rifampin and Skin-Diseases--Bacterial

Mycobacterium marinum (M. marinum) is a free-living, slow grower nontuberculous mycobacteria (NTM), strictly related to Mycobacterium tuberculosis, that causes disease in fresh and saltwater fish and it is one of the causes of extra-pulmonary mycobacterial infections, ranging in human from simple cutaneous lesions to disseminated forms in immunocompromised hosts. The first human cases of M. marinum infection were reported from skin lesions of swimmers in a contaminated pool, in 1951, in Sweden by Norden and Linell. Two conditions are required to develop M. marinum infection: (1) skin solution of continuity and (2) exposure to the contaminated water or direct contact with fish or shellfish. The so-called "fish-tank granuloma", the most frequent cutaneous manifestation of M. marinum infection, is characterized by a single papulonodular, verrucose and/or ulcerated granulomatous lesion in the inoculum site. Careful patient's history collection, high clinical suspicion and appropriate sample (e.g. cutaneous biopsy) for microbiological culture are crucial for a timely diagnosis. The treatment is not standardized yet and relies on administration of two active antimycobacterial agents, always guided by antimicrobial susceptibility test on culture, with macrolides and rifampin as pivotal drugs, as well as prompt surgery when feasible. In this narrative review, we provide to Clinicians an updated report of epidemiology, microbiological characteristics, clinical presentation, diagnosis, and management of M. marinum infection.

Topics: Animals; Anti-Bacterial Agents; Humans; Macrolides; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Skin Diseases, Bacterial; Water

Buruli ulcer is caused by

Topics: Africa, Western; Anti-Bacterial Agents; Buruli Ulcer; Clarithromycin; Humans; Macrolides; Mycobacterium Infections; Mycobacterium ulcerans; Neglected Diseases; Polymerase Chain Reaction; Rifampin; Skin Diseases, Bacterial; Streptomycin

Lepromatous leprosy (LL) has been reported in the literature with Non Hodgkin Lymphoma and rarely with Hodgkin Lymphoma. However, an extensive search of the literature shows no case report describing anaplastic large cell lymphoma (ALCL) in association with LL. We report a case of a young male with LL who was found to have ALCL. This is an interesting case of coexistence of an endemic infectious disease and a rare lymphoma involving the same lymph node, with a brief review of the literature.

Topics: Adult; Cell Nucleus Shape; Clofazimine; Histiocytes; Humans; Immunohistochemistry; Ki-1 Antigen; Leprosy, Lepromatous; Lymph Nodes; Lymphoma, Large-Cell, Anaplastic; Male; Mycobacterium leprae; Pancytopenia; Rifampin; Skin Diseases, Bacterial

Mycobacteruim kansasii occasionally causes disseminated infection with poor outcome in immunocompromised patients. We report the first case of disseminated M. kansasii infection associated with multiple skin lesions in a 48-yr-old male with myelodysplastic syndrome. The patient continuously had taken glucocorticoid during 21 months and had multiple skin lesions developed before 9 months without complete resolution until admission. Skin and mediastinoscopic paratracheal lymph node (LN) biopsies showed necrotizing granuloma with many acid-fast bacilli. M. kansasii was cultured from skin, sputum, and paratracheal LNs. The patient had been treated successfully with isoniazid, rifampin, ethmabutol, and clarithromycin, but died due to small bowel obstruction. Our case emphasizes that chronic skin lesions can lead to severe, disseminated M. kansasii infection in an immunocompromised patient. All available cases of disseminated M. kansasii infection in non HIV-infected patients reported since 1953 are comprehensively reviewed.

