Nontuberculous Mycobacterial Skin Infections : Clinical and Bacteriological Studies
PUNKAE MAHAISA V ARIY A, MD*, ANGKANA CHAIPRASERT, Dr rer nat** SUPAKAN KHEMNGERN, BS, MA*, JANE MANONUKUL, MD***, NIPA GENGVINIIJ,MSc**, PREY A WIS NA UBOL, BSc**, SOMRUEDEE PINITUGSORN, BSc**
Affiliation : * Department of Dermatology, **Department of Microbiology, *** Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Objective : Nontuberculous mycobacterial (NTM) skin infections were analysed in terms of clinical manifestation in different species to provide clues for the clinical diagnosis and sensitivity patterns of these species were studied for planning appropriate therapy.
Design : A retrospective study was performed in 123 suspected cases of NTM infections from January 1994 to December 2000. NTM infection was documented by culture result of the infected tissue obtained by skin biopsy. Drug susceptibility test was done as requested. Result: Rapid growers (M.fortuitum-chelonae) were found in 26 cases (65%) and M. marinum was responsible for 12 cases (30%) and caused only localized skin lesions on arms or legs as indurated plague, Disseminated skin infections manifested as multiple abscesses were found in 2 cases caused by M. avium in an HIV -infected male patient and mixed infection of M. szulgai and M. terrae in an immunocompetent female patient after a dental procedure. Both sexes were affected equally in overall number but male predominated in M. marinum infection and females predominated in rapid growers. All ages can be affected but most cases were middle aged. Scrofuloderma - like cervical lympha denitis and cutaneous abscesses were the common manifestation of rapid grower infections. Hyper keratotic verrucous plagues (tuberculosis verrucosa cutis - like) and sporotrichoid lesions were the common manifestations of M. marinum infection. M. marinum is sensitive to minocyclin, clarithro mycin, amikacin, rifampicin and ethambutol and a good clinical response was obtained with doxy cyclin 100 mg orally twice a day for 3 months. Clarithromycin and amikacin showed in vitro activity against the same strain of M. fortuitum but most strains of rapid growers resisted antituberculous drugs and also various antibiotics.
Conclusion : Clinical manifestations can be used as clues for diagnosis. Medical therapy is recommended forM. marinum infection and surgical treatment is recommended for rapid growers.
Keywords : Nontuberculous Mycobacterial Skin Infections, Clinical Study, Bacteriologic Study, Sensitivity Patterm
