Clin Lab. 2024 Aug 1;70(8). doi: 10.7754/Clin.Lab.2024.240327.
In December 2023, our hospital confirmed a case of finger infection with Mycobacterium marinum. The patient sought medical attention at our hospital due to a hard scratch on her left middle finger, which was red, swollen, and ulcerated for one month.
A lesion of approximately 1.5 cm x 2 cm in the patient's left middle finger, surrounded by redness and swelling, unclear boundaries, surface rupture, partial scabbing, and no tenderness during compression. She was treated at the previous clinic, common infectious diseases were considered, and was given intravenous infusion treatment: cefotaxime and clarithromycin, and erythromycin ointment was applied externally. She came to our hospital after poor treatment results. The patient has had hypertension for 3 years, no other systemic diseases, no similar medical history among family members, no history of drug or food allergies.
Clean the wound and remove the scab from the affected area, and use a surgical blade to scrape off necrotic tissue. Send the scraped tissue for pathogen testing: tissue bacterial culture+identification (matrix assisted laser desorption/ionization time-of-flight mass spectrometry, MALDI-TOF), tissue acid fast staining, and tissue metagenomic next-generation sequencing (mNGS). Other auxiliary examinations: blood routine, urine routine, blood fat, liver function, and kidney function.
Tissue bacterial culture+identification: growth of Mycobacterium marinum; Acid fast staining of tissue: positive; Tissue mNGS: Mycobacterium marinum. Clinical treatment plan: clarithromycin 0.5 g bid po+rifampicin 0.45 g qd po+5-aminolevulinic acid photodynamic therapy (ALA-PDT) qw+boric acid wash wet compress tid. After 14 days of treatment, the area of redness and swelling significantly decreased, and the degree of redness and swelling was significantly reduced compared to admission. The degree of ulcer edge protrusion was also reduced compared to admission. There was a small amount of exudation from the wound, and no necrotic tissue was observed. The patient improved and was discharged.
This article reports a case of finger infection with Mycobacterium marinum. Mycobacterium marinum was quickly and accurately identified by mNGS, and reasonable treatment measures were adopted clinically. The patient improved and was discharged. This study has important reference significance for the clinical diagnosis and treatment of Mycobacterium infection. In addition, mNGS as a novel detection method has considerable prospects for rapid diagnosis of pathogens.
2023 年 12 月，我院确诊 1 例海分枝杆菌手指感染病例。患者因左手中指被硬物划伤 1 个月，出现红肿、破溃就诊，查体：患者左手中指可见约 1.5cm×2cm 的皮损，周围红肿，边界不清，表面破溃，部分结痂，按压无触痛。曾于外院就诊，考虑常见传染性疾病，予头孢噻肟、克拉霉素静滴及红霉素软膏外用治疗，效果欠佳来我院。患者有高血压病史 3 年，无其他系统疾病，无类似疾病家族史，无药物及食物过敏史。
对患者皮损处进行清创及痂皮去除，使用外科刀片刮除坏死组织，送检刮取组织行病原体检查：组织细菌培养+鉴定（基质辅助激光解吸电离飞行时间质谱法、MALDI-TOF）、组织抗酸染色、组织宏基因组二代测序（mNGS）。其他辅助检查：血常规、尿常规、血脂、肝功能、肾功能。
组织细菌培养+鉴定：海分枝杆菌生长；组织抗酸染色：阳性；组织 mNGS：海分枝杆菌。临床治疗方案：克拉霉素 0.5g bid po+利福平 0.45g qd po+5-氨基酮戊酸光动力疗法（ALA-PDT）qw+硼酸溶液湿敷 tid。治疗 14 天后，患者红肿面积明显缩小，与入院时相比红肿程度明显减轻，溃疡边缘凸起程度较入院时也有所减轻。创面有少量渗出，未见坏死组织。患者好转出院。
本文报道了 1 例手指感染海分枝杆菌病例，通过 mNGS 快速、准确地鉴定出分枝杆菌，临床采取了合理的治疗措施，患者好转出院。本研究对分枝杆菌感染的临床诊治具有重要的参考意义。另外，mNGS 作为一种新型的病原体检测方法，对病原体的快速诊断具有较大的应用前景。
