1
|
Tabaja H, Saleem HY, Bakri K, Tande AJ. Two Decades of Insights into Nontuberculous Mycobacterial Hand Infections. Open Forum Infect Dis 2024; 11:ofae152. [PMID: 38651140 PMCID: PMC11034953 DOI: 10.1093/ofid/ofae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Background The objective of our study is to describe the clinical presentation, management, and outcome of a large cohort with nontuberculous mycobacteria (NTM) hand infection. Methods We reviewed the medical records of all adults (≥18 years) managed at the Mayo Clinic (Rochester, MN) for NTM hand infection between 1998 and 2018. Results Our cohort included 81 patients. The median age was 61.3 (interquartile range 51.7, 69.6) years; 39.5% were immunocompromised, and 67.9% reported a triggering exposure preceding infection. Infection was deep in 64.2% and disseminated in 3.7%. Up to 16.0% received intralesional steroids because of misdiagnosis with an inflammatory process. Immunocompromised patients had deeper infection, and fewer reports of a triggering exposure. Mycobacterium marinum, Mycobacterium avium complex, and Mycobacterium chelonae/abscessus complex were the most common species. The median antibiotic duration was 6.1 (interquartile range 4.6, 9.9) months. Deep infection and infection with species other than M marinum were associated with using a greater number of antibiotics for combination therapy and an extended duration of treatment. Immunosuppression was also associated with longer courses of antibiotic therapy. Surgery was performed in 86.5% and 32.4% required multiple procedures. Ten patients, mostly with superficial infections, were treated with antibiotics alone. The 5-year cumulative rate of treatment failure was 30.3% (95% confidence interval, 20.9-44.0). Immunosuppression and intralesional steroid use were risk factors for failure. Conclusions Treatment of NTM hand infection usually requires surgery and antibiotics, but antibiotics alone may occasionally be attempted in select cases. Immunosuppression and intralesional steroids are risk factors for treatment failure.
Collapse
Affiliation(s)
- Hussam Tabaja
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Humza Y Saleem
- Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Karim Bakri
- Department of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Renfree KJ, Scott KL, Polveroni TM, Mead-Harvey C, Vikram HR. Nonmarinum, Nontuberculous Mycobacterial Infections of the Upper Extremity: A Multi-Institutional Descriptive Report. J Hand Surg Am 2023; 48:1159.e1-1159.e10. [PMID: 35637039 DOI: 10.1016/j.jhsa.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 02/03/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We analyzed patient demographic factors involved in the development of nonmarinum, nontuberculous mycobacterial infections (NTMI) involving the upper extremity, and assessed diagnostic and prognostic values of commonly used preoperative laboratory and imaging studies, as well as factors related to recurrence of disease and patient outcomes. METHODS Patients from 2 academic, tertiary facilities with culture-proven, nonmarinum NTMI involving the upper extremity were reviewed. Patient-related factors and clinical outcomes were extracted. The analysis was based on pathogen identification (rapid- vs slow-growing subspecies) and immune status. RESULTS Our 76 patients had a mean age of 59 years, and 65% were male. Forty-eight percent reported an injury, and hands were frequently involved (58%). Forty-one percent were immunosuppressed (19% organ transplant recipients). The mean symptom duration prior to presentation was 203 days. The culture identification took a mean of 33 days, with 25 different species identified (subcategorized as rapid or slow growers). Seventy-seven percent had solitary lesions, with a cutaneous or subcutaneous location most common. Immunosuppressed patients were treated longer with antibiotics (243 vs 155 days in immunocompetent patients) and experienced higher rates of side effects, complications, and recurrence. All patients underwent debridement to control infection, including 4 individuals who required amputations. One-third experienced complications and/or recurrence, regardless of the organism type. CONCLUSIONS Upper-extremity nonmarinum NTMI is often misdiagnosed, causing management delays. Early consideration in differential diagnoses of chronic, painful swelling, nodular or inflammatory lesions, or septic arthritis is crucial. Tissue biopsy with specimens for histopathology and microbiological analysis (mycobacterial smear, cultures, and broad range polymerase chain reaction) and early involvement with an infectious disease specialist are recommended. Empiric antibiotic therapy is not standard. Debridement and prolonged, directed combination antimicrobial therapy is required; however, adverse reactions are commonly encountered. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
