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Franco-Paredes C, Marcos LA, Henao-Martínez AF, Rodríguez-Morales AJ, Villamil-Gómez WE, Gotuzzo E, Bonifaz A, et al.
Clinical microbiology reviews. Date of publication 2018 Nov 14;volume 32(1):.
1. Clin Microbiol Rev. 2018 Nov 14;32(1). pii: e00069-18. doi: 10.1128/CMR.00069-18. Print 2018 Jan. Cutaneous Mycobacterial Infections. Franco-Paredes C(1)(2), Marcos LA(3), Henao-Martínez AF(2), Rodríguez-Morales AJ(4)(5), Villamil-Gómez WE(6), Gotuzzo E(7), Bonifaz A(8). Author information: (1)Hospital Infantil de México Federico Gómez, Mexico City, Mexico carlos.franco-paredes@ucdenver.edu. (2)Division of Infectious Diseases, University of Colorado Denver Anschutz Medical Campus, Denver, Colorado, USA. (3)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. (4)Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia. (5)Universidad Privada Franz Tamayo, Cochabamba, Bolivia. (6)Departamento de Infectología, Hospital Universitario de Sincelejo, Sucre, Colombia. (7)Instituto de Medicina Tropical Alexander von Humboldt, University Cayetano Heredia, Lima, Peru. (8)Servicio de Dermatología y Departamento de Micología, Hospital General de México, Mexico City, Mexico. Humans encounter mycobacterial species due to their ubiquity in different environmental niches. 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. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of Mycobacterium tuberculosis infection, (ii) Buruli ulcer caused by Mycobacterium ulcerans and other related slowly growing mycobacteria, (iii) leprosy caused by Mycobacterium leprae and Mycobacterium lepromatosis, and (iv) cutaneous infections caused by rapidly growing mycobacteria. 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. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Mycobacterium ulcerans produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. 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. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines. Copyright © 2018 American Society for Microbiology. DOI: 10.1128/CMR.00069-18 PMCID: PMC6302357 PMID: 30429139 [Indexed for MEDLINE]
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Wound Culture - Swabs, Biopsies, Needle Aspiration