Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections

  • B. PetriniEmail author


Mycobacterium marinum is a waterborne mycobacterium that commonly infects fish and amphibians worldwide. Infection in humans occurs occasionally, in most cases as a granulomatous infection localized in the skin, typically following minor trauma on the hands. For this reason, infection is especially common among aquarium keepers. Such local infection may—though infrequently—spread to tendon sheaths or joints. Disseminated disease, which is rare, can occur in immunosuppressed patients. In order to obtain a definitive diagnosis, culture and histopathological examination of biopsies from skin or other tissues are recommended. Infections sometimes heal spontaneously, but drug treatment is usually necessary for several months in order to cure the infection. Doxycycline or clarithromycin is used most commonly, although in severe cases, a combination of rifampicin and ethambutol is recommended.


Clarithromycin Tuberculin Skin Test Ethambutol Cutaneous Leishmaniasis Granulomatous Inflammation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Clark HF, Shepard CC (1963) Effect of environmental temperatures on infection with Mycobacterium marinum (balnei) of mice and a number of poikilothermic species. J Bacteriol 86:1057–1069PubMedGoogle Scholar
  2. 2.
    Zeeli T, Samra Z, Pitlik S (2003) Ill from eel? Lancet Infect Dis 3:168–169CrossRefPubMedGoogle Scholar
  3. 3.
    Beecham HJ III, Oldfield EC III, Lewis DE, Buker JL (1991) Mycobacterium marinum infection from shucking oysters. Lancet 337:1487CrossRefPubMedGoogle Scholar
  4. 4.
    Aronson JD (1926) Spontaneous tuberculosis in salt water fish. J Infect Dis 39:314–320Google Scholar
  5. 5.
    Pattyn RP (1984) Mycobacterium marinum. In: Kubica GP, Wayne LG (eds) The mycobacteria. A sourcebook. Markel Dekker, New York, pp 1137–1139Google Scholar
  6. 6.
    Decostere A, Hermans K, Haesebrouck F (2004) Piscine mycobacteriosis: a literature review covering the agent and the disease it causes in fish and humans. Vet Microbiol 99:159–166CrossRefPubMedGoogle Scholar
  7. 7.
    Yanong RP, Curtis EW, Terrell, Case G (2003) Atypical presentation of mycobacteriosis in a collection of frogfish (Antennarius striatus). J Zoo Wildl Med 34:400–407PubMedGoogle Scholar
  8. 8.
    Bowenkamp KE, Frasca S Jr, Draghi A II, Tsongalis GJ, Koerting C, Hinckely L et al (2001) Mycobacterium dermatitis and panniculitis with chronic pleuritis in a captive white whale (Delphinapterus leucas) with aortic rupture. J Vet Diagn Invest 13:524–530PubMedGoogle Scholar
  9. 9.
    Sato T, Shibuya H, Ohba S, Nojiri T, Shirai W (2003) Mycobacteriosis in two captive Florida manatees (Trichechus manatus latiirostris). J Zoo Wildl Med 34:184–188PubMedGoogle Scholar
  10. 10.
    Clothier RH, Balls M (1973) Mycobacteria and lymphoreticular tumours in Xenopus laevis, the South African clawed toad. Oncology 28:445–480PubMedGoogle Scholar
  11. 11.
    Hernandez-Divers SJ, Shearer D (2002) Pulmonary mycobacteriosis caused by Mycobacterium hemophilum and M. marinum in a royal python. J Am Vet Med Assoc 220:1661–1663CrossRefPubMedGoogle Scholar
  12. 12.
    Vincent V, Brown-Elliott B, Jost KC Jr, Wallace RJ Jr (2003) Mycobacterium: phenotypic and genotypic identification. In: Murray PR (ed) Manual of clinical of microbiology. American Society for Microbiology, Washington DC, pp 560–584Google Scholar
  13. 13.
    Helguera-Repetto C, Cox RA, Munoz-Sanchez JL, Gonzalez-y-Merchand JA (2004) The pathogen Mycobacterium marinum, a faster growing close relative to Mycobacterium tuberculosis, has a single rRNA operon per gene. FEMS Microbiol Lett 235:281–288CrossRefPubMedGoogle Scholar
  14. 14.