| | - Kelly L Scott
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ
| | | | | | | |
Collapse
|
3
|
Aliotta RE, Jacob DD, Said SAD, Bassiri Gharb B, Rampazzo A. Upper Extremity Infections in the Transplant Population. J Hand Surg Am 2023; 48:953.e1-953.e9. [PMID: 35525682 DOI: 10.1016/j.jhsa.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE As the duration of lifetime survival after organ transplantation continues to increase, the consequences of long-term immunosuppression, such as opportunistic and rare infections, are a high-risk reality. This study examined upper extremity infections in the transplant population to determine the current clinical risk profile, management, and outcomes. METHODS An institutional database of 16,640 patients who underwent transplantation was queried for upper extremity infections from 2005 to 2017, defined as the presence of infection from the shoulder to the fingertips. The resulting data were analyzed using multivariable linear and logistic regression modeling. RESULTS A total of 230 eligible patients experienced upper extremity infections at a mean age of 54.1 ± 15.3 years, occurring, on average, 7.9 ± 8.6 years after transplantation. The most commonly transplanted organ was the kidney (51.3%), followed by the liver (20%). The most common location of infection was the forearm (31.7%), digits (27.4%), and upper arm (17%). The most common types of infection were cellulitis (69.1%), abscess (33.5%), joint sepsis (6.5%), infectious tenosynovitis (3.9%), and osteomyelitis (1.3%). Patients taking an antifungal medication, those who had a joint infection, or those who had undergone lung transplantation had an approximately 2.5-day longer stay in the hospital. For every 1-year increase in age at the time of transplantation, the time from transplantation to infection decreased by 0.21 years. Those who had undergone bone marrow transplantation or those who were taking tacrolimus were expected to have approximately 8- and 6-year decreases, respectively, in the time from transplantation to infection. CONCLUSIONS Upper extremity infections should be individually evaluated and treated because of the heterogeneity of transplant type, immunosuppression medications, the age of the patient, and infection characteristics. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
Affiliation(s)
- Rachel E Aliotta
- Department of Plastic & Reconstructive Surgery, Dermatology & Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - DeAsia D Jacob
- Department of Plastic & Reconstructive Surgery, Dermatology & Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Sayf Al-Deen Said
- Department of Plastic & Reconstructive Surgery, Dermatology & Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Bahar Bassiri Gharb
- Department of Plastic & Reconstructive Surgery, Dermatology & Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Antonio Rampazzo
- Department of Plastic & Reconstructive Surgery, Dermatology & Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
McDermott DG, Hill SM, Desai K, Jaggessarsingh D, Vitale MA. Septic Mycobacterium Avium Intracellulare Extensor Tenosynovitis of the Wrist. J Wrist Surg 2023; 12:273-279. [PMID: 37223375 PMCID: PMC10202564 DOI: 10.1055/s-0042-1749446] [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: 08/11/2021] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
Mycobacterium avium intracellulare (MAI) infections of the hand, wrist, and upper extremity are rare, but potentially devastating atypical mycobacterial infections that can affect tendon, bone, and other soft tissues of the musculoskeletal system. We present an immunocompromised patient presenting with acute swelling and pain in the dorsum of the hand and wrist that underwent a wrist extensor tenosynovectomy with intraoperative cultures revealing infection with MAI. The patient developed severe progression of the infection with osteomyelitis of the distal forearm and carpal bones, multiple subsequent extensor tendon ruptures, and dorsal skin necrosis. The infection was eradicated with a combination of surgical treatment and antibiotic therapy. The case is discussed in context of the prior scant literature of infectious tenosynovitis of the hand, wrist, and upper extremity caused by MAI. This case report and literature review outline recommendations for diagnosis and effective treatment of MAI.
