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Swimming pool granuloma

Aquarium granuloma; Fish tank granuloma; Mycobacterium marinum infection

A swimming pool granuloma is a long-term (chronic) skin infection. It is caused by the bacteria Mycobacterium marinum (M marinum).

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Causes

M marinum bacteria can live in fresh and salt water, unchlorinated swimming pools, and aquarium tanks. The bacteria can enter the body through a break in the skin, such as a cut, when you come into contact with water that contains this bacteria.

Signs of a skin infection appear about 2 to 3 weeks after exposure.

Risks include exposure of skin cuts or scrapes to swimming pools, aquariums, or fish or amphibians that are infected with the bacteria. As a result, people who fish or maintain aquariums and fish tanks are at higher risk.

Symptoms

The main symptom is a reddish to purple bump (papule) that slowly grows into a purplish and painful nodule.

The elbows, fingers, and back of the hands are the most commonly affected body parts. The knees and legs are other areas affected.

The nodules may break down, ulcerate, and leave an open sore. Sometimes, they spread up through the lymph nodes of the limb, but more often remain as a solitary nodule.

Since the bacteria cannot survive at the temperature of the internal organs, they usually stay in the skin, causing the nodules.

Exams and Tests

The health care provider will perform a physical examination and ask about your symptoms. You may also be asked if you recently swam in a pool or handled fish or amphibians.

Tests to diagnose swimming pool granuloma include:

• Skin test or blood test to check for tuberculosis infection, which may look similar
• Skin punch biopsy and culture
• X-ray or other imaging tests for infection that has spread to the joint or bone

Treatment

Antibiotics are used to treat this infection. They are chosen based on the results of the culture and skin biopsy.

You may need several months of treatment with more than one antibiotic. Surgery may also be needed to remove dead tissue if the lesions do not clear with antibiotics. This helps the wound heal.

Outlook (Prognosis)

Swimming pool granulomas can be cured with antibiotics, or they may heal on their own. They often leave a scar.

Possible Complications

Tendon, joint, or bone infections sometimes occur. The disease may be harder to treat in people whose immune system is not working well.

When to Contact a Medical Professional

Contact your provider if you develop reddish bumps on your skin that do not clear with home treatment.

Prevention

Wash hands and arms thoroughly after cleaning aquariums. Or, wear rubber gloves when cleaning.

Related Information

References

Brown-Elliott BA, Wallace RJ. Infections caused by nontuberculous mycobacteria other than mycobacterium avium complex. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 252.

Patterson JW. Bacterial and rickettsial infections. In: Patterson JW, ed. Weedon's Skin Pathology. 5th ed. Philadelphia, PA: Elsevier Limited; 2021:chap 24.

Review Date: 1/18/2023  

Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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