Skip to main content

Advertisement

SpringerLink
Log in

Overview of Cutaneous Mycobacterial Infections

  • Cutaneous Mycobacterial Diseases of the Skin and Soft Tissues (C Franco-Paredes, Section Editor)
  • Published:
Current Tropical Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Mycobacterial infections may affect any human organ and produce disseminated disease in immunocompromised individuals. Their most common clinical presentations include pulmonary, cutaneous (skin and soft tissues), and disseminated forms. The skin and soft tissues are frequent targets of affection by mycobacterial pathogens manifesting as localized or diffuse disease.

Recent Findings

Overall, infections due to Mycobacterium leprae, Mycobacterium ulcerans, and Mycobacterium tuberculosis are the most frequently recognized mycobacterial pathogens involving the skin and soft tissues. Additionally, all mycobacterial species of the nontuberculous group may also produce cutaneous disease. Of these, the most commonly identified organisms causing localized infections of the skin and subcutaneous tissues are the rapidly growing species (Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus complex), Mycobacterium marinum, and M. ulcerans. Since the skin and soft tissues are important protective barriers for environmental pathogens, their disruption often represents the portal of entry of nontuberculous environmental mycobacteria (soil, natural water systems, engineered water networks, etc.). Additionally, some mycobacterial diseases affecting cutaneous structures occur after exposure to infected animals or their products (i.e., Mycobacterium bovis). Mycobacterial infections of the skin and soft tissues may manifest with a broad range of clinical phenotypes such as cellulitis, single or multiple abscesses, subacute or chronic nodular lesions, macules, superficial lymphadenitis, plaques, nonhealing ulcers, necrotic plaques, verrucous lesions, and many other dermatologic manifestations.

Summary

Geography and environmental exposure play an important role in the epidemiology of cutaneous mycobacterial infections. Mycobacterial infection of the skin and subcutaneous tissue is an important cause of human suffering in terms of morbidity, deformity, dysfunction, and stigma. The diagnosis of cutaneous mycobacterial infections is challenging requiring a low threshold of clinical suspicion for obtaining skin biopsies of cutaneous lesions for acid-fast staining and cultures, and molecular probe assays to detect the presence of mycobacterial pathogens. The choice of antibacterial therapy combinations and length of therapy for cutaneous mycobacterial infections is species-specific.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Bottai D, Stinear TP, Supply P, Brosch R. Mycobacterial pathogenomics and evolution. Microbiol Spectr. 2014;2(1) MGM2–0025-2013. https://doi.org/10.1128/microbiolspec.MGM2-0025-2013. This article describes the evolution and pathogenomics of many mycobacterial species.

  2. •• Forbes BY, Hall GS, Miller MB, Sm N, Rowlinson MC, Salfinger M, et al. Practice guidelines for clinical microbiology laboratories: mycobacteria. Clin Microbiol Rev. 2018;31(2):e00038–17. In-depth discussion of microbiological techniques that assist clinicians in caring for individuals with cutaneous mycobacterial infections.

    Article  Google Scholar 

  3. Falkinham JO. Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment. J Appl Microbiol. 2009;107:356–67.

    Article  CAS  Google Scholar 

  4. Behr MA. Mycobacterium du jour: what’s on tomorrow’s menu? Microbes Infect. 2008;10:968–72.

    Article  CAS  Google Scholar 

  5. Behr MA, Gordon SV. Why doesn’t Mycobacterium tuberculosis spread in animals? Trends Microbiol. 2015;23(1):1–2.

    Article  CAS  Google Scholar 

  6. Mostowy S, Behr MA. The origin and evolution of Mycobacterium tuberculosis. Clin Chest Med. 2005;26:207–16.

    Article  Google Scholar 

  7. Avanzi C, Del-Pozo J, Benjak A, Stevenson K, Sipson VR, Busso P, et al. Red squirrels in the British Isles are infected with leprosy bacilli. Science. 2016;354(6313):744–474.

    Article  CAS  Google Scholar 

  8. Balamayooran G, Pena M, Sharma R, Truman RW. The armadillo as an animal model and reservoir host for Mycobacterium leprae. Clin Dermatol. 2015;33:108–15.

    Article  Google Scholar 

  9. Franco-Paredes C, Rodriguez-Morales AJ. Unsolved matters in leprosy: a descriptive review and call for further research. Ann Clin Microbiol Antimicrob. 2016;15:33.

    Article  Google Scholar 

  10. •• Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416. This is the most important clinical guidelines for the diagnosis and management of non-tuberculous mycobacteria.

    Article  CAS  Google Scholar 

  11. •• Wang SH, Pancholi P. Mycobacterial skin and soft tissue infection. Curr Infect Dis Rep. 2014;16:438. https://doi.org/10.1007/s11908-014-0438-5. This is an important publication that summarizes the clinical spectrum of disease caused by mycobacterial infections of the skin and soft tissues.

