Source: The First Affiliated Hospital of Wenzhou Medical University
Xiao Bai (pseudonym) is 6 years old this year, and his right auricles have been repeatedly suppurated for nearly a year and cannot be healed
I have sought medical treatment in many places but have not found the cause, which has caused great trouble to the psychology and physiology of the little boy, what happened to Xiao Bai?
<h1 class="pgc-h-arrow-right" data-track="10" > what disease did he get? </h1>
Recently, Xiao Bai's mother took Xiao Bai to the Department of Dermatology of the First Affiliated Hospital of Wenzhou Medical University for treatment. Because Xiao Bai's right ear pinna suppuration has been repeated but has not improved, Xiao Bai's mother is very depressed. The doctor examined the body and saw that the surface of the auricular wound had scabs and oozed yellow pus, and after careful consultation, he got an important message: Xiao Bai was infected after slipping in the swimming pool by the sea last year and breaking the right ear pinna. The doctor immediately collected a sample of pus at the small white auricle and sent it for bacterial culture. After the specimen was delivered to the laboratory department, the teacher of the microbiology room combined the causes and symptoms of Xiao Bai and quickly thought with a wealth of experience that this might be an infection of some kind of acid-fast bacillus. Therefore, immediately after smearing the pus sample, acid-resistance staining is performed.
Sure enough, a small amount of red bacilli (acid-fast bacilli) was detected under the microscope! After the initial verification of the idea, the culture time of the specimen bacteria was extended, and finally the "culprit" was locked on day 8, Mycobacterium sea, a slow-growing non-tuberculous mycobacteria.
When Xiao Bai came to the hospital for follow-up treatment again, the treatment became targeted. After two months of treatment with Mycobacterium sea, the wound on the small white pinna was significantly better, and after three months of treatment, the wound was completely healed.
Xiao Bai's auricle gradually recovered with the application of the drug
<h1 class="pgc-h-arrow-right" data-track="80" >What is Mycobacterium sea? </h1>
Mycobacterium marinum is a slow-growing, non-tuberculous mycobacterium associated with human diseases that is widely distributed in fresh and brackish environments, most commonly found in natural ponds, lakes and seawater in warmer regions. Infections caused by the bacterium occur all over the world and are more likely to occur in people who are often exposed to water, such as fishermen, fish farmers and swimmers, so chronic granulomatous skin disease caused by the bacterium is also known as "pool granuloma" or "fish tank granuloma".
Human infections caused by Mycobacterium sea are mainly skin infections, but can also affect the lungs, bones and joints and blood system. Typically presents with a single papular protrusion confined to a unilateral limb, commonly at the elbow, knee, foot, toes, or fingers. In addition, the bacteria can spread along the lymphatic vessels, causing complications such as tenosynovitis, arthritis, and bursitis.
<h1 class="pgc-h-arrow-right" What are the laboratory tests > data-track="81"? </h1>
01. Microscopic examination of specimen smear
Microscopy can be performed by acid-resistant staining and fluorescent staining, with low positivity, and smear microscopy alone cannot distinguish between Mycobacterium tuberculosis and non-Mycobacterium tuberculosis.
02. Isolation and culture
Culture is still one of the most sensitive techniques for detecting Mycobacterium sea, and a combination of solid culture and liquid culture can improve the positive rate of culture.
03. Molecular biology testing
PCR, gene chip, second-generation sequencing and other technologies to detect Mycobacteria sea DNA can be used for direct detection of Mycobacterium sea in specimens sent for examination.
04. Identification of strains
Homologous gene or sequence comparison method, matrix-assisted laser analytical ionization/time-of-flight mass spectrometry (MALDI-TOF-MS), etc.
05. Other inspections
Routine laboratory tests such as inflammatory markers CRP and erythrocyte sediment rate may be elevated; tuberculin skin test and γ-interferon release test (IGRA, including T-SPOT) may be positive; imaging tests; biopsy and histopathological examinations can be positive.
Acid-resistant staining smear of mycobacteria sea infection wound specimens and colony morphology after seven days of culture on blood plates
<h1 class="pgc-h-arrow-right" data-track="82" How to treat > unfortunate infection? </h1>
At present, the treatment methods mainly include oral antibacterial drugs and surgical debridement, etc., most patients can be cured with only antibacterial drugs, and a small number of patients need to be combined with surgical debridement and other treatments.
The combination of clarithromycin plus ethambutol or rifampicin + ethambutol is recommended in Fever. Other drugs that can be used in combination mainly include compound sulfamethoxazole, tetracycline drugs, quinolones and the like. Triple agents are used for deep tissue involvement, i.e., rifampicin + minocycline/doxycycline + clarithromycin. It should be noted that Mycobacterium sea is resistant to isoniazid and streptomycin.
Clarithromycin can be used for short-term treatment, and some patients with local skin involvement alone can be completely cured. Patients with deep infections are recommended as a combination of therapy and, if necessary, surgical debridement.
Here, we remind everyone when you are stabbed by seafood, fall in the pool, or when you are injured cleaning a fish tank
Remember not to be careless, especially when there is a lesion infection, you need to go to the hospital as soon as possible!