C. E. Goldsmith
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
| | - J. E. Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital
- School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, UK
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3
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Pourahmad F, Adams A, Thompson KD, Richards RH. Identification of aquatic mycobacteria based on sequence analysis of the 16S–23S rRNA internal transcribed spacer region. J Med Microbiol 2019; 68:221-229. [DOI: 10.1099/jmm.0.000891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- F. Pourahmad
- 1School of Veterinary Sciences, Ilam University, PO Box 69315516, Ilam, Iran
| | - A. Adams
- 2Institute of Aquaculture, University of Stirling, Stirling FK9 4LA, UK
| | - K. D. Thompson
- 3Aquaculture Research Group, Moredun Research Institute, Pentlands Science Park Bush Loan, Penicuik, Midlothian, UK
| | - R. H. Richards
- 2Institute of Aquaculture, University of Stirling, Stirling FK9 4LA, UK
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Abstract
ABSTRACT
Mycobacterium marinum
is a well-known pathogenic mycobacterium for skin and soft tissue infections and is associated with fishes and water. Among nontuberculous mycobacteria (NTM), it is the leading cause of extrarespiratory human infections worldwide. In addition, there is a specific scientific interest in
M. marinum
because of its genetic relatedness to
Mycobacterium tuberculosis
and because experimental infection of
M. marinum
in fishes mimics tuberculosis pathogenesis. Microbiological characteristics include the fact that it grows in 7 to 14 days with photochromogenic colonies and is difficult to differentiate from
Mycobacterium ulcerans
and other mycolactone-producing NTM on a molecular basis. The diagnosis is highly suspected by the mode of infection, which is related to the hobby of fishkeeping, professional handling of marine shells, or swimming in nonchlorinated pools. Clinics distinguished skin and soft tissue lesions (typically sporotrichoid or subacute hand nodules) and lesions disseminated to joint and bone, often related with the local use of corticosteroids. In clinical microbiology, microscopy and culture are often negative because growth requires low temperature (30°C) and several weeks to succeed in primary cultivation. The treatment is not standardized, and no randomized control trials have been done. Therapy is a combination of surgery and antimicrobial agents such as cyclines and rifampin, with successful outcome in most of the skin diseases but less frequently in deep tissue infections. Prevention can be useful with hand protection recommendations for professionals and all persons manipulating fishes or fish tank water and use of alcohol disinfection after contact.
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Methodological and Clinical Aspects of the Molecular Epidemiology of Mycobacterium tuberculosis and Other Mycobacteria. Clin Microbiol Rev 2016; 29:239-90. [PMID: 26912567 DOI: 10.1128/cmr.00055-15] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Molecular typing has revolutionized epidemiological studies of infectious diseases, including those of a mycobacterial etiology. With the advent of fingerprinting techniques, many traditional concepts regarding transmission, infectivity, or pathogenicity of mycobacterial bacilli have been revisited, and their conventional interpretations have been challenged. Since the mid-1990s, when the first typing methods were introduced, a plethora of other modalities have been proposed. So-called molecular epidemiology has become an essential subdiscipline of modern mycobacteriology. It serves as a resource for understanding the key issues in the epidemiology of tuberculosis and other mycobacterial diseases. Among these issues are disclosing sources of infection, quantifying recent transmission, identifying transmission links, discerning reinfection from relapse, tracking the geographic distribution and clonal expansion of specific strains, and exploring the genetic mechanisms underlying specific phenotypic traits, including virulence, organ tropism, transmissibility, or drug resistance. Since genotyping continues to unravel the biology of mycobacteria, it offers enormous promise in the fight against and prevention of the diseases caused by these pathogens. In this review, molecular typing methods for Mycobacterium tuberculosis and nontuberculous mycobacteria elaborated over the last 2 decades are summarized. The relevance of these methods to the epidemiological investigation, diagnosis, evolution, and control of mycobacterial diseases is discussed.
