His main research interests are vector-borne diseases and emerging infectious diseases in the United States and overseas. There are multiple remaining hazards in the epidemiology of leprosy that may make it impossible to eliminate leprosy transmission by the year 2020 (96, 97). Tuberculosis cutis orificialis occurs among severely immunocompromised middle-aged and older adults with advanced pulmonary, gastrointestinal, or genitourinary tuberculosis (47). Rampacci E, Stefanetti V, Passamonti F, Henao-Tamayo M. Pathogens. Surgical debridement and skin grafting are used to speed wound healing in those with large lesions. M. chelonae and M. abscessus usually present with multiple skin lesions, while M. fortuitum tends to present as a single lesion (24, 42, 43, 117). Localized cutaneous infections are due to posttraumatic wound infection, catheter-associated infections (e.g., from peritoneal dialysis or central venous catheters), postsurgical infections, and trauma-associated infections (Fig. USA.gov. Dermatol Clin. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. The diagnosis of BU maybe confirmed by direct microscopy of suspicious lesions, histopathology of skin biopsy specimens, culture, and IS2404 PCR (PCR) (24, 31, 109). This infection may occur among immunocompetent and immunocompromised hosts, including those with HIV infection/AIDS or with renal transplantation. Modes of acquisition, history of previous sensitization to Mycobacterium tuberculosis, and clinical features of the cutaneous presentations of tuberculosis. Mycobacterium peregrinum is a rapidly growing mycobacterium (RGM) that rarely causes skin infections. Certain slow-growing species of mycobacteria, namely Mycobacterium marinum, M. ulcerans, M. chimaera,andM. Scrofuloderma initially presents as a firm subcutaneous nodule or nodules that gradually enlarge, become confluent, ulcerate, and form draining sinus tracts of purulent or caseous material. This clinical form affects women predominantly and manifests as smoldering nodules and annular plaques, or it may present with hypertrophic or vegetative lesions. Leprosy reactions, due to their potential inflammatory compromise of the nerve fibers, lead to sensory and motor loss (85, 90–92). Tuberculosis verrucosa cutis of the hand, manifesting as verrucous plaques caused by direct…, Scrofuloderma presenting in the neck, resulting from direct extension of an infected left…, Clinical manifestations of leprosy: borderline…, Clinical manifestations of leprosy: borderline tuberculoid (BT) (A), borderline borderline (BB) (B), and…, An 11-year-old male demonstrating a destructive panniculitis causing ulceration with undermined borders, characteristic…, An adult with Mycobacterium abscessus infection presenting as scrofuloderma with extensive tissue destruction…, Infection caused by Mycobacterium fortuitum…. Most infections occur following skin … We report here 5 patients with cutaneous and/or soft tissue infection …  |  Because its optimal temperature for growth is around 30°C, cutaneous lesions most frequently occur in the upper or lower extremities and sometimes in the tip of the nose. Humans encounter mycobacterial species due to their ubiquity in different environmental niches. M. kansasii has been identified only in municipal water systems (21, 22, 42). In some of the British Isles, red squirrels may develop leprosy-like lesions due to either M. leprae or Mycobacterium lepromatosis (53). Cosmetic procedures such as mesotherapy (multiple injections of pharmaceutical products, plant extracts, homeopathic substances, vitamins, or other compounds into subcutaneous fat) have been involved in the transmission of rapidly growing mycobacteria (1, 24, 42, 117). Reconstructive surgery may be indicated for severe forms of cutaneous TB such as lupus vulgaris (69, 71). Luis A. Marcos, M.D., M.P.H., received his M.D. Many of these patients presented with surgical wound infections (41, 116, 125). Originally described in Mexico, this clinical form of leprosy also occurs in other countries (102–104). The precise mode of transmission remains to be elucidated, but M. ulcerans living in contaminated water can enter the host through insect bites, puncturing injuries, or skin trauma (31, 33). From a large mycobacterial pool, some species have evolved into potential major human pathogens (20, 23–25) (Fig. This form is also known as tuberculosis colliquative cutis. Pulmonary nontuberculous mycobacterial infections are multisystem and multigenic diseases (26). In both tuberculosis and leprosy, well-organized epithelioid granulomas are associated with a high degree of cell-mediated immunity (CMI) and a reduced bacterial load (47). Despite an increasing incidence of such infections, patients are often misdiagnosed. Eduardo Liceaga.” He is also a Researcher of the Health Systems, Health Secretary, Mexican Government, and Senior Researcher of the National System of Researchers (CONACYT). The infection may then be carried to other sites by immature cells (83, 84). 