Öz
Tüberküloz dışı mikobakteriyel enfeksiyonlar genellikle immün sistemi baskılanmış bireylerde görülmektedir. Ancak, Mycobacterium marinum immünkompetan konakları da etkileyebilen ve nadir görülen bir patojendir. Genellikle sadece deri ve yumuşak doku ile sınırlı, sistemik yayılım göstermeyen kutanöz bir enfeksiyon şeklinde ortaya çıkar; papül, plak veya tekil/çoklu lezyonlar gibi belirtilerle kendini gösterebilir. Su ve balıkla temas, iyi bilinen risk faktörleri arasında yer almaktadır. Ancak, sunduğumuz olguda bu tarz bir riskli teması öyküsü bulunmamasına karşın lezyonların olduğu bölgeden kestane ağacı dikeniyle yaralanma hikayesi mevcuttu. Ayırıcı tanıda diğer granülomatöz enfeksiyonlar ve otoimmün hastalıklar göz önünde bulundurulmalıdır. Hastalığın tanısı için tür düzeyinde tanımlama şarttır ancak her merkezde bunu yapabilmek mümkün değildir. M. marinum genellikle etambutol, rifampisin, sülfonamid ve makrolidlere duyarlıdır. Oysa olgumuzda beklenmedik bir direnç profiliyle karşılaşılmıştır. Doğru tanı ve etkili tedavi için tür düzeyinde tanımlama ve antibiyotik duyarlılık testleri büyük önem taşımaktadır.
Anahtar Kelimeler: Mycobacterium marinum, kestane dikeni, yumuşak doku enfeksiyonları, tüberküloz dışı mikobakteri, direnç
Kaynakça
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