Mycobacterium marinum as a cause of chronic granulomatous tenosynovitis in the hand.
OBJECTIVE
Mycobacterium marinum is an uncommon cause of chronic granulomatous flexor tenosynovitis and leads to significant morbidity in the hand. This paper aims to review our treatment of this infection and its clinical outcomes.


METHODS
We treated five cases of M. marinum flexor tenosynovitis from 2001 to 2006, which were confirmed after 6 weeks of mycobacterial culture.


RESULTS
All the patients were healthy immuno-competent hosts. There was a history of injury by a marine animal in each patient. Presentation was delayed at an average of 32.0 days after the injury. Excisional debridement was performed at an average of 63.4 days after the injury. The average number of debridements performed was 3.4. One patient had to undergo ray amputation to control the infection. The average duration of oral antibiotics was 15.4 weeks. Post-operatively, there were reductions in total active motion in all patients.


CONCLUSIONS
A high index of suspicion, based on the history and intra-operative findings, is necessary when managing these patients. This infection runs a protracted course that requires multiple debridements and is associated with poor functional outcome.
Pang
Hee-Nee
HN
Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. pangheenee@hotmail.com <pangheenee@hotmail.com>
Lee
Jonathan Yi-Liang
JY
Puhaindran
Mark Edward
ME
Tan
Soo-Heong
SH
Tan
Agnes Beng-Hoi
AB
Yong
Fok-Chuan
FC
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006105:Granulomatous Disease, Chronic / Q000188:drug therapy / Q000382:microbiology*; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000382:microbiology*; D019910:Mycobacterium marinum / Q000302:isolation & purification / Q000472:pathogenicity*; D013717:Tenosynovitis / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents