Fish tank granuloma: An emerging skin disease in Iran mimicking Cutaneous Leishmaniasis

Abstract

ObjectiveMycobacterium marinum causes a rare cutaneous disease known as fish tank granuloma (FTG). The disease manifestations resemble those associated with Cutaneous Leishmaniasis (CL). The aim of this study was to determine whether FTG was the cause of cutaneous lesions in patients who were referred to the Parasitology laboratory of Imam Reza Hospital in Mashhad to be investigated for CL.Materials/MethodsOne hundered patients, clinically diagnosed with CL between April 2014 and March 2015, were included in this study. Ziehl-Neelsen staining was performed to identify acid-fast Mycobacterium in addition to bacterial cultures using Löwenstein-Jensen medium. Skin lesion samples were also collected and kept on DNA banking cards for PCR testing.ResultsTwenty-nine of the 100 individuals with skin lesions, and therefore suspected of suffering from CL, tested positive for Mycobacterium marinum by PCR. Of these, 21 (72.4%) were male and 8(27.6%) were female. In 97% of these cases the lesions were located on hands and fingers. These patients had a history of manipulating fish and had been in contact with aquarium water. A sporotrichoid appearance was observed in 58.6% of the patients with mycobacterial lesions; 67% of patients had multiple head appearance.ConclusionPatients suspected to have CL and who test negative for CL could be affected by FTG. Therefore, after obtaining an accurate case history, molecular diagnosis is recommended for cases that give a negative result by conventional methods.

A Series of 35 Cutaneous Infections Caused by Mycobacterium marinum in Han Chinese Population

“…All patients in this study had pathologically confrmed granulomas and 17.1% were positive by AFB staining, similar to previous studies (0%-39%) [7,[10][11][12][13][14][15][16][17][18][19][20]. Although mycobacterial culture is considered the gold standard for diagnosis, sensitivity varies from 41% to 100% [7,[10][11][12][13][14][15][16][17][18][19][20].…”

“…In addition, 19 cases were caused by puncture wounds from fsh bones. Second, the lesions of 25 (71.4%) of the 35 patients had sporotrichoid patterns, slightly higher than that reported in prior studies (5.6%-58.6%) [5,7,12,16,20]. However, the median age of patients in this cohort was similar to that in previous studies (55 vs. 26-66 years, respectively) [5,7,12,13,15,16,18,19].…”

“…Human M. marinum infections are normally caused by exposure of skin wounds to contaminated water of fsh tanks or contaminated fsh [2,5]. Although M. marinum infections have been reported worldwide [7,[10][11][12][13][14][15][16][17][18][19][20], the cohort of this study had unique characteristics. First, M. marinum infection was more common in women than men (82.9% vs. 17.1%, respectively), while there was an opposite trend in previous studies [5,7,12,13,15,19,20].…”

“…Although M. marinum infections have been reported worldwide [7,[10][11][12][13][14][15][16][17][18][19][20], the cohort of this study had unique characteristics. First, M. marinum infection was more common in women than men (82.9% vs. 17.1%, respectively), while there was an opposite trend in previous studies [5,7,12,13,15,19,20]. As a possible explanation for this discrepancy, the cohort of the present study consisted only of ethnic Chinese and women who mainly prepare meals in Chinese society.…”

Investigation of Potential Reservoirs of Non-Tuberculous Mycobacteria in a European Sea Bass (Dicentrarchus labrax) Farm

“…The disease is often chronic and associated with drip mortality, though cumulative mortality can also be severe [ 1 ]. The zoonotic potential of M. marinum besides it being a fish pathogen [ 5 ] is noted in cases of skin disease (fish tank granulomas) in humans who handle fish or work in aquaculture [ 13 , 14 , 15 , 16 , 17 ]. M. marinum can also cause systemic infections in persons with immune deficiency or autoimmune disease [ 18 ].…”