Dear Frederique,
Before I begin to answer, let me refer you to the disclaimer on the
bottom of this page: "Answers and comments provided on Google Answers
are general information, and are not intended to substitute for
informed professional medical, [...] advice. " If you're concerned
after reading this answer, or know that you - or a loved one - has
this problem, contact a physician immidiately.
Atypical mycobacterium refers to a groups of subacute infections,
generally "encomapassing all non-Tuberculosis and Leprosy strains". It
can "cause a wide variety of infections such as abscesses, septic
arthritis and osteomyelitis (bone infection). They can also can infect
the lungs, lymph nodes, gastrointestinal tract, skin and soft
tissues." (SOURCE: MedLine Plus: Atypical mycobacterial infection
<http://www.nlm.nih.gov/medlineplus/ency/article/000640.htm>).
This used to be pretty rare problem. The mycobacterium marinum is
caused mostly by contact with infected fish/shellfish and is listed as
an occupational hazard for people who work in fish pools, aquariums or
fish tanks are at a higher risk, as they might be infected by contact
with an infected fish/shellfish. However, atypical mycobacterium
avium-intracellulare is one of the types of atypical mycobacterium
that is common among AIDS patients, "often causing fever,
lymphadenopathy (swollen lymph nodes), and diarrhea" (ibid). This
could be also the result of infection because of surgery, pedicures,
injuries, etc. People who have weak immune systems are more at risk of
contacting one of the types of the infection.
A more medical definition is "Atypical mycobacterial infection is due
to non-tuberculous mycobacteria. Cervical lymphadenitis is the most
common non-tuberculous mycobacterial infection in children less than
five years old. Because of the chronicity of the infection the skin
overlying the infected node is indurated with a dark to purplish hue.
So called atypical mycobacteria (tuberculoid bacilli) include the
following: M. kansasii (Kansas), M. marinum, M. scrofulaceum, M.
flavescens, M. gordonae, M. obuense, M. gilvum, M. duvali, M. szulgai,
M. intracellulare, M. xenopi (littorale), M. ulcerans, M. buruli, M.
terrae, M. fortuitum (minetti, giae), M. chelonae." (SOURCE: Dermis
(Medical Atlas), <http://www.dermis.net/doia/diagnose.asp?zugr=d&lang=e&diagnr=17015&topic=i>).
"M. avium-intracellulare (MAC or MAI) is a rare cause of lung disease
in otherwise healthy humans but a frequent cause of infection among
those whose resistance has been lowered by another disorder
(opportunistic infection). According to some experts, MAC infection is
an almost inevitable complication of HIV. The infection is caused by
one of two similar organisms, M. avium and M. intracellulare."
(SOURCE: Mycobacterial infections, atypical,
<http://www.chclibrary.org/micromed/00057390.html>).
"MAC and M. kansasii sometimes cause lung infections in middle-aged
and elderly people with chronic lung conditions. MAC, M. kansasii, and
M. scrofulaceum may cause inflammation of the lymph nodes in otherwise
healthy young children. M. fortuitum and M. chelonae cause skin and
wound infections and abscesses after trauma or surgical procedures. M.
marinum causes a nodular inflammation, usually on the arms and legs.
This infection is called "swimming pool granuloma" because it is
associated with swimming pools, fish tanks, and other bodies of water.
M. ulcerans infection causes chronic skin ulcerations, usually on an
arm or leg. Atypical mycobacteria infections can also occur without
causing any symptoms. In such cases, a tuberculin skin test may be
positive." (SOURCE: ibid).
Medline mention, among the symptoms:
Fever
Weight loss
Enlarged lymph glands
Diarrhea
Sweating, excessive -- night sweats
Fatigue
General discomfort, uneasiness or ill feeling (malaise)
Cough
Shortness of breath (dyspnea)
Skin lesions
Joint pain
Bone pain
Additional symptoms that may be associated with this disease:
Paleness
Flank pain
(SOURCE: MedLine Plus: Atypical mycobacterial infection
<http://www.nlm.nih.gov/medlineplus/ency/article/000640.htm>).
Treatment is different, according to the type of atypical
mycobacterium, and in any case, especially in case of AIDS patients,
this could be fatal (and in other cases, chronic).
If there is no AIDS or other problems of the immune system, treatment
could be handled effectively through antibiotics. As many as 4-6
drugs may be used to treat some infections and treatment may require 6
months to 2 years. [...] Certain lymph node infections and skin
lesions can be surgically removed." (SOURCE: ibid).
