Successful treatment of refractory cutaneous infection caused by Mycobacterium marinum with a combined regimen containing amikacin
Authors Huang Y, Xu X, Liu, Wu, Zhang, Liu, Zeng, Sun J, Jiang, wang H
Received 26 July 2012
Accepted for publication 25 September 2012
Published 22 November 2012 Volume 2012:7 Pages 533—538
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Yingxue Huang,* Xiulian Xu,* Yi Liu, Kan Wu, Wei Zhang, Pai Liu, Xuesi Zeng, Jianfang Sun, Yiqun Jiang, Hongsheng Wang
Key Laboratory of Molecular Biology for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
*These authors contributed equally to this work
Background: The incidence of Mycobacterium marinum infection has been increasing. First-line antituberculous drugs and other common antibiotics are effective for most cutaneous M. marinum infections; however, treatment failure still occurs in some rare cases. We report a case of a 70-year-old man with refractory cutaneous infection caused by M. marinum. Reasons for delayed diagnosis and related factors of the refractory infection are also discussed.
Methods: Samples of lesional skin were inoculated on Löwenstein–Jensen medium for acid-fast bacilli. Species of mycobacterium were identified by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) analysis. We then carried out genotyping by using mycobacterial interspersed repetitive units and sequencing of heat shock protein 65 (hsp65) and 16S rDNA genes.
Results: Tissue cultures for acid-fast bacilli were positive. PCR-RFLP analysis and sequencing of hsp65 and 16S rDNA genes confirmed the isolated organisms to be M. marinum. Systemic therapy with rifampicin, clarithromycin, and amikacin empirically over 6 months led to complete resolution of skin lesions leaving only some residual scars.
Conclusion: Key diagnostic elements for M. marinum infections include a high index of suspicion raised by chronic lesions, poor response to conventional treatments, and a history of fish-related exposure. Strong clinical suggestion of M. marinum infection warrants initial empirical treatment. The duration of therapy is usually several months or even longer, especially for elderly patients. Amikacin can be considered in multidrug therapy for treatment of some refractory M. marinum infections.
Keywords: amikacin, clarithromycin, skin infection, Mycobacterium marinum, nontuberculous mycobacteria
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