title: Nontuberculous mycobacterial infections of the skin: A retrospective study of 25 cases.
abstract: BACKGROUND
  Absence of a pathognomonic clinical picture and variable histologic findings often delay diagnosis of nontuberculous mycobacteria (NTM)-induced cutaneous infections, and antimicrobial therapy varies.
  
  
  OBJECTIVE
  We sought to investigate the clinical, microbiologic, and pathological findings of cutaneous NTM infections and response to different treatments.
  
  
  METHODS
  Records of patients with NTM infections of the skin confirmed by positive cultures or histologic findings were reviewed. Clinical, microbiologic, and epidemiologic data were collected and skin biopsy specimens were reassessed.
  
  
  RESULTS
  The series included 25 cases, one diagnosed by histology and 24 by positive culture: 16 cases with Mycobacterium marinum, 3 of atypical Mycobacterium without species identification, and one each with M chelonae, M xenopi, M abscessus, M gordonae, and M fortuitum. One of 16 patients with M marinum developed tenosynovitis. Mean interval between clinical presentation and diagnosis was 7.1 months (range: 1-27.3 months). All isolates analyzed for antimicrobial susceptibility pattern were sensitive to clarithromycin.
  
  
  CONCLUSIONS
  Limitations include methods of case collection, retrospective study, and relatively small number of patients.
  
  
  CONCLUSIONS
  Diagnosis of NTM should be confirmed by histology and bacteriology studies of tissue cultures. Strong clinical suggestion of M marinum infection warrants initial empirical treatment to prevent progression to deep infection. The recommended treatment as indicated by the results of the in vitro susceptibility and clinical response is clarithromycin.
authors: Department of Dermatology, Ha'emek Medical Center.
authors: Roni
authors: R
authors: Dodiuk-Gad
authors: Pavel
authors: P
authors: Dyachenko
authors: Michael
authors: M
authors: Ziv
authors: Ayelet
authors: A
authors: Shani-Adir
authors: Yehudit
authors: Y
authors: Oren
authors: Saul
authors: S
authors: Mendelovici
authors: Jan
authors: J
authors: Shafer
authors: Bibiana
authors: B
authors: Chazan
authors: Raul
authors: R
authors: Raz
authors: Yoram
authors: Y
authors: Keness
authors: Dganit
authors: D
authors: Rozenman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D003951:Diagnostic Errors; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005385:Fingers; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D009161:Mycobacterium / Q000145:classification / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin