Kutane nichttuberkulöse Mykobakteriosen

Zusammenfassung

Atypische Mykobakterien sind eine heterogene Gruppe ubiquitär vorkommender Umwelt-Saprophyten, die zu oberflächlichen und tiefen Hautinfektionen bis hin zu Hautinfektionen mit Systembeteiligung führen können. Die Erreger vermögen nach Bagatellverletzungen in die Haut einzudringen und führen insbesondere bei Immunsupprimierten zu schweren Infektionen. Klinisch werden schnell und langsam wachsende atypische Mykobakterien unterschieden. Für die Dermatologie wichtige Vertreter der langsam wachsenden Mykobakterien sind M. marinum, M. ulcerans und M. haemophilum. M. marinum verursacht das Schwimmbad- bzw. Aquariumgranulom, die in westlichen Industriestaaten häufigste atypische Mykobakteriose der Haut. M. ulcerans ist der Erreger der weltweit häufigsten kutanen atypischen Mykobakteriose und verursacht v. a. in Westafrika das sog. Buruli-Ulkus. M. haemophilum wird besonders bei Immunsupprimierten und bei Kindern mit begleitender zervikaler und perihilärer Lymphadenitis beobachtet. Zu den schnellwachsenden atypischen Mykobakterien gehören M. abscessus, M. chelonae und M. fortuitum. Relevant sind sie insbesondere als Verursacher von kutanen Mykobakteriosen, die in Zusammenhang mit iatrogener Immunsuppression sowie medizinischen und kosmetischen Prozeduren stehen. Das Management von NTM stellt eine besondere Herausforderung dar: Das klinische Erscheinungsbild ist vielfältig, die Diagnostik schwierig und die antibiotische Kombinationstherapie nicht standardisiert.

Abstract

Atypical mycobacteria constitute a heterogeneous group of ubiquitously occurring environmental saprophytes, which give rise to superficial and deep skin infections that may also lead to systemic manifestations. The pathogens may penetrate into the skin after minor injuries and can lead, particularly in case of immunocompromised patients, to severe infections. Within the clinical field, fast-growing and slowly growing atypical mycobacteria are distinguished. Dermatology recognizes M. marinum, M. ulcerans and M. haemophilum as salient representatives of slowly growing mycobacteria. M. marinum causes the aquarium or swimming pool granuloma, constituting the most common atypical skin mycobacteriosis in western industrialised countries. M. ulcerans is the pathogen responsible for the worldwide most common cutaneous atypical mycobacteriosis and causes, above all in West Africa, the so-called Buruli ulcer. M. haemophilum can be observed especially in immunosuppressed patients and children with accompanying cervical and perihilar lymphadenitis. M. abscessus, M. chelonae and M. fortuitum belong to the fast-growing atypical mycobacteria. They are particularly relevant as pathogens of cutaneous mycobacterioses, which are associated with iatrogenic immunosuppression as well as with medical and cosmetic procedures. The management of NTM poses a serious challenge: the clinical appearance is multifarious, the diagnosis difficult and the antibiotic combination therapy not yet standardized.

