海分枝杆菌皮肤感染的临床和病理特点:附12例分析  

Analyses of clinical and histopathological characteristics of twelve cases of cutaneous Mycobacterium marinum infections

作　　者：杨璐 李建建 刘婷 马寒 陈燕清 YANG Lu;LI Jianjian;LIU Ting;MA Han;CHEN Yanqing(Fifth Affiliated Hospital,Sun Yat-Sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院,广东珠海519000

出　　处：《皮肤性病诊疗学杂志》2024年第4期219-225,共7页Journal of Diagnosis and Therapy on Dermato-venereology

基　　金：国家自然科学基金青年项目(82203936);广东省基础与应用基础研究基金区域联合基金青年基金项目(2021A1515110592)。

摘　　要：目的通过分析海分枝杆菌皮肤感染的临床表现和组织病理学特征,提高对该病的认识,助力临床诊断和治疗。方法回顾性分析中山大学附属第五医院2020—2023年12例经病原学确诊的海分枝杆菌皮肤感染病例的临床表现、病理特征、治疗和转归情况。结果12例患者平均47.3岁,海产品引起的外伤是一个危险因素。皮损多表现为单侧上肢多发的慢性结节、斑块,可见孢子丝菌病样分布。病理可观察到表皮棘层肥厚、真皮非特异性炎症浸润,有时可见结核样肉芽肿,但抗酸染色检出率低。9例患者均采用基于克拉霉素联合利福平或莫西沙星的抗感染治疗,另3例于外院治疗,具体方案不详。无患者发生严重药物不良反应。所有患者皮损均消退,随访1年无复发。结论临床上对于皮损表现为慢性结节和斑块,病理表现为结核样肉芽肿改变或非特异性炎症浸润的患者,尤其是中老年、具有外伤或海产品接触史者,需要高度怀疑海分枝杆菌感染。对该类患者可用克拉霉素联合利福平或莫西沙星治疗。Objective To analyze the clinical manifestations and histopathological features of cutaneous Mycobacterium marinum infections in order to improve the understanding,diagnosis and treatment of this disease.Methods We retrospectively analyzed the clinical manifestations,histopathological features,treatment and outcome of 12 cases of cutaneous Mycobacterium marinum infections diagnosed at the Fifth Affiliated Hospital of Sun Yat-Sen University from 2020 to 2023.Results The average age was 47.3 years.Seafood-induced trauma was a risk factor.Clinical presentations often included unilateral distribution of multiple chronic nodules and plaques on the upper limb,resembling sporotrichosis.Pathological findings included epidermal acanthosis,dermal non-specific inflammatory infiltration,and sometimes with tuberculosis-like granulomas.However,the positive rate of acid-fast staining was low.Nine patients received anti-infective therapy consisting of clarithromycin combined with rifampicin or moxifloxacin.The treatment regimen for other three patients was unknown.All patients experienced resolution of their skin lesions without serious adverse drug reactions,and there were no recurrences during 1-year follow-up.Conclusions Mycobacterium marinum infection should be suspected in patients,especially middle-aged and elderly individuals with a history of trauma or handling seafood,presenting with chronic nodules and plaques,along with pathological findings of tuberculosis-like granuloma or non-specific inflammatory infiltration.These patients can be treated with clarithromycin and rifampicin.

关 键 词：海分枝杆菌 皮肤感染 临床特征 病理特点 

分 类 号：R754[医药卫生—皮肤病学与性病学]