They share phenotypic and genotypic features, including the large virulence plasmid (pMUM) required for mycolactone production. 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). Early identification of new cases likely prevents further transmission, but, importantly, it may also reduce the risk of neurological dysfunction and disability associated with leprosy (96–98). Their gene loss or acquisition reflects fluctuating environmental challenges and host-specific pathoadaptations (2, 3, 5) (Table 1). These infections are increasing at about 8% each year. All of these species have been isolated from humans, frogs, and fish. Classification of major pathogenic mycobacteria. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Ecological data suggest that environmental factors, such as trauma or skin breaks during soil and water exposures, insect vectors, free-living amoebas, and animal reservoirs (e.g., armadillos, squirrels, felines, or other animals), influence leprosy transmission (39, 47, 49–63). Mycobacterial infections are a group of multisystem infections caused by the members of the family Mycobacteriaceae. 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. Humans encounter mycobacterial species due to their ubiquity in different environmental niches. Rapid diagnostic tests to detect mycolactone are currently under evaluation for use as point-of-care tests in areas of high endemicity (109). Histologically, intraneural or perineural granulomas may assist the pathologist in distinguishing leprosy from cutaneous tuberculosis (47). In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. 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). Mycobacterium marseillense is a member of the M. avium complex that has caused infections with lymphatic or pulmonary involvement sporadically in humans (2–4).We report M. marseillense infection involving facial skin … The Ridley-Jopling staging system divides leprosy into tuberculoid, borderline (borderline tuberculoid, borderline borderline, and borderline lepromatous), and lepromatous forms (Fig. 6) (1, 24, 42, 117). This form is also known as tuberculosis colliquative cutis. Rapidly Growing MycobacteriaCutaneous NTM infections are transmitted via direct inoculation through skin barrier breaks, which may occur during trauma, surgical procedures, plastic surgery (including liposuction), injections, tattoos, acupuncture, and body piercings (Table 4) (1, 24, 42, 117). An infection … This article reviews the dermatologic manifestations of Mycobacterium avium-intracellulare (MAI, or MAC) infection.. MAI is an opportunistic pathogen that usually causes disease in the weakened immune system. Alexandro Bonifaz is Head of the Department of Mycology, Dermatology Service, Hospital General de Mexico “Dr. The most important conditions that should be considered in the differential diagnosis of BU include tropical phagedenic ulcers, cutaneous tuberculosis, vascular (venous or arterial) ulcerations, diabetic foot ulcerations, pyoderma gangrenosum, infections due to Haemophilus ducreyi, cutaneous leishmaniasis, ulcerative yaws, fungal infections (e.g., chromoblastomycosis), and pyogenic ulcerations (e.g., caused by Staphylococcus aureus) (24, 109, 112). He is Professor of Infectology and Tropical Medicine (University of Sucre, Colombia), Professor of the Graduate Promotion and Prevention of the University of Sucre (Colombia), member of the Research Committee of the University Hospital of Sinclejo (Colombia), Colciencias peer reviewer, coordinator of the Tropical Medicine and Zoonoses Committee of the Colombian Association of Infectology (2017 to 2019), and member of the editing and arbitration committees of multiple international journals. 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). In this review, we group cutaneous mycobacterial infections into four major categories: (i) infection due to Mycobacterium tuberculosis complex, (ii) infection caused by Mycobacterium leprae and M. lepromatosis, (iii) infection caused by Mycobacterium ulcerans and other slowly growing mycobacteria (SGM), and (iv) infection due to rapidly growing mycobacteria (RGM). Armadillos may also play a role in the transmission of leprosy in some areas in Colombia (55) and in Brazil (56). Azithromycin is the preferred agent in M. abscessus infections, whereas clarithromycin or azithromycin is effective in cases of M. massiliense (117, 118). Primary-inoculation TB occurs after exogenous inoculation in individuals not previously sensitized to M. tuberculosis, and it represents a phenomenon