A REPORTOF Six

ABSTRACT: Six cases of Mycobacierium marinum infections of the deeper sfruc tures of the hand are described which clinically and histologically were indistin guishable from tuberculosis. The infections became worse with steroid therapy. Surgical débridement with appropriate drug therapy (ethambutol or rifampm) was the freatment of choice. The organism must be suspected and then cultured at 30 to 32 degrees centigrade instead of the usual 37 degrees. Chronic infections of the hand can be a baffling problem to the treating physi cian as well as a disabling condition for the involved patient. Mycobacterium mar mum infections of the hand have been mistaken for gout, rheumatoid arthritis, and chronic pyogenic infections and are clinically and histologically indistinguishable from tuberculosis. One should have a high index of suspicion of Mycobacterium mar mum infections when there is a history of abrasion in contaminated water or a punc ture wound from marine life. The diagnosis should be established by culturing sus pect tissue on Lowenstein-Jensen's medium at 30 to 32 degrees centigrade rather than at 37 degrees centigrade (as for tuberculosis and other acid-fast bacilli). The six cases we are presenting illustrate some of the problems in diagnosis and treatment of chronic hand infections due to Mycobacterium marinum. Mycobacterium marinum was first isolated in 1926 by Aronson as the causative agent of spontaneous tuberculosis occurring in salt-water fish. He isolated this pre viously unknown acid-fast bacillus from tubercles found in the organs of dead fish in the Philadelphia Aquarium. Linell and Nordénin 1954 wrote a monograph entitled “¿ANew Acid-Fas