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Review
. 2022 Apr 1;35(2):79-87.
doi: 10.1097/QCO.0000000000000820.

Mycobacterial skin infection

Giulia Gardini  1 , Natalia Gregori  1 , Alberto Matteelli  1   2 , Francesco Castelli  1   3   4
Affiliations
Review

Mycobacterial skin infection

Giulia Gardini et al. Curr Opin Infect Dis. .

Abstract

Purpose of review: The aim of this article is to review the most recent evidences concerning mycobacterial skin infections, limiting the period of literature research to 2020--2021.

Recent findings: Mycobacterial skin infections include a heterogeneous group of cutaneous diseases.Cutaneous tuberculosis is usually the result of hematogenous dissemination or spread from underlying foci and it must be distinguished from tuberculids, resulting from the immunological reaction to Mycobacterium tuberculosis antigens. Leprosy prevalence was drastically reduced after introduction of multidrug therapy in the 1980 s, but cases are still reported due to underdiagnosis, and animal and environmental reservoirs. Recent advances concentrate in the diagnostic field. Specific guidelines for the treatment of nontuberculous mycobacteria skin infections are missing and surgical procedures may be required. Prognosis is better as compared to nontuberculous mycobacteria lung disease. Rapid laboratory-confirmed diagnosis of Buruli ulcer may be achieved by the IS2404 PCR. Among new drugs, telacebec is promising in terms of potency, shorter duration and tolerability in animal studies. A clinical trial in humans is planned.

Summary: Mycobacterial cutaneous lesions are nonpathognomonic and clinical suspicion must be confirmed by culture or molecular detection. Long-course multidrug treatment is required based on susceptibility tests. Surgical intervention may also be required. Rehabilitation and psychosocial support reduce long-term physical and mental consequences mostly in Buruli ulcer and leprosy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
New leprosy cases in 2019 (Source: WHO, Weekly Epidemiological Record No 36, 2020, 95, 417–440).
FIGURE 2
FIGURE 2
Bone and cutaneous tuberculosis in Ethiopian migrant.
FIGURE 3
FIGURE 3
Lymph nodal and cutaneous tuberculosis in a man from Morocco.
FIGURE 4
FIGURE 4
Tuberculoid leprosy lesions on the trunk (Courtesy of Damien Foundation Burundi).
FIGURE 5
FIGURE 5
Lepromatous leprosy lesions on the hands (Courtesy of Damien Foundation Burundi).
FIGURE 6
FIGURE 6
Disseminated skin infection by M. chelonae in immunocompromised woman.
FIGURE 7
FIGURE 7
Buruli ulcer in a man from Ivory Coast (Courtesy of Dr Antonella Bertolotti).
See this image and copyright information in PMC

References

    1. WHO. Global tuberculosis report 2020. https://www.who.int/publications/i/item/9789240013131. [Accessed 22 September 2021].
    1. Chatterjee D, Saikia UN, Ramesh V. Diagnostic dilemma of cutaneous tuberculosis: opening of the Pandora's box. Am J Dermatopathol 2021; 43:871–880. - PubMed
    1. WHO. Weekly Epidemiological record 4 September 2020, 95th Year No 36, 2020, 95, 417–440. http://www.who.int/wer. [Accessed 8 September 2021].
    1. Griffith DE, Aksamit T, Brown-Elliott BA, et al. . An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175:367–416. - PubMed
    1. Daley CL, Iaccarino JM, Lange C, et al. . Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis 2020; 71:e1–e36. - PMC - PubMed

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