    Article  PubMed  Google Scholar 

  12. Falkinham JO 3rd. Environmental sources of nontuberculous mycobacteria. Clin Chest Med. 2015;36:35–41.

    Article  Google Scholar 

  13. Merritt RW, Walker ED, Small PLC, Wallace JR, Johnson PDR, Benbow ME, et al. Ecology and transmission of Buruli ulcer disease: a systematic review. PLoS Negl Trop Dis. 2010;4(12):e911.

    Article  Google Scholar 

  14. Marsollier L, Stinear T, Aubry J, Saint Andre JP, Robert R, Legras P, et al. Aquatic plants stimulate the growth of and biofilm formation by Mycobacterium ulcerans in axenic culture and harbor these bacteria in the environment. Appl Environ Microbiol. 2004;70(2):1097–103.

    Article  CAS  Google Scholar 

  15. Smith S, Taylor GD, Fanning EA. Chronic cutaneous Mycobacterium haemophilum infection acquired from coral injury. Clin Infect Dis. 2003;37(7):e100–1.

    Article  Google Scholar 

  16. Mougari F, Guglielmetti L, Raskine L, Sermet-Gaudelus I, Veziris N, Cambau E. Infections caused by Mycobacterium abscessus: epidemiology, diagnostic tools and treatment. Expert Rev Anti-Infect Ther. 2016;14(120):1139–54.

    Article  CAS  Google Scholar 

  17. Henkle E, Winthrop KL. Nontuberculous mycobacteria infections in immunosuppressed hosts. Clin Chest Med. 2015;36:91–6.

    Article  Google Scholar 

  18. Smith WC, van Brakel W, Gillis T, Saunderson P, Richardus JH. The missing millions: a threat to the elimination of leprosy. PLoS Negl Trop Dis. 2015;9(4):e0003658.

    Article  Google Scholar 

  19. Stone AC, Wilbur AK, Buikstra JE, Roberts CA. Tuberculosis and leprosy in perspective. Am J Phys Anthropol. 2009;52:66–94.

    Article  Google Scholar 

  20. White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev. 2015;28(1):80–94.

    Article  CAS  Google Scholar 

  21. •• Scollard DM, Dacso MM, Abad-Venida ML. Tuberculosis and leprosy: classical granulomatous diseases in the twenty-first century. Dermatol Clin. 2015;33:541–62. Provides important clinical information on the diagnosis and management of leprosy and cutaneous tuberculosis.

    Article  CAS  Google Scholar 

  22. Röltgen K, Stinear TP, Pluschke G. The genome, evolution and diversity of Mycobacterium ulcerans. Infect Genet Evol. 2012;12(3):522–9.

    Article  Google Scholar 

  23. Doig KD, Holt KE, Fyfe JAM, Lavender CJ, Eddyani M, Portaels F, et al. On the origin of Mycobacterium ulcerans, the causative agent of Buruli ulcer. BMC Genomics. 2012;13:258.

    Article  CAS  Google Scholar 

  24. Nienhuis WA, Stienstra Y, Thompson WA, Awuah PC, Abass MK, Tuah W, et al. Antimycobacterial treatment for early, limited Mycobacterium ulcerans infection: a randomized controlled trial. Lancet. 2010;37:664–72.

    Article  Google Scholar 

  25. • Brown-Elliott BA, Wallace RJ Jr. Clinical and taxonomic status of pathogenic non-pigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev. 2002;15(4):716–46. This article reports the clinical and taxonomic status of non-tuberculous mycobacteria.

    Article  Google Scholar 

  26. Adjemian J, Olivier KN, Seitz AE, Holland SM, Prevots DR. Prevalence of nontuberculous mycobacterial lung disease in U.S. Medicare beneficiaries. Am J Respir Crit Care Med. 2012;185(8):881–6.

    Article  Google Scholar 

  27. Wu U, Holland SM. Host susceptibility to non-tuberculous mycobacterial infections. Lancet Infect Dis. 2015;15:968–80.

    Article  CAS  Google Scholar 

  28. Williams DL, Gillis TP. Drug-resistant leprosy: monitoring and current status. Lepr Rev. 2012;83(3):269–81.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Denver, CO, USA

    Carlos Franco-Paredes, Lorna Allen & Andrés F. Henao-Martínez

  2. Hospital Infantil de México, Federico Gómez, México City, Mexico

    Carlos Franco-Paredes

  3. Infectious Diseases Group Practice, University of Colorado Hospital, 1635 Aurora Court, Mail Stop B-163, Aurora, CO, 80045, USA

    Carlos Franco-Paredes, Lorna Allen & Andrés F. Henao-Martínez

  4. Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA

    Daniel B. Chastain

Authors
  1. Carlos Franco-Paredes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel B. Chastain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorna Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrés F. Henao-Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlos Franco-Paredes.

Ethics declarations

Conflict of Interest

The authors 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.

Additional information

This article is part of the Topical Collection on Cutaneous Mycobacterial Diseases of the Skin and Soft Tissues

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Franco-Paredes, C., Chastain, D.B., Allen, L. et al. Overview of Cutaneous Mycobacterial Infections. Curr Trop Med Rep 5, 228–232 (2018). https://doi.org/10.1007/s40475-018-0161-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40475-018-0161-7

Keywords

Search

Navigation