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Bémer P, Aubry A, Schramm F, Koebel C, Revillet H, Baltes V, Le Brun C, Chazerain P, Zeller V, Hamdad F, Morand PC, Guillouzouic A, Piau C, Roux AL, Soueges S, Martin C, Gaudart A, Hüssler S, Fihman V, Carricajo A, Caruba CG, Bador J, Dauchy FA, Dutronc H, Vignals C, Peuchant O. Clinical features and treatment outcomes of bone and joint nontuberculous mycobacterial infections according to immune status: a 9-year retrospective observational cohort. Int J Infect Dis 2024; 146:107122. [PMID: 38823623 DOI: 10.1016/j.ijid.2024.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVES Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status. METHODS We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period. We collected the clinical and microbiological characteristics, management, and clinical outcomes of the patients. RESULTS Overall, 95 patients were included, of whom 50.5% (48/95) were immunosuppressed. Tenosynovitis was more frequent in the immunocompetent group, and native arthritis more common in the immunosuppressed group. Mycobacerium marinum and M. abscessus complex were significantly more frequent in the immunocompetent group, and M. avium and M. xenopi were significantly more frequent in the immunosuppressed group. The combination of antibiotherapy with surgery tended to be more frequent in the immunocompetent than the immunosuppressed group (63.8% (30/47) vs 47.8% (22/46), respectively); of the latter, 45.7% (21/46) received antimicrobial therapy alone, a higher frequency than in the immunocompetent group (23.4%, 11/47). The median duration of antimicrobial treatment was similar in the two groups (11 months). Mortality was significantly higher in the immunosuppressed group. CONCLUSIONS Although the clinical presentations and the NTM species involved in BJI differed according to immune status, most recovered completely after treatment.
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Affiliation(s)
- Pascale Bémer
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Alexandra Aubry
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
| | - Frédéric Schramm
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Christelle Koebel
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Hélène Revillet
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Baltes
- Service d'infectiologie, AP-HP, Hôpital Cochin, Paris, France
| | - Cécile Le Brun
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Pascal Chazerain
- Service de rhumatologie, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Farida Hamdad
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Philippe C Morand
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France; Service de Bactériologie, AP-HP, Hôpital Cochin, Paris, France
| | - Aurélie Guillouzouic
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Caroline Piau
- Service de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Anne-Laure Roux
- Service de microbiologie, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Sarah Soueges
- Service de Maladies Infectieuses et Tropicales de l'Hôpital de la Croix-Rousse, Centre de Référence des Infections Ostéo-Articulaires Complexes de Lyon (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Christian Martin
- Laboratoire de Bactériologie, Virologie, Hygiène, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Alice Gaudart
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Sophie Hüssler
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Vincent Fihman
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Anne Carricajo
- Laboratoire des agents infectieux et Hygiène, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | | | - Julien Bador
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Frédéric-Antoine Dauchy
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hervé Dutronc
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Carole Vignals
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivia Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
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Kim DH, Park JY, Won HC, Park JS. Nontuberculous Mycobacterial Tenosynovitis of the Hand: A 10-Year Experience at Two Centers in South Korea. Clin Orthop Surg 2023; 15:477-487. [PMID: 37274504 PMCID: PMC10232306 DOI: 10.4055/cios22248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 06/06/2023] Open
Abstract
Background The aim of this study was to investigate the clinical characteristics of nontuberculous mycobacterial tenosynovitis and to report the process of diagnosis and the outcomes of surgical debridement and drug administration in South Korea. Methods Between 2010 and 2019, 23 patients (10 men and 13 women) with nontuberculous tenosynovitis of the hand were treated at two centers. Their average age was 64 years, and the average duration of symptoms was 8 months (range, 1-36 months). Eight patients had a history of trauma or surgery. The average number of corticosteroid injections before diagnosis was 2.6 for 7 patients. All 23 patients were treated with a combination of extensive tenosynovectomy and antibiotics. Results Of the 23 patients, 20 were available for the final follow-up (1, lost to follow-up; 1, transferred to another hospital; and 1, died from a comorbidity). The most common species was Mycobacterium intracellulare (70%), followed by Mycobacterium abscessus (10%). The frequency of involvement of the extensor/flexor tendon was similar to that of the wrist/finger. The mean number of surgical debridement operations was 2.2. The average duration of antibiotic administration was 9.8 months. At the last follow-up, 3 patients were symptom-free with full range of motion at the involved site, 1 patient complained of localized swelling or pain with full range of motion, 1 patient was found to have a recurrence of infection in a finger, and 15 complained of restricted joint motion. Conclusions The most common species noted in patients with nontuberculous mycobacterial tenosynovitis was M. intracellulare. Patients with only 1 finger involved showed good range of motion at the final follow-up. Most patients experienced delayed wound healing and adverse effects from drug therapy during treatment and limited joint motion at the final follow-up.
