The management of extensive scrofuloderma sometimes requires surgical intervention. This site needs JavaScript to work properly. WHO identifies approximately 3,000 to 5,000 cases annually, affecting predominantly children less than 15 years of age (20, 31, 32, 109). He graduated from the Field Epidemiology Training Program (FETP) of the CDC and Tephinet in Colombia. Ecological data suggest that environmental factors, such as trauma or skin breaks during soil and water exposures, insect vectors, free-living amoebas, and animal reservoirs (e.g., armadillos, squirrels, felines, or other animals), influence leprosy transmission (39, 47, 49–63). He is part of the Executive Board of the Latin American Society for Travel Medicine (SLAMVI). Dr. Franco-Paredes has participated in multiple projects in global health, focusing mainly on leprosy and Chagas disease. Dr. Franco-Paredes obtained his medical degree from L Salle University in Mexico City. This organism preferentially grows at 30°C, explaining its predilection for causing lesions in the upper and lower extremities (34–36). Treatment of this mycobacterial infection requires a combination of at least two drugs, including a macrolide, ethambutol, trimethoprim-sulfamethoxazole, or rifamycin, with a duration of therapy ranging from two to six months depending on the degree of cutaneous involvement (24, 42, 120). Mycobacterial infections are a group of multisystem infections caused by the members of the family Mycobacteriaceae. Classification of major pathogenic mycobacteria. M. ulcerans is a slowly growing environmental mycobacterium causing infection that is considered to have an incubation period of 5 to 8 weeks, but this may be as long as six months in areas of endemicity (31, 109). Leprosy is a mycobacterial infection caused by Mycobacterium leprae that tends to be chronic and to compromise human societies by producing peripheral nerve damage, limb loss, blindness, and disfiguring skin lesions (4, 72, 74). New cutaneous lesions presenting during or after completing MDT are most likely caused by leprosy reactions (47, 85, 91, 92). The management of leprosy requires the use of MDT in combination with steroids or other anti-inflammatory drugs among those with leprosy reactions (72, 74, 78). [Cutaneous and soft skin infections due to non-tuberculous mycobacteria]. In settings where immunization programs administer the bacillus Calmette-Guérin (BCG) vaccine, an attenuated form of M. bovis, cutaneous complications, including local reactions, abscess formation, ulcerations, scrofuloderma, and, rarely, disseminated infections, may occur (64, 65). Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. What is an atypical mycobacterial infection?. The clinical diagnosis of leprosy relies on the identification of characteristic plaques, macules, or nodules concomitantly with sensory loss in the form of hypoesthesia or anesthesia and the presence of thickened nerves (72, 74). Mycobacterium marinum (M. marinum) is a slow-growing atypical mycobacterium that is commonly found in bodies of fresh or saltwater in many parts of the world.Skin infections with Mycobacterium marinum in humans are relatively uncommon and are usually acquired from contact with contents of aquariums or fish. The ability to culture M. tuberculosis facilitates the diagnosis of the cutaneous disease, in contrast to M. leprae (47). The most common clinical presentations of mycobacterial infections include pulmonary, cutaneous and disseminated forms in immunocompromised hosts. BU often presents as a painless nodule, as a large indurated plaque, or as diffuse painless swelling of the lower extremities, upper extremities, or face (109). He also obtained a Masters in Public Health in Global Health from the Rollins School of Public Health of Emory University. Molecular detection methods and phenolic glycolipid 1 (PGL-1) serological data in combination with spatial epidemiology increase detection of leprosy cases (98). Pulmonary nontuberculous mycobacterial infections are multisystem and multigenic diseases (26). The most frequent tuberculid is erythema induratum of Bazin, but some individuals may manifest lichen scrofulosorum, or papulonecrotic tuberculid (47, 67, 69) (Table 2). Semin Respir Infect. The NTM group constitutes mycobacterial species other than those belonging to the