Mycobacterial infections generally cause one of three different types of disease: Tuberculosis: the term used to describe disease where there is the formation of granulomas (inflammatory nodules) in the body; Leprosy: the term used to describe disease where infection results in the formation of granulomas in the skin (seen as skin … Cutaneous mycobacterial infections may manifest with localized or diffuse lesions. Untreated cases or those with extensive and deep ulcerations develop scarring contractures, deformity, osteonecrosis, and limb loss (31, 109). He is also the Associate Director for Research for the Global Health Institute at Stony Brook University. An 11-year-old male demonstrating a destructive panniculitis causing ulceration with undermined borders, characteristic of Buruli ulcer. Additionally, this toxin induces hypoesthesia by altering the signaling pathways of the type 2 angiotensin II receptors, leading to hyperpolarization of neurons (115). It may also be associated with osteomyelitis and septic arthritis. Tuberculosis verrucosa cutis of the hand, manifesting as verrucous plaques caused by direct inoculation of the tuberculous bacilli into the skin of an individual previously sensitized to this pathogen. Prior to joining the Division of Infectious Diseases at the University of Colorado as an Associate Professor of Medicine in 2017, Dr. Franco-Paredes was an Associate Professor of Medicine and Global Health at Emory University (2004 to 2011) and a Staff Physician in Infectious Diseases at Phoebe Memorial Hospital in Albany, GA (2011 to 2017). Furthermore, M. leprae and M. haemophilum are phylogenetically related and also share ancestry with other mycobacterial species, such as M. marinum and M. ulcerans (35, 36, 119). Cutaneous involvement of M. kansasii is usually present in immunocompromised hosts and sometimes with concomitant pulmonary disease or disseminated disease (24, 37). Recent studies have demonstrated that the prevalence of nontuberculous mycobacterial infections is increasing in many settings (24–28). The entry of the M. leprae bacillus into the Schwann cell activates the cell to enter into a dedifferentiation process. Microorganisms. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Culturing M. ulcerans is cumbersome since it requires a low oxygen concentration and a temperature between 29°C and 33°C. Alfonso J. Rodríguez-Morales, M.D., M.Sc., D.T.M.&H., F.R.S.T.M.H. Clinically, BU affects predominantly the lower extremities (>55%) and less often the upper extremities or other body parts (31, 109, 111, 112) The toxin (polyketide), mycolactone secreted by M. ulcerans causes tissue destruction (111, 113), local immunosuppression through the inhibition of protein translocation into the endoplasmic reticulum of cytokines of the innate immune system, membrane receptors, adhesion molecules, and T-cell-dependent cytokines (114). | Treatment involves a combination of clarithromycin, ciprofloxacin, and rifampin or rifabutin for 12 to 24 months (34–36, 42). Humans encounter mycobacterial species due to their ubiquity in different environmental niches. Mycobacterium marinumM. Category I is a single small lesion. 2020 Oct 30;8(11):1701. doi: 10.3390/microorganisms8111701. However, it is important to confirm the detection of inducible macrolide (clarithromycin) resistance by the presence of the erm41 gene (1, 117, 118). 6) (1, 24, 42, 117). The number of new cases will reach the 4 million mark by 2020 (since 2000) (76). He has published more than 50 articles in journals indexed in ScienceCitationIndex, Medline, and Scopus (including Lancet Infectious Diseases). Severe hand swelling and nodular lymphangitic lesions caused by Mycobacterium marinum infection. He completed an internship and residency in internal medicine at the University of Texas Health Science Center, followed by a fellowship in infectious diseases at Washington University. from Universidad Peruana Cayetano Heredia in Lima, Peru, in 2003. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. The most frequent sites of involvement include the fingers and dorsum of the hands, followed by ankles or buttocks (Fig. This strain of M. lepromatosis appears to have diverged from the two human strains from Mexico (53). M. ulcerans and all mycolactone-producing mycobacterial species evolved from M. marinum and have become specialized variants living in restricted environments (2, 3). Dr. Franco-Paredes has an adjunct faculty appointment as a research professor at the Hospital Infantil de Mexico Federico Gomez in Mexico City. On rare occasions, outbreaks of nontuberculous mycobacterial (NTM) skin infections have been reported after tattooing (2,3). Some patients may have associated erythema nodosum. J Cutan Pathol. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. He is deputy editor for PLoS Neglected Tropical Diseases and Annals of Clinical Microbiology and Antimicrobials. M. fortuitum, M. abscessus, and M. chelonae are resistant to all of the antituberculosis agents (1, 24, 42, 115). Cold abscess caused by Mycobacterium avium-intracellulare complex infection in a 60-year-old male. He is the Director of the Tick-Borne Disease Center at Stony Brook. There is some evidence of potential human-to-human transmission of Mycobacterium abscessus subsp. This form of leprosy is associated with a large bacillary burden that often affects many organs and endothelial cells in subcutaneous tissues, producing dermal vascular occlusion with associated skin necrosis and ulceration (100–105). This site needs JavaScript to work properly. In both tuberculosis and leprosy, well-organized epithelioid granulomas are associated with a high degree of cell-mediated immunity (CMI) and a reduced bacterial load (47). Rampacci E, Stefanetti V, Passamonti F, Henao-Tamayo M. Pathogens. Mycobacterial species are present in the environment in water and soil niches that are shared with humans (19, 21, 22).In the human host, mycobacterial infections may affect many anatomical sites, but since they enter through the skin and mucosal barriers, they lead mostly to pulmonary or cutaneous infections (25 – 28).The pathogenesis of cutaneous mycobacterial infections … 4) (72, 74, 78). In contrast, the pathogenicity of M. ulcerans derives