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Affiliation(s)
- Dong Hee Kim
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Yong Park
- Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hee-Chan Won
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Gyeongsang University School of Medicine, Jinju, Korea
| | - Jin Sung Park
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon, Korea
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Maimaiti Z, Li Z, Xu C, Fu J, Hao L, Chen J, Li X, Chai W. Non-Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature. Orthop Surg 2023. [PMID: 37154097 DOI: 10.1111/os.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Periprosthetic joint infection (PJI) caused by non-tubercular mycobacteria (NTM) is uncommon but catastrophic. However, conclusive clinical data on PJI caused by NTM are lacking. In this case series and systematic review, the clinical manifestations, diagnosis, and management of NTM PJI are summarized and analyzed. METHODS From 2012 to 2020, we retrospectively analyzed consecutive PJI cases caused by NTM in our institution. A literature review was also conducted from January 2000 to December 2021, utilizing the PubMed, MEDLINE, Cochrane Library, and EMBASE databases to identify all reported NTM-induced PJI cases. The clinical characteristics, demographics, pathogen identification, treatment protocols, and prognosis of NTM PJI were summarized and analyzed. RESULTS In this retrospective analysis, seven patients infected with NTM following total joint arthroplasty at our institution were included, including six cases of PJI caused by NTM and one case of septic arthritis (SA) caused by NTM. There were six men and one woman, and their average age was 62.3 years. The average interval between TJA and PJI onset was 4 months. The preoperative serological markers, including the mean ESR (51 mm/h), CRP (4.0 mg/dL), fibrinogen (5.7 g/L), and D-dimer (1.1 g/L), were increased. Six patients underwent staged revision surgery, and one patient with SA received antibiotic-loaded bone cement beads to treat the infection. After an average of 33 months of observation following surgical intervention, none of the patients showed any symptoms of infection recurrence. From 2000 to 2021, 68 patients with NTM PJI were found in 39 studies in the published literature. Reinfections occurred within 1 year after arthroplasty in more than half (53.2%) of the patients. M. fortuitum and M. abscesses were the most prevalent rapidly growing mycobacteria (RGM) in all PJI patients, whereas Mycobacterium avium intracellulare (MAC) was the most prevalent slowly growing mycobacterium (SGM). The corresponding antibiotics were amikacin and ethambutol. The rate of culture-negative without specific clinical symptoms was as high as 36.4% (12/33), while 45% (18/40) utilized additional diagnostic techniques such as NGS. A final clinical follow-up record was available for 59 patients (86.7%; mean follow-up period, 29 months), and 10.1% of patients failed to respond to treatment. CONCLUSION Orthopaedic surgeons should consider NTM in patients with negative routine cultures who are at risk for Mycobacterium infection. Treatment options rely on the accurate result of microbiologic identification and drug sensitivity testing, and to achieve this, it may be necessary to send multiple culture specimens, extend the culture time, and change the culture medium. Every effort should be made to identify NTM and its various subtypes through modern diagnostic tools if necessary.
