title: Clinical and Pathological Evaluation of Mycobacterium marinum Group Skin Infections Associated With Fish Markets in New York City.
abstract: BACKGROUND
  From December 2013 through May 2014, physicians, dermatopathologists, and public health authorities collaborated to characterize an outbreak of Mycobacterium marinum and other nontuberculous mycobacterial skin and soft tissue infections (SSTIs) associated with handling fish in New York City's Chinatown. Clinicopathologic and laboratory investigations were performed on a series of patients.
  
  
  METHODS
  Medical records were reviewed for 29 patients. Culture results were available for 27 patients and 24 biopsy specimens were evaluated by histopathology, immunohistochemistry (IHC) staining for acid-fast bacilli (AFB), and mycobacterial polymerase chain reaction (PCR) assays.
  
  
  RESULTS
  All patients received antibiotics. The most commonly prescribed antibiotic regimen was clarithromycin and ethambutol. Of the 29 patients in this case series, 16 (55%) received surgical treatment involving incision and drainage, mass excision, and synovectomy. Of these, 7 (44%) had deep tissue involvement. All patients showed improvement. For those with culture results, 11 of 27 (41%) were positive for M. marinum; the remainder showed no growth. Poorly formed granulomas (96%), neutrophils (75%), and necrosis (79%) were found in 24 biopsies. Of 15 cases that were culture-negative and analyzed by other methods, 9 were PCR positive for M. marinum group species, 8 were IHC positive, and 3 were positive by AFB stains.
  
  
  CONCLUSIONS
  A multidisciplinary approach was used to identify cases in an outbreak of M. marinum infections. The use of histopathology, culture, and IHC plus PCR from full thickness skin biopsy can lead to improved diagnosis of M. marinum SSTIs compared to relying solely on mycobacterial culture, the current gold standard.
authors.affiliation: Columbia College of Physicians and Surgeons.
authors.forename: Tiffany Y
authors.initials: TY
authors.lastname: Sia
authors.affiliation: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sarah
authors.initials: S
authors.lastname: Taimur
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Blau
authors.affiliation: Division of Pathology, StrataDx, Lexington, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lambe
authors.affiliation: NYC Department of Health and Mental Hygiene.
authors.forename: Joel
authors.initials: J
authors.lastname: Ackelsberg
authors.affiliation: NYC Department of Health and Mental Hygiene.
authors.forename: Kari
authors.initials: K
authors.lastname: Yacisin
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jana
authors.initials: J
authors.lastname: Ritter
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Atis
authors.initials: A
authors.lastname: Muehlenbachs
authors.affiliation: Dermpath Diagnostics, Port Chester, New York.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shulman
authors.affiliation: Division of Plastics Surgery, Mount Sinai Beth Israel Medical Center.
authors.forename: Danny
authors.initials: D
authors.lastname: Fong
authors.affiliation: Division of Dermatology, Weill Cornell Medical College, New York, New York.
authors.forename: Elaine
authors.initials: E
authors.lastname: Kung
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001132:Arm; D003131:Combined Modality Therapy; D004196:Disease Outbreaks; D005260:Female; D005398:Fisheries; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D009519:New York City / Q000453:epidemiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Mycobacterium marinum; diagnosis; fish; outbreak; skin infection