Invasive Mycobacterium marinum infection of the hand

Abstract

Mycobacterium marinum infection of the hand is rare. We report the case of a 39-year-old man with M marinum infection that resulted in a chronic soft tissue infection, extensor tendon synovitis, and arthritis of the metacarpophalangeal (MCP) joints. The cause was probably tropical freshwater fishes.     

An unusually aggressive Mycobacterium marinum hand infection

An unusually aggressive Mycobacterium marinum infection of the hand that progressed despite surgical and medical treatment is presented. The infection progressed over a 3-week period after the patient had surgical treatment and received isoniazid (INH), rifampin, and ethambutol hydrochloride. The patient had a collar-button abscess, destruction of the metacarpophalangeal (MCP) joint capsule, flexor and extensor tenosynovitis, and metacarpal and proximal phalanx bone destruction at the MCP joint and metacarpal shaft. Although atypical mycobacterial infections of the hand are usually indolent but persistent, this Mycobacterium marinum hand infection progressed rapidly, even with surgical and medical treatment. A judgment was made to perform an index ray amputation. With a more complete excision of the infected tissue, there was a higher probability of controlling this severe infection. The patient was treated with antituberculosis medications for 6 months and is doing well 1 year after the operation.     

Mycobacterium marinum hand infection: case reports and review of literature.

Three patients with Mycobacterium marinum infection are described. Key elements in the diagnosis of this infection are a high index of suspicion, taking a history with an emphasis on exposure to tropical fish or other potential sources of M. marinum infection, and tissue biopsy for culture and histology. The microbiologist should be informed about the suspicion of M. marinum infection so that appropriate cultures can be performed. As M. marinum does not grow under routine culture conditions, the diagnosis is easily missed resulting in delayed treatment. The treatment is essentially antimicrobial therapy for the superficial lesions supplemented by an appropriate surgical debridement especially when deep structures are involved.     

Mycobacterium marinum infections of the hand

Fifteen patients had culture proven Mycobacterium marinum infections of the hand; 11 had injured their hands while fishing in water around Long Island. No patient had type I lesions (verrucal), six patients had type II lesions (subcutaneous granulomas), and nine patients had type III lesions (deep). Histologic examination showed noncaseating granulomas in all cases. A specific defect in the patients' lymphocytes ability to respond to M. marinum antigens was identified. A combination of surgery and tetracycline provided effective treatment. Follow-up averaged 2 1/2 years.     

Treating deep-seated mycobacterium marinum infection in the hand: a report of three cases.

We report three cases of an unusual aggressive type of Mycobacterium marinum infection of the hand which had been a nightmare both for us and the patient. These were the patients in which even after repeated thorough surgical debridement and appropriate (drug sensitive) medical treatment over a period had resulted in amputation or devastation of the soft tissues so extensively that almost only the neurovascular bundle, bone and the skin were the only structures left (cosmetic fingers - no function) at the last debridement after which the infection has not recurred. By presenting this article we want to stress on certain points pertaining to diagnosis, management, varied presentation and of course the dreadful complications of deep-seated M. marinum infection.     

Septic arthritis of the hand due to Mycobacterium marinum

Mycobacterium marinum infections of the hand are very rare in the United Kingdom and we found only one case of involvement of deep structures (tenosynovitis) in the British literature. We report a case of septic arthritis due to the organism.     

Mycobacterium marinum infection in a renal transplant recipient.

BACKGROUND: Infections with atypical mycobacteria occur more frequently in patients with solid organ transplants than in the normal host. METHODS: We report a case of cutaneous Mycobacterium marinum infection in a renal transplant recipient. The patient presented with nodules on the forearm after returning from a fishing trip and was treated for cellulitis without success. RESULTS: Cultures of a biopsy of the lesion grew M. marinum. The patient was treated with ethambutol and ciprofloxacin with a good response; however, 9 months of treatment were required for complete resolution. CONCLUSION: Immunosuppressive therapy for renal transplantation increases susceptibility to a variety of opportunistic infections. A patient who presents with nodules on the extremities should be questioned regarding contact with fish, aquatic environments, or fish tank water, in which case infection with M. marinum should be considered. The diagnosis and treatment of this infection in transplant recipients is discussed.     

Mycobacterium marinum infection in a lung transplant recipient.

We report a case of Mycobacterium marinum infection in a lung transplant recipient who presented with nodules on the hand and forearm following exposure to fish-tank water of a superficial hand burn. Skin biopsy revealed granulomatous inflammation and fibrosis. Tissue culture grew Mycobacterium marinum. The patient underwent surgical excision of the lesions and treatment with ethambutol and azithromycin for 12 months and experienced complete resolution of the infection. Transplant recipients who receive immunosuppressive therapy are at increased risk for opportunistic infections. For a patient with nodular lesions on the extremities, exposure to fish, fish-tank water, or swimming should suggest infection with Mycobacterium marinum.     

Mycobacterium tuberculosis infection of the wrist

Reports of tuberculous infections of the wrist have been scarce, especially during the past 30 years. The diagnosis of tuberculosis may be difficult and requires a high index of suspicion, especially in patients with significant risk factors. Prompt diagnosis and treatment are crucial, as untreated wrist infections can have disastrous outcomes. This article describes the clinical presentation and management of an atypical case of tuberculosis of the wrist--a case of extensive carpal destruction without tenosynovial involvement. Quiescent tuberculosis seemed to reactivate after an episode of minor trauma.     

Results of dorsal wrist synovectomies in the rheumatoid hand

Seventy-eight patients with rheumatoid arthritis had 102 dorsal wrist tenosynovectomies, intraarticular synovectomies, and Darrach resection from 1962 to 1982. Follow-up after surgery averaged 11 years, with a range from 3 to 20 years. Pain was diminished in all but 17 wrists and motion decreased an average of 13 degrees. Synovitis recurred in 16 wrists and x-ray evidence of progressive intraarticular destruction was seen in 45 wrists. Revision surgery was necessary in 28 wrists.     

Treatment of osteoarthritis in the hand and wrist. Nonoperative treatment

Osteoarthritis should initially be treated conservatively with the use of oral medication, intra-articular steroid injections, hand therapy, and splinting. The reduction of pain and the resultant increase in function to the patient are the ultimate goals of this treatment.