Topics: Antitubercular Agents; Clarithromycin; Glucocorticoids; Humans; Immunocompromised Host; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Myelodysplastic Syndromes; Rifampin; Skin Diseases, Bacterial; Sputum; Sweet Syndrome

Mycobacterium marinum is a nontuberculous mycobacteria that is often acquired via contact with contaminated salt or fresh water. We present a case of a 67-year-old man who developed several solitary nontender nodules on his hands and forearm after working on the underside of his boat. In addition, we provide a review of the literature and discuss how this infection is acquired, the underlying pathogenesis, the cutaneous and histologic findings, the differential diagnosis, the diagnostic methods, and the various treatment options.

Topics: Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antitubercular Agents; Clarithromycin; Ethambutol; Forearm; Hand Dermatoses; Humans; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Skin Diseases, Bacterial

Topics: Aged; Antitubercular Agents; Central Nervous System Bacterial Infections; Drug Resistance, Multiple, Bacterial; Ethambutol; Humans; Isoniazid; Lymphadenitis; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Rifampin; Skin Diseases, Bacterial

Topics: Anti-Bacterial Agents; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Mycobacterium ulcerans; Nontuberculous Mycobacteria; Rifampin; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium marinum is a rare cause of skin infections, and its treatment has been based primarily on the personal experience and preferences of individual investigators without the benefit of large studies.. Thirty-one patients with confirmed M marinum infection were identified at 33 Kaiser Permanente Northern California Region medical centers by microbiologic records, and their charts were reviewed.. The upper extremity was affected in 90% of cases, and lymphatic or local spread was seen during the initial examination or during observation in 25 patients (81%). Granuloma was present in 22 (63%) of 35 biopsy specimens, and staining for acid-fast bacteria yielded positive results in two of 22 specimens. Cure or improvement occurred in 22 (81%) of 27 patients in whom outcome could be evaluated. Treatment with ethambutol plus rifampin appeared more successful (effective in five [100%] of five cases) than minocycline treatment (effective in 10 [71%] of 14 cases), although not significantly so (P = .28). Adverse reactions, most of which were gastrointestinal, occurred in five patients (18%).. Ethambutol plus rifampin appears more useful than minocycline in treating cutaneous M marinum infection. This result remains to be confirmed by larger clinical studies, which may be difficult because this infection is relatively rare.

Topics: Adult; Aged; Child; Drug Therapy, Combination; Ethambutol; Female; Humans; Male; Middle Aged; Minocycline; Mycobacterium Infections, Nontuberculous; Rifampin; Skin Diseases, Bacterial

To describe the rationale, design and preliminary results of an open trial of 6 months uniform multi-drug therapy (U-MDT) for all types of leprosy patients assuming a cumulative relapse rate not exceeding 5% over 5 years of follow-up.. We intended to recruit 2500 patients each in multi-bacillary (MB) and pauci-bacillary (PB) groups from India (five centres) and China (two centres). Standardized clinical criteria were used to assess skin lesions in the field.. A total of 2912 patients enrolled from November 2003 to May 2007 (India, 2746; China, 166). MB patients constituted 39% and 3% had grade 2 disability. During follow-up, 27 patients (0.9%) developed new lesions. Of these, 78% were on account of reactions. Six patients had clinically confirmed relapse. Clofazimine-related skin pigmentation was short-lived and was acceptable to patients. We analysed data for clinical status of skin lesions. About 2.9% of patients were lost to follow-up; 85.9% completed treatment, of whom 19% had inactive skin lesions. PB patients responded better than MB patients (27%vs. 6%; P < 0.001). At the end of the first (n = 2013) and second year (n = 807) of follow-up post-U-MDT, in 49% and 46% patients, lesions were inactive, respectively (59% and 57% in PB, 37% and 28% in MB; P < 0.001).. U-MDT appears to be promising with respect to clinical status of skin lesions.