Collapse
Affiliation(s)
- Daniel G. McDermott
- ONS Foundation for Clinical Research and Education, Orthopaedic and Neurosurgery Specialists (ONS), Greenwich, Connecticut
| | - Samantha M. Hill
- ONS Foundation for Clinical Research and Education, Orthopaedic and Neurosurgery Specialists (ONS), Greenwich, Connecticut
| | - Kapil Desai
- Department of Radiology, Greenwich Hospital, Greenwich, Connecticut
| | | | - Mark A. Vitale
- ONS Foundation for Clinical Research and Education, Orthopaedic and Neurosurgery Specialists (ONS), Greenwich, Connecticut
- Department of Orthopaedic Surgery, Greenwich Hospital, Yale-New Haven Health, Greenwich, Connecticut
| |
Collapse
|
6
|
McLaughlin CM, Schade M, Cochran E, Taylor KF. A Case Report of a Novel Atypical Mycobacterial Infection: Mycobacterium Chimaera Hand Tenosynovitis. JBJS Case Connect 2022; 12:01709767-202209000-00046. [PMID: 36137058 DOI: 10.2106/jbjs.cc.22.00292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/15/2022] [Indexed: 06/16/2023]
Abstract
CASE A 76-year-old fisherman with a history of diabetes mellitus, coronary artery bypass grafting, and a previous ipsilateral elbow wound presented with a 1-year history of hand pain and swelling. Anti-inflammatories and antibiotics were administered without improvement. Magnetic resonance imaging and ultrasound demonstrated flexor tenosynovitis. Intraoperative cultures revealed Mycobacterium chimaera. The treatment course included 2 tenosynovectomies and a 1-year course of triple antimycobacterial therapy. CONCLUSION Nontuberculous mycobacteria infections should be considered in cases of indolent tenosynovitis. M. chimaera should be considered in patients with a history of cardiopulmonary bypass given its association with cardiopulmonary heater-cooler units.
Collapse
Affiliation(s)
- C M McLaughlin
- Penn State Hershey Medical Center, Department of Surgery, Division of Plastic and Reconstructive Surgery, Hershey, Pennsylvania
| | - M Schade
- Penn State Hershey Medical Center, Department of Internal Medicine, Division of Infectious Disease, Hershey, Pennsylvania
| | - E Cochran
- Penn State Hershey Medical Center, Department of Pathology, Hershey, Pennsylvania
| | - K F Taylor
- Penn State Hershey Medical Center, Department of Orthopaedics and Rehabilitation, Division of Hand Surgery, Hershey, Pennsylvania
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Kaji Y, Nakamura O, Yamaguchi K, Nomura Y, Oka K, Yamamoto T. Combined administration of rifampicin, ethambutol, and clarithromycin for the treatment of tenosynovitis of the hand caused by Mycobacterium avium complex: Case series and literature review. Medicine (Baltimore) 2021; 100:e25283. [PMID: 33907090 PMCID: PMC8084042 DOI: 10.1097/md.0000000000025283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/04/2022] Open
Abstract
ABSTRACT We report the clinical results and problems of combined administration of rifampicin, ethambutol, and clarithromycin (REC) for the treatment of Mycobacterium avium complex (MAC) infection of the hand (hand MAC).Participants included 7 patients with hand MAC. After resection of the infected lesion, REC was prescribed for 12 months. For these patients, the site of infection, clinical course after initiation of REC, adverse drug effects (ADEs), and incidence of recurrence were evaluated.Sites of infection were the flexor tenosynovium in 5 patients, extensor tenosynovium in 1 patient, and both flexor and extensor tenosynovium in 1 patient. ADEs of REC occurred in 5 patients, and included visual disturbance caused by ethambutol in 2 patients, liver function abnormality caused by rifampicin in 2 patients, and fever with diarrhea caused by rifampicin in 1 patient. For 2 of these 5 patients, desensitization therapy was applied and REC was able to be reinstated. In the remaining 3 patients, the causative drugs were discontinued and levofloxacin, a new quinolone, was administered. Complete healing was achieved in 5 patients, and recurrence was observed in 2 patients. These 2 patients with recurrence included 1 patient in whom REC was completed and 1 patient in whom REC therapy was modified due to ADE.REC provided relatively good clinical results as a treatment for hand MAC. However, recurrences were observed even after the completion of REC and the use of an alternative drug. Optimal duration of REC and appropriate alternative drugs need to be identified in the future.
Collapse
Affiliation(s)
- Yoshio Kaji
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine
- Department of Rehabilitation Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Osamu Nakamura
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine
| | - Konosuke Yamaguchi
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine
| | - Yumi Nomura
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine
| | - Kunihiko Oka
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine
| |
Collapse
|
9
|
Abstract
Background: Nontuberculous mycobacteria are an uncommon pathogen for musculoskeletal infection and are difficult to treat because of delays in diagnosis, prolonged treatment requiring both antimycobacterial therapy and surgical debridement, and high rates of resistance to antimycobacterial therapy. Case Report: We report the case of an 88-year-old male with recurrent Mycobacterium avium complex tenosynovitis despite receiving multiple courses of pharmacologic therapy and surgical debridement. Conclusion: Nontuberculous mycobacterial musculoskeletal infections can be difficult to diagnose and equally difficult to treat. A combination of antimycobacterial therapy and surgical debridement is often required; however, the rate of treatment failure remains high, particularly with rapidly growing mycobacteria such as Mycobacterium avium.
