Bouceiro-Mendes R, Ortins-Pina A, Fraga A, Marques T, Viveiros M, Machado D, Soares-de-Almeida L, Freitas J P, Filipe P
Dermatology Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon.
Dermatol Online J. 2019 Feb 15;25(2):13030/qt5bb78905.
Mycobacterium marinum is a nontuberculous mycobacteria with worldwide distribution that lives in fresh or salt water and is responsible for infections in fish, and sometimes in humans. Human disease consists mainly of cutaneous nodules, but deep structure involvement may also occur. Diagnosis of M. marinum infection remains a challenge, with a considerable time delay between onset of symptoms and diagnosis. We present a 33-year-old man with no immunosuppressive history who was seen in our department with skin nodules over his hand and forearm, distributed in a sporotrichoid pattern. His hobbies included maintaining an aquarium of tropical fish. Histological examination of the patient's skin biopsy was compatible with the diagnosis of mycobacterial infection, and the Ziehl-Neelsen staining revealed acid-fast bacilli. Molecular techniques confirmed the suspicion of M. marinum infection. A necropsy was performed on one of the patient's fish, more specifically, a Poecilia reticulata, and resulted in identification of M. marinum from its gut. The patient was treated with clarithromycin, ethambutol, and rifampicin for 9 months, with clearance of infection.
海分枝杆菌是一种分布于全球的非结核分枝杆菌，存在于淡水或咸水中，可导致鱼类感染，有时也会感染人类。人类疾病主要表现为皮肤结节，但也可能累及深部组织。海分枝杆菌感染的诊断仍然是一项挑战，从症状出现到诊断之间往往有相当长的时间延迟。我们报告一名33岁无免疫抑制病史的男性，他因手部和前臂出现呈孢子丝菌病样分布的皮肤结节前来我科就诊。他的爱好包括饲养热带鱼水族箱。患者皮肤活检的组织学检查结果符合分枝杆菌感染的诊断，齐-尼氏染色显示抗酸杆菌。分子技术证实了海分枝杆菌感染的怀疑。对患者的一条鱼，具体来说是一条孔雀鱼进行了尸检，结果从其肠道中鉴定出海分枝杆菌。患者接受克拉霉素、乙胺丁醇和利福平治疗9个月，感染得以清除。
