title: Treatment of biopsy and culture negative Mycobacterium marinum: diagnostic and therapeutic considerations.
abstract: Mycobacterium marinum infections are frequently linked to aquatic environments. Cutaneous infections with these organisms cause superficial nodules, ulcerations, and pustules on the skin. Involvement of the deeper tissue may occur when diagnosis and treatment are delayed, allowing the organisms to spread. The diagnostic criteria for infections rely on a detailed patient history, a typical clinical presentation, positive cultures, characteristic organism smear, and if available CR-RFLP analysis and sequencing of 65 kD hsp gene. However, when the pathology is not diagnostic for and the cultures and smears are negative, treatment may be delayed despite clinical suspicion. The accuracy of bacterial cultures and smears for infections has been shown to be variable with ranges between 10%-60%, leaving many infections unconfirmed. Despite the difficulty in diagnosis, early suspicion of is critical because of the dangers imposed by delayed treatment. Prior reports have documented invasive surgical debridement and amputation due to delayed diagnosis and treatment. This case study demonstrates the need for clinical suspicion and accurate patient history for the correct treatment. The patient reported presented with classic signs and symptoms as well as a strong history of frequent contact with aquariums and with fish obtained during frequent fishing trips but did not have positive stains or a positive culture. The approach to patients such as this one is critical to avoidance of complications and prolonged infections, which can have dire consequences.
authors: Patrick
authors: P
authors: Tenbrick
authors: Michael
authors: M
authors: Beer
authors: Kenneth
authors: K
authors: Beer
mesh_terms: D000368:Aged; D001426:Bacterial Proteins / Q000235:genetics; D001706:Biopsy; D018834:Chaperonin 60 / Q000235:genetics; D006801:Humans; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy; D019910:Mycobacterium marinum / Q000302:isolation & purification*; D012150:Polymorphism, Restriction Fragment Length
chemical_list: D001426:Bacterial Proteins; D018834:Chaperonin 60; C074119:heat-shock protein 65, Mycobacterium