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Affiliation(s)
- Zulipikaer Maimaiti
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Zhuo Li
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Chi Xu
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Jun Fu
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Libo Hao
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Jiying Chen
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiang Li
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Wei Chai
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
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Waletzko B, Lin PL, Lopez SMC. "Hot Tub Lung" With M. avium complex in an Immunocompetent Adolescent. Pediatr Infect Dis J 2023; 42:e84-e87. [PMID: 36729986 DOI: 10.1097/inf.0000000000003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a case of pulmonary Mycobacterium avium complex (MAC) infection in an immunocompetent pediatric patient after a hot tub near drowning event with a literature review of pediatric MAC-associated disease after hot tub exposure.
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Affiliation(s)
- Benjamin Waletzko
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Philana Ling Lin
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Santiago M C Lopez
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, South Dakota
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Yu H, Fan J, Shehla N, Qiu Y, Lin Y, Wang Z, Cao L, Li B, Daniyal M, Qin Y, Peng C, Cai X, Liu B, Wang W. Biomimetic Hybrid Membrane-Coated Xuetongsu Assisted with Laser Irradiation for Efficient Rheumatoid Arthritis Therapy. ACS NANO 2022; 16:502-521. [PMID: 34965104 DOI: 10.1021/acsnano.1c07556] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease underlying a cascade of chronic inflammatory processes. Over the past decades, the response rate of effective RA treatments has remained scarce despite numerous advancements in the current therapeutic interventions, owing largely to the associated off-target adverse events and poor accumulation in the inflamed joints. Recently, there is a high interest in the development of targeted drug delivery system by using nanotechnology, as it can provide a handle to improve the therapy efficacy of RA. Here, multifunctional HA@RFM@PB@SE nanoparticles (HRPS NPs) are developed by loading schisanlactone E (SE, also called with xuetongsu), an anti-RA compound isolated from Tujia ethnomedicine xuetong, into Prussian blue nanoparticles (PB NPs) and further camouflage of RBC-RAFLS hybrid membrane with HA modification onto PB@SE NPs (PS NPs). We demonstrated that the modification of RFM makes PB NPs ideal decoys for targeting inflammatory mediators of arthritis due to the homing effects of the parental cells. Moreover, the encapsulation of RFM on the PB@SE NPs extended the blood circulation time and improved its targeting ability, which accordingly achieved optimal accumulation of SE in arthritic rat paws. In vitro and in vivo assay demonstrated the outstanding performance of HRPS NPs for synergistic chemo-/photothermal therapy of RA without side effects to healthy tissues. Molecular mechanism exploration indicated that the ultrastrong inhibition of synovial hyperplasia and bone destruction was partly via suppressing NF-κB signaling pathway and the expression of matrix metalloproteinases. In summary, the nanodrug delivery system showed controllable release behavior, targeted accumulation at arthritic sites and systemic regulation of immunity, hence improved therapeutic efficacy and clinical outcomes of the disease without attenuating safety.
