Treatment and Outcome of Culture-Confirmed Mycobacterium marinum Disease

Abstract

Background Mycobacterium marinum is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment consists of multiple antibiotics, sometimes combined with surgical debridement. There is little evidence for the choice of antibiotics, the duration of treatment, and the role of susceptibility testing. Methods We performed a retrospective cohort study of culture-confirmed M. marinum infections in the Netherlands in the 2011–2018 period. Clinical characteristics, in vitro susceptibility, extent of disease, treatment regimens, and outcomes were analyzed. Incidence was assessed from laboratory databases. Results Forty cases of M. marinum infection could be studied. Antibiotic treatment cured 36/40 patients (90%) after a mean treatment duration of 25 weeks. Failure/relapse occurred in 3 patients, and 1 patient was lost to follow-up. Antibiotic treatment consisted of monotherapy in 35% and 2-drug therapy in 63%. Final treatment contained mostly ethambutol–macrolide combinations (35%). Eleven patients (28%) received additional surgery. We recorded high rates of in vitro resistance to tetracyclines (36% of isolates). Tetracycline resistance seemed correlated with poor response to tetracycline monotherapy. The annual incidence rate was 0.15/100 000/year during the study period. Conclusions Prolonged and susceptibility-guided treatment results in a 90% cure rate in M. marinum disease. Two-drug regimens of ethambutol and a macrolide are effective for moderately severe infections. Tetracycline monotherapy in limited disease should be used vigilantly, preferably with proven in vitro susceptibility.

Nontuberculous Mycobacteria: Ecology and Impact on Animal and Human Health

“…Extrapulmonary mycobacterioses have been described primarily as skin infections. The following species of NTM have been demonstrated: tattoo-associated cutaneous Mycobacterium (M.) mageritense infection [ 28 ], M. marinum hand infection masquerading as tinea manuum [ 29 ] and the treatment and outcome of M. marinum infections in 40 patients in the Netherlands [ 30 ], M. terrae and M. intracellulare tenosynovitis following hurricane relief efforts in the USA [ 31 ], and M. smegmatis skin infection following cosmetic procedures [ 32 ]. Two M. abscessus outbreaks at pediatric dental clinics were documented with more than 20 confirmed infected children with a median age of 6 years in both clinics in Atlanta, Georgia [ 4 ], and Anaheim, California [ 33 ].…”

Mycobacterium marinum: A Challenging Cause of Protracted Tenosynovitis

“…and the bacteria’s grow at low temperatures. The infection is, in most cases, associated with an aquatic exposure (>80%) [ 2 , 11 , 12 ]. Tenosynovitis caused by M. marinum is commonly seen specifically in the hand or wrist because of the higher risk of penetrating injury [ 13 ].…”

Mandibular Nodule Caused by <i>Mycobacterium marinum</i> with False Positive Interferon-γ Release Assay

“…There is little evidence to support the choice of antibiotics and the duration of the treatment. The exact role of drug susceptibility testing in the management of M. marinum is also not established, in part because most isolates show low minimum inhibitory concentrations (MICs) to the most frequently used antimycobacterial drugs (10). A combination of antimicrobials including clarithromycin, ethambutol, rifampin, and minocycline is often used.…”