M. fortuitum, M. abscessus, and M. chelonae are resistant to all of the antituberculosis agents (1, 24, 42, 115). Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Rampacci E, Stefanetti V, Passamonti F, Henao-Tamayo M. Pathogens. Scrofuloderma is a form of TB that is caused by M. tuberculosis or M. bovis and commonly affects children, adolescents, and older adults (47, 69). The following discussion will focus on non tuberculous mycobacteriu… Usually occur on the arms or knees. Epidemiology of disease caused by nontuberculous mycobacteria. Visceral tuberculosis (pulmonary or extrapulmonary) is rarely associated with concomitant cutaneous involvement (68). Wilmer E. Villamil-Gómez, M.D., Ph.D.(c), is a medical doctor (graduated from the University of Cartagena), family medicine specialist (University of Cartagena), specialist in epidemiology (School of Medicine, Juan N Corpas University), candidate for Ph.D. in tropical medicine and infectious diseases (University of Cartagena and University of the Atlantic), and fellow in infectology (University of Buenos Aires). Atypical mycobacterial infections are infections caused by a species of mycobacterium other than Mycobacterium tuberculosis, the causative bacteria of pulmonary TB and extrapulmonary TB including cutaneous TB; and Mycobacterium leprae, the cause of leprosy.. Atypical mycobacteria may cause many different types of infections… 2010 Jan;28 Suppl 1:46-50. doi: 10.1016/S0213-005X(10)70008-2. Humans encounter mycobacterial species due to their ubiquity in different environmental niches. A combined therapeutic approach, including surgical drainage, debridement and prolonged treatment with combined antimicrobial agents, has been used in some cases of atypical mycobacteria. from Universidad Peruana Cayetano Heredia in Lima, Peru, in 2003. These topics have been dealt with elsewhere in the CDS. HHS He is part of the Executive Board of the Latin American Society for Travel Medicine (SLAMVI). The most common cutaneous forms of acquisition of NTM involve direct inoculation via trauma (33), postsurgical infections (42), or iatrogenic acquisition with indwelling medical devices, plastic surgery, cosmetic procedures, or prosthetic implants (24, 42). 359-77. This clinical form presents predominantly in children, but when it is present in adults, it tends to occur among those with occupational exposures, such as butchers or farmers. This progressive clinical form originates through lymphatic spread or by contiguous spread from a lymph node or bone (47). It is recommended that rapidly growing mycobacteria be tested against selected antibacterial drugs of different classes (1, 42). He has a Scopus H index of 17. He received his M.P.H. Most cases of cutaneous infections take place among individuals who suffered puncture injuries or other types of trauma in freshwater or salt water. Some lesions may mimic scrofuloderma. Lupus vulgaris may occur concomitantly with scrofuloderma, or it rarely may be associated with primary-inoculation TB. The diagnosis of Buruli ulcer is mostly a clinical one and is based on the age of presentation, geographic area, and location (31, 109, 112). Since M. leprae is not cultivable, the bacteriostatic and bactericidal effects of antimycobacterial drugs against M. leprae have been assessed in laboratory studies (47). These organisms are characterized by their staining and are identified as acid fast bacilli. chelonae [3†]. Histologically, intraneural or perineural granulomas may assist the pathologist in distinguishing leprosy from cutaneous tuberculosis (47). Mycobacterium chelonae is a nonchromogenic and rapidly growing mycobacteria (Figure 17) that is widely recoverable from man-made environment such as tap water or from fresh and seawater.The most common clinical manifestations are skin, soft tissue, and bone infections … haemophilum requires iron or hemin supplementation for growth (35, 36, 42, 119). 