    Stamm LM, Brown EJ (2004) Mycobacterium marinum: the generalization and specialization of a pathogenic mycobacterium. Microbes Infect 6:1418–1428CrossRefPubMedGoogle Scholar
  15. 15.
    Gao LY, Groger R, Cox JS, Beverley SM, Lawson EH, Brown EJ (2003) Transposon mutagenesis of Mycobacterium marinum identifies a locus linking pigmentation and intracellular survival. Infect Immun 71:922–929CrossRefPubMedGoogle Scholar
  16. 16.
    Taalat AM, Reimschuessel R, Wasserman SS, Trucksis M (1998) Goldfish, Carassius auratus, a novel animal model for the study of Mycobacterium marinum pathogenesis. Infect Immun 66:2938–2942Google Scholar
  17. 17.
    Davis JM, Clay H, Lewis JL, Ghori N, Herbomel P, Ramakrishnan L (2002) Real-time visualization of mycobacterium-macrophage interactions leading to initiation of granuloma formation in zebrafish embryos. Immunity 17:693–702CrossRefPubMedGoogle Scholar
  18. 18.
    Pasnik DJ, Smith SA (2005) Immunogenic and protective effects of a DNA vaccine for Mycobacterium marinum in fish. Vet Immunol Immunopathol 103:195–206CrossRefPubMedGoogle Scholar
  19. 19.
    Lancaster RD, Colston MJ, Hilson GR, Turner SM (1981) The effect of body temperature and cell-mediated immunity on the growth of Mycobacterium marinum and Mycobacterium leprae in mice. J Med Microbiol 14:493–500PubMedCrossRefGoogle Scholar
  20. 20.
    Collins FM, Montalbine V, Morrison NE (1975) Growth of Mycobacterium marinum in the footpads of T-cell-depleted mice. Infect Immun 11:1088–1093PubMedGoogle Scholar
  21. 21.
    Dionne MS, Ghori N, Schneider DS (2003) Drosophila melanogaster is a genetically tractable model host for Mycobacterium marinum. Infect Immun 71:3540–3550CrossRefPubMedGoogle Scholar
  22. 22.
    Solomon JM, Leung GS, Isberg RR (2003) Intracellular replication of Mycobacterium marinum within Dicostelium discoidum: efficient replication in the absence of host corionin. Infect Immun 71:3578–3586CrossRefPubMedGoogle Scholar
  23. 23.
    Steinert M, Heuner K (2005) Dictyostelium as host model for pathogenesis. Cell Microbiol 7:307–314CrossRefPubMedGoogle Scholar
  24. 24.
    Geub G, Taoult D (2004) Microorganisms resistant to free-living amoebae. Clin Microbiol Rev 17:413–433CrossRefGoogle Scholar
  25. 25.
    Cirillo JD, Falkow S, Tompkins LS, Bermudez LE (1997) Interaction of Mycobacterium avium with environmental amoebae enhances virulence. Infect Immun 65:3759–3767PubMedGoogle Scholar
  26. 26.
    Primm TP, Christie AL, Falkinham III JO (2004) Health impacts of environmental mycobacteria. Clin Microbiol Rev 17:98–106CrossRefPubMedGoogle Scholar
  27. 27.
    Ramakrishnan L, Falkow S (1994) Mycobacterium marinum persists in cultured mammalian calls in a temperature-restricted fashion. Infect Immun 62:3222–3229PubMedGoogle Scholar
  28. 28.
    van der Sar AM, Abdallah AM, Sparrius M, Reinders E, Vandenbroucke-Grauls CM, Bitter W (2004) Mycobacterium marinum strains can be divided into two distinct types based on genetic diversity and virulence. Infect Immun 72:6306–6312CrossRefPubMedGoogle Scholar
  29. 29.
    Ucko M, Colorni A (2005) Mycobacterium marinum infections in fish and humans in Israel. J Clin Microbiol 43:892–895CrossRefPubMedGoogle Scholar
  30. 30.
    Sciacca-Kirby J, Kim E, Jaffer S (2002) Mycobacterium marinum infection of the skin. http// Cited 8 Feb 2006
  31. 31.
    Leoni E, Legnani P, Mucci MT, Pirani R (1999) Prevalence of mycobacteria in a swimming pool environment. J Appl Microbiol 87:683–688CrossRefPubMedGoogle Scholar
  32. 32.
