Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Infections
Abstract number: 23298
MYCOBACTERIUM MARINUM INFECTION OF THE HAND AND WRIST: A
REVIEW OF ANTIBIOTIC TREATMENT REGIMENS
Jason Pui Yin CHEUNG
Queen Mary Hospital, Hong Kong (HONG KONG)
Introduction: Mycobacterium marinum infection is an occupational hazard for workers
with marine exposure. Delayed treatment leads to prolonged drug use, extension of
cutaneous infections to the tenosynovium and poorer prognosis with multiple
debridements and joint contractures. The objective of this study is to review available
evidence on the epidemiology and management of mycobacterium marinum
infections. Methods: Literature search using the search term mycobacterium
marinum. Data on epidemiology, microbiology, diagnostic difficulties, clinical
presentation, culture, histology, treatment and long-term outcomes (such as loss of
hand function) were included. Results: Delayed or wrong treatment can lead to the
loss of hand function. For instance, initial misdiagnoses have lead to intra-lesional
injections of corticosteroid which exacerbates the condition. 54% of patients received
steroid injections before admission and 84.6% of these patients resulted in delayed
wound healing or poor response to medications and subsequently requiring surgical
debridement. Extensive synovectomy lead to fingers stiffness (average total active
motion of 93.8 degrees). Immobilization of the hand for 7 to 10 days before allowing
vigorous exercise lead to a range of motion of involved wrist and fingers similar to
that of the unaffected hand in 87.5% of patients. Conclusion: Patients at risk for
infection are fisherman and have documented aquatic exposure with preceding
trauma. Proactive approach towards obtaining a histological diagnosis is
recommended as positive culture results are usually unavailable or late. The authors
advise clinicians to be alert, commence medical treatment early and proceed to
surgical debridement in cases of deep seated infections.
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