"Atypische Mycobacteriële Huidziekten"

Pathology

Box 1.

Predisposing factors.

Table 2.

Some important clinical syndromes and the organisms involved.

Pulmonary symptoms are probably the most common presentation of NTM disease, usually in the context of underlying chronic pulmonary disease (such as cystic fibrosis [CF], bronchiectasis or chronic obstructive pulmonary disease [COPD]), although NTM organisms can still cause pulmonary symptoms in those with no pre-existing lung disease. The disease is usually caused by the M. avium-intracellulare complex (MAC), although other species of mycobacteria have been reported to cause pulmonary disease. 4

Disease in the immuno-competent host is rare but sometimes presents as a typical febrile respiratory syndrome with fever, cough, dyspnea and night sweats. By contrast, in the immuno-compromised host, the presentation is rather non-specific and usually manifests as an unexplained fever and weight loss.

Diagnosis is usually challenging and can be laborious as it entails the elimination of a list of more common respiratory pathologies. The American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) guidelines suggest a triad of radiological, bacteriological and clinical criteria to establish the diagnosis (Table ​ (Table3 3 ). 4

Table 3.

Diagnostic features of NTM-related pulmonary disease.

Lymph node disease is more common in children than in adults and is often caused by MAC, although other NTM organisms are also known to cause it. The disease is usually localized, affecting the cervical lymph nodes, and has no systemic manifestations. It tends to follow a chronic course and can resolve with no specific intervention.

Sind Mykobakterien ansteckend ?

Atypische Mykobakterien sind normalerweise nicht so ansteckend wie andere Arten von Bakterien wie beispielsweise Tuberkulose-Bakterien. In der Regel werden sie nicht von Mensch zu Mensch übertragen, sondern durch direkten Kontakt mit der Umwelt oder kontaminiertem Material wie Wasser oder Boden aufgenommen.

Es gibt jedoch einige Fälle, in denen eine Übertragung von atypischen Mykobakterien von Mensch zu Mensch stattfinden kann. Personen mit einem schwachen Immunsystem sollten keine medizinischen Geräte gemeinsam mit anderen Personen benutzen oder längeren Kontakt mit diesen vermeiden.

Eine Tuberkulose-Infektion durch Mykobakterium tuberculosis, kann sehr ansteckend sein und wird durch Tröpfcheninfektion, z.B. beim Husten oder Niesen, verbreitet.

Mycobacterium marinum: een opkomende dermatologische zoönose

Infectie met Mycobacterium marinum, vaak “vistuberculose” genoemd, treft vooral aquarium- en kweekvissoorten, met name tropische soorten. De ziekte komt minder vaak voor bij schildpadden, krokodillen en kikkers. Deze infectie wordt wereldwijd aangetroffen in zowel zoet- als zoutwateraquaria. De frequentie blijft onbekend.

Mycobacterium marinum wordt voornamelijk overgedragen door de inname van besmet voedsel of detritus van waterdieren. Het kan ook voorkomen door inoculatie van de huid. Symptomen van een huidinfectie kunnen aanvankelijk jarenlang onopgemerkt blijven. Later kunnen ze zich manifesteren als huidlaesies zoals schaalverlies, ulceratie, verkleuring, zwelling van de buik of exoftalmos. In acute gevallen kan de infectie leiden tot plotse dood.

De diagnose van tuberculose bij vissen is vaak moeilijk vanwege de aspecifieke symptomen, waarvoor tijdrovende en dure laboratoriumtests nodig zijn. De meest vatbare soorten in aquaria zijn cypriniden, cichliden, characiden, labyrintvissen en zeedieren. De beschikbare behandelingen zijn beperkt en de infectie is vaak fataal voor de getroffen vissen. Vanwege het zoönotische risico en de resistentie van Mycobacterium marinum tegen conventionele behandelingen, worden behandelingen op basis van sulfonamiden en antibiotica aanbevolen en voorbehouden aan gespecialiseerde dierenartsen. Onmiddellijk na detectie wordt aanbevolen om besmette vissen te isoleren. Het aquarium moet grondig worden schoongemaakt om verspreiding van de infectie te voorkomen.

Epidemiology

MAC/MAI pulmonary disease is most commonly found in adults and those with impaired host defense of the lung, such as Human immunodeficiency virus (HIV), patients on TNF-alpha inhibitors, and cystic fibrosis. Adult pulmonary disease preferentially impacts White, middle-aged, or older men, who often have comorbid diagnoses of chronic obstructive pulmonary disease, alcohol use, or tobacco use. A less common presentation referred to as "hot tub lung" can be seen as part of a hypersensitivity syndrome related to bathing or recreational water exposure following MAC exposure. Disseminated MAC/MAI is primarily observed in patients with significantly immunocompromised states, such as acquired immunodeficiency syndrome.[3][4][5][6]

Skin and Soft Tissue: Atypical Mycobacteria enter the skin and soft tissue through trauma, surgical procedures, or indwelling medical equipment. All species of atypical mycobacteria can cause skin and soft tissue infections. The most common species that cause skin and soft tissue infection are Mycobacterium chelonae, abscessus, fortuitum, ulcerans, and marinum. Mycobacterium marinum infection is also known as the fish tank granuloma after originally being discovered to cause soft tissue infection in fish tank workers/enthusiasts. It most commonly causes localized erythema and granuloma formation of the digits, which can progress to nodular lymphangitis of the hands and forearms similar in appearance to sporotrichosis. These bacteria more rarely can affect tendons and joint spaces and cause osteomyelitis. Immunocompromised patients have had recorded cases of disseminated infection.