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Affiliation(s)
- Huanghe Yu
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Jialong Fan
- College of Biology, Hunan University, Changsha 410082, China
| | - Nuzhat Shehla
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Yixing Qiu
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Ye Lin
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Zhou Wang
- College of Biology, Hunan University, Changsha 410082, China
| | - Liang Cao
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Bin Li
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Muhammad Daniyal
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Yan Qin
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Caiyun Peng
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Xiong Cai
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Bin Liu
- College of Biology, Hunan University, Changsha 410082, China
| | - Wei Wang
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha 410208, China
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Aryee JN, Akinleye SD, Ugwu-Oju OC, Moore CC, Freilich AM. A Series of Nontuberculous Mycobacterial Flexor Tenosynovitis Infections and Cost of Treatment. J Wrist Surg 2021; 10:511-515. [PMID: 34881106 PMCID: PMC8635812 DOI: 10.1055/s-0041-1728801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Background Nontuberculous mycobacteria (NTM) are rare but potentially devastating causes of musculoskeletal infection and impairment in immunocompetent patients. Purpose Given the sparse body of literature surrounding these infections, we describe a series of patients with and the cost of treatment of upper extremity NTM infections. Patients and Methods In a retrospective review of seven patients with NTM infections of the upper extremity treated at a university hospital from 2010 to 2019, we assessed patient demographics, exposures, infection characteristics, management course, outcomes, and costs of treatment. Results Insidious pain and swelling were the most common clinical manifestation of infection. Despite coupled surgical and medical management, recurrence was common. Two patients required amputation, and three others had lasting functional deficits. The most common pathogen was Mycobacterium avium complex (5 of 7). The estimated median charge related to management was $85,126 with a range from $8,361 to $1,66,229. Conclusions The treatment of NTM infections is complex and expensive. Diagnosis is usually delayed, which further complicates the management of these patients who often suffer from lasting debilitation. Due to its potentially devastating course, NTM infection should be considered and tested for whenever flexor tenosynovitis is suspected. Regardless of initial presentation, our experience suggests that a protocol of serial surgical debridement immediately after tissue diagnosis is necessary for optimal outcomes. Furthermore, NTM infections require collaboration with infectious disease colleagues to guide antimicrobial regimens based on susceptibility testing and therapeutic drug monitoring for the recommended 6 to 12 months of therapy after the final operative debridement. Level of Evidence This is a Level IV, case series study.
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Affiliation(s)
- Jomar N.A. Aryee
- Department of Orthopaedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sheriff D. Akinleye
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Obinna C. Ugwu-Oju
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Christopher C. Moore
- Department of Internal Medicine, Division of Infectious Disease, University of Virginia, Charlottesville, Virginia
| | - Aaron M. Freilich
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Langkilde HZ, Nesten K, Morillon MB. Rare case of Mycobacterium marinum in a patient presenting with tenosynovitis. BMJ Case Rep 2021; 14:e234417. [PMID: 33980549 PMCID: PMC8118076 DOI: 10.1136/bcr-2020-234417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/03/2022] Open
Abstract
A 72-year-old man presented with tenosynovitis of the left hand's extensor tendons that had been present for several months. He was initially treated with corticosteroids, first by local injection then systemically, but with no effect. When re-evaluated, the patient had developed a rash, and the symptoms had spread locally to surrounding structures. At this point, the patient added to the medical history that he had been stung by a sculpin a month before the debut of symptoms. Based on this, the patient's involved area was biopsied, and subsequent microbiology findings proved consistent with Mycobacterium marinum infection. By the time of diagnosis, the patient had soft tissue involvement, arthritis and osteomyelitis with an overlying rash. This case emphasises the need for reassessment when treatment is not effective and for further investigations of the medical history to establish the correct diagnosis and treatment.
