Cutaneous Mycobacterial Infections.

Authors:
Carlos Franco-Paredes
Carlos Franco-Paredes
Emory University School of Medicine
United States
Luis A Marcos
Luis A Marcos
Washington University School of Medicine
Andres F Henao-Martinez
Andres F Henao-Martinez
Washington University School of Medicine
United States
Alfonso J Rodriguez-Morales
Alfonso J Rodriguez-Morales
Emory University School of Medicine
United States
Eduardo Gotuzzo
Eduardo Gotuzzo
Instituto de Medicina Tropical Alexander von Humboldt
San Martín de Porres | Peru
Alexandro Bonifaz
Alexandro Bonifaz
General Hospital of Mexico
Mexico

Clin Microbiol Rev 2018 01 14;32(1). Epub 2018 Nov 14.

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 infection, (ii) Buruli ulcer caused by and other related slowly growing mycobacteria, (iii) leprosy caused by and , 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 infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. , a mycobacterial species related to , is linked to diffuse lepromatous leprosy of Lucio and Latapí. produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. , a close relative of , is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, , the complex, and may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the group, , and , 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.

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Source
http://dx.doi.org/10.1128/CMR.00069-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302357PMC
January 2018
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