Mycobacterium marinum skin infections. Report of 31 cases and review of the literature.
BACKGROUND
Mycobacterium marinum is a rare cause of skin infections, and its treatment has been based primarily on the personal experience and preferences of individual investigators without the benefit of large studies.


METHODS
Thirty-one patients with confirmed M marinum infection were identified at 33 Kaiser Permanente Northern California Region medical centers by microbiologic records, and their charts were reviewed.


RESULTS
The upper extremity was affected in 90% of cases, and lymphatic or local spread was seen during the initial examination or during observation in 25 patients (81%). Granuloma was present in 22 (63%) of 35 biopsy specimens, and staining for acid-fast bacteria yielded positive results in two of 22 specimens. Cure or improvement occurred in 22 (81%) of 27 patients in whom outcome could be evaluated. Treatment with ethambutol plus rifampin appeared more successful (effective in five [100%] of five cases) than minocycline treatment (effective in 10 [71%] of 14 cases), although not significantly so (P = .28). Adverse reactions, most of which were gastrointestinal, occurred in five patients (18%).


CONCLUSIONS
Ethambutol plus rifampin appears more useful than minocycline in treating cutaneous M marinum infection. This result remains to be confirmed by larger clinical studies, which may be difficult because this infection is relatively rare.
Edelstein
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Department of Internal Medicine, Kaiser Permanente Medical Center, San Rafael, Calif.
D000328:Adult; D000368:Aged; D002648:Child; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects / Q000627:therapeutic use; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy; D012293:Rifampin / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
D004977:Ethambutol; D008911:Minocycline; D012293:Rifampin