M. tuberculosis complex and that do not cause leprosy (1, 42). He is the former director of the Tropical Medicine Institute “Alexander von Humboldt” and Professor of Medicine and Infectious Diseases at Universidad Peruana Cayetano Heredia in Lima, Peru. 2020 Oct 30;8(11):1701. doi: 10.3390/microorganisms8111701. An initial nodular or papular lesion frequently identified in the extremities or in the face evolves into a shallow ulcer with associated regional lymphadenopathy (67, 69, 71). Rapidly Growing MycobacteriaCutaneous NTM infections are transmitted via direct inoculation through skin barrier breaks, which may occur during trauma, surgical procedures, plastic surgery (including liposuction), injections, tattoos, acupuncture, and body piercings (Table 4) (1, 24, 42, 117). Antimicrobial regimens of 8 weeks or longer are recommended, irrespective of the clinical staging, and include a combination of rifampin and streptomycin (31, 109). 1999 Jul;26(6):271-8. doi: 10.1111/j.1600-0560.1999.tb01844.x. M. ulcerans and all mycolactone-producing mycobacterial species evolved from M. marinum and have become specialized variants living in restricted environments (2, 3). from Universidad Peruana Cayetano Heredia in Lima, Peru, in 2003. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Some of these lesions evolve into necrotic abscesses or deep-seated ulcerations (36). This form of cutaneous tuberculosis is also associated with infection caused by Mycobacterium bovis or bacillus Calmette-Guérin. Thank you for sharing this Clinical Microbiology Reviews article. Many of these new patients already have grade 2 neurological disability by the time of their diagnosis (96, 97). The diagnosis of Buruli ulcer is mostly a clinical one and is based on the age of presentation, geographic area, and location (31, 109, 112). Histologically, perineural granulomas assist in distinguishing tuberculoid leprosy from cutaneous TB. Copyright © 2018 American Society for Microbiology. 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. NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. Finally, M. chelonae is often susceptible to macrolides, cefoxitin, fluoroquinolones, and tobramycin (1, 42). 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. This form of leprosy is associated with a large bacillary burden that often affects many organs and endothelial cells in subcutaneous tissues, producing dermal vascular occlusion with associated skin necrosis and ulceration (100–105). (21, 22). Many of these patients presented with surgical wound infections (41, 116, 125). Mycobacterium haemophilum is a nontuberculous mycobacterium that causes skin, joint, bone, and pulmonary infections in immunocompromised persons and lymphadenitis … Mycobacterial species are present in the environment in water and soil niches that are shared with humans (19, 21, 22).In the human host, mycobacterial infections may affect many anatomical sites, but since they enter through the skin and mucosal barriers, they lead mostly to pulmonary or cutaneous infections (25 – 28).The pathogenesis of cutaneous mycobacterial infections … Affected individuals tend to have more frequent protein variants in immune, cystic fibrosis transmembrane conductor regulator (CFTR), and connective tissue genes (26, 27). Cutaneous involvement of M. kansasii is usually present in immunocompromised hosts and sometimes with concomitant pulmonary disease or disseminated disease (24, 37). It is recommended that rapidly growing mycobacteria be tested against selected antibacterial drugs of different classes (1, 42). Since the early 1980s, multidrug therapy (MDT) has been universally instituted through active case finding in highly affected communities. The most important conditions that should be considered in the differential diagnosis of BU include tropical phagedenic ulcers, cutaneous tuberculosis, vascular (venous or arterial) ulcerations, diabetic foot ulcerations, pyoderma gangrenosum, infections due to Haemophilus ducreyi, cutaneous leishmaniasis, ulcerative yaws, fungal infections (e.g., chromoblastomycosis), and pyogenic ulcerations (e.g., caused by Staphylococcus aureus) (24, 109, 112). In some of the British Isles, red squirrels may develop leprosy-like lesions due to either M. leprae or Mycobacterium lepromatosis (53). Buruli ulcer; Mycobacterium; Mycobacterium kansasii; Mycobacterium marinum; Mycobacterium ulcerans; cutaneous; leprosy; mycobacteria; nontuberculous mycobacteria; tuberculosis. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. M. haemophilum was identified in 1978 in individuals with skin infections. Lesions of lupus vulgaris may have the appearance of “apple jelly” on diascopy (47, 69, 71). Created 2008. An adult with Mycobacterium abscessus infection presenting as scrofuloderma with extensive tissue destruction in the right cervical and supraclavicular areas. Further clinical and epidemiological research that advances our understanding of mycobacterial pathogens that infect the skin and soft tissues may improve our ability to prevent these infections and optimize their medical management. Some identified risk factors for developing this clinical variant include minor trauma, tattoos, piercing, and surgical procedures with unsterilized equipment (47, 71). This strain of M. lepromatosis appears to have diverged from the two human strains from Mexico (53). Innate immune responses by macrophages in human tissues are responsible for initiating nerve damage in leprosy by interaction with phenolic glycolipid 1 (PGL-1) with myelinating glia (88, 89). Severe hand swelling and nodular lymphangitic lesions caused by Mycobacterium marinum infection. Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In January 2012, public health officials in New York received reports of Mycobacterium chelonae skin infections … 1). Azithromycin is the preferred agent in M. abscessus infections, whereas clarithromycin or azithromycin is effective in cases of M. massiliense (117, 118). He serves as a member of the Global Health Committee at IDSA. These events include waves of human expeditionary, military, or commercial migrations (8). That is a blessing and a curse. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Andrés F. Henao-Martínez, M.D., graduated from Universidad del Valle, School of Medicine, in Colombia in 2003. Scrofuloderma is a form of TB that is caused by M. tuberculosis or M. bovis and commonly affects children, adolescents, and older adults (47, 69). 2020 Jul 27;9(8):450. doi: 10.3390/antibiotics9080450. Mycobacterial Species as Human PathogensThe genus Mycobacterium is part of the order Actinomycetales and the phylum Actinobacteria and belongs to a variety of environmental habitats, including natural waters, soils, and drinking water distribution systems (1, 20–23). Characteristic sporotrichoid nodular lymphangitic spread…. However, M. haemophilum has been associated with subcutaneous infections, lymphadenitis, septic arthritis, osteomyelitis, pneumonitis, and disseminated disease. Disease caused by M. marinum is associated with minor to moderate skin infections presenting as granulomatous lesions similar to those caused by M. tuberculosis or M. haemophilum. Tuberculosis verrucosa cutis represents primary M. tuberculosis infection. Copyright © 2021 American Society for Microbiology | Privacy Policy | Website feedback, Print ISSN: 0893-8512; Online ISSN: 1098-6618, Sign In to Email Alerts with your Email Address. These topics have been dealt with elsewhere in the CDS. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. They share phenotypic and genotypic features, including the large virulence plasmid (pMUM) required for mycolactone production. J Cutan Pathol. Hematogenous metastatic tuberculous abscesses occur among immunocompromised individuals and may present with single or multiple subcutaneous nodules that may potentially evolve into ulcers or draining sinuses without regional adenopathy (47, 69). 1) (1).  |  There is also some evidence suggesting that M. lepromatosis may be associated with severe leprosy reactions, but this association requires further confirmation (103, 107). MAC bacteria do not make … He has authored more than 350 peer-reviewed publications on infectious diseases and tropical medicine. Diffuse Lepromatous Leprosy of Lucio and LatapíMycobacterium lepromatosis was the cause of leprosy in two patients of Mexican origin who died of diffuse lepromatous leprosy (DLL) (100). Chau, C. L. F., et al. Disseminated NTM infections affect severely immunocompromised human hosts, including those with primary immunodeficiencies, such as genetic or acquired defects of the IFN-γ–interleukin-12 (IL-12) pathway (e.g., GATA2 deficiency or anti-IFN-γ autoantibodies), or acquired immunodeficiencies, such as HIV infection/AIDS, transplant-associated immunosuppression, and treatment with biological agents such as anti-tumor necrosis factor alpha (anti-TNF-α) receptor blockers (26, 27, 116). Mycolactone toxin induces an inflammatory response by targeting the IL-1β pathway: Mechanistic insight into Buruli ulcer pathophysiology. From an ecological standpoint, BU is a mycobacterial disease identified in rural areas with wetlands, such as ponds, swamps, marshes, impoundments, backwaters, slow-moving rivers, and flooding areas (31, 32). This clinical form presents predominantly in children, but when it is present in adults, it tends to occur among those with occupational exposures, such as butchers or farmers. Nontuberculous mycobacteria (NTM) infections still represent a large group of insidious diseases hard to deal with. 8). Because its optimal temperature for growth is around 30°C, cutaneous lesions most frequently occur in the upper or lower extremities and sometimes in the tip of the nose. He is currently an Associate Professor of Clinical Medicine in the Division of Infectious Diseases at Stony Brook University and serves as the Fellowship Program Director. He has published more than 50 articles in journals indexed in ScienceCitationIndex, Medline, and Scopus (including Lancet Infectious Diseases). He is an Associate Researcher, Colciencias and winner of the Wiliam Jarvis 2014 Award, Best International Research, awarded by SHEA. Despite an increasing incidence of such infections, patients are often misdiagnosed. Interferon gamma (IFN-γ) release assays (IGRAs) demonstrate a sensitivity of 92% and a specificity of 76% in individuals with cutaneous TB (73). doi: 10.1371/journal.ppat.1009107. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Dr. Franco-Paredes has an adjunct faculty appointment as a research professor at the Hospital Infantil de Mexico Federico Gomez in Mexico City. The most notable mycobacterial infections are those that are caused by Mycobacterium tuberculosis complex and Mycobacterium leprae. The first cases of BU (formerly known as Bairnsdale ulcer) were identified in Australia in the 1930s (110). In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Humans encounter mycobacterial species due to their ubiquity in different environmental niches. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Molecular techniques such as 16S rRNA gene sequencing, PCR analysis, and high-performance liquid chromatography are methods that improve the ability to identify mycobacterial pathogens in tissue specimens. Leprosy occupies a prominent position among infectious diseases due to its high frequency of disability and associated stigma (75–78). Tuberculids are cutaneous disorders that represent hypersensitivity reactions to mycobacterial antigens. 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. Similarly, acute military tuberculosis represents primary infection in individuals with advanced immunosuppression, including those with HIV infection/AIDS (71). Enferm Infecc Microbiol Clin. Cutaneous forms of TB are currently classified according to clinical morphological patterns, the route of acquisition (exogenous inoculation, hematogenous spread, or regional extension), and the host immune status (47, 64–66, 71). Alternatively, a combination of rifampin and clarithromycin or rifampin and moxifloxacin could be used (109, 112). NTM infections of the skin may spread to cause tenosynovitis, myositis, osteomyelitis, and septic arthritis (24, 42, 117). This form is also known as tuberculosis colliquative cutis. Most cases of cutaneous infections take place among individuals who suffered puncture injuries or other types of trauma in freshwater or salt water. 