    Dailloux M, Harteman P, Peurey J (1980) Study on the relationship between isolation of mycobacteria and classical microbiological and chemical indicators of water quality in swimming pools. Zbl Bakteriol Mikrobiol Hyg [B] 171:473–486Google Scholar
  33. 33.
    Linell F, Norden A (1954) Mycobacterium balnei, a new acid-fast bacillus occurring in swimming pools and capable of producing skin lesions in humans Acta Tuberc Scand (Suppl) 33:1–84Google Scholar
  34. 34.
    Jernigan JA, Farr BM (2000) Incubation period and sources of exposure for cutaneous Mycobacterium marinum infection: case report and review of the literature. Clin Infect Dis 31:439–443CrossRefPubMedGoogle Scholar
  35. 35.
    Adams RM, Remington JS, Steinberg J, Seibert JS (1970) Tropical fish aquariums. A source of Mycobacterium marinum infections resembling sporotrichosis. JAMA 211:457–461CrossRefPubMedGoogle Scholar
  36. 36.
    Keczes K (1974) Tropical fish tank granuloma. Brit J Dermatol 91:709CrossRefGoogle Scholar
  37. 37.
    Mollohan CS, Romer MS (1961) Public health significance of swimming pool granuloma. Am J Pub Health 51:883–891PubMedCrossRefGoogle Scholar
  38. 38.
    Morgan JK, Blowers R (1964) Swimming-pool granuloma in Britain. Lancet i:1034–1035CrossRefGoogle Scholar
  39. 39.
    Aubry A, Chosidow O, Caumes E, Robert J, Cambau E (2002) Sixty-three cases of Mycobacterium marinum infection: clinical features, treatment, and antibiotic susceptibility of causative isolates. Arch Intern Med 162:1746–1752CrossRefPubMedGoogle Scholar
  40. 40.
    Clark RB, Spector H, Friedman DM, Oldrati KJ, Young CL, Nelson SC (1990) Osteomyelitis and synovitis produced by Mycobacterium marinum in a fisherman. J Clin Microbiol 28:570–572Google Scholar
  41. 41.
    Speight EL, Williams HC (1997) Fish tank granuloma in a 14-month-old girl. Pediatr Dermatol 14:209–212PubMedGoogle Scholar
  42. 42.
    Khosrovaneh A, Briski LE, Jankowski E, Khatib R (2002) Nostril infection due to Mycobacterium marinum in an immunocompetent host. Scand J Infect Dis 34:929–931CrossRefPubMedGoogle Scholar
  43. 43.
    Gould WM, McMeekin DR, Bright RD (1968) Mycobacterium marinum (balnei) infection: report of a case with cutaneous and laryngeal lesions. Arch Dermatol 97:159–162CrossRefPubMedGoogle Scholar
  44. 44.
    Chow SP, Ip FK, Lau JH, Collins RJ, Luk KD, So YC, Pun WK (1987) Mycobacterium marinum infection of the hand and wrist. Results of conservative treatment in twenty-four cases. J Bone Joint Surg Am 69:1161–1168PubMedGoogle Scholar
  45. 45.
    Barton A, Bernstein RM, Struthers JK, O’Neill TW (1997) Mycobacterium marinum infection causing septic arthritis and osteomyelitis. Br J Rheumatol 36:1207–1209CrossRefPubMedGoogle Scholar
  46. 46.
    Saadatmand B, Poulton JK, Kauffman CL (1999) Mycobacterium marinum with associated bursitis. J Cutan Med Surg 3:218–220PubMedGoogle Scholar
  47. 47.
    Powers R, Fisher M (2005) Tenosynovitis due to Mycobacterium marinum. N Engl J Med 351:911CrossRefGoogle Scholar
  48. 48.
    Lahey T (2003) Invasive Mycobacterium marinum infections. Emerg Infect Dis 9:1496–1498PubMedGoogle Scholar
  49. 49.
    Gombert M, Goldstein E, Corrado M, Shin A, Butt K (1981) Disseminated Mycobacterium marinum infection after renal transplantation. Ann Intern Med 94:486–487PubMedGoogle Scholar
  50. 50.