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Affiliation(s)
- Henrik Zachar Langkilde
- Department of Medicine, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Kim Nesten
- Department of Orthopedic Surgery, Hand Surgery, University Hospital of Southern Denmark, Vejle, Denmark
| | - Melanie Birger Morillon
- Department of Internal Medicine, Odense University Hospital - Svendborg, Denmark, Svendborg, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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8
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Serling-Boyd N, Wallace Z, Jarolimova J, Arvikar S, Miloslavsky EM. An 80-Year-Old Man With Fevers, Altered Mental Status, and Joint Effusions. Arthritis Care Res (Hoboken) 2020; 72:293-300. [PMID: 31562791 PMCID: PMC7228541 DOI: 10.1002/acr.24082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
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9
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Singh J, Antony SJ. Prosthetic joint infection due to Mycobacterium moriokaense in an immunocompetent patient after a total knee replacement. Proc (Bayl Univ Med Cent) 2020; 33:97-99. [DOI: 10.1080/08998280.2019.1674089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Joya Singh
- Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico
| | - Suresh J. Antony
- Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico
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10
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Napaumpaiporn C, Katchamart W. Clinical manifestations and outcomes of musculoskeletal nontuberculous mycobacterial infections. Rheumatol Int 2019; 39:1783-1787. [DOI: 10.1007/s00296-019-04392-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/22/2019] [Indexed: 11/24/2022]
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Affiliation(s)
| | | | - David L Goldman
- Department of Pediatrics and Microbiology and Immunology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY
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Diaz MAA, Huff TN, Libertin CR. Nontuberculous mycobacterial infections of the lower extremities: A 15-year experience. J Clin Tuberc Other Mycobact Dis 2019; 15:100091. [PMID: 31720418 PMCID: PMC6830119 DOI: 10.1016/j.jctube.2019.100091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives Nontuberculous mycobacterial infection (NTMI), which is increasing in prevalence, is challenging to diagnose and manage despite the availability of capable laboratories because of subtle and nonspecific clinical findings and nonstandardized treatment guidelines. We aimed to present our experience with lower-extremity NTMI and to compare clinical characteristics and treatment outcomes between immunocompetent and immunocompromised patients. Methods To determine clinical presentations and outcomes, we reviewed electronic health records of all patients with lower-extremity NTMI treated and followed up at our institution from January 2002 through December 2017. Results Twenty-four patients were included in this study. Mean (SD) age was 58 (19) years. Eighteen patients (75%) were men; 13 (54%) were immunocompetent; and 9 (37%) had bone and joint involvement. No significant differences existed between immunocompetent and immunocompromised patients, except immunocompetent patients had significantly more infections at the hip, thigh, and toe. Bone and joint infection required significantly longer treatment time than skin and soft-tissue infection. Conclusions Regardless of immune status, patients with lower-extremity NTMI had similar characteristics, treatments, and outcomes. However, immunosuppression can be a major risk factor in the development of disseminated NTMI and associated complications. Acid-fast bacilli culture is strongly recommended for evaluation of delayed or nonhealing lesions. Aggressive medical and surgical management can be associated with good clinical outcomes.
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Affiliation(s)
- Mark Anthony A. Diaz
- Division of Infectious Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, United States
| | - Tamara N. Huff
- St. Francis Orthopaedic Institute, St. Francis Medical Group, Columbus, GA, United States
| | - Claudia R. Libertin
- Division of Infectious Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, United States
- Corresponding author.
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Ingraham NE, Schneider B, Alpern JD. Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature. Case Rep Infect Dis 2017; 2017:8682354. [PMID: 28280641 PMCID: PMC5322427 DOI: 10.1155/2017/8682354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/24/2017] [Indexed: 01/28/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.