analogous to the Ghon complex in the lung (47, 69). Interferon gamma (IFN-γ) release assays (IGRAs) demonstrate a sensitivity of 92% and a specificity of 76% in individuals with cutaneous TB (73). He has authored more than 350 peer-reviewed publications on infectious diseases and tropical medicine. Dr. Franco-Paredes has an adjunct faculty appointment as a research professor at the Hospital Infantil de Mexico Federico Gomez in Mexico City. This strain of M. lepromatosis appears to have diverged from the two human strains from Mexico (53). [Cutaneous and soft skin infections due to non-tuberculous mycobacteria]. Enter multiple addresses on separate lines or separate them with commas. Another is Mycobacterium abscessus, which can lead to lung damage and infections of the skin and soft tissue, which includes cartilage, tendons, and the layers of fat and muscle underneath the skin. Mycobacterium haemophilumM. eCollection 2020 Dec. Microorganisms. Usually occur on the arms or knees. M. haemophilum was identified in 1978 in individuals with skin infections. Some individuals may manifest with a single lesion, but others manifest with multiple lesions, depending on the mode of acquisition and level of host immunity (42, 117). Another one causes leprosy. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Hematogenous metastatic tuberculous abscesses occur among immunocompromised individuals and may present with single or multiple subcutaneous nodules that may potentially evolve into ulcers or draining sinuses without regional adenopathy (47, 69). haemophilum requires iron or hemin supplementation for growth (35, 36, 42, 119). Molecular detection methods and phenolic glycolipid 1 (PGL-1) serological data in combination with spatial epidemiology increase detection of leprosy cases (98). Mycobacterial species reside in a wide-variety of environments due to multiple adaptations. NTM infections of the skin may spread to cause tenosynovitis, myositis, osteomyelitis, and septic arthritis (24, 42, 117). Since cases of leprosy in children indicate ongoing transmission of M. leprae in settings of endemicity, targeted screening involving school-based surveillance followed by continuous household surveillance increases early detection of new leprosy cases (97). Identifying M. tuberculosis in tissue specimens through culture or molecular detection is of paramount significance when suspecting most clinical forms of cutaneous tuberculosis. Created 2008. The WHO recommended the institution of multidrug therapy with dapsone, rifampin, and clofazimine in 1982 (47, 97, 99). Some of the features include the presence of a lipid-rich hydrophobic outer membrane, which is a major determinant of surface adherence, biofilm formation, aerosolization, and antibiotic/disinfectant resistance. 2020 Dec 18;16(12):e1009107. M. marinum may produce deep tissue involvement (Fig. In children, this infection usually presents as cervical lymphadenitis (35, 36). In addition, histopathological evaluation of tissue samples contributes to defining the immunopathological spectrum of polar and borderline forms of leprosy (47). We report here 5 patients with cutaneous and/or soft tissue infection … 7) (24, 42, 117). 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. M. fortuitum is susceptible to macrolides, amikacin, doxycycline, fluoroquinolones, and trimethoprim-sulfamethoxazole. For example, leprosy and tuberculosis (TB) have had a profound effect on human suffering for thousands of years (16). Skin and soft tissue (typically following surgery, trauma, injection of medications or other substances) Device associated infections (e.g., central line associated bloodstream infection, exit site infections, pacemaker pocket site infections… from the Bloomberg School of Public Health at Johns Hopkins University. Mycobacterium abscessus was first identified in a patient with a knee infection and subcutaneous abscesses in 1950 (117). Disease caused by M. marinum is associated with minor to moderate skin infections presenting as granulomatous lesions similar to those caused by M. tuberculosis or M. haemophilum. Cutaneous mycobacterial infections may manifest with localized or diffuse lesions. He is an Associate Researcher, Colciencias and winner of the Wiliam Jarvis 2014 Award, Best International Research, awarded by SHEA. Susceptibilities to antimicrobials depend on the species. Early diagnosis and treatment are crucial to minimize morbidity and prevent long-term disability (2, 3, 109). This form is also known as tuberculosis colliquative cutis. Phylogenetic