    Ekerot L, Jacobsson L, Forsgren A (1998) Mycobacterium marinum wrist arthritis: local and systemic dissemination caused by concomitant immunosuppressive therapy. Scand J Infect Dis 30:84–87CrossRefPubMedGoogle Scholar
  51. 51.
    King AJ, Fairley JA, Rasmussen JE (1983) Disseminated cutaneous Mycobacterium marinum infection. Arch Dermatol 119:268–270CrossRefPubMedGoogle Scholar
  52. 52.
    Lacaille F, Blanche S, Bodmer C, Durand C, de Prost Y, Gaillard J (1984) Persistent Mycobacterium marinum infection in a child with probable visceral involvement. Pediatr Infect Dis 9:58–60Google Scholar
  53. 53.
    Ho PL, Ho P, Fung BK, Ip WY, Wong SS (2001) A case of disseminated Mycobacterium marinum infection following systemic steroid therapy. Scand J Infect Dis 33:232–233CrossRefPubMedGoogle Scholar
  54. 54.
    Tchornobay A, Claudy AL (1992) Fatal disseminated Mycobacterium marinum infection. Int J Dermatol 31:286–287PubMedGoogle Scholar
  55. 55.
    Lai C, Lee L, Chang Y, Lee Y, Ding L, Hsueh P (2005) Pulmonary infection due to Mycobacterium marinum in an immunocompetent patient. Clin Infect Dis 40:206–208CrossRefPubMedGoogle Scholar
  56. 56.
    Vasquez JA, Sobel JD (1992) A case of disseminated Mycobacterium marinum infection in an immunocompetent patient. Eur J Clin Microbiol Infect Dis 11:908–911CrossRefGoogle Scholar
  57. 57.
    Cosma CL, Humbert O, Ramakrishnan L (2004) Superinfecting mycobacteria home to established tuberculous granulomas. Nat Immunol 5:778–779CrossRefGoogle Scholar
  58. 58.
    Stamm LM, Morisaki JH, Gao LY, Jeng RL, McDonald KL, Roth R et al (2003) Mycobacterium marinum escapes from phagosomes and is propelled by actin-based motility. J Exp Med 198:1361–1368CrossRefPubMedGoogle Scholar
  59. 59.
    Hess CL, Wolock BS, Murphy MS (2005) Mycobacterium marinum infections of the upper extremity. Plast Reconstr Surg 115:55–59CrossRefGoogle Scholar
  60. 60.
    Tobin EH, Jih WW (2001) Sporotrichoid lymphocutaneous infections: etiology, diagnosis and therapy. Am Fam Physician 63:326–332PubMedGoogle Scholar
  61. 61.
    Lewis FM, Marsh BJ, von Reyn CF (2003) Fish tank exposure and cutaneous infections due to Mycobacterium marinum: tuberculin skin testing, treatment, and prevention. Clin Infect Dis 37:390–397CrossRefPubMedGoogle Scholar
  62. 62.
    Woods GL (2000) Susceptibility testing for mycobacteria (2000) Clin Infect Dis 31:1209–1215CrossRefPubMedGoogle Scholar
  63. 63.
    Cummins DL, Delacerda D, Tausk FA (2005) Mycobacterium marinum with different responses to second-generation tetracyclines. Int J Dermatol. 44:518–520CrossRefPubMedGoogle Scholar
  64. 64.
    American Thoracic Society (1997) Diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med 156:1–25Google Scholar
  65. 65.
    Donta ST, Smith PW, Levitz RE, Quintiliani R (1986) Therapy of Mycobacterium marinum infections. Use of tetracyclines vs. rifampicin. Arch Intern Med 146:902–904CrossRefPubMedGoogle Scholar
  66. 66.
    Sutherland GE, Lauwasser M, McNeely DJ, Shands JW Jr (1980) Heat treatment for certain chronic granuloumatous skin infections. South Med J 73:1564–1565PubMedGoogle Scholar
  67. 67.
    Hisamichi K, Hiruma M, Yamazaki M, Matsushita A, Ogawa H (2002) Efficacy of oral minocycline and hyperthermic treatment in a case of atypical mycobacterial skin infection by Mycobacterium marinum. J Dermatol 29:810–811PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Clinical MicrobiologyKarolinska University Hospital (Solna) and Karolinska InstitutetStockholmSweden

Personalised recommendations