With AIDS patients, "rifabutin (a cousin of the anti-tuberculosis drug
rifampin) and clofazimine (an anti-leprosy drug) have helped some
patients. It is also possible to contain the infection to some degree
by combining different drugs, including ethionamide, cycloserine,
ethambutol, and streptomycin." (SOURCE: Mycobacterial infections,
atypical, <http://www.chclibrary.org/micromed/00057390.html>).
"Treatment of atypical mycobacterial infections depends upon the
infecting organism and the severity of the infection. In most cases a
course of antibiotics is necessary. These include rifampicin,
ethambutol, isoniazid, minocycline, ciprofloxacin, clarithromycin,
azithromycin and cotrimoxazole. Usually treatment consists of a
combination of drugs. Some points to consider when treating atypical
mycobacterial infections:
Mycobacterium marinum species are often resistant to isoniazid.
Treatment with other antibiotics should be for at least two months.
Mycobacterium kansasii should be treated for at least 18 months.
AIDS patients on HIV protease inhibitor drugs cannot be treated with
rifampicin because rifampicin significantly increases the breakdown of
these drugs. Rifabutin is a suitable alternative. Antibiotics are
usually ineffective in treating large skin lesions caused by
Mycobacterium ulcerans. Rifampicin may promote healing of
pre-ulcerative lesions. Most lesions eventually spontaneously heal
after 6-9 months but may leave behind extensive scarring and
disfigurement." (SOURCE: DermNet NZ, atypical mycobacterium
<http://dermnetnz.org/bacterial/atypical-mycobacteria.html> )
Success rates and "seriousness" depend on the type of atypical
mycobacterium, as well as on the condition of the patient beforehand.
It could cause mortality of AIDS pantients, but with other, non
elderly or immunocompromised patients, treatment has been effective.
Travelling might be problematic:
- Insurance: one is expected to take antibiotics for several weeks,
while insurance usually does not approve perscriptions for more than
14-30 days.
- If it is a lung related atypical mycobacterium, some travel
conditions might worsen the condition;
- Depends on the destination: travelling to a country with lesser
medical services could set a risk;
- Side effects of some of the antibiotics might not suit travelling.
As for researchers in the US, again, this really depends on the nature
of the problem and the diagnosis. However, Noah Scheinfeld seems to
have written extesively about the subejct:
Noah Scheinfeld
1090 Amsterdam Avenue
Suite 11D
New York NY 10025
+1 212-523-5898
nss32@columbia.edu
If the problem is mycobacterium marinum, William A. Burke might be
your answer, as an expert in marine dermatology:
<http://www.ecu.edu/ecuphysicians/search_p.cfm?id=670>
If the problem is mycobacterium avium-intracellulare and AIDS related,
the answer should be found in leading AIDS treatment centres:
Mulligan, Kathleen, Ph.D.
Phone Numbers
415-206 5882
415-476 4918
E-mail kmulligan@sfghgcrc.ucsf.edu
Sometimes, there is need of a surgical solution. This depends on the
case. "Surgical removal of infected lymph nodes and skin lesions is
sometimes necessary. In severe cases, skin grafts may be necessary to
repair the surgical wound." (SOURCE: DermNet NZ, atypical
mycobacterium <http://dermnetnz.org/bacterial/atypical-mycobacteria.html>
)
Further Reading
===============
The DermAtlas (dermatological atlas, for skin diseases) has several
pictures of the problem, from different patients:
atypical mycobacterium
<http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1004060303>
HazMap - Atypical mycobacterium skin infections
<http://hazmap.nlm.nih.gov/cgi-bin/hazmap_generic?tbl=TblDiseases&id=301>
HelathLInk - Atypical Mycobacteria
<http://healthlink.mcw.edu/article/954973743.html>
Health Central - Atypical mycobacterial infection
<http://ads.partner2profit.com/abs_adserve.cfm?campaign_id=21125&sites=%%SITE%%&noscript=1&rand=29771>
DermNet NZ
<http://dermnetnz.org/bacterial/atypical-mycobacteria.html>
I hope this answered your question. Please contact me if you need any
clarification on this answer before you rate it. My search strategy
has been to search for the infection's name, for the names of the
different infections, in addition to words such as "treatment"
"surgery". |
