1/19. mycobacterium marinum with associated bursitis.BACKGROUND: mycobacterium marinum infections have been reported for over 50 years, mostly in association with trauma in the setting of water exposure. OBJECTIVE: The differential diagnosis for nodules in a sporotrichoid distribution with simultaneous bursitis is discussed. mycobacterium marinum treatment regimens for skin and joint involvement are reviewed. methods: mycobacterium marinum was identified by skin tissue culture with Lowenstein-Jensen medium at 32 degrees C. Histopathologic findings support mycobacterial infection. RESULTS: bursitis and nodules resolved in the first 2 months of a 6-month course of minocycline treatment. CONCLUSION: bursitis is an extremely rare but significant complication of M. marinum.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/19. Localized primary cutaneous mycobacterium kansasii infection in an immunocompromised patient.mycobacterium kansasii is a rare primary cutaneous pathogen, most commonly affecting persons exposed to contaminated water, particularly after local trauma. Most patients who present with localized primary cutaneous M kansasii infection are immunocompetent, whereas the majority of patients with disseminated or pulmonary infection are immunocompromised. We describe a primary cutaneous M kansasii infection in an iatrogenically immunosuppressed patient.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
3/19. Familial cluster of cutaneous mycobacterium avium infection resulting from use of a circulating, constantly heated bath water system.We describe familial cases of cutaneous infection caused by mycobacterium avium. A 45-year-old father, his 14-year-old son and 11-year-old daughter, among five persons in a family, presented with a 2-month history of inflammatory subcutaneous nodules and ulcerations. histology of skin biopsy specimens showed granulomatous inflammation, and mycobacterial colonies isolated from the skin of each patient were identified as M. avium by dna hybridization analysis. The patients were all treated successfully with combined drug therapy consisting of rifampicin, isoniazid and clarithromycin. Their lesions were purely cutaneous M. avium infection, without any visceral involvement. Neither systemic disease nor immunological impairment was detected in the family. However, they all used a circulating, constantly heated bath water system. The bath water was continuously heated to about 40 degrees C without changing the water for a few months, and M. avium was isolated from the filter of the bath tub heating unit. It is considered that this unusual familial cluster of cutaneous M. avium infection in healthy persons may have resulted from the use of contaminated bath water.- - - - - - - - - - ranking = 8keywords = water (Clic here for more details about this article) |
4/19. Incubation period and sources of exposure for cutaneous mycobacterium marinum infection: case report and review of the literature.The diagnosis of cutaneous mycobacterium marinum infection is often delayed for months after presentation, perhaps because important clinical clues in the patient's history are frequently overlooked. knowledge of the incubation period allows the clinician to target questions about the patient's history. Prompted by a case with a prolonged incubation period, we sought to determine more precisely the incubation period of M. marinum infection. The medline database for the period 1966-1996 was searched for information regarding incubation period and type of exposure preceding M. marinum infection. Ninety-nine articles were identified, describing 652 cases. Forty cases had known incubation periods (median, 21 days; range, 5-270 days). Thirty-five percent of cases had an incubation period > or =30 days. Of 193 infections with known exposures, 49% were aquarium-related, 27.4% were related to fish or shellfish injuries, and 8.8% were related to injuries associated with saltwater or brackish water. Because the incubation period for cutaneous M. marinum infection can be prolonged, patients with atypical cutaneous infections should be questioned about high-risk exposures that may have occurred up to 9 months before the onset of symptoms.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
5/19. Characterization of Mycobacterium bohemicum isolated from human, veterinary, and environmental sources.Chemotaxonomic and genetic properties were determined for 14 mycobacterial isolates identified as members of a newly described species Mycobacterium bohemicum. The isolates recovered from clinical, veterinary, and environmental sources were compared for lipid composition, biochemical test results, and sequencing of the 16S ribosomal dna (rDNA) and the 16S-23S rDNA internal transcribed spacer (ITS) regions. The isolates had a lipid composition that was different from those of other known species. Though the isolates formed a distinct entity, some variations were detected in the features analyzed. Combined results of the phenotypic and genotypic analyses were used to group the isolates into three clusters. The major cluster (cluster A), very homogenous in all respects, comprised the M. bohemicum type strain, nine clinical and veterinary isolates, and two of the five environmental isolates. Three other environmental isolates displayed an insertion of 14 nucleotides in the ITS region; they also differed from cluster A in fatty alcohol composition and produced a positive result in the Tween 80 hydrolysis test. Among these three, two isolates were identical (cluster B), but one isolate (cluster C) had a unique high-performance liquid chromatography profile, and its gas liquid chromatography profile lacked 2-octadecanol, which was present in all other isolates analyzed. Thus, sequence variation in the 16S-23S ITS region was associated with interesting variations in lipid composition. Two of the isolates analyzed were regarded as potential inducers of human or veterinary infections. Each of the environmental isolates, all of which were unrelated to the cases presented, was cultured from the water of a different stream. Hence, natural waters are potential reservoirs of M. bohemicum.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
