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Myobacterium marinum

- See: Myobacterium tuberculosis     

- Discussion:
    - causes chronic granuloma of the hand or a sub acute inflammation, which may be difficult to distinguish from chronic tenosynovitis or chronic inflammation of the fingers or the hand;
          - can be confused w/ rheumatoid hand and will temporarily respond to steroid injection;
    - organism is usually associated with swimming, fish handling, etc;

- Clinical Finding:
    - painful swelling in the hand;
    - subcutaneous mass;
    - tenosynovitis, which involves the extensors more frequently then the flexors;

- Gram Stain: utilizes Ziehl Neelson staining;

- Culture:
    - culture must be incubated at 30-32 deg (rather than 37 deg), & must be incubated w/ Lowenstein-Jensen medium - often culture for 6 weeks in required;

- Treatment:
    - ethambutol and rifampin are curative;
    - also consider oral minocycline which has lesser side effects;
    - synovectomy and debridement are often required


Mycobacterium marinum infections of the hand.  

Experience with atypical mycobacterial infection in the deep structures of the hand.

Year Book: Mycobacterium marinum Infection of the Hand and Wrist: Results of conservative treatment in twenty-four cases.

Buruli's ulcer: three cases diagnosed and treated in France.