Department of Dermatology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Department of Infectious Diseases, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
J Dermatol. 2022 Nov;49(11):1075-1084. doi: 10.1111/1346-8138.16531. Epub 2022 Jul 29.
Nontuberculous mycobacteria cause a wide range of infections, including cutaneous infections, in both immunocompromised and immunocompetent patients. Although pulmonary nontuberculous mycobacterial infections have increased significantly in Japan in recent years, there is less evidence on clinical and microbiological characteristics of cutaneous nontuberculous mycobacterial infections in Japan. We reviewed 86 Japanese cases reported between July 2016 and November 2021 and analyzed them in conjunction with the eight patients from our institution who were diagnosed with cutaneous nontuberculous mycobacterial infections by culture between 2015 and 2021. In the aggregate series, the average patient age was 60 years, and the ratio of immunocompromised hosts was 53%, both of which were higher than those in previous reports from other countries. No female predominance was observed, unlike in pulmonary nontuberculous mycobacteria infections. Rapidly growing mycobacteria accounted for 58% of the cases (n = 54), whereas slowly growing mycobacteria for 43% (n = 40). Mycobacterium marinum (also known as Mycobacteroides marinum) (n = 20, 21%) was the most common cause, followed by Mycobacterium chelonae (n = 18, 19%), Mycobacterium abscessus (also known as Mycobacteroides abscessus) (n = 15, 16%), and Mycobacterium ulcerans (n = 11, 12%). While clinical appearance was variable, M ulcerans infections usually presented with ulcers, while nodules were common among infections caused by M chelonae and M marinum. Disseminated infections involving multiple organs were observed in 23 patients (24%). Thirty-two cases (30%) were preceded by exposure, including raising or handling fish, trauma, and invasive medical procedures. Most patients were treated with more than two antibiotics and responded to therapy.
非结核分枝杆菌可引起广泛的感染，包括免疫功能受损和免疫功能正常的患者的皮肤感染。尽管近年来日本的非结核分枝杆菌肺部感染显著增加，但日本的皮肤非结核分枝杆菌感染的临床和微生物学特征的证据较少。我们回顾了 2016 年 7 月至 2021 年 11 月期间报告的 86 例日本病例，并结合我们机构在 2015 年至 2021 年间通过培养诊断为皮肤非结核分枝杆菌感染的 8 例患者进行了分析。在综合系列中，平均患者年龄为 60 岁，免疫功能低下宿主的比例为 53%，均高于其他国家的先前报告。与非结核分枝杆菌肺部感染不同，未观察到女性优势。快速生长分枝杆菌占 58%（n=54），而缓慢生长分枝杆菌占 43%（n=40）。海洋分枝杆菌（也称为海洋分枝杆菌）（n=20，21%）是最常见的病因，其次是脓肿分枝杆菌（n=18，19%）、溃疡分枝杆菌（也称为溃疡分枝杆菌）（n=15，16%）和龟分枝杆菌（n=11，12%）。虽然临床表现多种多样，但 M ulcerans 感染通常表现为溃疡，而结节是 M chelonae 和 M marinum 感染的常见表现。23 例患者（24%）存在播散性感染，涉及多个器官。32 例（30%）在发病前有接触史，包括养鱼、创伤和有创性医疗操作。大多数患者接受了两种以上抗生素的治疗，并对治疗有反应。
