Skin-nontumor / Clinical Dermatology - Mycobacteria

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Skin-nontumor / Clinical Dermatology

Infectious disorders

Mycobacteria - atypical

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 24 August 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Skin disorders (ulcerations, abscesses, rheumatoid-like nodules, histiocytic reactions, panniculitis), most commonly due to M. kansasii, M. marinum, M. ulcerans

Epidemiology
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● Non tuberculous mycobacteria are non pathogenetic; they inhabit vegetation and water (stagnant, fresh or salty) and are saprophytic in soil, on animals and within animal feces
● Mycobacterium marinum is contracted most often in swimming pools (swimming pool granuloma, fish tank granuloma)
● Mycobacterium ulcerans is third most common mycobacterial disease in immunocompetent after tuberculosis and leprosy; often in tropical wetlands of Central and West Africa (Buruli ulcer), particularly areas with high prevalence of schistosomiasis (Trop Med Int Health 2001;6:554)

Clinical features
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● Upper limbs are common site of infection
● Typically cause painless inflammatory nodules or plaques that may ulcerate and discharge
● Mycobacterium kansasii mainly affects lung and lymph nodes, rarely causes skin lesions; has nodules which may be verrucous or become crusted ulcers; also papulopustules, cellulitis or spreading infection resembling sporotrichosis
● Rarely, squamous cell carcinoma may arise in a chronic Buruli ulcer

Case reports
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● 52 year old woman with foot infection (University of Pittsburgh)
● 61 year old woman with SLE and Sjogren's syndrome (Dermatology Online Journal 16 (11): 21)

Clinical images
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Mycobacterium marinum infection of hand

61 year old woman with SLE and Sjogren's syndrome

Micro description
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● Usually early cutaneous necrosis with abscess formation; abscess is gradually replaced by granulomatous inflammation and fibrosis

Micro images
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81 year old fisherman who fell into water in Chesapeake Bay - Mycobacterium marinum

61 year old woman with SLE and Sjogren's syndrome: H&E and Fite stain

Molecular / cytogenetics
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● PCR with liquid media facilitates species identification

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > Mycobacteria - atypical

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