2020 Sep 9;8(9):1380. doi: 10.3390/microorganisms8091380. Severe hand swelling and nodular lymphangitic lesions caused by Mycobacterium marinum infection. The infection may then be carried to other sites by immature cells (83, 84). The clinical spectrum of cutaneous disease caused by M. marinum includes a solitary papule or nodule that may ulcerate and then spreads in a sporotrichoid pattern (lymphangitic spread) (Fig. There is also some evidence suggesting that M. lepromatosis may be associated with severe leprosy reactions, but this association requires further confirmation (103, 107). Despite an increasing incidence of such infections, patients are often misdiagnosed. Armadillos may also play a role in the transmission of leprosy in some areas in Colombia (55) and in Brazil (56). Histologically, perineural granulomas assist in distinguishing tuberculoid leprosy from cutaneous TB. Their geographic distribution has not been completely described; RGM-borne cutaneous disease has been reported throughout the world. Mycobacterium marseillense is a member of the M. avium complex that has caused infections with lymphatic or pulmonary involvement sporadically in humans (2–4).We report M. marseillense infection involving facial skin … He is a member of the Committee on Tropical Medicine, Zoonoses and Travel Medicine of ACIN. 2020 Oct 30;8(11):1701. doi: 10.3390/microorganisms8111701. Dr. Franco-Paredes has an adjunct faculty appointment as a research professor at the Hospital Infantil de Mexico Federico Gomez in Mexico City. All of these species have been isolated from humans, frogs, and fish. In a period of approximately 4 weeks, the nodule, plaque, or edematous area evolves into an ulcer with undermined borders. They share phenotypic and genotypic features, including the large virulence plasmid (pMUM) required for mycolactone production. Confirming a diagnosis of cutaneous mycobacterial infections requires tissue biopsies of cutaneous lesions to assess for the presence of acid-fast bacilli and cultures of tissue specimens or material obtained from draining lesions (1, 42). Clinical manifestations of leprosy: borderline tuberculoid (BT) (A), borderline borderline (BB) (B), and lepromatous (LL) (C). Mycobacterial species are present in the environment in water and soil niches that are shared with humans (19, 21, 22). Currently, the NTM group is also divided into two major subgroups defined by their ability to grow on solid culture media: (i) rapidly growing mycobacteria (RGM) and (ii) slowly growing mycobacteria (SGM) (Fig. Molecular assays are useful in some cases. Tissue biopsies of lesions may demonstrate, using Fite-Faraco staining, the presence of acid-fast bacilli residing inside nerves and perineural or intraneural granulomas (47). Localized cutaneous infections are due to posttraumatic wound infection, catheter-associated infections (e.g., from peritoneal dialysis or central venous catheters), postsurgical infections, and trauma-associated infections (Fig. This strain of M. lepromatosis appears to have diverged from the two human strains from Mexico (53). Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Category II is defined by the presence of nonulcerative or ulcerative plaques and edematous forms (Fig. Currently, most cases of Buruli ulcer occur in parts of western and central Africa, but cases occur in at least 33 countries, mostly in South America and Western Pacific regions (110). Disseminated NTM infections affect severely immunocompromised human hosts, including those with primary immunodeficiencies, such as genetic or acquired defects of the IFN-γ–interleukin-12 (IL-12) pathway (e.g., GATA2 deficiency or anti-IFN-γ autoantibodies), or acquired immunodeficiencies, such as HIV infection/AIDS, transplant-associated immunosuppression, and treatment with biological agents such as anti-tumor necrosis factor alpha (anti-TNF-α) receptor blockers (26, 27, 116). Sometimes it may start as a collection of reddish papules that coalesce to form plaques with serpiginous or verrucous borders with central clearing and atrophy. 3). Many of these new patients already have grade 2 neurological disability by the time of their diagnosis (96, 97). Untreated cases of lupus vulgaris may evolve into verrucous squamous cell carcinoma (67, 69). Skin and soft tissue infections are the most common pre-sentation for the rapid-growing speciesMycobacterium fortuitum, M. abscessus,andM. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Thank you for sharing this Clinical Microbiology Reviews article. