Purpose of Study Our goal is to describe clinical presentations, risk factors, management strategies and outcome for M. marinum infections among patients presenting to us from the Gulf Coast.
Methods A retrospective review was performed of clinical charts of patients with M. marinum infection from 1990 through 2004. Data collected included demographics, presence or absence of immunocompromised state, site of infection, source of exposure, microbiologic and routine labs, antibiotic choice and length of therapy, and outcome information.
Results There were 7 subjects identified for analysis. The mean age was 45.4 years (range 34-72); subjects were more likely to be male (86% vs 14% female), Caucasian (86% vs 14% African-American), with no underlying chronic disease (71%); only 2 of 7 (29%) were immunocompromised secondary to HIV/AIDS (1) or diabetes mellitus (1). Marine exposure accounted for 6 (86%). The majority of the patients (86%) had an infection involving the upper extremity. Three subjects (43%) had localized soft tissue infection of a finger presenting as nodules, abscess, or ulceration; four subjects (57%) had deeper involvement with tenosynovitis, tendonitis, or tenolysis of the hand. Three patients (43%) had multiple ascending nodules (“sporotrichoid disease”), and two (29%) had disseminated cutaneous involvement of multiple extremities. Surgical débridement revealed the diagnosis among 71%, and 86% received antibiotics as monotherapy or combination therapy for a mean duration of 5.6 months. The one HIV-1 subject with a resistant isolate required intravenous therapy with imipenem and amikacin for 4 months after failing a traditional oral regimen. All subjects who received antibiotics reported subsequent resolution of the infection. Among subjects with tenosynovitis/tenolysis, 50% reported significant limitation of function of the involved phalanx.
Conclusion In this series of patients from the Gulf Coast region, most cases were due to inoculation of M. marinum related to marine exposure. While the majority of our patients were healthy, we describe the rare cases of a subject with HIV/AIDS and M. marinum infection and of cutaneous dissemination in an immunocompetent patient. Based upon our series, cases of M. marinum infection should respond to appropriate antimicrobial therapy.