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Affiliation(s)
- Nicholas E Ingraham
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brenton Schneider
- Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jonathan D Alpern
- Department of Infectious Disease, University of Minnesota, Minneapolis, MN, USA
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Chiba M, Yanaba K, Kohara A, Nakayama M, Nakagawa H, Fukuda T, Ishii N, Yoshida K. Septic arthritis caused by Mycobacterium marinum infection. J Dermatol 2016; 44:1179-1180. [PMID: 27862193 DOI: 10.1111/1346-8138.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Miki Chiba
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Yanaba
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Aki Kohara
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minako Nakayama
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ken Yoshida
- Department of Rheumatology, The Jikei University School of Medicine, Tokyo, Japan
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15
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Ferrati-Fidelin G, Pham-Ledard A, Fauconneau A, Chauvel A, Houard C, Doutre MS, Beylot-Barry M. [Latent-disseminated tuberculosis revealed by atypical skin ulcerations]. Ann Dermatol Venereol 2016; 143:616-621. [PMID: 27342431 DOI: 10.1016/j.annder.2016.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/01/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cutaneous tuberculosis (CT) is rare in industrialized countries. Given the clinicopathological polymorphism and the difficulty of isolating the pathogen, diagnosis can be difficult. The condition may be associated with other known locations of the disease or in rare cases, it may be a tell-tale sign, as in our case, in which leg ulcers revealed paucisymptomatic disseminated tuberculosis. OBSERVATION A 67-year-old man was referred for rapidly extensive ulcers of the right leg contiguous to debilitating arthritis of the knee of unknown aetiology for 18 months. Earlier investigations revealed thymoma and a pulmonary nodule considered to be sarcoidosis. A skin biopsy showed a granulomatous eosinophilic-rich infiltrate and vasculitis of the small vessels. Screening of the skin sample and gastric aspirate for Koch Bacillus (BK) was negative. A diagnosis of sarcoidosis was made. A positive QuantiFERON test eventually led to the correct diagnosis. On further testing of bronchoalveolar fluid and a synovial biopsy, culture for Mycobacterium tuberculosis (MT) was positive. The PET scan showed high metabolism in the prostate, bone, spleen, liver, nodes and heart. The quad- and then dual-antibiotic antitubercular therapies produced a rapid improvement but treatment was continued over 12 months, given the persistence of high metabolism on PET-CT scan and the low blood rifampicin concentration. DISCUSSION A CT should be considered in the presence of giant-cell granulomas, even in the absence of caseous necrosis, and where both direct examination and culture for the skin are negative. Our case also underlines the importance of an extensive workup to rule out disseminated disease even if the patient is not symptomatic.
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Affiliation(s)
- G Ferrati-Fidelin
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Pham-Ledard
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Fauconneau
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Chauvel
- Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - C Houard
- Service de médecine nucléaire, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - M-S Doutre
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - M Beylot-Barry
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
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16
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Jeong JS, Kim JH, Park SH, Jeong JH, Ryu YJ, Moon KW. Tuberculous Osteomyelitis of the First Metatarsophalangeal Joint Misdiagnosed as Gouty Arthritis. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.5.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jin-Seon Jeong
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ji-Hyun Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sung-Hyun Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Hoon Jeong
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Joon Ryu
- Department of Pathology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ki Won Moon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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Plana-Veret C, Iranzo-Fernández P, Peris P, Monegal A, Guañabens N. Invasive Mycobacterium marinum infection. Joint Bone Spine 2015; 82:462. [PMID: 26184528 DOI: 10.1016/j.jbspin.2014.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/01/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Carlos Plana-Veret
- Rheumatology department, hospital Clínic, university of Barcelona, 170, Villarroel, 08036 Barcelona, Spain.
| | - Pilar Iranzo-Fernández
- Dermatology department, hospital Clínic, university of Barcelona, 170, Villarroel, 08036 Barcelona, Spain
| | - Pilar Peris
- Rheumatology department, hospital Clínic, university of Barcelona, 170, Villarroel, 08036 Barcelona, Spain
| | - Ana Monegal
- Rheumatology department, hospital Clínic, university of Barcelona, 170, Villarroel, 08036 Barcelona, Spain
| | - Nuria Guañabens
- Rheumatology department, hospital Clínic, university of Barcelona, 170, Villarroel, 08036 Barcelona, Spain
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18
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Twenty-eight cases of Mycobacterium marinum infection: retrospective case series and literature review. Infection 2015; 43:655-62. [PMID: 25869820 DOI: 10.1007/s15010-015-0776-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Invasive Mycobacterium marinum disease (tenosynovitis and osteomyelitis) may be an increasingly common manifestation of M. marinum infection that presents unique diagnostic and therapeutic challenges. We conducted a retrospective case series and literature review of M. marinum infection to better understand the clinical spectrum of invasive versus cutaneous disease. METHODS We reviewed electronic medical records for all M. marinum infections at Duke University Medical Center from January 1, 1996 to April 30, 2014. Published case series of M. marinum infection since 1990 reporting >5 cases were systematically ascertained and reviewed. RESULTS Twenty-eight cases of M. marinum infection were identified from our institution. Twenty cases (87 %) involved aquatic exposure, and 26 (93 %) involved finger and/or hand lesions. Median time to diagnosis was 3.5 months. Nineteen (68 %) cases had invasive infection, and 9 (32 %) were cutaneous; invasive infection was more common with older age. Granulomatous inflammation and acid-fast bacilli were noted on pathologic examination in 11 (58 %) and 3 (16 %) cases, respectively. Primarily monotherapy was used in 2 (12 %) cases, dual therapy in 8 (47 %) cases, and three-drug therapy in 7 (41 %) cases; three-drug therapy was more common with invasive infection. Median duration of treatment was 5 months. Adjunctive surgery was performed for 18 (95 %) cases of invasive infection and 4 (44 %) of cutaneous infection. Twenty-one (75 %) cases improved, while 7 (25 %) were lost to follow-up. CONCLUSIONS Distinguishing between invasive and cutaneous M. marinum infection may have important consequences in terms of antibiotic choice and need for adjunctive surgery.
