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Rzadkie przyczyny trudno gojących się ran: ziarniniak akwariowy

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Mycobacterium marinum to bakterie występujące na ciele wielu gatunków ryb morskich i słodkowodnych, a niekiedy gadów. Infekcja tym drobnoustrojem może przyczynić się do wystąpienia owrzodzeń i ropni skóry, a u osób z osłabioną odpornością – do ciężkiej uogólnionej choroby.

Infekcje wywołane przez szczep M. marinum u ludzi nie są częste (1 przypadek na 100 tys. osób), chociaż w ostatnim czasie odnotowuje się wzrost ich występowania. Do zakażenia dochodzi najczęściej poprzez kontakt z rybami lub zanieczyszczoną wodą jezior i akwariów. Drobnoustroje mogą również bytować w nieodkażonych basenach kąpielowych.

Czynniki infekcji M. marinum

Na infekcję M. marinum najbardziej narażone są osoby starsze z osłabionym układem odpornościowym lub dzieci, u których układ immunologiczny nie jest w pełni rozwinięty. Bakterie dostają się do organizmu poprzez uszkodzenia skóry, np. otarcia.

Najwięcej przypadków zakażeń M. marinum odnotowuje się wśród osób mających częsty kontakt ze słoną wodą oraz zwierzętami morskimi – u rybaków, sprzedawców ryb czy właścicieli akwariów, a także u osób korzystających z akwaparków lub pracowników tych miejsc. Odnotowano również przypadki zakażenia u osób korzystających z basenów, w których woda nie została dokładnie odkażona.

Objawy ziarniaka akwariowego/basenów pływackich

Chorobę spowodowaną przez zakażenie M. marinum określa się jako ziarniniak akwariowy lub ziarniak basenów pływackich. Pierwsze objawy infekcji manifestują się poprzez zaczerwienienie skóry lub czerwonofioletowe guzki w okolicach uszkodzeń skóry, gdzie doszło do zakażenia. Mogą być one pojedyncze, ale częściej występują w licznych skupieniach lub rozprzestrzeniają się na całej zmienionej chorobowo powierzchni ciała. Rzadziej występują czerwone guzki, które układają się w jednej linii wzdłuż naczyń limfatycznych. Zakażenie objawia się również owrzodzeniami, które mogą się powiększać. W 90 proc. przypadków zmiany skórne dotyczą rąk, stóp, kolan i łokci – miejsc, w których skóra najczęściej ulega uszkodzeniom. Zmianom tym towarzyszyć może świąd, bolesność, a także powiększenie węzłów chłonnych. Ponadto choroba manifestuje się symptomami takimi jak obrzęk brzuszny, utrata masy ciała, brak koordynacji ruchów.

W przypadku osób z osłabionym układem immunologicznym zakażenie może rozwinąć się w chorobę uogólnioną. Infekcja dotyka wówczas głębiej położone tkanki i może wywołać zapalenie pochewki ścięgna oraz septyczne zapalenie stawów. Może dojść również do włóknistego zapalenia pęcherzyków płucnych, mięśni oraz kości. Infekcja niekiedy przybiera postać chroniczną i atakuje narządy wewnętrzne – wątrobę, nerki, śledzionę. U osób z osłabionym układem immunologicznym pojawiają się także inne objawy, takie jak gorączka, powiększenie regionalnych węzłów chłonnych. Zakażenie M. marinum w rzadkich przypadkach prowadzi do śmierci.

Diagnoza i leczenie infekcji M. marinum

Zakażenie M. marinum może przyjmować różne postacie, dlatego nadal prowadzone są badania nad opracowaniem skutecznej terapii. Postawienie właściwej diagnozy często jest utrudnione i opóźnione nawet o 4 miesiące, ponieważ okres inkubacji bakterii trwa od 2 do 16 tygodni.

Diagnostykę choroby przeprowadza się poprzez badanie histopatologiczne, które obejmuje identyfikację zmian ziarniniakowych, a także test PCR bioptatów zmian chorobowych. Tylko u 30 proc. pacjentów za pomocą badań diagnostycznych udaje się potwierdzić obecność M. marinum, dlatego ważny jest dokładny wywiad lekarski.

Na zmiany skórne w praktyce klinicznej zalecane są maści antybiotykowe. W procesie leczenia lekarz może również podjąć decyzję o wdrożeniu krioterapii, radioterapii lub naświetlania promieniami X. Niekiedy konieczna jest interwencja chirurgiczna, jeżeli stwierdzono głębokie guzy na dłoniach lub stopach.  Łagodna postać choroby może ustąpić samoistnie, jednak proces ten może trwać nawet dwa do trzech lat.

 

Źródła:

Z. Gliński, K. Kostro, Zagrożenie człowieka chorobami zakaźnymi od zwierząt towarzyszących. Część II. Jersinioza, bartonelozy, kolibakterioza, zakażenie Mycobacterium marinum, grzybica skóry i kryptokokoza, Życie weterynaryjne, 2014, str. 327

M. Fol, J. Olek, M. Kowalewicz-Kulbat i wsp., Nontuberculous mycobacteria: M. marinum, M. ulcerans, M. xenopi – brief characteristics of the bacteria and diseases caused by tchem, Postępy Hig Med Dosw 2011; 65, str. 574-583

Przeczytaj także: Rzadkie przyczyny trudno gojących się ran: sporotrychoza

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