Collapse
|
10
|
Kitagawa A, Nakamura T, Hashimoto Y. Infectious Rice Body Formation in a Patient with Anti-aminoacyl-t RNA Synthetase Syndrome: A Case Report. JBJS Case Connect 2020; 10:e20.00205. [PMID: 33512928 DOI: 10.2106/jbjs.cc.20.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An adult woman with anti-aminoacyl-t RNA synthetase syndrome developed pain and swelling of both hands and her left forearm, initially diagnosed as seronegative rheumatoid arthritis. Surgical exploration revealed multiple "rice bodies," and the specimen grew Mycobacterium intracellurale. She subsequently received antibiotic therapy. CONCLUSION In the diagnosis of rice body formation in musculoskeletal tissues, it is necessary to consider not only rheumatic diseases but also mycobacterial infection.
Collapse
Affiliation(s)
- Atsushi Kitagawa
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Hyogo, Japan.,Department of Rheumatoligy, Hyogo Rehabilitation Center Hospital, Hyogo, Japan
| | - Tomoko Nakamura
- Department of Rheumatoligy, Hyogo Rehabilitation Center Hospital, Hyogo, Japan
| | - Yasushi Hashimoto
- Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Hyogo, Japan
| |
Collapse
|
11
|
Bianchi S, Hoffman DF, Tamborrini G, Poletti PA. Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2469-2482. [PMID: 32459879 DOI: 10.1002/jum.15349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
The most common etiology of carpal tunnel syndrome (CTS) is idiopathic. However, secondary causes of CTS should be considered when symptoms are unilateral, or electrodiagnostic studies are discrepant with the clinical presentation. Imaging of the carpal tunnel should be performed when secondary causes of CTS are suspected. An ultrasound evaluation of the carpal tunnel can assess for pathologic changes of the median nerve, detect secondary causes of CTS, and aid in surgical planning.
Collapse
Affiliation(s)
- Stefano Bianchi
- Cabinet d'Imagerie Médicale SA, Geneva, Switzerland
- Division of Radiology, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Giorgio Tamborrini
- Ultraschall Zentrum Rheumatologie Aeschenvorstadt, Basel, Switzerland
- Rheumatology University Hospital Basel, Basel, Switzerland
| | | |
Collapse
|
12
|
Cheema K, Raad M, Sehjal R, Virani S, Relwani J. Atypical mycobacterium infection of sternoclavicular joint: A unique case. Shoulder Elbow 2020; 12:349-352. [PMID: 33093873 PMCID: PMC7545528 DOI: 10.1177/1758573219859466] [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: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
We report a rare case of atypical Mycobacterium intracellulare infection encountered in a left sternoclavicular joint of an immunocompetent patient. The 34-year-old female patient presented with a one-year history of left sternoclavicular joint pain and swelling. The patient had multiple radiological investigations, which were suspicious for an infective cause. The patient had a biopsy of the joint, which returned showing acid-fast bacilli. The patient consequently received a prolonged course of medical treatment for M. intracellulare.
Collapse
Affiliation(s)
- K Cheema
- K Cheema, William Harvey Hospital – Trauma and Orthopaedics, Kennington Road, Ashford TN24 0LZ, UK.
| | | | | | | | | |
Collapse
|
13
|
Abstract
Mycobacterial hand infections are uncommon. These infections have an indolent course and are marked by variable and nonspecific presentations, often leading to diagnostic and treatment delays. The pathogens involved in mycobacterial hand infections include Mycobacterium tuberculosis complex, atypical mycobacteria, and M leprae. Initial treatment involves a combination of long-term antibiotics and surgical débridement to cure the infection. Reconstructive procedures aid in restoring hand function lost secondary to the disease.
