1
|
Khadka DK, Acharya R, Agrawal S. Sporotrichoid lymphocutaneous pattern in a fish-merchant under immunosuppressant medications: Clues to differential diagnoses. Clin Case Rep 2022; 10:e6708. [PMID: 36483864 PMCID: PMC9723480 DOI: 10.1002/ccr3.6708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 12/12/2022] Open
Abstract
Sporotrichoid-lymphocutaneous-pattern is classically seen in sporotrichosis, though also present in other infections like atypical mycobacteriosis and leishmaniasis. Cutaneous atypical mycobacterial infection presents as localized lesions in immunocompetent and is widespread in immunosuppressed patients. Here, we present a case of sporotrichoid-lymphocutaneous infection due to atypical mycobacteria, in a fish-seller under immunosuppressants.
Collapse
Affiliation(s)
- Dhan Keshar Khadka
- Department of Dermatology and VenereologyB.P Koirala Institute of Health SciencesDharanNepal
| | - Ripala Acharya
- Department of Dermatology and VenereologyB.P Koirala Institute of Health SciencesDharanNepal
| | - Sudha Agrawal
- Department of Dermatology and VenereologyB.P Koirala Institute of Health SciencesDharanNepal
| |
Collapse
|
2
|
Wu TS, Chiu CH, Yang CH, Leu HS, Huang CT, Chen YC, Wu TL, Chang PY, Su LH, Kuo AJ, Chia JH, Lu CC, Lai HC. Fish tank granuloma caused by Mycobacterium marinum. PLoS One 2012; 7:e41296. [PMID: 22911774 PMCID: PMC3401166 DOI: 10.1371/journal.pone.0041296] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/19/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction Mycobacterium marinum causes skin and soft tissue, bone and joint, and rare disseminated infections. In this study, we aimed to investigate the relationship between treatment outcome and antimicrobial susceptibility patterns. A total of 27 patients with M. marinum infections were enrolled. Methods Data on clinical characteristics and therapeutic methods were collected and analyzed. We also determined the minimum inhibitory concentrations of 7 antibiotics against 30 isolates from these patients. Results Twenty-seven patients received antimycobacterial agents with or without surgical debridement. Eighteen patients were cured, 8 failed to respond to treatment, and one was lost to follow-up. The duration of clarithromycin (147 vs. 28; p = 0.0297), and rifampicin (201 vs. 91; p = 0.0266) treatment in the cured patients was longer than that in the others. Surgical debridement was performed in 10 out of the 18 cured patients, and in 1 of another group (p = 0.0417). All the 30 isolates were susceptible to clarithromycin, amikacin, and linezolid; 29 (96.7%) were susceptible to ethambutol; 28 (93.3%) were susceptible to sulfamethoxazole; and 26 (86.7%) were susceptible to rifampicin. However, only 1 (3.3%) isolate was susceptible to doxycycline. Discussion Early diagnosis of the infection and appropriate antimicrobial therapy with surgical debridement are the mainstays of successful treatment. Clarithromycin and rifampin are supposed to be more effective agents.
Collapse
Affiliation(s)
- Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsun Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Chang Gung, Taoyuan, Taiwan
| | - Hsieh-Shong Leu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Chieh Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Pi-Yueh Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Lin-Hui Su
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
| | - An-Jing Kuo
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Ju-Hsin Chia
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Chen Lu
- Department of Respiratory Therapy, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Hsin-Chih Lai
- Department of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Medical Biotechnology and Laboratory Sciences, Chang Gung University, Taoyuan, Taiwan
- Research Center for Pathogenic Bacteria, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| |
Collapse
|
5
|
Abstract
Mycobacterium marinum is a non-tuberculous mycobacterium found in non-chlorinated water, with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. It presents as a solitary, red-to-violaceous plaque or nodule with an overlying crust or verrucous surface, or as inflammatory nodules or abscesses, usually in a sporotrichotic type of distribution. Deep infections may also occur. Although diagnosis is confirmed by isolation and identification of the organism in practice diagnosis remains largely presumptive based on clinicohistological features and the response to treatment. Polymerase chain reaction allows the routine early detection of the organism from a biopsy specimen. In the near future, it seems possible that histopathological examination might be greatly assisted by the rapidly improving possibilities with in vivo imaging. There have been many therapeutic modalities used effectively in the treatment of M. marinum infections. Spontaneous remission has also been reported in untreated infections and in immunocompetent hosts. However, there is no proven treatment of choice because M. marinum is naturally multi-drug resistant species and treatment is based primarily on the personal experience and preference of individual investigators, without the benefit of large studies. In superficial cutaneous infections minocycline, clarithromycin, doxycycline and trimethoprim-sulfamethoxazole as monotherapy are effective treatment options, but drug resistance varies and thereby combination therapy usually of two drugs may be required. Ciprofloxacin has shown considerable effectiveness. In cases of severe infections, including those with a sporotrichoid distribution pattern, a combination of rifampicin and ethambutol seems to be the recommended regimen. The use of isoniazid, streptomycin and pyrazinamide as empirical treatment options should be avoided. Surgical treatment is not usually recommended and must be cautiously applied. Cryotherapy, X-ray therapy, electrodesiccation, photodynamic therapy and local hyperthermic therapy have been reported as effective therapeutic alternatives. M. marinum infection should always be included in the differential diagnosis of all cases with poor-healing wounds in upper extremities and a history of exposure to aquariums.
Collapse
Affiliation(s)
- Efstathios Rallis
- Army General Hospital, Department of Dermatology, 11 Pafsaniou street, 11635, Athens, Greece.
| | | |
Collapse
|
6
|
Kumar V, Taranu R. Masquerading Mycobacterium: Plastic surgeon to the rescue. Can J Plast Surg 2005; 13:36-8. [PMID: 24223001 DOI: 10.1177/229255030501300110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A patient with a Mycobacterium marinum infection of the hand is described. The present case illustrates that M marinum infection may mimic common skin conditions such as eczema, and fungal and parasitic infestations. Key elements in the diagnosis and management of this infection are a high index of suspicion, a detailed history of recreational or occupational exposure to exotic fish, tissue biopsy, wound culture and prompt empirical antibiotic therapy. Once in vitro organism sensitivities are obtained, antibiotic treatment may last for up to 24 months. Surgical drainage and debridement are an important supplement to antimicrobial therapy when subcutaneous structures are involved, as in the present report. Invasive digital and hand infections can rapidly result in permanent residual stiffness, deformity and loss of function; therefore, it is important to raise awareness of the condition among those considered to be at risk.
Collapse
Affiliation(s)
- V Kumar
- Department of Plastic Reconstructive Surgery, The James Cook University Hospital, Middlesbrough, United Kingdom
| | | |
Collapse
|