Two Cases Reports Of Cutaneous Infection Caused By Mycobacterium Marinum And A Review Of The Literature

ObjectiveCutaneous infection caused by Mycobacterium marinum due to no obvious specificity,and certain difficulty exists in the diagnosis,the purpose of this paper is to analysis the incidence of the disease cause,clinical manifestation,diagnosis,treatment and prognosis,improve the overall understanding of the disease,way of thinking,help to improve diagnosis and treatment of the disease.MethodsRetrospective analysis was made on the medical history,clinical manifestations,auxiliary examination methods,diagnosis and treatment history and follow-up of 2 cases of mycobacterium marinum dermophysiae infection admitted to the department of dermatology,qilu hospital,shandong university.Relevant literatures were reviewed by searching CNKI,Pubmed,Elsevier and other databases,and a retrospective analysis was made on 92 cases with relatively complete clinical data from 2005 to 2020.General data such as gender,age,clinical manifestation,auxiliary examination,treatment plan and prognosis of the cases were collected,and the etiology,clinical manifestation,laboratory examination,diagnosis,treatment and prognosis were analyzed.ResultWe report 2 cases of cutaneous infection caused by Mycobacterium marinum,with previous history of trauma or contact with aquatic products,presenting as erythema,papules,nodules,pustules and ulcerations,and pathological changes of skin lesions to infectious granuloma.We searched CNKI,Pubmed,Elsevier and other databases,reviewed relevant literature,and collected 92 cases of mycobacterium dermal Marine fish infection with relatively complete clinical data.The cases were as follows:1.Age and sex distribution of onsetAmong the 92 patients,the youngest was 3 years old,the oldest 82 years old,and the mean age was 48.6 years old.The duration of the disease is as short as 1 month and as long as 60 months.Among the 92 patients,63 were male and 29 were female,among whom 1 was pregnant.2.Inducement and incubation period11 patients were aquarium workers or fishermen who had daily contact with aquatic products.Twenty-nine patients reported exposure to water or aquatic products after injury due to stab wounds from fish,crabs or other aquatic animals.Thirty-one patients reported having been exposed to fish or other aquatic products or cleaning fish tanks or swimming before onset.Five patients had trauma,but denied any exposure to water or aquatic animals.Three patients clearly stated that they had no history of trauma or exposure to aquatic animals or water.The incubation period,most patients can not determine the specific time between their exposure to the cause and the onset of disease,according to the time clearly stated in the patients,the incubation period is the longest 2 months,the shortest is not more than 10 days.3.Clinical manifestationsThe primary site of 82 patients was the upper limb,which accounted for 72.8%of the total cases.The time from initial onset to effective treatment varies from 1 month to 5 years.Clinical manifestations are in the pathogenic bacteria invasion site of the occurrence of reddish-brown or purplish red papules,nodules or plaques,occasionally can soften break ulceration form superficial ulcer,or contains pustules,the condition is relatively light more without conscious symptoms.Multiple foci are usually arranged in the direction of lymphatic drainage in the form of sporidiomycosis,accounting for 51%of all cases.Deep tissue invasion accounted for 30.4%of the total.Severe cases of systemic spread occurred in 5 out of 92 patients.4.The diagnosisLaboratory tests included:lesions typical of infectious granulomatous lesions were seen in about 65.6%of patients;In all 4 patients treated with anti-tumor necrosis factor(anti-tnfa),there was no pathological manifestation of granulomatous inflammation in the lesions,but non-specific inflammation.However,only 27.4%of the patients were positive for acid fast staining.In this study,the shortest time was 2 weeks,the longest time was 7 weeks,and 67.4%of the cases were positive.In 5.4%of the cases,acid-fast staining and mycobacterium marinum culture were negative.Thirty-one cases were positive by PCR.5.Treatment and prognosisOf the cases treated,6 achieved good results with single drug therapy,and 86 patients received 2 to 3 antibiotic combinations,such as amikacin,clarithromycin,ethambutol,minocycline,rifampicin,trimethoprim-sulfamethoxazole,moxifloxacin,and levofloxacin.The course of treatment was 3-6 months for 53.5%of the patients,and the treatment time of 2 patients was more than 1 year.Two patients died of sepsis and 51 were cured without scars.Conclusion1.Cutaneous infection caused by Mycobacterium marinum occurs most frequently in adults who have occupational or daily contact with water and aquatic products.The incubation period is usually 2-4 weeks.2.Most of the skin lesions are typical papules,nodules or plaques,which can be seen along the lymphatic vessels in a linear distribution.3.Most of the histopathological features are infectious granuloma,and the positive rate of acid-fast staining was not high.4.Diagnosis depends on exposure history,clinical manifestations,bacterial culture and PCR techniques5.Two or three kinds of antibiotics are commonly used in therapy.The duration of treatment is recommended to be 3-6 months.If necessary,surgical treatment should be performed.