Abstract

PRIMARY SKIN INFECTIONS CAUSED BY AQUATIC HABITAT MYCOBACTERIA

Cudberto Contreras Pérez, Carlos A. Vázquez Chacón, Carlos Cruz and José D. Méndez*

ABSTRACT

The study of 3 cases with chronic skin infection is presented. The patients had in common the management of tropical fish. The infection was acquired after trauma. The evolution time was 3 months in 2 cases and 4 years in the other. In two patients there was lymphatic spread, one of the cases was HIV positive and the other had no significant history. The other patient had a localized verrucous lesion and disseminated psoriasis coexisted. Direct bacilloscopy of the lesions revealed acid resistant bacilli in all 3 cases. The culture was positive in 2 of them, developing the mycobacteria at 37 oC. The identification of the cultures was carried out by molecular biology PCR / RFLP tests, amplifying a fragment of the gene that encodes the 65 KDa heat shock protein. The amplicon was cut with Bst EII and Hae III enzymes. The bands found coded with the species Mycobacterium szulgai and Mycobacterium marinum. The histological image was a non-specific inflammatory reaction and no caseous necrosis was observed in any of the three cases. The patients had a good response to the combination of rifampicin, isoniazid and ethambutol. In one case streptomycin was added with good results. In another patient, there was a good response to ciprofloxacin, since he was allergic to isoniazid.

Keywords: Cutaneous mycobacteriosis, Mycobacterium szulgai, Mycobacterium marinum, Ciprofloxacin, Ethambutol, Isoniazid, Rifampicin, Streptomycin.