1631. Risk Factors and Management Strategy of Disseminated Mycobacterium Marinum Infection with Bacteremia
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • marinum poster idsa.pdf (2.0 MB)
  • Background:

    Mycobacterium marinum is the most common atypical mycobacterium to cause skin infection, known as “fish tank” granuloma. M. marinum causes disease in humans by traumatic inoculation of the skin. The infection usually occurs at the site of inoculation and often presents as a localized cutaneous eruption. In the setting of immunosuppression, cutaneous/systemic dissemination can occur.  We report a case of disseminated M. marinum infection misdiagnosed as rheumatoid arthritis (RA) and review the literature on previously reported cases of disseminated disease.

    Methods:

    We retrospectively reviewed the literature for all cases of disseminated M. marinum infection reported between 1962 and 2012 utilizing the PUBMED database.  A comparative analysis was performed to explore risk factors, treatments and outcomes.

    Results:

    Seventeen cases of disseminated infection were identified.  The risk factors for disseminated disease appear to be delayed diagnosis and the lack of intact cellular immunity.  The mean age was 51 years.  The male:female ratio was 1.4:1.  All patients were immunocompromised. Most cases reported some form of aquatic exposure.  The diagnosis of M. marinum infection was frequently delayed. Interestingly, 5/17 patients (29%) were misdiagnosed as having RA.  The most common antibiotics prescribed were clarithromycin, rifampin, ethambutol, minocycline, and TMP/SMX. Most disseminated cases were treated with 2 or more agents for several months (median was 8 months). Five patients required surgical intervention in addition to antibiotics to decrease disease burden. There were 4 reported cases of death directly or indirectly related to M. marinum. The mortality of disseminated disease was 24%.

    Conclusion:

    M. marinum is a common though not universally recognized environmental human pathogen. It may be misdiagnosed as RA and treated with either corticosteroid or other immunomodulators, increasing risk for disease progression. Since delayed diagnosis can affect outcome and lead to disease dissemination, or even death, prompt recognition of M. marinum associated clinical syndromes and diagnostic modalities is critical. Thus, a detailed history, especially occupational and recreational exposure is essential to facilitate an early diagnosis and prevent disease dissemination.

    Lily Jones, DO, Infectious Diseases and International Medicine, University of South Florida, Tampa, FL, Jose Montero, MD, University of South Florida, Tampa, FL and Richard Oehler, MD, FACP, FIDSA, Division of Infectious Disease and International Medicine, University of South Florida, Tampa, FL

    Disclosures:

    L. Jones, None

    J. Montero, None

    R. Oehler, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.