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Comparison of clinical characteristics of tuberculosis between two age groups at an Italian Tertiary Hospital. Infection 2015; 43:361-6. [PMID: 25808263 DOI: 10.1007/s15010-015-0765-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
Differences in clinical characteristics and outcome between elderly (>60 years) and younger (18-59 years) tuberculosis (TB) patients were retrospectively evaluated. Alcohol abuse, radiological evidence of cavitation, and cough at presentation were more frequent among younger patients. Older patients were more likely to have comorbidities, disseminated TB, longer duration of symptoms and higher TB-related mortality (19 vs 0%). Very old patients (≥80 years) showed increased liver toxicity and hospital acquired infections compared to patients aged 60-79 years.
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20
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Weber E, Gagneux-Brunon A, Jacomo V, Rousselon T, Lucht F, Botelho-Nevers E. Tenosynovitis: a rare presentation of tuberculosis better known by hand surgeons than infectious diseases specialists. Infection 2015; 43:261-6. [PMID: 25690847 DOI: 10.1007/s15010-015-0741-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Clinical presentation of tuberculosis is pleomorphic. Some forms are rare and better known by surgeons than infectious disease specialists. METHODS We describe a rare case of isolated chronic tenosynovitis of the wrist due to Mycobacterium tuberculosis in a 66-year-old man and review similar cases in the literature. RESULTS On literature search, only 23 other cases of tuberculous tenosynovitis were retrieved. Our case is similar, with an insidious classical presentation. The diagnosis was suggested at the surgical presentation by the presence of rice body masses. CONCLUSION The diagnosis of tuberculous tenosynovitis should be considered in chronic tenosynovitis. Functional prognosis may be committed without adequate treatment.
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Affiliation(s)
- Emmanuelle Weber
- Infectious Diseases Department, University Hospital, 42055, Saint-Etienne Cedex 2, France
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21
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Yun JH, Sung H, Kim T, Hong SI, Chong YP, Kim SH, Choi SH, Kim YS, Woo JH, Lee SO. Comparison of the clinical characteristics of Mycobacterium tuberculosis and nontuberculous mycobacteria patients with joint involvement. Infection 2015; 43:207-9. [PMID: 25623639 DOI: 10.1007/s15010-015-0731-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/14/2015] [Indexed: 01/15/2023]
Abstract
Nontuberculous mycobacteria (NTM) joint involvement is rare. However, the incidence of NTM disease is increasing and it is difficult to distinguish NTM from Mycobacterium tuberculosis (MTB). Here, the clinical characteristics of NTM joint involvement were compared with those of MTB. Distal joint involvement and precipitating factors were significantly more frequent for NTM joint infections. Because pathologic findings of NTM and MTB were similar, microbiological investigations are needed.