reconstructions of genomic sequences suggest that Mycobacterium marinum, Mycobacterium leprae, Mycobacterium ulcerans, and M. tuberculosis evolved from a common environmental ancestor (2, 15, 16, 19). In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Clinical manifestations of leprosy: borderline tuberculoid (BT) (A), borderline borderline (BB) (B), and lepromatous (LL) (C). This progressive clinical form originates through lymphatic spread or by contiguous spread from a lymph node or bone (47). He is a member of the Committee on Tropical Medicine, Zoonoses and Travel Medicine of ACIN. Infiltrated erythematous plaque with yellowish scales and crusts (A) resolved to a scar after clearance of infection … However, when it occurs, it is usually in the form of scrofuloderma or lupus vulgaris (47, 67–70). 1999 Jul;26(6):271-8. doi: 10.1111/j.1600-0560.1999.tb01844.x. In 2016, he edited a textbook, Neglected Tropical Diseases in Latin America and the Caribbean (Springer-Verlag), and he has written a textbook on infectious diseases (Core Concepts in Clinical Infectious Diseases [Elsevier]). He is also the Associate Director for Research for the Global Health Institute at Stony Brook University. marinum is a slowly growing pigmented organism responsible for “fish tank granuloma” due to its ability to cause localized skin and soft tissue infections in individuals with exposure to contaminated freshwater or salt water (24, 42, 120). Curr Opin Infect Dis. 2020 Aug 6;9(8):641. doi: 10.3390/pathogens9080641. Some identified risk factors for developing this clinical variant include minor trauma, tattoos, piercing, and surgical procedures with unsterilized equipment (47, 71). Identification of mycobacterial DNA in cutaneous lesions of sarcoidosis. Reconstructive surgery may be indicated for severe forms of cutaneous TB such as lupus vulgaris (69, 71). Pulmonary nontuberculous mycobacterial infections are multisystem and multigenic diseases (26). Because its optimal temperature for growth is around 30°C, cutaneous lesions most frequently occur in the upper or lower extremities and sometimes in the tip of the nose. Originally described in Mexico, this clinical form of leprosy also occurs in other countries (102–104). Journal of Microbiology & Biology Education, Microbiology and Molecular Biology Reviews, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, Division of Infectious Diseases, University of Colorado Denver Anschutz Medical Campus, Denver, Colorado, USA, Division of Infectious Diseases, Department of Medicine and Department of Microbiology and Molecular Genetics, and Global Health Institute, Stony Brook University, Stony Brook, New York, USA, Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia, Universidad Privada Franz Tamayo, Cochabamba, Bolivia, Departamento de Infectología, Hospital Universitario de Sincelejo, Sucre, Colombia, Instituto de Medicina Tropical Alexander von Humboldt, University Cayetano Heredia, Lima, Peru, Servicio de Dermatología y Departamento de Micología, Hospital General de México, Mexico City, Mexico, Human Societies and the Origin and Spread of Major Mycobacterial Pathogens, Diffuse Lepromatous Leprosy of Lucio and Latapí, Mycobacterium leprae Mycobacterium ulcerans, Practice guidelines for clinical microbiology laboratories: mycobacteria, Unsolved matters in leprosy: a descriptive review and call for further research, Mycobacterial pathogenomics and evolution, Many neglected tropical diseases may have originated in the Paleolithic or before: new insights from genetics, Genome-wide comparison of medieval and modern, Comparative phylogenomics of pathogenic and non-pathogenic, Human genetic ancestral composition correlates with the origin of, Comparative analyses of nonpathogenic, opportunistic, and totally pathogenic mycobacteria reveal genomic and biochemical variabilities and highlight the survival attributes of, Insights from the complete genome sequence of, A glimpse into the past and predictions for the future: the molecular evolution of the tuberculosis agent, Aquatic plants stimulate the growth of and biofilm formation by, Reductive evolution and niche adaptation inferred from the genome of, Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria, Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment, Environmental sources of nontuberculous mycobacteria, Mycobacterial skin and soft tissue infection, Host susceptibility to non-tuberculous mycobacterial infections, Pulmonary nontuberculous mycobacterial infection. 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