StopTB Italia Onlus, Milan, Italy; Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
StopTB Italia Onlus, Milan, Italy; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
Eur J Intern Med. 2022 Nov;105:15-19. doi: 10.1016/j.ejim.2022.07.013. Epub 2022 Jul 19.
Mycobacterium marinum (M. marinum) is a free-living, slow grower nontuberculous mycobacteria (NTM), strictly related to Mycobacterium tuberculosis, that causes disease in fresh and saltwater fish and it is one of the causes of extra-pulmonary mycobacterial infections, ranging in human from simple cutaneous lesions to disseminated forms in immunocompromised hosts. The first human cases of M. marinum infection were reported from skin lesions of swimmers in a contaminated pool, in 1951, in Sweden by Norden and Linell. Two conditions are required to develop M. marinum infection: (1) skin solution of continuity and (2) exposure to the contaminated water or direct contact with fish or shellfish. The so-called "fish-tank granuloma", the most frequent cutaneous manifestation of M. marinum infection, is characterized by a single papulonodular, verrucose and/or ulcerated granulomatous lesion in the inoculum site. Careful patient's history collection, high clinical suspicion and appropriate sample (e.g. cutaneous biopsy) for microbiological culture are crucial for a timely diagnosis. The treatment is not standardized yet and relies on administration of two active antimycobacterial agents, always guided by antimicrobial susceptibility test on culture, with macrolides and rifampin as pivotal drugs, as well as prompt surgery when feasible. In this narrative review, we provide to Clinicians an updated report of epidemiology, microbiological characteristics, clinical presentation, diagnosis, and management of M. marinum infection.
海分枝杆菌（M. marinum）是一种自由生活的、生长缓慢的非结核分枝杆菌（NTM），与结核分枝杆菌密切相关，可引起淡水和咸水鱼类发病，是肺部外分枝杆菌感染的原因之一，在人类中从单纯的皮肤损伤到免疫功能低下宿主的播散性形式不等。Norden 和 Linell 于 1951 年在瑞典首次报道了首例因污染池中的游泳者皮肤损伤而导致的人类海分枝杆菌感染病例。发生 M. marinum 感染需要具备两个条件：（1）皮肤连续性损伤和（2）暴露于受污染的水或直接接触鱼类或贝类。所谓的“鱼缸肉芽肿”，即海分枝杆菌感染最常见的皮肤表现，其特征是在接种部位出现单个丘疹结节状、疣状和/或溃疡性肉芽肿性病变。仔细收集患者病史、高度临床怀疑和适当的样本（例如皮肤活检）进行微生物培养对于及时诊断至关重要。目前治疗尚未标准化，依赖于两种有效的抗分枝杆菌药物的使用，始终根据培养的药敏试验进行指导，大环内酯类和利福平是关键药物，并且在可行时及时进行手术。在本叙述性综述中，我们为临床医生提供了海分枝杆菌感染的流行病学、微生物学特征、临床表现、诊断和管理的最新报告。