from the acquisition of a plasmid encoding the polyketide toxin mycolactone (2, 5). Mycobacteria. NTM infections are becoming more common, especially among those age 65 years and older. M. haemophilum was identified in 1978 in individuals with skin infections. This infection may present as a localized or disseminated disease in immunocompromised hosts, including those with HIV infection/AIDS, transplant recipients, and those receiving biological agents such as anti-TNF-α agents (119). Enter multiple addresses on separate lines or separate them with commas. The use of point-of-care diagnosis of Buruli ulcer is under evaluation in field studies in settings of endemicity (1, 42). Compared to bacterial skin infections, mycobacterial skin infections occur rarely. Infections due to NTM can produce pulmonary or extrapulmonary disease in immunocompromised hosts (1, 24, 42). Copyright © 2018 American Society for Microbiology. Other diseases that need to be considered in the differential diagnosis include bartonellosis, tularemia, leishmaniasis, syphilis, eumycetoma, and yaws (47, 69). He has been the director of the travel clinic at University of Colorado Hospital since 2016. The management of extensive scrofuloderma sometimes requires surgical intervention. Epub 2015 May 8. doi: 10.1371/journal.ppat.1009107. Lesions of lupus vulgaris may have the appearance of “apple jelly” on diascopy (47, 69, 71). Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Epidemiology of disease caused by nontuberculous mycobacteria. The differential diagnosis of lupus vulgaris is with conditions such as discoid lupus, sarcoidosis, Spitz nevus, chromoblastomycosis, tuberculoid leprosy, and leishmaniasis. Modern molecular genomic analysis of ancient human remains and records of ancient texts demonstrate that the spread of some mycobacterial diseases, including TB and leprosy, track historical milestones of human societies (7–10). Comparative genomic analyses have demonstrated that M. lepromatosis and M. leprae are related mycobacterial species that are distinguishable at the genomic level but cause similar clinical manifestations (104–107). His H index is currently 24. Category III is when there is evidence of severe disease with dissemination, osteitis, osteomyelitis, or joint involvement (31, 109). He graduated from the Field Epidemiology Training Program (FETP) of the CDC and Tephinet in Colombia. Nontuberculous mycobacteria (NTM), i.e., those mycobacterial species that do not cause tuberculosis or leprosy, are frequently present in municipal water systems, residing mostly in the pipeline biofilms (21, 22, 38, 39). Would you like email updates of new search results? Tuberculids are cutaneous disorders that represent hypersensitivity reactions to mycobacterial antigens. massiliense among patients with cystic fibrosis (43, 44). Azithromycin is the preferred agent in M. abscessus infections, whereas clarithromycin or azithromycin is effective in cases of M. massiliense (117, 118). An 11-year-old male demonstrating a destructive panniculitis causing ulceration with undermined borders, characteristic of Buruli ulcer. Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacterium, which causes infections of the human skin and soft tissue. The clinical spectrum of cutaneous disease caused by M. marinum includes a solitary papule or nodule that may ulcerate and then spreads in a sporotrichoid pattern (lymphangitic spread) (Fig. From a large mycobacterial pool, some species have evolved into potential major human pathogens (20, 23–25) (Fig. eCollection 2020 Dec. Microorganisms. The most frequent tuberculid is erythema induratum of Bazin, but some individuals may manifest lichen scrofulosorum, or papulonecrotic tuberculid (47, 67, 69) (Table 2). Lupus vulgaris occurs predominantly in Asia and southern Africa. He is Professor of Medicine and Veterinary Medicine and Director of Scientific Research of the Faculty of Health Sciences of the Universidad Tecnológica de Pereira (UTP) in Pereira, Risaralda, Colombia. haemophilum requires iron or hemin supplementation for growth (35, 36, 42, 119). This strategy has helped to reduce the prevalence of this infection (93–97). WHO identifies approximately 3,000 to 5,000 cases annually, affecting predominantly children less than 15 years of age (20, 31, 32, 109). Disseminated NTM infections affect severely immunocompromised human hosts, including those with primary immunodeficiencies, such as genetic or acquired defects of the IFN-γ–interleukin-12 (IL-12) pathway (e.g., GATA2 deficiency or anti-IFN-γ autoantibodies), or acquired immunodeficiencies, such as HIV infection/AIDS, transplant-associated immunosuppression, and treatment with biological agents such as anti-tumor necrosis factor alpha (anti-TNF-α) receptor blockers (26, 27, 116). Recent outbreaks of severe, life-threatening infections caused by M. chimera were associated with extracorporeal circulation following cardiothoracic surgery procedures. In addition, histopathological evaluation of tissue samples contributes to defining the immunopathological spectrum of polar and borderline forms of leprosy (47). Relapse or reinfection is considered a rare clinical phenomenon (47, 78, 86, 87). That is a blessing and a curse. 1999 Jul;26(6):271-8. doi: 10.1111/j.1600-0560.1999.tb01844.x. Untreated primary-inoculation TB may resolve in a period of 12 months or longer or may progress to disseminated forms of the disease by hematogenous spread of the bacillus to other organs. He is currently an Associate Professor of Clinical Medicine in the Division of Infectious Diseases at Stony Brook University and serves as the Fellowship Program Director. MAC bacteria do not make … Dr. Franco-Paredes obtained his medical degree from L Salle University in Mexico City. Opportunistic pathogens but may invade the skin of immunocompetent individuals causing indolent granulomatous disease is by... 1999 Jul ; 33 ( 3 ):563-77. doi: 10.3390/antibiotics9080450 has served on the of! And cultures represent the cornerstone of diagnosis research activities include the fingers and dorsum of Tick-Borne. In Colombia, Colciencias and winner of the CDC and Tephinet in Colombia, Colciencias and winner of Public! 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