Collapse
Affiliation(s)
- Abdo Bachoura
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA
| | - David S Zelouf
- The Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA.
| |
Collapse
|
14
|
Horseshoe abscess of the hand with rice bodies secondary to mycobacterium avium intracellulare infection. Clin Imaging 2020; 63:24-29. [PMID: 32120309 DOI: 10.1016/j.clinimag.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 01/01/2023]
Abstract
A horseshoe abscess is caused by infection that spreads between the flexor tendon sheath of the thumb or little finger through the radial and ulnar bursae through communication between the two and/or the space of Parona. We present a case of an 80-year-old woman with rheumatoid arthritis who presented with 6 months of right hand and wrist soft tissue swelling, initially treated as a rheumatoid arthritis flare. MRI demonstrates the horseshoe abscess and after surgical irrigation and debridement with synovectomy, cultures demonstrated infection with mycobacterium avium intracellulare (MAI). This case demonstrates the importance of MRI in diagnosing and evaluating the extent of hand infections and for considering mycobacterial organisms for appropriate treatment and antibiotic regimen.
Collapse
|
15
|
Huayllani MT, Sisti A, Boczar D, Restrepo DJ, Parker AS, Sarabia-Estrada R, Rinker BD, Forte AJ. Chronic Tenosynovitis of the Upper Extremities Caused by Mycobacterium kansasii : A Clinical Case and Systematic Review of Literature. Indian J Plast Surg 2020; 53:25-35. [PMID: 32367915 PMCID: PMC7192657 DOI: 10.1055/s-0040-1709377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Chronic tenosynovitis of the upper extremities caused by Mycobacterium kansasii ( M. kansasii ) is uncommon, but symptoms may overlap with other more common diseases. Late diagnosis and treatment can lead to disfiguration of structures and rupture of tendons, resulting in worse cosmetic outcomes after reconstruction. Methods We present a clinical case and literature review of M. kansasii in patients with chronic tenosynovitis of upper extremities. PubMed was queried for cases of upper extremities tenosynovitis caused by M. kansasii . The keywords " M. kansasii ," "tenosynovitis" and synonyms were used for search in different combinations. Manuscripts, with no specific data or another condition, where the infection was not located in the upper extremities, were reviews, or not in English, were excluded from the study. Results We described 23 reported cases of tenosynovitis of the upper extremity caused by M. kansasii . An immunosuppressed state was present in eight (34.8%) cases, and 12 (52.2%) patients received immunosuppressive treatment. A long-time period between the first appearance of symptoms and the definitive diagnosis was identified (median: 7 months, interquartile range: 9). The most frequent symptoms were local swelling (65.2%), pain (56.5%), mass effect (26%), and stiffness (13%). Tendon rupture was found in three (13%) patients as a complication of the disease. Moreover, seven (30.4%) patients underwent previous surgeries to try to relieve the symptoms before definitive diagnosis was achieved. Conclusion M. kansasii is an important differential causal pathogen for tenosynovitis of the upper extremities. Although rare, raising awareness about this infectious disease is imperative to avoid inadequate management and hazardous aesthetic sequelae.
Collapse
Affiliation(s)
- Maria T. Huayllani
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrea Sisti
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - David J. Restrepo
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Alexander S. Parker
- University of Florida, College of Medicine, Jacksonville, Florida, United States
| | | | - Brian D. Rinker
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| |
Collapse
|
16
|
Ward C, Milam G. Atypical Mycobacterial Septic Arthritis of the Wrist: A Report of Two Cases. JBJS Case Connect 2019; 8:e42. [PMID: 29952776 DOI: 10.2106/jbjs.cc.17.00222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASES Two patients with human immunodeficiency virus (HIV) developed wrist pain following the initiation of antiretroviral treatment, and were diagnosed with chronic atypical mycobacterial septic arthritis. Aggressive operative debridement led to clinical improvement, provided tissue samples for diagnosis, and allowed for a targeted long-term antibacterial regimen. CONCLUSION Clinicians should consider atypical mycobacterial organisms as a cause of joint infection in patients with HIV. Symptoms may become apparent after patients experience immune system recovery following antiretroviral treatment.
Collapse
Affiliation(s)
- Christina Ward
- Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, Saint Paul, Minnesota
| | - Graham Milam
- Lankford Hand Surgery Association, Dallas, Texas
| |
Collapse
|
17
|
Abstract
Infections of the hand are common entities that are frequently encountered by orthopaedic surgeons and primary care physicians. A high clinical suspicion and a thorough medical history with information about the social and working history of the patients, correct identification of the type and cause of the infection, and prompt initiation of appropriate treatment by the infectious diseases physicians and orthopaedic surgeons are required. Late diagnosis and inappropriate treatment may be a significant cause of morbidity for the hand and mortality for the patients. This article reviews the clinical spectrum and microbiology of the most common infections of the hand, and discusses the current concepts for their treatment. The aim is to increase the awareness of the treating physicians of the diagnosis and management of infections in the hand.