6/19. mycobacterium marinum infection in a lung transplant recipient.We report a case of mycobacterium marinum infection in a lung transplant recipient who presented with nodules on the hand and forearm following exposure to fish-tank water of a superficial hand burn. skin biopsy revealed granulomatous inflammation and fibrosis. Tissue culture grew mycobacterium marinum. The patient underwent surgical excision of the lesions and treatment with ethambutol and azithromycin for 12 months and experienced complete resolution of the infection. Transplant recipients who receive immunosuppressive therapy are at increased risk for opportunistic infections. For a patient with nodular lesions on the extremities, exposure to fish, fish-tank water, or swimming should suggest infection with mycobacterium marinum.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
7/19. Fulminant stenotrophomonas maltophilia soft tissue infection in immunocompromised patients: an outbreak transmitted via tap water.Soft tissue infection caused by stenotrophomonas maltophilia is uncommon, but nosocomial infections had been reported. We describe herein 2 young female patients, with severe neutropenia, on broad spectrum antimicrobial agents for neutropenic fever, with Hickman-type central venous catheter, who developed mucocutaneous and soft tissue infections with rapidly progressive and devastating course. Cultures from the skin of both patients and from blood of one of them grew S. maltophilia. Both patients died and post mortem examination of the patient with S. maltophilia bacteremia revealed extensive soft tissue necrosis and a vegetation on the mitral valve that grew S. maltophilia. The infection occurred in both patients at the same time and in the same ward. Epidemiological study was done, and surveillance cultures grew the organism from the faucets from the room of 1 patient and also from some of the neighboring rooms in our ward but not from any other ward nor in the water reservoir of the building.- - - - - - - - - - ranking = 5keywords = water (Clic here for more details about this article) |
8/19. Disseminated cutaneous infection with mycobacterium chelonae in a patient with steroid-dependent rheumatoid arthritis.mycobacterium chelonae is a rapidly growing atypical mycobacterium that is a normal commensal of water and soil. We report a case of a 61-year-old man with seronegative rheumatoid arthritis and fibrosing alveolitis on long-term prednisolone who presented with a number of tender, red, subcutaneous nodules on his upper arms and a pustule on his left cheek. Histopathologic examination revealed dense neutrophilic collections within the deep dermis and subcutaneous fat with abscess formation. Long filamentous organisms were seen within these collections and were subsequently identified by special stains and PCR as mycobacterium chelonae. Treatment was not possible as the patient developed bacteria bronchopneumonia before identification of the organism and he subsequently died. Post-mortem revealed no extra-cutaneous evidence of mycobacterium infection.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
9/19. Successive development of cutaneous polyarteritis nodosa, leucocytoclastic vasculitis and Sweet's syndrome in a patient with cervical lymphadenitis caused by mycobacterium fortuitum.mycobacterium fortuitum is a rapidly growing mycobacterium found in soil and water throughout the world. It can cause diseases in immunocompetent patients, usually resulting in localized skin and soft tissue infections. Cervical lymphadenitis caused by M. fortuitum is rare. We report a 46-year-old woman in whom skin lesions of cutaneous polyarteritis nodosa, leucocytoclastic vasculitis and Sweet's syndrome had successively developed before the diagnosis of cervical lymphadenitis caused by M. fortuitum was made. The skin lesions responded to colchicine and systemic corticosteroids but recurred intermittently. After establishment of the diagnosis, she received treatment with clarithromycin and ciprofloxacin. The cervical lymph nodes decreased in size 6 months later and no more new skin lesions were found.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
10/19. Cutaneous melioidosis in a man who was taken as a prisoner of war by the Japanese during world war ii.melioidosis, an infection caused by the gram-negative bacillus burkholderia pseudomallei, is endemic to Southeast asia and Northern australia. Human infection is acquired through contact with contaminated water via percutaneous inoculation. Clinical manifestations range from skin and soft tissue infection to pneumonia with sepsis. We report a case of a man who was taken as a prisoner of war by the Japanese during world war ii who presented with a nonhealing ulcer on his right hand 62 years after the initial exposure.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
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