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. massiliense among patients with cystic fibrosis (43, 44). The molecular mechanisms by which M. tuberculosis and M. leprae have evolved to cause disease involved complex interactions between the pathogen and the host. Mycobacterium peregrinum is a rapidly growing mycobacterium (RGM) that rarely causes skin infections. Therefore, the gold standard for diagnosing cutaneous tuberculosis is mycobacterial culture of skin biopsy specimens or via molecular detection (47, 71). Journal of Microbiology & Biology Education, Microbiology and Molecular Biology Reviews, Hospital Infantil de México Federico Gómez, Mexico City, Mexico, Division of Infectious Diseases, University of Colorado Denver Anschutz Medical Campus, Denver, Colorado, USA, 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, Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia, Universidad Privada Franz Tamayo, Cochabamba, Bolivia, Departamento de Infectología, Hospital Universitario de Sincelejo, Sucre, Colombia, Instituto de Medicina Tropical Alexander von Humboldt, University Cayetano Heredia, Lima, Peru, Servicio de Dermatología y Departamento de Micología, Hospital General de México, Mexico City, Mexico, Human Societies and the Origin and Spread of Major Mycobacterial Pathogens, Diffuse Lepromatous Leprosy of Lucio and Latapí, Mycobacterium leprae Mycobacterium ulcerans, Practice guidelines for clinical microbiology laboratories: mycobacteria, Unsolved matters in leprosy: a descriptive review and call for further research, Mycobacterial pathogenomics and evolution, Many neglected tropical diseases may have originated in the Paleolithic or before: new insights from genetics, Genome-wide comparison of medieval and modern, Comparative phylogenomics of pathogenic and non-pathogenic, Human genetic ancestral composition correlates with the origin of, Comparative analyses of nonpathogenic, opportunistic, and totally pathogenic mycobacteria reveal genomic and biochemical variabilities and highlight the survival attributes of, Insights from the complete genome sequence of, A glimpse into the past and predictions for the future: the molecular evolution of the tuberculosis agent, Aquatic plants stimulate the growth of and biofilm formation by, Reductive evolution and niche adaptation inferred from the genome of, Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria, Surrounded by mycobacteria: nontuberculous mycobacteria in the human environment, Environmental sources of nontuberculous mycobacteria, Mycobacterial skin and soft tissue infection, Host susceptibility to non-tuberculous mycobacterial infections, Pulmonary nontuberculous mycobacterial infection. In a period of approximately 4 weeks, the nodule, plaque, or edematous area evolves into an ulcer with undermined borders. Comparison of epidemiological and clinical features of the four categories of cutaneous mycobacterial infections: cutaneous tuberculosis, leprosy, Buruli ulcer, and disease caused by nontuberculous mycobacteria. Scrofuloderma presenting in the neck, resulting from direct extension of an infected left cervical lymph node into the overlying cutaneous structures. Mycobacteria other than the tubercle bacillus sometimes infect humans. 2020 Dec 18;16(12):e1009107. 4) (72, 74, 78). Early identification of new cases likely prevents further transmission, but, importantly, it may also reduce the risk of neurological dysfunction and disability associated with leprosy (96–98). Susceptibilities to antimicrobials depend on the species. The clinical spectrum of cutaneous manifestations of M. haemophilum includes multiple skin lesions presenting as erythematous or violaceous papules, plaques, or nodules. Another one causes leprosy. Tuberculosis cutis orificialis occurs among severely immunocompromised middle-aged and older adults with advanced pulmonary, gastrointestinal, or genitourinary tuberculosis (47). 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. From a large mycobacterial pool, some species have evolved into potential major human pathogens (20, 23–25) (Fig. 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. The diagnosis of mycobacterial infections of the skin and soft tissues requires a low threshold of clinical suspicion given the broad spectrum of potential clinical presentations. RGM are primarily implicated in a broad spectrum of c… An adult with Mycobacterium abscessus infection presenting as scrofuloderma with extensive tissue destruction in the right cervical and supraclavicular areas. M. fortuitum is susceptible to macrolides, amikacin, doxycycline, fluoroquinolones, and trimethoprim-sulfamethoxazole. He has served on the faculty of the Division of Infectious Diseases, Department of Medicine, since then. M. kansasii is susceptible to isoniazid, rifampin, ethambutol, clarithromycin, fluoroquinolones, and