Mycobacterium Marinum. Free Essay Example

Mycobacterium marinum is a non-tuberculous-causing strain of bacteria. The first case of M. marinum was noticed in a human in 1951 in Sweden. In the US, however, it was first detected in the tubercles from the necropsy of dead fish. It was in salt water in an aquarium in Philadelphia in 1926. The bacteria is known to cause a tuberculosis-like disease in fish. In humans, the condition occurs when the skin gets exposed to an aqueous environment contaminated by Mycobacterium marinum. It is an atypical Mycobacterium species that survive in warm or cold, salted, or freshwater (Saito & David 1-5).

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Infections due to Mycobacterium marinum occurs the exposure of soft-tissue and skin injuries that get exposed to marine animals and the aquatic environment. Such disease will be present in a localized granuloma, then evolve into lymphangitis similar to sporotrichosis, or permeate into deeper tissues. Mycobacterium marinum is a pathogen in the Runyon group 1. They produce pigment during culturing and exposure to light (photochromogen). This study will look at the Mycobacterium marinum, focusing on the Ehrlichia species, which is a tick-borne disease (Saito & David 5-8).

What is EhrlichiosisEhrlichiosis is a bacteria-caused illness, transmitted by a tick bite. Its cause is a bacteria belonging to the Rickettsiae family. The rickettsiae bacteria is known to cause other conditions like typhus, and the Rocky Mountain spotted fever. Both diseases can be spread to human beings through a mite bite, flea, or tick. The ehrlichiosis disease was first detected in 1990 and existed in two forms in the United States. First is Human Monocytic Ehrlichiosis (HME), caused by the rickettsial bacteria known as the Ehrlichia chaffeensis (Saito & David 9-12). Second, is the Human Granulocytic Ehrlichiosis (HGE), also called Human Granulocytic Anaplasmosis (HGA), caused by the rickettsial bacteria called Anaplasma phagocytophilum. Carriers of the Ehrlichia bacteria include the American dog tick (Dermacentor variabilis), the deer tick (Ixodes scapularis), also known to cause Lyme disease, and the lone star tick (Amblyomma americanum). In America, HME is commonly found in the southeast and the central states, while HGE is in the upper west and the Northeast (Saito & David 13-17).

Predisposing Factors for EhrlichiosisEhrlichiosis's major predisposing factors include living in proximity to an area with a lot of tick population, the presence of a pet that may harbor ticks, and playing or walking amidst long grasses, which can act as holding grounds for ticks (Aguiar, Araujo, Nakazato, Bard, & Cabezas-Cruz 1). Staying out in warm weather, especially in summer and spring, is a predisposing factor too. Other factors include being in an area known for a high lone tick population. In America, such areas include South-central, Eastern and Southeastern states. Lastly, males are more predisposed, possibly due to the increased time they spend outdoors (Aguiar, Araujo, Nakazato, Bard, & Cabezas-Cruz 2-3).

Symptoms

The disease has an incubation period of between 7 to 14 days. The period is when the tick first bites, and the victim starts to show signs of illness. The symptoms exhibited may be like that of flu (influenza) and include muscle aches, fever, and chills, headache, and nausea. Other possible symptoms may be a flat red rash (uncommon), diarrhea, small pinhead-sized lesions in the skin (petechial rash), and malaise. The symptoms may appear as mild but may necessitate a visit to a physician (Saito & David 15).

Management/ Treatment

Treating M. marinum infections do not require routine susceptibility testing. Given no existence of much correlation between clinical response and in vitro susceptibilities, there is, therefore, no standard treatment. The most used drug in treating M. marinum is with MIC90 of < 0.5mg/mL (Akram & Shamma, 1-3). Some research documents that the MIC for ethambutol should be 2.0 mg/mL to 4.0 mg/mL, and for doxycycline should be 16.0 mg/mL. That for imipenem is 8.0 mg/mL, and 8.0 mg/mL for INH. M. marinum proved to be resistant to pyrazinamide. The disease has moderately high MIC90 for levofloxacin and ciprofloxacin. It is however susceptible to moxifloxacin (MIC90) of 1 mg/mL - 2 mg/ml). Linezolid has also proven to act well against the disease too. Clinically-based solutions using clarithromycin have shown a high success rate despite the Vitro MIC values (Akram & Shamma, 3-5).

There is, however, no consensus on the period of the treatment regimen in the treatment for M. marinum infections. An array of antibiotic regimens are appropriate in various cases. There have also been cases of monotherapy using Minocycline when treating immunocompetent patients. Combined therapy is necessary to treat immunosuppressed patients. In case of a slow response to the existing treatment, there will be a need to consider treatment with a specific regimen for about three months before changing the antibiotic therapy. Effective antibiotic treatment can treat the skin lesions in one month of the start of the procedure (Akram & Shamma, 5-7).

At the end of one month, the immunocompetent patients should go on with the medications for another two more months. Patients who prove that they are immunocompromised should continue with two agents for six months. It is advisable to treat immunocompromised patients of M. marinum using two agents, clarithromycin included (Saito & David 15-17). The optimal period for the therapy in the case of immunocompromised patients is not known. Most therapists recommend six months of treatment, even a lifelong period, whenever the illness persists among immunocompromised patients. In such a case, doctors recommend a treatment period of one year. In the case of invasive M. marinum infections, the standard drugs were ethambutol and Rifampin. Among 61 clinical isolates, the drugs clarithromycin and rifamycins proved better in killing the bacteria (Saito & David 17).

Conclusion

From the preceding, it is prudent to conclude that the tick-borne disease called Ehrlichia is one of the species under the Mycobacterium marinum. The infection is bacterial and got noticed first in America in 1926. In human beings, the illness occurs when the skin gets exposed to contaminated aqueous surroundings. This species is known to survive in Mycobacterium marinum warm or cold, salted, or freshwater. The disease has very minimal cases of complications whenever there exist early diagnosis and proper therapy. A section of patients may show persistent ulceration in the areas where initial exposure occurred.

A delayed therapy or poor selection of antibiotics may cause the patients to develop deeper infections. Severe cases may lead to tenosynovitis, and sometimes the disseminated disease, which may lead to tissue amputation. In many instances, and among patients exhibiting immunocompetency, M marinum infection has good cases of prognosis. Failure to treat the disease may cause ulcerative skin lesions and deeper-structure involvement. The bacteria have minimal risk of antimicrobial resistance, and a persistent immunocompromised state, coupled with the risk of exposure, can lead to an escalation of the risk of the disease. Such cases may see some patients needing lifelong therapy to suppress the disease.

References

Aguiar, D. M., Araujo, J. P., Nakazato, L., Bard, E., & Cabezas-Cruz, A. "Complete genome sequence of an Ehrlichia minasensis strain isolated from cattle." Microbiol Resour Announc 8.15 (2019): pp.1-3.

https://mra.asm.org/content/ga/8/15/e00161-19.full.pdf

Akram, Sami M., and Shamma Aboobacker. "Mycobacterium Marinum." StatPearls [Internet]. StatPearls Publishing, (Updated 2020), pp. 1-7.

https://www.ncbi.nlm.nih.gov/books/NBK441883/Saito, Tais B., and David H. Walker. "Ehrlichioses: An important one health opportunity." Veterinary sciences 3.3 (2016), pp.1-17.

https://www.mdpi.com/2306-7381/3/3/20/htm