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Mycobacterial Skin Infections

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This information was reviewed and approved by Shannon H. Kasperbauer, MD (7/1/2017).

NTM most commonly affects the lungs; however, there are species that often involve the skin: M. leprae (the cause of leprosy), M. ulcerans (the cause of Buruli ulcer) and M. marinum (the cause of fish tank infection).

Leprosy and Buruli ulcer are extremely rare in the United States. However, infections with M. marinum are seen in low, but consistent, numbers. In people who have a weakened immune system or a history of a traumatic wound. Other species of NTM have been implicated in causing skin infections. Because these organisms are abundant in the water and soil, one can understand how they could be introduced in a traumatic wound. They have also been related to contaminated medical procedures, acupuncture and tattooing.

Compared to bacterial skin infections, mycobacterial skin infections occur rarely. That is a blessing and a curse. Providers often do not think of mycobacteria as being the culprit for the infection, and the diagnosis is delayed. An infection can smolder for days, weeks and sometimes months before it is discovered. Routine bacterial cultures will not detect these infections. Special mycobacterial cultures are required. They are held to incubate for several weeks, as these organisms are very slow growers.

Depending on the organism discovered, NTM treatment may involve 2 – 3 oral antibiotics. They may also involve multiple intravenous and oral antibiotics in addition to surgical resection. In cases of unusual species or lack of familiarity with the infection, we encourage people with NTM skin infections and providers to seek expert guidance.

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