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Mycobacterium marinum
Aka: Mycobacterium marinum
- Pathophysiology: Causes Nodular Lymphangitis
- Mycobacterium marinum most common etiology
- Other atypical Mycobacteria can also cause
- Exposure risks: Fresh and Saltwater Exposure
- Fish Handlers
- Tropical aquarium keepers (fish tanks)
- Swimming in ocean water, lakes, and pools
- Signs
- Primary lesion after 2-8 week incubation
- Papular lesion develops at inoculation site
- Secondary lesions
- Erythematous Papules, Nodules develop up lymph chain
- Lesions ulcerate or form abscess
- Systemic symptoms are rare
- Fever
- Regional adenopathy
- Differential Diagnosis
- See Nodular Lymphangitis
- Labs
- Microscopic examination
- Organisms rarely seen
- Culture of biopsied tissue
- Requires special incubation Temperatures
- Purified Protein Derivative (PPD)
- Usually >10 mm in active Mycobacterium marinum cases
- Management
- Apply warm compresses for 40 to 60 minutes per day
- Antibiotics for 2-3 months after symptom resolution
- Combination Protocol 1
- Clarithromycin 30 mg/kg/day and
- One of the following
- Rifampin 10-15 mg/kg/day or
- Ethambutol 25 mg/kg/day
- Combination Protocol 2
- Rifampin 15 mg/kg/day and
- Ethambutol 25 mg/kg/day
- Alternative antibiotic option (based on sensitivity)
- Minocycline 100 mg PO bid
- References
- Edelstein (1994) Arch Intern Med 154:1359-64 [PubMed]
- Lewis (2003) Clin Infect Dis 37:390-7 [PubMed]
- Tobin (2001) Am Fam Physician 63:326-32 [PubMed]