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]
