期刊
CLINICAL INTERVENTIONS IN AGING
卷 7, 期 -, 页码 533-538出版社
DOVE MEDICAL PRESS LTD
DOI: 10.2147/CIA.S36371
关键词
amikacin; clarithromycin; skin infection; Mycobacterium marinum; nontuberculous mycobacteria
资金
- National Natural Science Foundation of China [30972651]
- Natural Funds of Jiangsu Health Office, PR China [H200638]
- special fund for basic research and development of Chinese national scientific research institutes
- fund for the Key Clinical Program of the Ministry of Health [2010-2012-125]
Background: The incidence of Mycobacterium marinum infection has been increasing. First-line antituberculous drugs and other common antibiotics are effective for most cutaneous M. marinum infections; however, treatment failure still occurs in some rare cases. We report a case of a 70-year-old man with refractory cutaneous infection caused by M. marinum. Reasons for delayed diagnosis and related factors of the refractory infection are also discussed. Methods: Samples of lesional skin were inoculated on Lowenstein-Jensen medium for acid-fast bacilli. Species of mycobacterium were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. We then carried out genotyping by using mycobacterial interspersed repetitive units and sequencing of heat shock protein 65 (hsp65) and 16S rDNA genes. Results: Tissue cultures for acid-fast bacilli were positive. PCR-RFLP analysis and sequencing of hsp65 and 16S rDNA genes confirmed the isolated organisms to be M. marinum. Systemic therapy with rifampicin, clarithromycin, and amikacin empirically over 6 months led to complete resolution of skin lesions leaving only some residual scars. Conclusion: Key diagnostic elements for M. marinum infections include a high index of suspicion raised by chronic lesions, poor response to conventional treatments, and a history of fish-related exposure. Strong clinical suggestion of M. marinum infection warrants initial empirical treatment. The duration of therapy is usually several months or even longer, especially for elderly patients. Amikacin can be considered in multidrug therapy for treatment of some refractory M. marinum infections.
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