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Andrés F. Henao-Martínez, M.D., graduated from Universidad del Valle, School of Medicine, in Colombia in 2003. Alexandro Bonifaz is Head of the Department of Mycology, Dermatology Service, Hospital General de Mexico “Dr. Treatment guidelines recommend performing susceptibility testing of mycobacterial isolates with the goal of optimizing the choice of specific antimycobacterial drug combinations, since the MIC to specific antimicrobials correlates clinically with in vivo responses to antimicrobial therapy for many mycobacterial species (1, 42). This infection may occur among immunocompetent and immunocompromised hosts, including those with HIV infection/AIDS or with renal transplantation. Category III is when there is evidence of severe disease with dissemination, osteitis, osteomyelitis, or joint involvement (31, 109). The high prevalence of tuberculosis worldwide (one-third of the world population), its transmissible nature, and the significant morbidity and mortality associated with this infection … "Rice-body formation in atypical mycobacterial … This organism preferentially grows at 30°C, explaining its predilection for causing lesions in the upper and lower extremities (34–36). Furthermore, M. leprae and M. haemophilum are phylogenetically related and also share ancestry with other mycobacterial species, such as M. marinum and M. ulcerans (35, 36, 119). Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Affected individuals tend to have more frequent protein variants in immune, cystic fibrosis transmembrane conductor regulator (CFTR), and connective tissue genes (26, 27). 1996 Dec;11(4):244-51. Cold abscess caused by Mycobacterium avium-intracellulare complex infection in a 60-year-old male. doi: 10.1371/journal.ppat.1009107. Results The medical records of 63 patients with skin or soft tissue infections due to rapidly growing mycobacteria were reviewed. Mycobacterium abscessus was first identified in a patient with a knee infection and subcutaneous abscesses in 1950 (117). An infection … His H index is currently 24. Similarly, acute military tuberculosis represents primary infection in individuals with advanced immunosuppression, including those with HIV infection/AIDS (71). Phylogenetic reconstructions of genomic sequences suggest that Mycobacterium marinum, Mycobacterium leprae, Mycobacterium ulcerans, and M. tuberculosis evolved from a common environmental ancestor (2, 15, 16, 19). The differential diagnosis of this condition includes paracoccidioidomycosis, syphilis, lymphogranuloma venereum, pyoderma gangrenosum, and skin malignancies (47, 69). M. ulcerans is a slowly growing environmental mycobacterium causing infection that is considered to have an incubation period of 5 to 8 weeks, but this may be as long as six months in areas of endemicity (31, 109). See this image and copyright information in PMC. 2020 Dec 18;16(12):e1009107. Modern genomic, phylogenetic, and ecological studies have shed light on the origins of most important mycobacterial infections affecting humans (1–20). Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Human Societies and the Origin and Spread of Major Mycobacterial PathogensMycobacteria are aerobic rod-shaped bacteria that do not form spores and that are lipid rich with long-chain mycolic acids in their cell walls, which are largely responsible for their acid fastness (1). A, B) Facial skin lesion of woman with M. marseillense infection before and after treatment. In the human host, mycobacterial infections may affect many anatomical sites, but since they enter through the skin and mucosal barriers, they lead mostly to pulmonary or cutaneous infections (25–28). Leprosy reactions, due to their potential inflammatory compromise of the nerve fibers, lead to sensory and motor loss (85, 90–92). Nontuberculous mycobacteria (NTM), i.e., those mycobacterial species that do not cause tuberculosis or leprosy, are frequently present in municipal water systems, residing mostly in the pipeline biofilms (21, 22, 38, 39). Treatment involves a combination of clarithromycin, ciprofloxacin, and rifampin or rifabutin for 12 to 24 months (34–36, 42). The number of new cases will reach the 4 million mark by 2020 (since 2000) (76). The clinical manifestations of leprosy are related to the immune response to the leprosy bacillus (Table 3) (4, 47, 72, 74, 78). 4) (72, 74, 78). 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