Elsevier

Dermatologic Clinics

Volume 27, Issue 1, January 2009, Pages 63-73
Dermatologic Clinics

Atypical Mycobacterial Cutaneous Infections

https://doi.org/10.1016/j.det.2008.07.009Get rights and content

Atypical mycobacterial infections have been a cause of steadily growing infections over the past decades, especially in immunocompromised patients. They are classified by their ability to produce pigment, growth rate, and optimal temperature. Mycobacterium marinum, M kansasii, and M avium-intracellulare are examples of slow-growing mycobacteria. M fortuitum, M chelonei, and M abscessus are examples of rapidly growing mycobacteria. Atypical mycobacteria are ubiquitous in the environment. No specific treatment guidelines exist but a multidrug regimen combined with surgical modalities is often used for therapy.

Section snippets

Classification

The genus mycobacterium is divided into obligate and facultative pathogens. The obligate group involves M tuberculosis and M leprae. The facultative group is divided into slow-growing and rapid-growing mycobacteria. Runyon further classified the slow-growing mycobacteria based on their ability to produce pigment, growth rate, and optimal temperature.3, 4 This classification is depicted in Table 1.

Photochromogens produce pigment only when exposed to light. Scotochromogens produce pigment under

Mycobacterium Marinum (Mycobacterium Balnei or Mycobacterium Platypoecilus)

M marinum is a slow-growing photochromogen that usually causes disease in fish but can cause human disease by penetration through impaired skin barrier. It was first discovered in 1926 by Aronson who isolated the organism from a saltwater fish in a Philadelphia aquarium.5 The first human case was reported in 1951 in a patient who developed granulomatous lesions after visiting a contaminated swimming pool.6 The disease caused by M marinum is sometimes referred to as swimming pool granuloma or

Mycobacterium Scrofulaceum

M scrofulaceum is a slow-growing scotochromogen that produces light yellow to orange pigment when exposed to both light and dark conditions. It is most prevalent in southeastern United States.47 It has been isolated from raw milk and other dairy products, pooled oysters, soil, and water.48 Cutaneous infections from M scrofulaceum are rare and usually are part of disseminated infection involving internal organs and the integumentary system. Immunocompromised patients, such as those who have

Mycobacterium Avium-Intracellulare

M avium-intracellulare complex (MAC) consists of M avium, M intracellulare, and other unidentified species. Because it is not possible to differentiate between M avium and M intracellulare by normal biochemical means they are usually grouped together. The sensitization to M intracellulare was shown to be increasing by Khan and colleagues58 from 1 in 9 people in 1971 to 1972 to 1 in 6 people in 1999 to 2000, which corresponded to the increased number of pulmonary NTM infections in the USA.

MAI is

Mycobacterium Fortuitum

M fortuitum is a rapid grower that is widely distributed in the environment and found in soil, dust, water, milk, marine life, biofilm, and saliva of healthy humans.12, 40 Colonies are visible in 1 week or less. Outbreaks caused by rapid growers, such as M fortuitum and M chelonei, have been associated with jet injectors, hemodialysis, peritoneal dialysis, contaminated gentian violet skin-marking solution, catheters, prosthetic valves, surgical site infections, nail salons, full-face skin

Summary

Atypical mycobacteria infections have been increasing over the past few decades and thus we have to be aware of their clinical presentation. Clinical features may vary from chronic localized skin infections to cervical lymphadenitis. The most common presentation in children is adenitis. Rapid growers, such as M fortuitum and M chelonei, may present as both cutaneous and lymph node infections, whereas M marinum only causes cutaneous disease. Biopsy should be done for histopathology diagnosis.

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