Edelstein H
Department of Internal Medicine, Kaiser Permanente Medical Center, San Rafael, Calif.
Arch Intern Med. 1994 Jun 27;154(12):1359-64. doi: 10.1001/archinte.154.12.1359.
Mycobacterium marinum is a rare cause of skin infections, and its treatment has been based primarily on the personal experience and preferences of individual investigators without the benefit of large studies.
Thirty-one patients with confirmed M marinum infection were identified at 33 Kaiser Permanente Northern California Region medical centers by microbiologic records, and their charts were reviewed.
The upper extremity was affected in 90% of cases, and lymphatic or local spread was seen during the initial examination or during observation in 25 patients (81%). Granuloma was present in 22 (63%) of 35 biopsy specimens, and staining for acid-fast bacteria yielded positive results in two of 22 specimens. Cure or improvement occurred in 22 (81%) of 27 patients in whom outcome could be evaluated. Treatment with ethambutol plus rifampin appeared more successful (effective in five [100%] of five cases) than minocycline treatment (effective in 10 [71%] of 14 cases), although not significantly so (P = .28). Adverse reactions, most of which were gastrointestinal, occurred in five patients (18%).
Ethambutol plus rifampin appears more useful than minocycline in treating cutaneous M marinum infection. This result remains to be confirmed by larger clinical studies, which may be difficult because this infection is relatively rare.
海分枝杆菌是皮肤感染的罕见病因，其治疗主要基于个别研究者的个人经验和偏好，缺乏大型研究的支持。
通过微生物学记录在加利福尼亚州北部33家凯撒医疗中心确定了31例确诊的海分枝杆菌感染患者，并对其病历进行了回顾。
90%的病例上肢受累，25例患者（81%）在初次检查或观察期间出现淋巴或局部扩散。35份活检标本中有22份（63%）存在肉芽肿，22份标本中有2份抗酸杆菌染色呈阳性。在可评估结局的27例患者中，22例（81%）治愈或好转。乙胺丁醇加利福平治疗似乎比米诺环素治疗更成功（5例中有5例[100%]有效，而14例米诺环素治疗患者中有10例[71%]有效），尽管差异无统计学意义（P = 0.28）。5例患者（18%）出现不良反应，多数为胃肠道不良反应。
乙胺丁醇加利福平在治疗皮肤海分枝杆菌感染方面似乎比米诺环素更有效。这一结果有待更大规模的临床研究证实，由于这种感染相对罕见，可能难以开展此类研究。