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Affiliation(s)
- J H Yun
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
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Madruga Dias J, Costa MM, Pereira da Silva JA, Viana de Queiroz M. Septic arthritis: patients with or without isolated infectious agents have similar characteristics. Infection 2013; 42:385-91. [PMID: 24318567 DOI: 10.1007/s15010-013-0567-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 11/26/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE Septic arthritis can be disabling and life-threatening, requiring prompt diagnosis and treatment. The infectious agent is not always identified in these patients. We revaluate septic arthritis cases discharged from our department, describing the affected population, causative microorganisms and antibiotic therapy used, and characterised differences between patients with and without isolated pathogenic agents. METHODS Sixty-eight septic arthritis patients were included in this study. Diagnosis was based on clinical findings, and/or the presence of joint purulent material, and/or bacterial pathogen isolation from joint fluid/synovial membrane/blood cultures and response to antibiotics. Data analysis was performed using SPSS 20. RESULTS Patients had a mean age of 61.1 ± 18.8 years, without sex predominance. 26.5 % had an infection ≤ 15 days before septic arthritis diagnosis. Besides previous infection, 57.4 % had ≥ 1 risk factors for septic arthritis, most commonly pharmacological immunosuppression (20.6 %), diabetes mellitus type 2 (19.1 %) and rheumatoid arthritis (17.6 %). The knee was the most often affected (54.3 %). Only 39.7 % presented fever from clinical onset until hospital admission (mean 13.4 ± 18.9 days). Leucocytosis was present in 45.6 % of patients, elevated erythrocyte sedimentation rate (ESR) in 75 % and elevated C-reactive protein (CRP) in 97.1 %. 5.9 % had articular damage attributable to septic arthritis. An infectious agent was isolated in 41.2 % of patients, with Staphylococcus aureus being the most frequent. 38.7 % of synovial fluid and 23.5 % of synovial membrane cultures were positive. Patients with an identified infectious agent have no significant differences other than more days of hospitalisation (p = 0.003) and in-hospital antibiotic treatment (p = 0.017). CONCLUSION Synovial fluid and synovial membrane cultures more often identified pathogens compared to blood or urine cultures. Patients with and without an identified infectious agent have similar demographic, clinical, laboratory and radiographic characteristics.
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Affiliation(s)
- J Madruga Dias
- Rheumatology Department, Santa Maria Hospital, Centro Hospitalar de Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal,
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Nukui Y, Nakamura H, Ishioka H, Miyamoto H, Okamoto A, Kazumi Y, Yotsuyanagi H, Moriya K, Hatakeyama S. Synovitis of the wrist caused by Mycobacterium florentinum. Infection 2013; 42:437-40. [PMID: 24264693 DOI: 10.1007/s15010-013-0561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022]
Abstract
Mycobacterium florentinum is a newly identified, rare, slow-growing species of nontuberculous mycobacteria (NTM). Here, we report a case of M. florentinum-induced synovitis of the wrist in an immunocompromised Japanese patient. M. florentinum was identified by sequence analysis of the rpoB, hsp65, and 16S rRNA genes. The M. florentinum strain in this study could not be differentiated from certain M. triplex strains by the hsp65 or 16S rRNA sequences alone, because they occasionally shared more than 99 % sequence identity. The isolated M. florentinum strain was only susceptible to clarithromycin and amikacin. Initially, the patient was treated with clarithromycin, levofloxacin, and ethambutol, and then with clarithromycin, levofloxacin, and rifampicin. To our knowledge, M. florentinum-induced synovitis has not been previously reported. Our results suggest that, in addition to other well-known pathogenic NTM, the recently identified M. florentinum strain should be considered as a possible cause of synovitis. Moreover, we should be cautious when identifying M. florentinum because this strain closely resembles M. triplex in genotype.
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Affiliation(s)
- Y Nukui
- Department of Infection Control and Prevention, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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