W. Handrick

Kutane Infektionen durch Mycobacterium marinum

ZusammenfassungMycobacterium marinum gehört zu den nichttuberkulösen oder „atypischen“ Mykobakterien. Das Reservoir dieser ubiquitär vorkommenden und langsam wachsenden Bakterien ist das Salz- und auch Süßwasser. Insbesondere Aquarien bilden eine wesentliche Infektionsquelle für diese „Freizeit- oder Hobby-Infektion“ der Haut vorzugsweise an Fingern, Händen und Unterarmen. Betroffen sind nicht nur Immunsupprimierte, sondern auch Personen mit intaktem Immunsystem. Charakteristisch sind erythematöse Plaques und Knoten mit Neigung zur Hyperkeratose, Verkrustung und oberflächlichen Ulzeration, manchmal auch sporotrichoid fortgeleitete Infektionen. Diagnostisch wegweisend ist die Histologie mit nicht verkäsenden Granulomen mit Epitheloidzellen und Langhans-Riesenzellen. In der Ziehl-Neelsen-Färbung stellen sich nicht immer die typischen säurefeste Stäbchen dar. Der molekularbiologische Nachweis von Mykobakterien-DNS mittels Polymerasekettenreaktion stellt heute eine diagnostische Standardmethode dar. Zur oft langwierigen Behandlung kommen nach der meist zunächst praktizierten Kryotherapie die Tuberkulostatika bzw. Antibiotika Rifampicin, Ethambutol und Clarithromycin einzeln oder in Kombination zum Einsatz.AbstractMycobacterium marinum belongs to the non-tuberculous or “atypical” mycobacteria. The reservoirs for these ubiquitous and slowly growing bacteria are both fresh water and salt water. In particular, aquaria should be considered as important source of hobby-related infections especially of fingers, hands and forearms. Affected are both immunosuppressed patients and persons with an intact immune system. Distinctive are erythematous plaques and nodules with tendency for hyperkeratosis, crusting, and superficial ulcerations, sometimes as sporotrichoid lymphocutaneous infection. The histology shows non-caseation granulomas containing epithelioid cells and Langhans giant cells. Using the Ziehl Neelsen staining, typical acid-fast rods are not always detectable. The molecular biological detection of mycobacterial DNA using polymerase chain reaction represents the standard method of diagnosis. Cryotherapy is frequently used as first treatment. For the often long-term tuberculostatic therapy, rifampicin, ethambutol, and clarithromycin are the most used agents.

Infections of finger and toe nails due to fungi and bacteria

Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

Infektionen an Finger- und Zehennägeln durch Pilze und Bakterien

Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

[Infections due to Mycobacterium marinum: a review].

ZusammenfassungMycobacterium marinum gehört zu den nichttuberkulösen oder „atypischen“ Mykobakterien. Das Reservoir dieser ubiquitär vorkommenden und langsam wachsenden Bakterien ist das Salz- und auch Süßwasser. Insbesondere Aquarien bilden eine wesentliche Infektionsquelle für diese „Freizeit- oder Hobby-Infektion“ der Haut vorzugsweise an Fingern, Händen und Unterarmen. Betroffen sind nicht nur Immunsupprimierte, sondern auch Personen mit intaktem Immunsystem. Charakteristisch sind erythematöse Plaques und Knoten mit Neigung zur Hyperkeratose, Verkrustung und oberflächlichen Ulzeration, manchmal auch sporotrichoid fortgeleitete Infektionen. Diagnostisch wegweisend ist die Histologie mit nicht verkäsenden Granulomen mit Epitheloidzellen und Langhans-Riesenzellen. In der Ziehl-Neelsen-Färbung stellen sich nicht immer die typischen säurefeste Stäbchen dar. Der molekularbiologische Nachweis von Mykobakterien-DNS mittels Polymerasekettenreaktion stellt heute eine diagnostische Standardmethode dar. Zur oft langwierigen Behandlung kommen nach der meist zunächst praktizierten Kryotherapie die Tuberkulostatika bzw. Antibiotika Rifampicin, Ethambutol und Clarithromycin einzeln oder in Kombination zum Einsatz.AbstractMycobacterium marinum belongs to the non-tuberculous or “atypical” mycobacteria. The reservoirs for these ubiquitous and slowly growing bacteria are both fresh water and salt water. In particular, aquaria should be considered as important source of hobby-related infections especially of fingers, hands and forearms. Affected are both immunosuppressed patients and persons with an intact immune system. Distinctive are erythematous plaques and nodules with tendency for hyperkeratosis, crusting, and superficial ulcerations, sometimes as sporotrichoid lymphocutaneous infection. The histology shows non-caseation granulomas containing epithelioid cells and Langhans giant cells. Using the Ziehl Neelsen staining, typical acid-fast rods are not always detectable. The molecular biological detection of mycobacterial DNA using polymerase chain reaction represents the standard method of diagnosis. Cryotherapy is frequently used as first treatment. For the often long-term tuberculostatic therapy, rifampicin, ethambutol, and clarithromycin are the most used agents.

Infektionen an Finger- und Zehennägeln durch Pilze und Bakterien@@@Infections of finger and toe nails due to fungi and bacteria

Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

Kutane Infektionen durch Mycobacterium marinum@@@Infections due to Mycobacterium marinum: Eine Übersicht@@@A review

ZusammenfassungMycobacterium marinum gehört zu den nichttuberkulösen oder „atypischen“ Mykobakterien. Das Reservoir dieser ubiquitär vorkommenden und langsam wachsenden Bakterien ist das Salz- und auch Süßwasser. Insbesondere Aquarien bilden eine wesentliche Infektionsquelle für diese „Freizeit- oder Hobby-Infektion“ der Haut vorzugsweise an Fingern, Händen und Unterarmen. Betroffen sind nicht nur Immunsupprimierte, sondern auch Personen mit intaktem Immunsystem. Charakteristisch sind erythematöse Plaques und Knoten mit Neigung zur Hyperkeratose, Verkrustung und oberflächlichen Ulzeration, manchmal auch sporotrichoid fortgeleitete Infektionen. Diagnostisch wegweisend ist die Histologie mit nicht verkäsenden Granulomen mit Epitheloidzellen und Langhans-Riesenzellen. In der Ziehl-Neelsen-Färbung stellen sich nicht immer die typischen säurefeste Stäbchen dar. Der molekularbiologische Nachweis von Mykobakterien-DNS mittels Polymerasekettenreaktion stellt heute eine diagnostische Standardmethode dar. Zur oft langwierigen Behandlung kommen nach der meist zunächst praktizierten Kryotherapie die Tuberkulostatika bzw. Antibiotika Rifampicin, Ethambutol und Clarithromycin einzeln oder in Kombination zum Einsatz.AbstractMycobacterium marinum belongs to the non-tuberculous or “atypical” mycobacteria. The reservoirs for these ubiquitous and slowly growing bacteria are both fresh water and salt water. In particular, aquaria should be considered as important source of hobby-related infections especially of fingers, hands and forearms. Affected are both immunosuppressed patients and persons with an intact immune system. Distinctive are erythematous plaques and nodules with tendency for hyperkeratosis, crusting, and superficial ulcerations, sometimes as sporotrichoid lymphocutaneous infection. The histology shows non-caseation granulomas containing epithelioid cells and Langhans giant cells. Using the Ziehl Neelsen staining, typical acid-fast rods are not always detectable. The molecular biological detection of mycobacterial DNA using polymerase chain reaction represents the standard method of diagnosis. Cryotherapy is frequently used as first treatment. For the often long-term tuberculostatic therapy, rifampicin, ethambutol, and clarithromycin are the most used agents.