• Literatur

• 1 Rahama O, Thaker H. Atypical mycobacteria: an important differential for the general physician. Clin Med (Lond) 2013; 13: 504-506
• 2 Falkinham 3rd JO. Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment. J Appl Microbiol 2009; 107: 356-367
• 3 Peters F, Batinica M, Plum G. et al. Bug or no bug: challenges in diagnosing cutaneous mycobacterial infections. J Dtsch Dermatol Ges 2016; 14: 1227-1235
• 4 Runyon EH. Anonymous mycobacteria in pulmonary disease. Med Clin North Am 1959; 43: 273-290
• 5 Bicmen C, Gunduz AT, Coskun M. et al. Molecular detection and identification of mycobacterium tuberculosis complex and four clinically important nontuberculous mycobacterial species in smear-negative clinical samples by the genotype mycobacteria direct test. J Clin Microbiol 2011; 49: 2874-2878
• 6 Gonzalez-Santiago TM, Drage LA. Nontuberculous mycobacteria: skin and soft tissue infections. Dermatol Clin 2015; 33: 563-577
• 7 Caron J, Michot C, Fabre S. et al. Aggressive cutaneous infection with Mycobacterium marinum in two patients receiving anti tumor necrosis factor-alfa agents. J Am Acad Dermatol 2011; 65: 1060-1062
• 8 Ang P, Rattana-Apiromyakij N, Goh CL. Retrospective study of Mycobacterium marinum skin infections. Int J Dermatol 2000; 39: 343-347
• 9 Aubry A, Mougari F, Reibel F. et al. Mycobacterium marinum. Microbiol Spectr 2017; 5: 1-17
• 10 Lewis FMT, Marsh BJ, von Reyn CF. Fish tank exposure and cutaneous infections due to Mycobacterium marinum: tuberculin skin testing, treatment and prevention. Clin Infect Dis 2003; 37: 390-397
• 11 Kaneko S, Seishima M, Asano Y. et al. Mycobacterium marinum infection in a case of psoriasis treated with antitumor necrosis factor α antibody detected by QuantiFERON(®)-TB test. Int J Dermatol 2014; 53: e187-e189
• 12 Griffith DE, Aksamit T, Brown-Elliott BA. et al. An official ATS/IDSA statement: diagnosis, treatment and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175: 367-416
• 13 Brown-Elliott BA, Nash KA, Wallace RJ. Antimicrobial susceptibility testing, drug resistance mechanisms and therapy of infections with nontuberculous mycobacteria. Clin Microbiol Rev 2012; 25: 545-582
• 14 Wu TS, Chiu CH, Yang CH. et al. Fish tank granuloma caused by Mycobacterium marinum. PLoS One 2012; 7: e41296
• 15 Sarfo FS, Phillips R, Wansbrough-Jones M. et al. Recent advances: role of mycolactone in the pathogenesis and monitoring of Mycobacterium ulcerans infection/Buruli ulcer disease. Cell Microbiol 2016; 18: 17-29
• 16 Silva MT, Portaels F, Pedrosa J. Aquatic insects and Mycobacterium ulcerans: an association relevant to Buruli ulcer control?. PLoS Med 2007; 4: e63
• 17 Pszolla N, Sarkar MR, Strecker W. et al. Buruli ulcer: a systemic disease. Clin Infect Dis 2003; 37: e78-e82
• 18 Guarner J, Bartlett J, Whitney EAS. et al. Histopathologic Features of Mycobacterium ulcerans Infection. Emerg Infect Dis 2003; 9: 651-656
• 19 World Health Organization. Fact sheet. Treatment of mycobacterium ulcerans disease (Buruli ulcer): guidance for health workers. 2012
• 20 Lindeboom JA, Bruijnesteijn van Coppenraet LES, van Soolingen D. et al. Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev 2011; 24: 701-717
• 21 Seitz CS, Trautmann A, Bröcker EB. et al. Skin nodules in rheumatoid arthritis due to infection with Mycobacterium haemophilum. Acta Derm Venereol 2008; 88: 428-429
• 22 Philips RC, Hunter-Ellul LA, Martin JE. et al. Mycobacterium fortuitum infection arising in a new tattoo. Dermatol Online J 2014; 20: pii: 13030/qt6bs3q0h0
• 23 Quiñones C, Ramalle-Gómara E, Perucha M. et al. An outbreak of Mycobacterium fortuitum cutaneous infection associated with mesotherapy. J Eur Acad Dermatol Venereol 2010; 24: 604-606
• 24 [No authors listed]. Management of opportunist mycobacterial infections: Joint Tuberculosis Committee guidelines 1999. Thorax 2000; 55: 210-218
• 25 Misch EA, Saddler C, Davis JM. Skin and soft tissue infections due to nontuberculous mycobacteria. Curr Infect Dis Rep 2018; 20: 6
• 26 Winthrop KL, Abrams M, Yakrus M. et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med 2002; 346: 1366-1371