Cite this article: EFORT Open Rev 2019;4:183-193. DOI: 10.1302/2058-5241.4.180082
Collapse
Affiliation(s)
- Dimitrios A Flevas
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sophia Syngouna
- Department of Upper Extremity Surgery and Microsurgery, KAT Hospital, Athens, Greece
| | - Emmanouel Fandridis
- Department of Upper Extremity Surgery and Microsurgery, KAT Hospital, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
18
|
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.
Collapse
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.
| |
Collapse
|
19
|
Saraya T, Fukuoka K, Maruno H, Komagata Y, Fujiwara M, Kaname S, Arimura Y, Yamada A, Takizawa H. Tenosynovitis with Rice Body Formation Due to Mycobacterium Intracellulare Infection After Initiation of Infliximab Therapy. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:656-662. [PMID: 29875354 PMCID: PMC6020799 DOI: 10.12659/ajcr.908785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Female, 74 Final Diagnosis: Tenosynovitis Symptoms: Arthralgia • pain Medication: — Clinical Procedure: — Specialty: Infectious Diseases
Collapse
Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicne, Mitaka, Tokyo, Japan
| | - Kazuhito Fukuoka
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hideto Maruno
- Department of Orthopedics, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yoshinori Komagata
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Masachika Fujiwara
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shinya Kaname
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yoshihiro Arimura
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Akira Yamada
- Department of Rheumatology and Nephrology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| |
Collapse
|
20
|
Smidt KP, Stern PJ, Kiefhaber TR. Atypical Mycobacterial Infections of the Upper Extremity. Orthopedics 2018; 41:e383-e388. [PMID: 29570764 DOI: 10.3928/01477447-20180320-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/22/2018] [Indexed: 02/03/2023]
Abstract
Atypical mycobacterial infections of upper extremity synovial-lined structures are often misdiagnosed and unrecognized. Despite an increasing incidence, lack of physician awareness of these pathogens may result in considerable delay in diagnosis and management, potentially leading to permanent disability. The authors conducted a literature review and analyzed 31 cases of penetrating atypical mycobacterial infection to better understand the clinical characteristics and to evaluate their posttreatment complication rate compared with available literature. Medical records for culture-positive cases of tenosynovial or intra-articular atypical mycobacterial infections of the upper extremity that were treated were retrospectively reviewed. Treatment outcomes were analyzed against published case reviews and case series. Thirty-one cases of penetrating atypical mycobacterial infection were identified. Mycobacterium marinum (n=11) was the most common organism and was associated with aquatic exposure. Twenty-eight cases received empiric treatment, 17 of which received contraindicated treatment. Patients saw an average of 5 physicians prior to receiving an accurate diagnosis, and the mean time to diagnosis was 10 months. All cases received antibiotic treatment in addition to surgical management. Twenty cases (68%) failed treatment outcomes. Delay in diagnosis and inappropriate management of atypical mycobacterial infections may lead to a treatment failure rate that is higher than what has been reported in the literature. Mycobacterium avium and M fortuitum had significantly higher failure rates than other organisms. A high index of suspicion is required to make a diagnosis and prevent residual disability. [Orthopedics. 2018; 41(3):e383-e388.].
