Treatment ofMycobacterium marinumcutaneous infections

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.

Inactivation of tesA Reduces Cell Wall Lipid Production and Increases Drug Susceptibility in Mycobacteria

“…We compared the susceptibility of Mm WT ϩ pCP0, Mm ⌬tesA ϩ pCP0, and Mm ⌬tesA ϩ pCP0-tesAmm to six clinical antibiotics of different classes. The group tested included rifampicin, doxycycline, ciprofloxacin, and streptomycin, all of which have reported use in the treatment of Mm infections (48). Remarkably, Mm ⌬tesA ϩ pCP0 displayed increased susceptibility to five of these antibiotics compared with Mm WT ϩ pCP0, as judged by IC 50 and MIC values ( Table 2).…”

Treatment of Sporotrichoid Fish Tank Granuloma with Pulsed Clarithromycin

“…Clarithromycin seems to be the only effective macrolide in M. marinum skin infections. In fact, erythromycin has not proven to be effective [1,29]. As far as azithromycin is concerned, it was effective in one patient [30]; however, it showed no activity against M. marinum in vitro [9,31].…”

“…Mycobacterium marinum infections are classified into four clinical presentations: type I - single superficial erosive or ulcerated or crusted or verrucous papules, nodules or plaques; type II - more or less numerous and widespread lesions, often with a sporotrichoid distribution; type III - deep infections (bursitis, tenosynovitis, arthritis, osteomyelitis), with or without skin involvement; type IV - systemic involvement and bacteraemia, almost exclusively in immunocompromised patients [1]. …”

“…Furthermore, no therapeutic studies based on large groups of patients have been published so far. The therapy of M. marinum infections is therefore based mainly on the personal experience of the physician [1]. We present the results of a study in which 12 out of 14 patients with type II M. marinum infections were successfully treated with pulsed clarithromycin monotherapy.…”

Molecular Characterization of Mycobacterial Ribonucleotide Reductase (RNR) and its Implication as a Novel Drug Target

“…Nearly one third of known Mycobacterium species have been observed to be associated with disease in humans [16]. The species of NTM associated with human disease are : M. avium, M. intracellulare [17,18], M. kansasii [19], M. paratuberculosis [20], M. scrofulaceum [21], M. simiae [22,23], M. interjectum [24], M. xenopi [25], M. szulgai [26], M. fortuitum [27], M. chelonae [28], M. marinum [29], M. genavense [30], M. ulcerans [31], M. smegmatis [32], M. thermoresistible [33], M. neoaurum [34], M. vaccae [35]. Presently little information is available on the evolution of RNR in different species of Mycobacterium which governs the central metabolic pathways by directing the DNA replication.…”