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BACKGROUND: Mycobacterium marinum, a bacterium found in both freshwater and saltwater, has been reported to cause infections among persons working with fish or who have contact with aquariums. During January–February 2014, the New York City Department of Health and Mental Hygiene (NYCDOHMH) was notified of 25 cases of suspected M. marinum infection among persons purchasing raw or live fish or seafood from Chinese markets.
METHODS: A confirmed case was skin or soft-tissue infection of the upper extremity in a person who had handled fish from a NYC market, with symptom onset after June 1, 2013, and evidence of M. marinum by culture, immunohistochemical stain, or polymerase chain reaction. A possible case met clinical and epidemiologic criteria but lacked laboratory confirmation. NYCDOHMH alerted local providers and requested reporting of suspected or confirmed cases.
RESULTS: As of March 7, 2014, a total of 35 cases (5 confirmed) had been identified among patrons of 11 Chinese markets in 2 different areas of NYC. Of 23 patients interviewed, median age was 66 years (range: 52–82 years); 18 (78%) were female; and all spoke Cantonese or Mandarin. Twenty patients (87%) reported infection onset during August–November 2013. All patients had prepared live or raw fish or seafood for cooking before symptoms began; 4 (17%) had worn gloves when preparing fish or seafood, and 13 (57%) had purchased live fish from tanks.
CONCLUSIONS: This is the first reported M. marinum outbreak among persons purchasing live fish from markets. Persons handling live or raw fish or seafood should wear waterproof gloves. An environmental investigation is ongoing to identify a common distributor or aquafarm and to recommend interventions for disease prevention.