Diagnosis of Mycobacterium marinum Infection Based on Seroconversion of QuantiFERON-TB Gold Test

Abstract

Mycobacterium marinum is a slow-growing photochromatic acid fast bacilli (AFB). Following exposure of injured skin to fish tanks and other aquatic bodies, it usually causes indolent skin and soft tissue infections. Incubation period differs but it is generally long; hence, diagnosis is often missed leading to delay in treatment. Obtaining proper history along with histopathology and cultures leads to diagnosis. There is evidence of cross-reactivity of M. marinum with QuantiFERON-TB gold test. In patients without risk factors for tuberculosis, recent seroconversion may provide a clue to diagnosis and eliminate differentials. We present a case of M. marinum skin and soft tissue infection diagnosed based on seroconversion of QuantiFERON-TB gold test in an immunocompromised patient. This was confirmed by AFB culture after six weeks.

Acid-fast bacteria as causative agents of skin and soft tissue infections: case presentations and literature review

“…Clarithromycin plus Ethambutol plus Doxycycline 5 months, Brodalumab was administered because of arthritis recurrence Cure Zimmerlich et al 35 M/48 Germany Infliximab (ulcerative colitis) Small wound on his right ring finger – cleaning his two aquariums without gloves Right arm Lymphocutaneous form, lesion on the nailfold of the right ring finger and multiple painless skin lesions on his right upper extremity Clarithromycin plus Ethambutol plus Rifampicin 12 months plus Percutaneous abscess drainage. Then Clarithromycin plus Rifampicin 14 months Cure Nachimuthu et al 36 F/53 USA Golimumab (rheumatoid arthritis), diabetes Cleaning her fish tank with bare hands, use of lancets for checking blood glucose, injuries from rose thorns Left arm Lymphocutaneous form tender nodules with surrounding redness on her left index finger and forearm. Minocycline plus Clarithromycin 9 months Cure Berman et al 37 M/70 USA Golimumab (ulcerative colitis) Cleaning his fish tank Left hand, arm Lymphocutaneous form, single erythematous indurated plaque with a central ulcer on his left hand and painful nodules on his left arm Minocycline 1 week, then Rifampin plus Minocycline (given his immunomodulatory state) 10 weeks Cure Bachiyska et al 38 F/66 Bulgaria Hand injury, cleaning an ornamental tropical fish aquarium without using protective gloves.…”

“…MALDI-TOF MS has achieved up to 98% agreement with 16S rRNA, hsp65 and rpoB genes sequencing 59 . Ancillary to physical examination and medical history, a positive result of an interferon-gamma release assay for tuberculosis may provide an important diagnostic clue, before the laboratory confirmation is provided 36 .…”

Cutaneous Mycobacterium marinum infection mimicking chromoblastomycosis

“…TB‐IGRA can detect interferon‐γ produced by activated T cells after exposure to two specific antigens of M. tuberculosis : early secretory antigenic target 6 (ESAT‐6) and culture filtrate protein 10 (CFP‐10) 10 . However, since the genes encoding ESAT‐6 and CFP‐10 are also present in M. marinum , positive results from TB‐IGRA should arouse suspicion of infections with M. marinum in patients with an exposure history and a low risk of M. tuberculosis infection 10,11 . In conclusion, clinicians should combine clinical and microbiological evidence to diagnose M. marinum infection.…”

“…10 However, since the genes encoding ESAT-6 and CFP-10 are also present in M. marinum, positive results from TB-IGRA should arouse suspicion of infections with M. marinum in patients with an exposure history and a low risk of M. tuberculosis infection. 10,11 In conclusion, clinicians should combine clinical and microbiological evidence to diagnose M. marinum infection. Clarithromycin monotherapy or combined treatment with clarithromycin, rifampicin, and ethambutol is commonly used.…”

Kutane Mycobacterium marinum‐Infektion imitiert Chromoblastomykose

“…TB‐IGRA kann Interferon‐γ nachweisen, das von aktivierten T‐Zellen nach Exposition gegenüber zwei spezifischen Antigenen von M. tuberculosis produziert wird: Early Secreted Antigenic Target 6 (ESAT‐6) und Culture Filtrate Protein 10 (CFP‐10) 10 . Da die Gene, die für ESAT‐6 und CFP‐10 kodieren, jedoch auch bei M. marinum vorhanden sind, sollten positive Ergebnisse von TB‐IGRA bei Patienten mit einer Expositionsgeschichte und einem geringen Risiko einer M. tuberculosis ‐Infektion den Verdacht auf eine Infektion mit M. marinum wecken 10,11 . Ärzte sollten klinische und mikrobiologische Befunde kombinieren, um eine M. marinum ‐Infektion zu diagnostizieren.…”