Adhikesavan Leena G, Harrington Thomas M
Department of Rheumatology, Geisinger Health System, Danville, PA 17822, USA.
J Clin Rheumatol. 2008 Jun;14(3):156-60. doi: 10.1097/RHU.0b013e31817759fe.
Mycobacterium marinum is a free-living, nontuberculous, photochromogenic mycobacterium, which can cause opportunistic infections in humans. It can cause infection through the skin that has undergone minor trauma, as the portal of entry from contaminated water, fish tanks and nonchlorinated swimming pools. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We describe 3 patients seen in Geisinger Medical Center from 2000 to 2005 in whom the diagnosis of M. marinum infection was made. All 3 patients described had sporotrichoid nodular lesions, one had a preceding minor trauma, one was initially misdiagnosed as having rheumatoid arthritis and developed disseminated infection requiring prolonged treatment, and one had direct exposure to fish and fish tank. M. marinum infection is frequently misdiagnosed probably due to its rarity of occurrence, indolent presentation and difficulty in isolation and culture. Recognition depends on a high index of suspicion and eliciting a history of aquatic exposure. Diagnosis usually requires tissue biopsy for histopathologic examination and culture.
海分枝杆菌是一种自由生活的、非结核性的、产色分枝杆菌，可引起人类机会性感染。它可通过遭受轻微创伤的皮肤引起感染，作为来自受污染水、鱼缸和未加氯游泳池的进入门户。它可引起皮肤病变，可为单个丘疹结节性病变，局限于一个肢体，或可能类似皮肤孢子丝菌病。这种感染还可引起更深层的感染，包括腱鞘炎、滑囊炎、关节炎和骨髓炎。免疫功能低下的患者中曾有播散性感染和内脏受累的报道。我们描述了2000年至2005年在盖辛格医疗中心就诊的3例患者，他们被诊断为海分枝杆菌感染。所有3例患者均有孢子丝菌样结节性病变，1例有先前的轻微创伤，1例最初被误诊为类风湿关节炎并发生播散性感染，需要长期治疗，1例直接接触过鱼类和鱼缸。海分枝杆菌感染常因发生罕见、表现隐匿以及分离培养困难而被误诊。识别依赖于高度的怀疑指数并了解水生接触史。诊断通常需要进行组织活检以进行组织病理学检查和培养。