Topics: Adolescent; Adult; Aged; Child; China; Clofazimine; Dapsone; Drug Therapy, Combination; Female; Humans; India; Leprostatic Agents; Leprosy; Male; Middle Aged; Rifampin; Skin Diseases, Bacterial; Treatment Outcome

Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Rifampin; Skin Diseases, Bacterial; Skin Ulcer; Streptomycin; Treatment Outcome

A sporotrichoid pattern describes a clinical presentation in which inflammatory nodules spread along the path of lymphatic drainage, being reported in association with several infectious, neoplastic, and inflammatory skin conditions. Herein, we report a 65-year-old man presenting with a three-month history of erythematous nodules in a linear distribution along the left hand and forearm. He reported recent rose gardening and regular contact with an aquarium. The diagnosis was made through culture of skin biopsy tissue and isolation of Mycobacterium marinum. The patient was treated with a combination of clarithromycin and rifampicin and clinical resolution was evident within two months. We present a patient with a sporotrichoid cutaneous infection by Mycobacterium marinum, highlighting that even with the availability of novel microbiological detection techniques, tissue culture remains an essential tool for diagnostic confirmation.

Topics: Aged; Anti-Bacterial Agents; Biopsy; Clarithromycin; Culture Techniques; Forearm; Hand Dermatoses; Humans; Male; Mycobacterium Infections, Nontuberculous; Rifampin; Skin Diseases, Bacterial

Topics: Abscess; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Lymphadenitis; Male; Middle Aged; Minocycline; Mycobacterium Infections, Nontuberculous; Rifampin; Skin Diseases, Bacterial

Complicated skin and soft tissue infections constitute a heterogeneous group of severe disorders, with surgical site infections being the most common hospital-acquired ones. The aim of our study was to investigate the synergistic and bactericidal activities of antimicrobial combinations of fosfomycin with rifampicin and tigecycline against Enterococcus faecalis, Enterococcus faecium and methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates, and also to evaluate their in vivo effects in a mouse wound infection model. In in vitro studies, the combinations of fosfomycin with rifampicin and tigecycline were both synergistic. These synergies were confirmed in in vivo studies: the drug combinations showed the highest antimicrobial effects compared to monotherapy. In conclusion, the efficacy of fosfomycin combinations, also confirmed in our in vivo model, may suggest new directions in the treatment of infected skin and a possible alternative way to control bacterial skin infection.

Topics: Animals; Anti-Bacterial Agents; Enterococcus faecalis; Enterococcus faecium; Fosfomycin; Gram-Positive Cocci; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Minocycline; Rifampin; Skin Diseases, Bacterial; Soft Tissue Infections; Surgical Wound Infection; Tigecycline

Mycobacterium marinum (M. marinum) is a slowly growing nontuberculous mycobacterium. The incidence of M. marinum infections in Denmark is unknown. We conducted a retrospective nationwide study including all culture confirmed cases of M. marinum from 2004 to 2017 in Denmark. All available medical records were reviewed. Demographics, clinical characteristics, and treatment regiments were analyzed. Fifty-five patients were identified, 40 (72.7%) were men with a median age of 50 years. Aquatic exposure was reported by 48 (90.6%) of the patients. Site of infection was upper extremities in 49 (92.5%) patients and 49 (92.5%) had superficial infection. The median time from symptom presentation to diagnosis was 194 days. All patients received antibiotics. Median time of treatment duration among all patients was 112 days. Treatment outcome was classified as improved in 40 (75%), improved with sequela in 4 (7.6%) patients and only 3 patients (3.8%) were classified as failed. Infection with M. marinum is rare and there is a long delay from symptom manifestation to diagnosis. The infection is predominantly related to aquatic exposure. M. marinum should be a differential diagnose in patients with slow-developing cutaneous elements and relevant exposure. Treatment outcomes are overall good and severe sequela are rare.

