Jason Pui Yin Cheung, Boris Fung, Samson Sai Yin Wong, Wing Yuk Ip Queen Mary Hospital, Hong Kong

Introduction

Mycobacterium marinum infection is prevalent worldwide and is hazardous to people exposed to a marine environment. The objective of this study is to approach to the diagnosis and management of this condition. (assess our )

Methods 

166 patients were included in this retrospective study. Inclusion criteria include patients with occupational or recreational exposure to a marine environment, a history of trauma and positive histological diagnosis of chronic granulomatous infection. Exclusion criteria include positive culture growth of an organism other than mycobacterium marinum. Data was analyzed with Mann-Witney and Chi-square tests using SPSS version 16.0.

Results

A positive marine exposure was associated with earlier presentation (median of 2 months versus 3.5 months, p=0.001) and less resulting deformity (no deformity versus residual stiffness, p=0.03). Steroid injections was associated with longer antibiotic duration (7 months versus 6 months, p=0.017), more debridements (2 versus 1, p=0.026) and resulting deformity (residual stiffness versus no deformity, p=0.00). The antibiotic regime, antibiotic duration or number of postoperative days before mobilization was not associated with long term finger and hand deformity.

Conclusion

Patients with risk factors such as positive marine exposure, documented preceding injury and positive histology was associated with earlier consultations and thus lead to less deformity. However, in patients with less obvious presentations, misdiagnosis can have drastic consequences. Misdiagnosis such as trigger finger will lead to intralesional steroid injections, ultimately prolonging antibiotic duration, leading to more debridements and deformities. Similar to other studies worldwide, the antibiotic regime and duration was not associated with long term prognosis for these patients. Thus, early management decisions for this condition are the most important factors in the outcome.