Collapse
|
21
|
Kazmers NH, Fryhofer GW, Gittings D, Bozentka DJ, Steinberg DR, Gray BL. Acute Deep Infections of the Upper Extremity: The Utility of Obtaining Atypical Cultures in the Presence of Purulence. J Hand Surg Am 2017; 42:663.e1-663.e8. [PMID: 28550986 DOI: 10.1016/j.jhsa.2017.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/16/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE In the setting of acute deep upper extremity infections, evidence is lacking to guide the decision whether to send atypical cultures (fungal and acid-fast-bacillus [AFB]) during surgical debridement, especially in the presence of purulent fluid that is commonly observed with typical bacterial infections. Our purpose was to determine the frequency of positive atypical cultures and the frequency with which they alter treatment, and identify factors associated with positive atypical cultures. METHODS We retrospectively identified 100 adult patients undergoing surgical debridement of acute deep infections of the upper extremity in which fungal and/or AFB cultures were sent. Necrotizing and superficial infections were excluded. Descriptive statistics were used to describe patient characteristics, infection diagnoses, number of cultures sent with corresponding rates of positivity, and treatments. Cohorts with positive and negative atypical cultures were compared with bivariate analysis for all collected variables. RESULTS One or more immunocompromising comorbidities were present in 46% of patients. Diagnoses included soft tissue abscess (46%), suppurative flexor tenosynovitis (22%), septic arthritis (21%), osteomyelitis (9%), and septic bursitis (2%). Aerobic bacterial, anaerobic bacterial, fungal, and AFB cultures were sent in 100%, 99%, 94%, and 82% of patients, respectively. Corresponding rates of positivity were 74%, 34.3%, 5.3%, and 2.4%, respectively. Atypical cultures were positive for 7% of patients and 2.9% of all atypical tests sent. Antibiotic treatment was influenced by atypical culture data for 4% of patients. For patients with positive atypical cultures, purulence was observed during surgery in 86% of cases. Bivariate analysis demonstrated symptom duration greater than 7 days as potentially associated with atypical culture positivity. CONCLUSIONS Intraoperative purulence at the time of surgical intervention should not deter the surgeon from obtaining atypical cultures. As expected, atypical cultures are infrequently positive given the rarity of associated diseases. Symptoms greater than 7 days may predict a higher incidence of atypical culture positivity for patients being treated surgically within 30 days of initial symptom onset. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
Collapse
Affiliation(s)
| | - George W Fryhofer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | |
Collapse
|
22
|
Monoartritis séptica erosiva y osteomielitis de la muñeca por Mycobacterium intracellulare en un paciente inmunocompetente. Med Clin (Barc) 2017; 149:44-45. [DOI: 10.1016/j.medcli.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 01/25/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
|
23
|
Abstract
Atypical infections of the hand are caused by organisms such as Mycobacterium, fungi, and viruses, and often do not respond to conventional management. They exist within a wide spectrum of presentations, ranging from cutaneous lesions to deep infections such as tenosynovitis and osteomyelitis. Having a high clinical suspicion for atypical hand infections is vital because diagnosis often requires special tests and/or cultures. Obtaining a detailed medical, work, and travel history is extremely important. An indolent clinical course, late diagnosis, and delayed treatment are common. In addition to medical therapies, surgical debridement is often required to effectively treat these infections.
Collapse
|
24
|
Abstract
ABSTRACT
Mycobacterium marinum
is a well-known pathogenic mycobacterium for skin and soft tissue infections and is associated with fishes and water. Among nontuberculous mycobacteria (NTM), it is the leading cause of extrarespiratory human infections worldwide. In addition, there is a specific scientific interest in
M. marinum
because of its genetic relatedness to
Mycobacterium tuberculosis
and because experimental infection of
M. marinum
in fishes mimics tuberculosis pathogenesis. Microbiological characteristics include the fact that it grows in 7 to 14 days with photochromogenic colonies and is difficult to differentiate from
Mycobacterium ulcerans
and other mycolactone-producing NTM on a molecular basis. The diagnosis is highly suspected by the mode of infection, which is related to the hobby of fishkeeping, professional handling of marine shells, or swimming in nonchlorinated pools. Clinics distinguished skin and soft tissue lesions (typically sporotrichoid or subacute hand nodules) and lesions disseminated to joint and bone, often related with the local use of corticosteroids. In clinical microbiology, microscopy and culture are often negative because growth requires low temperature (30°C) and several weeks to succeed in primary cultivation. The treatment is not standardized, and no randomized control trials have been done. Therapy is a combination of surgery and antimicrobial agents such as cyclines and rifampin, with successful outcome in most of the skin diseases but less frequently in deep tissue infections. Prevention can be useful with hand protection recommendations for professionals and all persons manipulating fishes or fish tank water and use of alcohol disinfection after contact.