Topics: Adult; Clarithromycin; Diagnosis, Differential; Ethambutol; Female; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Retrospective Studies; Rifampin; Skin Diseases, Bacterial; Treatment Outcome

A case of disseminated Mycobacterium kansasii infection involving the skin and soft tissue in a 57-year-old male farmer who presented with recurrent fever, respiratory syndromes, and skin lesions is reported. The positive findings of syndromes, laboratory examinations, and identification of M. kansasii in puncture fluid indicated the diagnosis of disseminated M. kansasii infection involving the skin and soft tissue, lungs, and mediastinal lymph nodes. After applying the standard HRE regimen (isoniazid 300mg/day, rifampicin 600mg/day, and ethambutol 750mg/day), the patient's temperature normalized and his symptoms improved gradually. No notable adverse drug reactions occurred and the skin lesions had healed after 4 months of follow-up. Disseminated M. kansasii infections occur mainly in immunocompromised patients. Moreover, disseminated infections with skin lesions is rare in immunocompetent patients. Following a review of the literature, only eight similar cases were identified as of disseminated M. kansasii infection with cutaneous lesions, and thecase presented here appears to be the second involving an immunocompetent individual. Special attention should be paid to a persistent and chronic rash following a chronic respiratory syndrome in order to exclude skin disease caused by non-tuberculous mycobacteria.

Topics: Drug Therapy, Combination; Ethambutol; Humans; Immunocompetence; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Rifampin; Skin; Skin Diseases, Bacterial

Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Eyelid Diseases; Gram-Positive Bacterial Infections; Humans; Immunocompetence; Male; Middle Aged; Rifampin; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Mycobacterium intracellulare-caused pulmonary infections have mostly been reported in immunocompromised hosts, while cutaneous M. intracellulare infections are rare. We describe here an immunocompetent patient with cutaneous lesions due to M. intracellulare, which was diagnosed by acid-fast staining, in vitro culture, histopathology, and PCR-restriction fragment length polymorphism analysis and gene sequencing of heat-shock protein (hsp) 65 and 16S rDNA genes. In vitro susceptibility testing was also carried out and the patient was successfully treated with clarithromycin, rifampicin, and ethambutol.

Topics: Adult; Antitubercular Agents; Bacterial Proteins; Chaperonin 60; Clarithromycin; DNA, Bacterial; Drug Therapy, Combination; Ethambutol; Humans; Immunocompetence; Male; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Polymerase Chain Reaction; Ribotyping; Rifampin; RNA, Ribosomal, 16S; Skin; Skin Diseases, Bacterial

Buruli ulcer is an indolent disease that needs aggressive curettage of caseous subcutaneous tissue beneath the undermined skin. We report the successful treatment of an 18-day-old baby.

Topics: Adult; Antibiotics, Antitubercular; Buruli Ulcer; Female; Humans; Infant, Newborn; Mycobacterium ulcerans; Rifampin; Skin; Skin Diseases, Bacterial; Treatment Outcome

Topics: Adult; Clofazimine; Dapsone; Diagnostic Errors; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Rifampin; Sarcoidosis; Skin Diseases, Bacterial

After a laboratory-confirmed case of Mycobacterium haemophilum skin infection in a recently tattooed immunocompetent adult was reported, we investigated to identify the infection source and additional cases. We found 1 laboratory-confirmed and 1 suspected case among immunocompetent adults who had been tattooed at the same parlor.

Topics: Adult; Anti-Bacterial Agents; Ciprofloxacin; Clarithromycin; Contact Tracing; Drug Therapy, Combination; Humans; Male; Mycobacterium haemophilum; Mycobacterium Infections; Rifampin; Skin Diseases, Bacterial; Tattooing; Treatment Outcome; Washington

Primary cutaneous nocardiosis can present in various forms. Clinically, it can present as acute infection (abscess or cellulitis), mycetoma, or sporotrichoid infection. Mycetoma over the back is rare.. We herein describe a case of primary cutaneous nocardiosis presenting as a mycetoma, caused by Nocardia brasiliensis. The patient had extensive lesions over the back, which can be attributed to the fact that the patient, being an agriculturist, has been exposed to recurrent trauma while carrying firewood and soiled sacks. He responded well to a modified Welsh regimen. Initially, within 2 cycles, the patient showed dramatic improvement clinically, wherein the sinuses, granulation tissue, and induration were no longer apparent. However, the patient showed a small discharging sinus at the end of 3rd pulse, so a total of 6 cycles were given. An additional 2 months of maintenance phase treatment with cotrimoxazole and rifampicin were given. On follow-up, the patient showed no recurrence at 6 months.. We report a case of primary cutaneous nocardiosis presenting as a mycetoma on the back. Enlisting the help of a microbiologist allowed us to isolate the causative organism. Early recognition and prompt treatment prevents unwarranted surgical debridement and complications.

