Johnson Matthew G, Stout Jason E
Department of Medicine, Duke University Medical Center, Box 102539, 315 Trent Drive, Durham, NC, 27710, USA.
Infection. 2015 Dec;43(6):655-62. doi: 10.1007/s15010-015-0776-8. Epub 2015 Apr 14.
Invasive Mycobacterium marinum disease (tenosynovitis and osteomyelitis) may be an increasingly common manifestation of M. marinum infection that presents unique diagnostic and therapeutic challenges. We conducted a retrospective case series and literature review of M. marinum infection to better understand the clinical spectrum of invasive versus cutaneous disease.
We reviewed electronic medical records for all M. marinum infections at Duke University Medical Center from January 1, 1996 to April 30, 2014. Published case series of M. marinum infection since 1990 reporting >5 cases were systematically ascertained and reviewed.
Twenty-eight cases of M. marinum infection were identified from our institution. Twenty cases (87 %) involved aquatic exposure, and 26 (93 %) involved finger and/or hand lesions. Median time to diagnosis was 3.5 months. Nineteen (68 %) cases had invasive infection, and 9 (32 %) were cutaneous; invasive infection was more common with older age. Granulomatous inflammation and acid-fast bacilli were noted on pathologic examination in 11 (58 %) and 3 (16 %) cases, respectively. Primarily monotherapy was used in 2 (12 %) cases, dual therapy in 8 (47 %) cases, and three-drug therapy in 7 (41 %) cases; three-drug therapy was more common with invasive infection. Median duration of treatment was 5 months. Adjunctive surgery was performed for 18 (95 %) cases of invasive infection and 4 (44 %) of cutaneous infection. Twenty-one (75 %) cases improved, while 7 (25 %) were lost to follow-up.
Distinguishing between invasive and cutaneous M. marinum infection may have important consequences in terms of antibiotic choice and need for adjunctive surgery.
侵袭性海分枝杆菌病（腱鞘炎和骨髓炎）可能是海分枝杆菌感染日益常见的表现形式，带来了独特的诊断和治疗挑战。我们开展了一项关于海分枝杆菌感染的回顾性病例系列研究并进行文献综述，以更好地了解侵袭性疾病与皮肤疾病的临床谱。
我们回顾了1996年1月1日至2014年4月30日期间杜克大学医学中心所有海分枝杆菌感染的电子病历。系统确定并回顾了自1990年以来报告超过5例病例的已发表海分枝杆菌感染病例系列。
我们机构共确定了28例海分枝杆菌感染病例。20例（87%）有接触水的情况，26例（93%）累及手指和/或手部病变。诊断的中位时间为3.5个月。19例（68%）为侵袭性感染，9例（32%）为皮肤感染；侵袭性感染在老年人中更常见。分别有11例（58%）和3例（16%）病例在病理检查中发现肉芽肿性炎症和抗酸杆菌。主要采用单药治疗的有2例（12%），双联治疗的有8例（47%），三联治疗的有7例（41%）；三联治疗在侵袭性感染中更常见。治疗的中位持续时间为5个月。18例（95%）侵袭性感染病例和4例（44%）皮肤感染病例接受了辅助手术。21例（75%）病例病情改善，7例（25%）失访。
区分侵袭性和皮肤性海分枝杆菌感染在抗生素选择和辅助手术需求方面可能具有重要意义。