3). Comparative genomic analyses have demonstrated that M. lepromatosis and M. leprae are related mycobacterial species that are distinguishable at the genomic level but cause similar clinical manifestations (104–107). In 1947, Mycobacterium ulcerans was identified as the cause of Buruli ulcer (BU) (2, 3, 31, 32, 109–111). Mycobacterium haemophilum is a nontuberculous mycobacterium that causes skin, joint, bone, and pulmonary infections in immunocompromised persons and lymphadenitis … Untreated cases of lupus vulgaris may evolve into verrucous squamous cell carcinoma (67, 69). Earlier lesions presenting as papules or nodules are usually painless but when these lesions evolve into ulcerations or abscesses, patients may experience significant pain. Tuberculosis verrucosa cutis of the hand, manifesting as verrucous plaques caused by direct inoculation of the tuberculous bacilli into the skin of an individual previously sensitized to this pathogen. Infiltrated erythematous plaque with yellowish scales and crusts (A) resolved to a scar after clearance of infection … This strategy has helped to reduce the prevalence of this infection (93–97). Alexandro Bonifaz is Head of the Department of Mycology, Dermatology Service, Hospital General de Mexico “Dr. This form of cutaneous tuberculosis is also associated with infection caused by Mycobacterium bovis or bacillus Calmette-Guérin. Antibiotics (Basel). An adult with Mycobacterium abscessus infection presenting as scrofuloderma with extensive tissue destruction in the right cervical and supraclavicular areas. Leprosy is a mycobacterial infection caused by Mycobacterium leprae that tends to be chronic and to compromise human societies by producing peripheral nerve damage, limb loss, blindness, and disfiguring skin lesions (4, 72, 74). Preclinical Models of Nontuberculous Mycobacteria Infection for Early Drug Discovery and Vaccine Research. RGM are primarily implicated in a broad spectrum of c… Mycobacterial infections are uncommonly diagnosed in New Zealand. Clinical manifestations of leprosy: borderline tuberculoid (BT) (A), borderline borderline (BB) (B), and lepromatous (LL) (C). In the human host, mycobacterial infections may affect many anatomical sites, but since they enter through the skin and mucosal barriers, they lead mostly to pulmonary or cutaneous infections (25–28). Mycobacterium haemophilumM. Mycobacterial Species as Human PathogensThe genus Mycobacterium is part of the order Actinomycetales and the phylum Actinobacteria and belongs to a variety of environmental habitats, including natural waters, soils, and drinking water distribution systems (1, 20–23).  |  Mycobacteria other than the tubercle bacillus sometimes infect humans. kansasii was identified in 1953 as causing an infectious disease that produces lung cavitary lesions resembling those in pulmonary TB (119). Among patients with relapse, some researchers have detected drug resistance with the use of rapid DNA-based molecular assays (99). Molecular detection methods and phenolic glycolipid 1 (PGL-1) serological data in combination with spatial epidemiology increase detection of leprosy cases (98). Currently, the NTM group is also divided into two major subgroups defined by their ability to grow on solid culture media: (i) rapidly growing mycobacteria (RGM) and (ii) slowly growing mycobacteria (SGM) (Fig. Skin infections may clear up without treatment. Phylogeographic studies uncovered the origin of leprosy in eastern Africa and its spread through the Silk Road or the transatlantic slave migration trade routes (7, 8, 10, 12). Clinical studies need to determine whether differences between infection with M. leprae and M. lepromatosis are clinically distinguishable (102, 107, 108) or whether coinfection with M. leprae and M. lepromatosis may potentially predispose individuals to experience more severe leprosy reactions (108). Culturing M. ulcerans is cumbersome since it requires a low oxygen concentration and a temperature between 29°C and 33°C. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Phylogenetic reconstructions of genomic sequences suggest that Mycobacterium marinum, Mycobacterium leprae, Mycobacterium ulcerans, and M. tuberculosis evolved from a common environmental ancestor (2, 15, 16, 19). Ecological data suggest that environmental factors, such as trauma or skin breaks during soil and water exposures, insect vectors, free-living amoebas, and animal reservoirs (e.g., armadillos, squirrels, felines, or other animals), influence leprosy transmission (39, 47, 49–63).