Clinical and Pathological Evaluation of Mycobacterium marinum Group Skin Infections Associated With Fish Markets in New York City

Clin Infect Dis. 2016 Mar 1;62(5):590-5. doi: 10.1093/cid/civ937. Epub 2015 Dec 16.

Abstract

Background: From December 2013 through May 2014, physicians, dermatopathologists, and public health authorities collaborated to characterize an outbreak of Mycobacterium marinum and other nontuberculous mycobacterial skin and soft tissue infections (SSTIs) associated with handling fish in New York City's Chinatown. Clinicopathologic and laboratory investigations were performed on a series of patients.

Methods: Medical records were reviewed for 29 patients. Culture results were available for 27 patients and 24 biopsy specimens were evaluated by histopathology, immunohistochemistry (IHC) staining for acid-fast bacilli (AFB), and mycobacterial polymerase chain reaction (PCR) assays.

Results: All patients received antibiotics. The most commonly prescribed antibiotic regimen was clarithromycin and ethambutol. Of the 29 patients in this case series, 16 (55%) received surgical treatment involving incision and drainage, mass excision, and synovectomy. Of these, 7 (44%) had deep tissue involvement. All patients showed improvement. For those with culture results, 11 of 27 (41%) were positive for M. marinum; the remainder showed no growth. Poorly formed granulomas (96%), neutrophils (75%), and necrosis (79%) were found in 24 biopsies. Of 15 cases that were culture-negative and analyzed by other methods, 9 were PCR positive for M. marinum group species, 8 were IHC positive, and 3 were positive by AFB stains.

Conclusions: A multidisciplinary approach was used to identify cases in an outbreak of M. marinum infections. The use of histopathology, culture, and IHC plus PCR from full thickness skin biopsy can lead to improved diagnosis of M. marinum SSTIs compared to relying solely on mycobacterial culture, the current gold standard.

Keywords: Mycobacterium marinum; diagnosis; fish; outbreak; skin infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Arm
  • Combined Modality Therapy
  • Disease Outbreaks*
  • Female
  • Fisheries
  • Hand
  • Humans
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Mycobacterium Infections, Nontuberculous / epidemiology*
  • Mycobacterium Infections, Nontuberculous / pathology
  • Mycobacterium Infections, Nontuberculous / therapy
  • New York City / epidemiology
  • Skin Diseases, Bacterial / diagnosis
  • Skin Diseases, Bacterial / epidemiology*
  • Skin Diseases, Bacterial / pathology
  • Skin Diseases, Bacterial / therapy
  • Soft Tissue Infections / diagnosis
  • Soft Tissue Infections / epidemiology*
  • Soft Tissue Infections / pathology
  • Soft Tissue Infections / therapy

Substances

  • Anti-Bacterial Agents

Supplementary concepts

  • Infection with Mycobacterium marinum