Atypical Mycobacterial Infection Associated with Noodling

Noodling is the practice of trying to catch a large cat-fish by sticking an arm into its mouth while it is in its underwater burrow.

The practice:

(1) involves breaks in the skin.

(2) tends to occur in Southern states with warmer waters

(3) requires the person to be submerged

The usual atypical mycobacterium involved is M. marinum but other species are possible.

The atypical mycobacterial infection may manifest itself as:

(1) a localized skin lesion and/or synovitis of the hand or forearm

(2) regional lymphadenitis in the upper extremity

(3) pneumonia

(4) disseminated disease

The infection may be misdiagnosed as seronegative rheumatoid arthritis.

Culture and routine stains are relatively insensitive. Molecular methods may be helpful in difficult cases.