Clinical and Pathological Evaluation ofMycobacterium marinumGroup Skin Infections Associated With Fish Markets in New York City

Abstract

A multidisciplinary approach was used to identify cases in an outbreak of M. marinum infections. The use of histopathology, culture, and IHC plus PCR from full thickness skin biopsy can lead to improved diagnosis of M. marinum SSTIs compared to relying solely on mycobacterial culture, the current gold standard.

Management of Extrapulmonary Nontuberculous Mycobacterial Infections

“…1 An outbreak of M. marinum infections in New York City during 2013 to 2014 was associated with the handling of fish sold at a Chinese market. 72 Infection results in localized, cutaneous disease in immunocompetent individuals. Less common involvement of deeper tissues may cause tenosynovitis, arthritis, and osteomyelitis.…”

“…The most sensitive test tends to be histologic analysis of cutaneous or deep tissue biopsies for evidence of granulomatous inflammation, although diagnostic yield differs among case series. 72,75 Granulomas may vary with respect to their morphology, and the presence of caseation, necrosis, and suppuration. Stains for acid-fast bacilli, including Ziehl-Nielsen and immunohistochemistry stains, are not commonly positive.…”

Mycobacterium marinum infection with sporotrichoid spread from fish tank exposure

“…1 Infection typically occurs on the upper limbs several weeks after injury in aquatic environments or after handling fish. [1][2][3] Although lesions are initially solitary or multiple, a linear distribution of papulonodular lesions along lymphatic channels resembling sporotrichosis can occur. The differential diagnosis also includes nocardiosis, leishmaniasis and other mycobacterial or fungal infections.…”

“…The differential diagnosis also includes nocardiosis, leishmaniasis and other mycobacterial or fungal infections. 2 Results of microbiologic studies are sometimes negative. One case series (n = 29) reported positive M. marinum cultures in 41% of probable infections.…”

“…3 It typically includes single-or double-agent coverage with tetracyclines, sulfamethoxazole-trimethoprim, clarithromycin, ethambutol or rifampin for at least three to four months. [1][2][3] …”