Wertman Rebecca, Miller Melissa, Groben Pamela, Morrell Dean S, Culton Donna A
Department of Dermatology, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA.
Arch Dermatol. 2011 Apr;147(4):454-8. doi: 10.1001/archdermatol.2011.58.
Mycobacterium bolletii and Mycobacterium massiliense are recently described species of nontuberculous mycobacteria. Footbaths preceding pedicures at nail salons have been implicated as reservoirs of infection with nontuberculous mycobacteria. To our knowledge, this case series represents the first documented outbreak of M bolletii/M massiliense furunculosis, identified by heat-shock protein 65 gene, hsp65, sequencing, occurring in immunocompetent patrons of a North Carolina nail salon.
We describe 3 cases of lower extremity furunculosis caused by M bolletii/M massiliense associated with pedicure footbaths from the same North Carolina nail salon. Lesions developed within 1 month of the salon visit and were characterized by erythematous, indurated papules and plaques. Histologic examination revealed suppurative granulomatous dermatitis. Mycobacterium bolletii/M massiliense was identified by sequencing the 16S ribosomal RNA (rRNA) and hsp65 genes. All 3 patients responded to different combinations of clarithromycin, doxycycline hydrochloride, azithromycin, and moxifloxacin hydrochloride for complete lesion resolution.
Clinicians should elicit a history of pedicure footbaths and maintain a high level of suspicion when faced with skin lesions of the lower extremities that are culture negative or are refractory to conventional antibiotic therapy. Accurate identification and discrimination of M massiliense and M bolletii is difficult and requires sequencing of multiple gene targets beyond their identical 16S rRNA sequences.
博氏分枝杆菌和马赛分枝杆菌是最近被描述的非结核分枝杆菌菌种。美甲沙龙修脚前的足浴已被认为是非结核分枝杆菌的感染源。据我们所知，本病例系列代表了首例经热休克蛋白65基因（hsp65）测序鉴定的博氏分枝杆菌/马赛分枝杆菌引起的疖病暴发，发生在北卡罗来纳州一家美甲沙龙的免疫功能正常的顾客中。
我们描述了3例由博氏分枝杆菌/马赛分枝杆菌引起的下肢疖病病例，这些病例与北卡罗来纳州同一家美甲沙龙的足浴有关。皮损在光顾沙龙后1个月内出现，表现为红斑、硬结性丘疹和斑块。组织学检查显示化脓性肉芽肿性皮炎。通过对16S核糖体RNA（rRNA）和hsp65基因进行测序鉴定出博氏分枝杆菌/马赛分枝杆菌。所有3例患者对克拉霉素、盐酸多西环素、阿奇霉素和盐酸莫西沙星的不同组合治疗均有反应，皮损完全消退。
临床医生在面对培养阴性或对传统抗生素治疗无效的下肢皮肤病变时，应询问足浴史并保持高度怀疑。准确鉴定和区分马赛分枝杆菌和博氏分枝杆菌很困难，除了它们相同的16S rRNA序列外，还需要对多个基因靶点进行测序。
