Gbery I P, Djeha D, Yobouet P, Aka B, Kanga J M
Centre de dermato-vénéro-logie, CHU de Treichville, Abidjan, Côte d'Ivoire.
Sante. 1996 Sep-Oct;6(5):317-22.
The incidence of cutaneous atypical mycobacterial infections is increasing. Their clinical presentation is variable. The atypical mycobacteria are difficult to culture and thus diagnosis can be difficult to establish. PCR (Polymerase Chain Reaction) and mycolic acid analysis have recently been used for mycobacterial species identification, but are not routinely used. Risk factors for cutaneous atypical mycobacterial infection include (1) immunodepression due to HIV infection, lymphoma, leukemia or immunosuppressive therapy. Immunodepression is responsible for the emergence of cutaneous infections by a large variety of atypical mycobacterial species, particularly in industrialized countries. (2) The natural environment is directly responsible for the emergence of cutaneous infections but a small number of atypical mycobacterial species including M. marinum in Europe and North America, and M. ulcerans in the tropics. (3) The medical environment when sterilization is inadequate is also not uncommonly responsible. Clinical features are rarely specific for mycobacterial species, and thus analysis of factors relevant to treatment is more important than species classification. We describe environmental forms (Buruli ulcer caused by M. ulcerans is endemic in the tropics, and swimming pool granuloma which is the aquatic form of M. marinum infection), opportunist forms caused by various species in immunodepressed hosts and iatrogenic and accidental forms mostly due to M. fortiutum and M. chelonei. We review the literature and update the clinical characteristics and risk factors for these diseases.
皮肤非典型分枝杆菌感染的发病率正在上升。其临床表现多样。非典型分枝杆菌难以培养，因此诊断可能难以确立。聚合酶链反应（PCR）和分枝菌酸分析最近已用于分枝杆菌菌种鉴定，但尚未常规使用。皮肤非典型分枝杆菌感染的危险因素包括：（1）由人类免疫缺陷病毒（HIV）感染、淋巴瘤、白血病或免疫抑制治疗引起的免疫抑制。免疫抑制是导致多种非典型分枝杆菌引起皮肤感染的原因，在工业化国家尤其如此。（2）自然环境直接导致皮肤感染，但涉及的非典型分枝杆菌种类较少，包括欧洲和北美的海分枝杆菌，以及热带地区的溃疡分枝杆菌。（3）医疗环境中消毒不充分也常常是原因之一。临床特征很少能明确区分分枝杆菌菌种，因此分析与治疗相关的因素比菌种分类更为重要。我们描述了环境型（溃疡分枝杆菌引起的布鲁里溃疡在热带地区流行，游泳池肉芽肿是海分枝杆菌感染的水生型）、免疫抑制宿主中由各种菌种引起的机会型以及主要由偶然分枝杆菌和龟分枝杆菌引起的医源性和意外型。我们回顾了文献并更新了这些疾病的临床特征和危险因素。
