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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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