Topics: Adult; Amikacin; Anti-Infective Agents; Humans; Male; Nocardia; Nocardia Infections; Rifampin; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged, 80 and over; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Facial Dermatoses; Female; Granuloma; Humans; Isoniazid; Mycobacterium Infections; Pyrazinamide; Rifampin; Skin Diseases, Bacterial

Topics: Adult; Asian People; Clofazimine; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Tuberculoid; Mycobacterium leprae; Rifampin; Skin Diseases, Bacterial; Skin Tests

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Rheumatoid; Azithromycin; Drug Therapy, Combination; Ethambutol; Female; Glucocorticoids; Humans; Immunocompromised Host; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prednisone; Rifampin; Skin Diseases, Bacterial

Topics: Agricultural Workers' Diseases; Animals; Brucellosis; Cysts; Doxycycline; Humans; Male; Middle Aged; Rifampin; Skin Diseases, Bacterial; Zoonoses

Topics: Combined Modality Therapy; Debridement; Ethambutol; Forearm; Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Postoperative Care; Rifampin; Skin Diseases, Bacterial; Skin Ulcer; Surgical Flaps

Mycobacterium marinum infections (fish tank granuloma) are infrequently encountered and when they do arise, they can pose a diagnostic challenge for clinicians. They can present as non-healing wounds along with several other presentations that may not be typical, as patients can have other comorbidities that cause immunosuppression and invasive symptoms of the disease. Treatment regimens vary in length, and are based on the patient's response to treatment couple with resolution of symptoms. Rifampicin and ethambutol are effective treatment options, together with use of macrolides. A thorough history from patients must be taken as to establish contact with aquatic animals.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Female; Humans; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Skin Diseases, Bacterial; Thumb; Treatment Outcome

Buruli ulcer is a recognized public health problem in West Africa. In Benin, from 1989 to 2001, the Centre Sanitaire et Nutritionnel Gbemoten (CSNG) treated >2,500 Buruli ulcer patients. From March 2000 to February 2001, field trips were conducted in the Zou and Atlantique regions. The choice of the 2 regions was based on the distance from CSNG and on villages with the highest number of patients treated at CSNG. A total of 66 (44.0%) of 150 former patients treated at CSNG were located in the visited villages. The recurrence rate of CSNG-treated patients after a follow-up period of up to 7 years was low (6.1%, 95% confidence interval [CI] 2.0-15.6). We attribute this low rate to the high quality of Buruli ulcer treatment at an accessible regional center (CSNG). The World Health Organization definition of a Buruli ulcer recurrent case should be revised to include a follow-up period >1 year.

Topics: Anti-Bacterial Agents; Benin; Endemic Diseases; Follow-Up Studies; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Recurrence; Rifampin; Skin Diseases, Bacterial; Streptomycin

We report on two male patients with cutaneous Mycobacterium marinum infection. After the diagnosis was established by culture, therapy with rifampicin and clarithromycin over a period of three months led to remarkable improvement.