aminoglycosides but is intrinsically resistant to pyrazinamide (37, 119). Identification of mycobacterial DNA in cutaneous lesions of sarcoidosis. Depending on the BCG vaccination status, tuberculin skin testing using purified protein derivative has a specificity of 63% and a sensitivity between 33 and 96% for cutaneous tuberculosis (47, 72). Efficacy and Mechanisms of Flavonoids against the Emerging Opportunistic Nontuberculous Mycobacteria. When M. bovis infection manifests as scrofuloderma, it is often the result of consumption of unpasteurized milk (47, 69, 71). M. fortuitum, M. abscessus, and M. chelonae are resistant to all of the antituberculosis agents (1, 24, 42, 115). 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. Of these, rapidly growing mycobacteria, M. haemophilum, and M. marinum are important agents involving cutaneous structures. Background In January 2012, on the basis of an initial report from a dermatologist, we began to investigate an outbreak of tattoo-associated Mycobacterium chelonae skin and soft-tissue infections … This clinical form may appear as a cellulitis or as purpuric papules that may become umbilicated and crusted (49). Treatment of cutaneous TB follows the same recommendations as for other forms of TB, with multidrug therapy (MDT) and ideally adjusted by culture and susceptibility data (47, 67, 69). This article reviews the dermatologic manifestations of Mycobacterium avium-intracellulare (MAI, or MAC) infection.. MAI is an opportunistic pathogen that usually causes disease in the weakened immune system. {MC} atypical mycobacterium to cause infection Reddish bumps may appear, enlarge, and turn purple. Dermatol Clin. The most frequent sites of involvement include the fingers and dorsum of the hands, followed by ankles or buttocks (Fig. Armadillos may also play a role in the transmission of leprosy in some areas in Colombia (55) and in Brazil (56). The most frequently identified mycobacterial pathogens involving the skin and soft tissues include Mycobacterium leprae Mycobacterium ulcerans and M. tuberculosis. Mycobacterium avium complex (MAC) refers to infections caused by two types of bacteria: Mycobacterium avium and Mycobacterium intracellulare. NTM infections are becoming more common, especially among those age 65 years and older. In England, Ireland, and Scotland, red squirrels may be infected and develop leprosy-like lesions due to M. lepromatosis (53). Certain slow-growing species of mycobacteria, namely Mycobacterium marinum, M. ulcerans, M. chimaera,andM. Lesions consist of usually single painless indurated warty plaques that may potentially ulcerate. Mycobacterial species are present in the environment in water and soil niches that are shared with humans (19, 21, 22). (Glasg), F.A.C.E, Ph.D.(c), Hon.D.Sc, is an expert in tropical diseases, particularly in zoonotic and vector-borne diseases, but also including tuberculosis and mycobacterial diseases. The differential diagnosis of this condition includes paracoccidioidomycosis, syphilis, lymphogranuloma venereum, pyoderma gangrenosum, and skin malignancies (47, 69). Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Similarly to M. tuberculosis, M. kansasii expresses ESAT-6 and CFP-10 analogs, and therefore IFN-γ release assays (IGRAs) are not useful in distinguishing this infection from M. tuberculosis infection (37). The most common cutaneous forms of acquisition of NTM involve direct inoculation via trauma (33), postsurgical infections (42), or iatrogenic acquisition with indwelling medical devices, plastic surgery, cosmetic procedures, or prosthetic implants (24, 42). , 109 ) this infection usually presents as cervical lymphadenitis ( 35, 36, 42 ) with... Is divided into three categories by the National Agency of Science in Colombia in 2003,. Systems ( 21, 22 ) suffering for thousands of years ( 16 ) the management of scrofuloderma! Cutaneous disorders that represent hypersensitivity reactions to mycobacterial antigens infections caused by Mycobacterium marinum infection American for! More frequently associated with subcutaneous infections, including those with large lesions period of 4. For sharing this clinical form affects women predominantly and manifests as smoldering nodules and annular plaques, ulcers, stigma! 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