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Rapid detection and identification of nontuberculous mycobacterial pathogens in fish by using high-resolution melting analysis. Appl Environ Microbiol 2013; 79:7837-45. [PMID: 24123734 DOI: 10.1128/aem.00822-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterial infections in fish are commonly referred to as piscine mycobacteriosis, irrespectively of the specific identity of the causal organism. They usually cause a chronic disease and sometimes may result in high mortalities and severe economic losses. Nearly 20 species of Mycobacterium have been reported to infect fish. Among them, Mycobacterium marinum, M. fortuitum, and M. chelonae are generally considered the major agents responsible for fish mycobacteriosis. As no quick and inexpensive diagnostic test exists, we tested the potential of high-resolution melting analysis (HRMA) to rapidly identify and differentiate several Mycobacterium species involved in fish infections. By analyzing both the melting temperature and melting profile of the 16S-23S rRNA internal transcribed spacer (ITS), we were able to discriminate 12 different species simultaneously. Sensitivity tests conducted on purified M. marinum and M. fortuitum DNA revealed a limit of detection of 10 genome equivalents per reaction. The primers used in this procedure did not lead to any amplification signal with 16 control non-Mycobacterium species, thereby demonstrating their specificity for the genus Mycobacterium.
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Mycobacterium senegalense tissue infection in a child after fish tank exposure. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2012; 22:101-3. [PMID: 22942887 DOI: 10.1155/2011/206532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present report describes the first known case of an otherwise healthy child who developed a soft tissue infection due to Mycobacterium senegalense - a pathogen usually found in east Africa that is responsible for infecting various animals. The patient presented with nonhealing wounds after sustaining facial lacerations from the shattered glass of a fish tank. The patient responded well to scar revision and antibiotics, with no subsequent relapse.
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Reavill DR, Schmidt RE. Mycobacterial lesions in fish, amphibians, reptiles, rodents, lagomorphs, and ferrets with reference to animal models. Vet Clin North Am Exot Anim Pract 2012; 15:25-v. [PMID: 22244111 DOI: 10.1016/j.cvex.2011.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mycobacteriosis is a serious disease across many animal species. Approximately more than 120 species are currently recognized in the genus Mycobacterium. This article describes the zoonotic potential of mycobacteria and mycobacteriosis in fish, amphibians, rodents, rabbits, and ferrets. It considers clinical signs; histology; molecular methods of identification, such as polymerase chain reaction and DNA sequencing; routes of infection; and disease progression. Studying the disease in animals may aid in understanding the pathogenesis of mycobacterial infections in humans and identify better therapy and preventative options such as vaccines.
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Affiliation(s)
- Drury R Reavill
- Zoo/Exotic Pathology Service, West Sacramento, CA 95605, USA.
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Thibeaut S, Levy PY, Pelletier ML, Drancourt M. Mycobacterium conceptionense infection after breast implant surgery, France. Emerg Infect Dis 2010; 16:1180-1. [PMID: 20587205 PMCID: PMC3321890 DOI: 10.3201/eid1607.090771] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Commercial DNA probes for mycobacteria incorrectly identify a number of less frequently encountered species. J Clin Microbiol 2009; 48:307-10. [PMID: 19906898 DOI: 10.1128/jcm.01536-09] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although commercially available DNA probes for identification of mycobacteria have been investigated with large numbers of strains, nothing is known about the ability of these probes to identify less frequently encountered species. We analyzed, with INNO LiPA MYCOBACTERIA (Innogenetics) and with GenoType Mycobacterium (Hein), 317 strains, belonging to 136 species, 61 of which had never been assayed before. INNO LiPA misidentified 20 taxa, the majority of which cross-reacted with the probes specific for Mycobacterium fortuitum and the Mycobacterium avium-Mycobacterium intracellulare-Mycobacterium scrofulaceum group. GenoType misidentified 28 taxa, most of which cross-reacted with M. intracellulare and M. fortuitum probes; furthermore, eight species were not recognized as members of the genus Mycobacterium. Among 54 strains investigated with AccuProbe (Gen-Probe), cross-reactions were detected for nine species, with the probes aiming at the M. avium complex being most involved in cross-reactions.
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