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Volume 9, Number 11—November 2003

Letter

Invasive Mycobacterium marinum Infections

Timothy Lahey*Comments to Author 
Author affiliation: *Harvard Medical School, Boston, Massachusetts, USA

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Table

Summary of Invasive Mycobacterium marinum infection cases published since 1966

Ref. Age Sex Symptoms Source Immune impairment Dx delay (mo) Medications Surgery ? Treatment duration (mo)
(2) 32 M Disseminated cutaneous, larynx Minor trauma Systemic steroids 240 I, S Yes >36
(3) 37 M R middle finger osteomyelitis Fishing injury Local steroid injection 3 Erythromycin, S Yes 5
(3) 30 M R long finger osteomyelitis Minor trauma None 12 Declined No --
(3) 56 M R ring finger tenosynovitis Minor trauma, fishing and cleaning boats Local steroid injection 1.2 E Yes 9
(3) 52 M L index finger osteomyelitis and synovitis None Local steroid injection 7 Cycloserine, ethionamide, R Yes ?
(3) 60 M R ring finger synovitis and osteomyelitis Shrimp cleaning injury None 7 E, R Yes 6
(3) 55 M L long finger synovitis and skin ulcer Shrimp cleaning injury None 23 E Yes 6
(4) 30 M Disseminated skin nodules, lymphangitis Aquarium cleaning Systemic steroids and azathioprine for renal transplant 2 E, R, T No ?
(5) 1.3 F Disseminated cutaneous nodules Aquarium exposure None 2 E, I, R No 8
(6) 26 M R hand tenosynovitis Fisherman Local steroid injection 8 E, P, R, tetracycline Yes ?
(6) 45 M R index tenosynovitis Saltwater fishing Local steroid injection 1 E, R, tetracycline Yes ?
(6) 22 M R hand tenosynovitis Fisherman None 2 I, R, S Yes ?
(6) 56 F L hand tenosynovitis Fishing injury Local steroid injections 5 I, R, S Yes ?
(6) 53 M R hand and forearm synovitis, bursitis Fisherman Local steroid injections 78 E, I, R, S Yes ?
(7) 47 F R hand tenosynovitis and osteomyelitis None None 1 E, I, R Yes ?
(8) 32 M L hand tenosynovitis None Local steroid injection 1 E, R, sulfamethoxazole Yes 24
(8) 42 M L hand tenosynovitis Shrimp fishing None 3 E, I, R Yes 24
(8) 52 F R hand tenosynovitis Shrimp spine injury None 1 D, E, R No 24
(8) 31 F L index finger tenosynovitis Crab bite Local steroid injection 6 D, E, R Yes 24
(9) 56 M L index finger osteomyelitis and wrist synovitis Fisherman Local steroid injections 12 E, M, R Yes 9
(10) 5 M Polyarthritis, disseminated skin lesions, hepatic function abnormalities None Abnormalities in monocyte function 48 A, clofazamine, E, R, T No 9
(11) 35 F L hand and wrist septic arthritis, cutaenous lesions on arm Puffer fish sting Systemic steroids for SLE flares 18 M No >12
(12) 62 F L middle finger osteomyelitis with skin nodules Injury while gardening, owned tropical fish aquarium None 8 E, R Yes 4
(13) 33 M R hand nodules, LAD, pneumonia, bacteremia Fish tank AIDS (CD4<5) 0.5 C, clofazimine, ethionamide Yes 3 until death
(14) 56 M L ring finger septic arthritis, osteomyelitis Minor trauma, fish tank Local steroid injection 2 C, E, R No 12
(15) 0.25 M Diffuse pustules, osteomyelitis, bacteremia Bathed in bathtub in which fishtank washed SCID ? I, R, T No 6 until death
(16) 71 M R 2nd MCP synovitis, septic arthritis, osteomyelitis Swimming and fishing injury Local steroid injection 9 C, E, I, R Yes 12
(17) 48 F L hand osteomyelitis, R forearm cutaneous lesions, R ankle septic arthritis and osteomyelitis Fish tank cleaning Cyclosphosphamide and systemic steroids for polymyositis 10 D, I pyrazinamide, R Yes 5
(18) 52 F R hand tenosynovitis and osteomyelitis Fish dealer, puncture injury Systemic steroids and local herbal injections 2 Clarithromycin, D, E, I, R Yes 18
(19) 41 F R index flexor sheath tenosynovitis Fishmonger Local steroid injection 3 M Yes 1.5
(20) 53 M R middle finger tenosynovitis, septic arthritis, wrist osteomyelitis, discharging sinuses Nonpenetrating trauma, home aquarium Local steroid injections, systemic methotrexate 24 C, E, R, S No 13
(21) 81 M L forearm plaque, L index finger ulcer, R forearm cellulitis, bone marro cx + pancytopenia Aquarium exposure Systemic steroids and azathioprine for myasthenia gravis 5 C, D No <1 before death
(22) 22 M R wrist tenosynovitis, nodular skin lesions “Fish-related hobby”, aquarium Systemic steroids for Still’s disease 0.25 C, clarithromycin, E, R Yes 4
(23) 70 M R hand and wrist tenosynovitis, subcutaneous nodules, L knee septic arthritis Fish fin wound Systemic steroids 12 A, E, M, R Yes 12
(24) 60 F Disseminated ulcerating abscesses Tropical aquarium Systemic steroids and chemotherapy for non-Hodgkin lymphoma 8 clarithromycin, clotrimazole, E, immunoglobulins, levofloxacin, R, S, No ?

aDx, diagnosis; l, left; R, right; MCP,metacarpophalangeal; A, amikacin; C, ciprofloxacin; D, doxycycline; E, ethambutol; I, isoniazid; M, minocycline; P, pyrazinamide; R, rifampin; S, streptomycin; T, trimethoprim/sulfamethoxazole

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