Manifestations of Mycobacterium marinum in the Immunocompromised Host
Purpose of Review
Atypical Mycobacterium infections are occasionally encountered in clinical practice. As a result of immune function modulation in some particular populations (i.e., transplant, immunotherapies for chronic rheumatological diseases, chronic steroid therapy), there has been an increase in the number of diagnosed cases with atypical Mycobacterium, in particular M. marinum, associated with a history of exposure to natural or artificial water systems. The aim of this study is to review recent clinical presentations, risk factors, and management of M. marinum infections in immunocompromised individuals.
M. marinum exposure may potentially cause skin and soft tissue infections leading to important morbidity with sometimes life-threatening complications among immunocompromised hosts. The diagnosis of this infection is frequently delayed by months due to the often-atypical clinical presentations. A common immunosuppression associated with infection is TNF inhibition secondary to novel TNF inhibitors. These patients often present with infection within the nose. This atypical clinical presentation, in contrast to the classic “fish tank granuloma” hand lesion, may be related to immunosuppressive factors.
Increasing awareness of this particular nontuberculous mycobacterial infection among physicians caring for patients with potential exposure to aquatic environments may reduce the time of diagnosis to treatment and avoid further complications.
KeywordsMycobacterium marinum Skin lesions Immunocompromised host
Compliance with Ethical Standards
Conflict of Interest
Annabelle Jones and Luis A. Marcos declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 3.Smidt KP, Stern PJ, Kiefhaber TR. Atypical mycobacterial infections of the upper extremity. Orthopedics. 2018:1–6.Google Scholar
- 6.• Hashish E, Merwad A, Elgaml S, Amer A, Kamal H, Elsadek A, et al. Mycobacterium marinum infection in fish and man: epidemiology, pathophysiology and management; a review. Vet Q. 2018;38:35–46. Nice review of the pathogenesis of M. marinum infection and virulent factors. Google Scholar
- 7.•• Holden IK, Kehrer M, Andersen AB, Wejse C, Svensson E, Johansen IS. Mycobacterium marinum infections in Denmark from 2004 to 2017: a retrospective study of incidence, patient characteristics, treatment regimens and outcome. Sci Rep. 2018;8:6738. Good epidemiological study in Denmark of this rare infection; one of the largest series of cases of M. marinum . CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Yacisin K, Hsieh JL, Weiss D, Ackelsberg J, Lee E, Jones L, et al. Outbreak of non-tuberculous mycobacteria skin or soft tissue infections associated with handling fish—New York City, 2013-2014. Epidemiol Infect. 2017;145:2269–79.Google Scholar
- 10.Avneri L, Eidlitz-Markus T, Mor M, Zeharia A, Amir J, Haimi-Cohen Y. Mycobacterium marinum: a rare cause of chronic lymphocutaneous syndrome. Eur J Pediatr. 2018; https://doi.org/10.1007/s00431-018-3102-5.
- 12.Nguyen HH, Fadul N, Ashraf MS, Siraj DS. Osteomyelitis infection of Mycobacterium marinum: a case report and literature review. Case Rep Infect Dis. 2015:905–20.
- 13.Oh TH, Kim UJ, Kang SJ, Jang HC, Park KH, Jung SI, et al. Disseminated invasive Mycobacterium marinum infection involving the lung of a patient with diabetes mellitus. Infect Chemother. 2018;50:59–64.Google Scholar
- 15.•• Johnson MG, Stout JE. Twenty-eight cases of Mycobacterium marinum infection: retrospective case series and literature review. Infection. 2015;43:655–62. Nice review on a large series of cases of M. marinum infection comparing skin versus invasive disease and treatment outcomes. CrossRefPubMedGoogle Scholar
- 16.Timoney I, Lynch M, Timoney L, Feeney E, Kirby B. Mycobacterium marinum infection contracted from seaweed wrap in a psoriasis patient undergoing treatment with adalimumab. Dermatol Online J. 2017;23(8)
- 18.Sia TY, Taimur S, Blau DM, Lambe J, Ackelsberg J, Yacisin K, et al. Clinical and pathological evaluation of Mycobacterium marinum group skin infections associated with fish markets in New York City. Clin Infect Dis. 2016;62:590–5. https://doi.org/10.1093/cid/civ937.
- 19.Veronese F, Zavattaro E, Farinelli P, Colombo E, Savoia P. An unusual cutaneous infection caused by Mycobacterium marinum. JMM case reports. 2017:4(4).Google Scholar
- 24.Chiba M, Yanaba K, Kohara A, Nakayama M, Nakagawa H, Fukuda T, et al. Septic arthritis caused by Mycobacterium marinum infection. J Dermatol. 2017;44:1179–80.Google Scholar
- 25.Asakura, T., Ishii, M., Kikuchi, T., Kameyama, K., Namkoong, H., Nakata, N., et al. Disseminated Mycobacterium marinum infection with a destructive nasal lesion mimicking extranodal NK/T cell lymphoma: a case report. Medicine, 2016;95(11).Google Scholar
- 26.Djurinec P, Radoš J, Katalinić-Janković V, Lakoš Jukić I, Kostović K. Mycobacterium marinum infection of the hand in an immunocompromised aquarium hobbyist. Acta Dermatovenerol Croat. 2017;25:50–0.Google Scholar
- 28.Di Meo, N., Stinco, G., Trevisini, S., De Marchi, S., Albano, A., & Trevisan, G. Sporotrichoid Mycobacterium marinum infection in an elderly woman. Dermatology online journal, 2015;21(5).Google Scholar