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Sixty-three Cases of Mycobacterium marinum Infection
Clinical Features, Treatment, and Antibiotic Susceptibility of Causative Isolates
Alexandra Aubry, MD;
Olivier Chosidow, MD, PhD;
Eric Caumes, MD;
Jérôme Robert, MD, PhD;
Emmanuelle Cambau, MD, PhD
Arch Intern Med. 2002;162:1746-1752.
Background Mycobacterium marinum is a nontuberculous mycobacterium
responsible for skin infections. Although cases have been seldom reported,
no series of M marinum infection has been recently
reported and the treatment is not standardized.
Methods A national survey was conducted on culture-confirmed M marinum infections that occurred in France from January 1, 1996,
to December 31, 1998. Clinical characteristics and therapeutic data were analyzed,
and the minimum inhibitory concentrations of 11 antibiotics were determined
against the causative isolates.
Results Sixty-three cases of M marinum infection were
studied. In 53 (84%) of the patients, inoculation was related to fish tank
exposure. The site of infection was mainly the upper limb (in 60 [95%] of
the 63 patients), and infection was spread to deeper structures in 18 (29%)
of the patients. All patients were treated with antibiotics (median time,
3 months), and 30 (48%) underwent surgery. Various antibiotic regimens
were prescribed, and the initial regimen was modified in 22 (35%) of the patients.
Clarithromycin, cyclines, and rifampin were the most commonly prescribed antibiotics.
Cure was observed for 55 (87%) of the patients. Failure was related to deep
structure involvement (3 of 45 vs 5 of 18 patients; P
= .04) but not to any antibiotic regimen. All strains showed the same susceptibility
pattern without acquired resistance. The 90% minimum inhibitory concentrations
of rifampin and rifabutin were far lower (0.5 and 0.06 µg/mL, respectively)
than the 90% minimum inhibitory concentrations of clarithromycin (2 µg/mL)
and the cyclines (minocycline, 4 µg/mL; and doxycycline, 8 µg/mL).
Conclusions Mycobacterium marinum infections are emerging
infections related to fish tank hobby. Because of the severity of the cases
with spread of infection, clinical awareness of M marinum infection and its associated risk factors is important so that the
diagnosis can be made and therapy can be initiated promptly.
From the Laboratoire de Bactériologie, Centre National de Référence
pour la Surveillance des Infections à Mycobactéries et de leur
Résistance aux Antituberculeux (Drs Aubry, Robert, and Cambau), and
the Services de Médecine Interne (Dr Chosidow) and Maladies Infectieuses
(Dr Caumes), Groupe Hospitalier Pitié-Salpêtrière, Assistance
Publique-Hôpitaux de Paris, Paris, France.
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