Topics: Clarithromycin; Drug Therapy, Combination; Foot Dermatoses; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Skin; Skin Diseases, Bacterial

Topics: Animals; Animals, Domestic; Anti-Bacterial Agents; Antibiotics, Antitubercular; Diabetes Mellitus, Type 2; Drug Resistance, Bacterial; Fishes; Hand Dermatoses; Humans; Male; Middle Aged; Minocycline; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Risk Factors; Skin Diseases, Bacterial; Spinocerebellar Degenerations; Water Microbiology

Nontubercular mycobacteria (NTM) may cause cutaneous infections which are difficult to interpret due to the variability of the clinical manifestations. This study involved eight patients (four men and four women) with primary cutaneous infections caused by NTM; the skin lesions included dermo-hypodermal abscesses, suppurative granulomas, and papulonodules localized on the legs, arms, hands, and face. The general condition of the patients was relatively good and they were not immunosuppressed.. All samples were processed with standard methods and the isolates were identified by pattern restriction analysis after polymerase chain reaction (PCR-PCA) amplification of the heat shock protein of 65 kDa.. In this way, we were able to identify three Mycobacterium chelonae strains, two Mycobacterium marinum, two Mycobacterium fortuitum, and one Mycobacterium avium. The lesions disappeared in 3 or 4 weeks after treatment with two or more antimicrobials.. For a correct diagnosis of cutaneous infection by NTM, demonstrating the presence of mycobacteria is essential; routinely available techniques lack sensitivity and are extremely tedious; often mycobacteria are not seen after acid-fast stain. We used PCR-PCA to identify mycobacteria grown in liquid media; the time of identification of mycobacteria was shortened relative to conventional methods.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Proteins; Chaperonin 60; Chaperonins; Clarithromycin; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Polymerase Chain Reaction; Rifampin; Skin Diseases, Bacterial

A 36-year-old man with treated hairy cell leukemia developed a skin infection due to Mycobacterium marinum. A spectrum of atypical cutaneous mycobacteriosis presentations with immunosuppression can be found. The recognition of the disease needs cutaneous biopsies for histopathology and its identification by specific laboratory methods to adapt treatment.

Topics: Adult; Biopsy; Clarithromycin; Drug Therapy, Combination; Granuloma; Humans; Leukemia, Hairy Cell; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Skin Diseases, Bacterial

In April 1997, a 58-year-old renal transplant recipient presented with abscess-like nodules in his left calf and on his right foot. Furuncular disease was suspected and the patient was treated with flucloxacillin. However, the lesions increased in size and became ulcerative. In the following 3 months, cultures of punctuated material, blood, and urine remained negative and gram stains did not reveal micro-organisms. In June 1997, acid-fast stains were positive. A diagnosis of a nontuberculous mycobacterium (NTM) infection was made and empirical antimycobacterial therapy was started. The combination of relatively minor symptoms with enlarged purulent lesions, causing severe morbidity, raises the possibility of NTM infection in the immunocompromised patient.

Topics: Clarithromycin; Drug Therapy, Combination; Ethambutol; Foot; Humans; Kidney Transplantation; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Ofloxacin; Postoperative Complications; Rifampin; Skin Diseases, Bacterial

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Antitubercular Agents; Bacteriological Techniques; Clarithromycin; Diagnosis, Differential; Drug Therapy, Combination; Ethambutol; Humans; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Rifampin; Skin Diseases, Bacterial; Sporotrichosis

A chronic, painless sore developed over a 2-month period on the left calf of a Canadian man traveling for 8 months in Africa. A presumptive diagnosis of a Mycobacterium spp. infection was made despite initially negative biopsy and culture results, after failure of several courses of anti-bacterial antibiotics. Mycobacterium ulcerans was eventually isolated and the lesion progressed despite treatment with multiple anti-mycobacterial agents. The lesion finally responded to wide and repeated excision, aggressive treatment with anti-mycobacterial antibiotics, and split-thickness skin grafting. The isolation and treatment of this unusual organism are discussed.

Topics: Adult; Africa; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antitubercular Agents; Ciprofloxacin; Clarithromycin; Cloxacillin; Ethambutol; Humans; Leg Ulcer; Male; Metronidazole; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Penicillins; Rifampin; Skin Diseases, Bacterial; Skin Transplantation; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence

The incidence of cutaneous bacterial infection after carbon dioxide (CO2 laser resurfacing is increasing. Patients with staphylococcal colonization of their anterior nares may be at greater risk for postoperative cutaneous colonization and/or infection, which can potentially cause scarring.. We present a case report of methicillin-resistant Staphylococcus aureus secondary infection of the skin after CO2 laser resurfacing. We discuss the possible etiologies of this patient's infection, her postoperative management, and preoperative suggestions for possibly preventing infection.. A 49-year-old woman was treated with CO2 laser resurfacing for moderate actinic damage and facial rhytides. She developed a cutaneous infection with methicillin-resistant S. aureus, which caused diffuse linear scarring on her cheeks and upper lip.. The patient was successfully treated with oral minocycline, rifampin, and topical mupiricin ointment to her cutaneous erosions.. We propose that it would be helpful for patients undergoing CO2 laser resurfacing to have their nares cultured to see if they are staphylococcal carriers. If a patient is found to be a carrier, mupiricin ointment can be used preoperatively treat to the nares, to help decrease the risk of infection of the skin from this potential source.

Topics: Dermatologic Surgical Procedures; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Laser Therapy; Methicillin Resistance; Middle Aged; Minocycline; Mupirocin; Rifampin; Skin Aging; Skin Diseases, Bacterial; Staphylococcal Infections; Staphylococcus aureus; Surgery, Plastic; Surgical Wound Infection

A patient with mycosis fungoides that had progressed to tumor stage responded to chemotherapy and electron beam treatment, but 6 years later a peripheral neuropathy, extensive plaques, erythroderma, and enlarged pinnae containing acid-fast organisms developed while he was being treated with photopheresis. The skin lesions cleared with administration of rifampin and dapsone, but a reversal reaction biopsy specimen showed features of both mycosis fungoides and leprosy. This case raises the question of whether there may be an association between mycosis fungoides and leprosy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Dapsone; Humans; Leprosy, Lepromatous; Male; Middle Aged; Mycosis Fungoides; Photopheresis; Rifampin; Skin Diseases, Bacterial; Skin Neoplasms

A patient with AIDS developed a purplish, necrotic skin lesion followed by fevers, constitutional symptoms, and watery diarrhea. Stains of samples from the skin lesion and of stool and bone marrow revealed acid-fast bacilli, and Mycobacterium avium was isolated from cultures of these specimens and blood. With the initiation of multiagent oral antimycobacterial therapy, the patient's symptoms abated and the cutaneous lesion reepithelialized. We believe this lesion to be a manifestation of disseminated infection due to Mycobacterium avium complex (MAC). As the population of patients with AIDS who have CD4 cell counts of < 100/mm3 increases, new and unusual manifestations of disseminated MAC infection can be expected. New oral agents with increased activity against MAC may make early recognition and treatment of MAC infections more rewarding.

Topics: Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Ciprofloxacin; Clarithromycin; Drug Therapy, Combination; Ethambutol; Humans; Male; Mycobacterium avium; Mycobacterium avium-intracellulare Infection; Rifampin; Skin Diseases, Bacterial

An unusual case of Mycobacterium marinum cutaneous infection is described. As a result of marked delay in the diagnosis, extensive local inflammation and destructive osteomyelitis occurred together with cutaneous dissemination in an immunocompetent host. Pathologic fractures in the infected bone necessitated amputation of the involved digit. The most striking feature of this case was the development of multiple widespread cutaneous lesions for several months following amputation of the infected digit and initiation of appropriate antimicrobial therapy. These new cutaneous lesions may reflect local immune and inflammatory reactions to previously disseminated microorganisms.

Topics: Amputation, Surgical; Ethambutol; Female; Finger Injuries; Fractures, Bone; Humans; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Osteomyelitis; Rifampin; Skin Diseases, Bacterial; Water Microbiology; Wounds, Penetrating