Collapse
|
25
|
Abstract
Background: Atypical mycobacterial infections are uncommon and characterized by a chronic, indolent course before diagnosis. Historically, these infections are associated with marine-related injury and/or immune dysfunction. Our institution has successfully diagnosed and treated an increasing number of these infections. The objective of this study is to review our experience with these rare infections and verify the developing trends encountered. Methods: A retrospective review was performed for patients with positive nontuberculous mycobacterial cultures of the upper extremity from 2000 to 2013. Patient demographics, source of transmission, symptom duration, mycobacterial species, operative and antibiotic treatments, and outcomes were recorded. Results: Thirty-four patients were identified. The mean symptomatic period before diagnosis was 9 months (range, 1-60 months). Fourteen patients had identifiable causes of immune dysfunction while the rest appeared immune competent. Patients were infected by Mycobacterium marinum (n = 14), Mycobacterium abscessus (n = 8), Mycobacterium fortuitum (n = 7), and other less common species (n = 5). Although most patients had unidentifiable causes of infection (n = 15), some could correlate infection to marine injury, lacerations, insect bites, animal bites, and tattoos. All patients received operative intervention including debridement. Antibiotics were given for a mean duration of 5 months. Ninety-seven percent had complete resolution of disease. Conclusions: Although M. marinum infections make up the majority of infections at our institution, we report a higher total incidence of nonmarinum infections. These infections are occurring in seemingly healthy individuals with no history of exposure with marine water. Successful treatment relies on having a heightened clinical awareness and adequate diagnosis.
Collapse
Affiliation(s)
| | - Julie Croley
- University of Texas Medical Branch, Galveston, USA
| | - Kevin D. Murphy
- University of Texas Medical Branch, Galveston, USA,Kevin D. Murphy, Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard Route 0724, Galveston, TX 77555, USA.
| |
Collapse
|
26
|
Coexistent Pseudogout and Mycobacterium avium-intracellulare Septic Arthritis in a Patient with HIV and ESRD. Case Rep Rheumatol 2016; 2016:5495928. [PMID: 27803833 PMCID: PMC5075596 DOI: 10.1155/2016/5495928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/28/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022] Open
Abstract
Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD). Septic arthritis due to Mycobacterium avium-intracellulare (MAI) is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC) count in the synovial fluid analysis, she was empirically started on intravenous (IV) vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB) culture was still in process. Seventeen days later, AFB culture grew Mycobacterium avium-intracellulare (MAI), and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.
Collapse
|
27
|
Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-Tissue Infections and Their Imaging Mimics: From Cellulitis to Necrotizing Fasciitis. Radiographics 2016; 36:1888-1910. [DOI: 10.1148/rg.2016160068] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Mycobacterium arupense, Mycobacterium heraklionense, and a Newly Proposed Species, "Mycobacterium virginiense" sp. nov., but Not Mycobacterium nonchromogenicum, as Species of the Mycobacterium terrae Complex Causing Tenosynovitis and Osteomyelitis. J Clin Microbiol 2016; 54:1340-51. [PMID: 26962085 DOI: 10.1128/jcm.00198-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium terrae complex has been recognized as a cause of tenosynovitis, with M. terrae and Mycobacterium nonchromogenicum reported as the primary etiologic pathogens. The molecular taxonomy of the M. terrae complex causing tenosynovitis has not been established despite approximately 50 previously reported cases. We evaluated 26 isolates of the M. terrae complex associated with tenosynovitis or osteomyelitis recovered between 1984 and 2014 from 13 states, including 5 isolates reported in 1991 as M. nonchromogenicum by nonmolecular methods. The isolates belonged to three validated species, one new proposed species, and two novel related strains. The majority of isolates (20/26, or 77%) belonged to two recently described species: Mycobacterium arupense (10 isolates, or 38%) and Mycobacterium heraklionense (10 isolates, or 38%). Three isolates (12%) had 100% sequence identity to each other by 16S rRNA and 99.3 to 100% identity by rpoB gene region V sequencing and represent a previously undescribed species within the M. terrae complex. There were no isolates of M. terrae or M. nonchromogenicum, including among the five isolates reported in 1991. The 26 isolates were susceptible to clarithromycin (100%), rifabutin (100%), ethambutol (92%), and sulfamethoxazole or trimethoprim-sulfamethoxazole (70%). The current study suggests that M. arupense, M. heraklionense, and a newly proposed species ("M. virginiense" sp. nov.; proposed type strain MO-233 [DSM 100883, CIP 110918]) within the M. terrae complex are the major causes of tenosynovitis and osteomyelitis in the United States, with little change over 20 years. Species identification within this complex requires sequencing methods.
Collapse
|
29
|
Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature. IDCases 2015; 2:59-62. [PMID: 26793457 PMCID: PMC4672609 DOI: 10.1016/j.idcr.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/02/2015] [Accepted: 04/05/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction Nontuberculous mycobacteria are an uncommon cause of septic olecranon bursitis, though cases have increasingly been described in both immunocompromised and immunocompetent hosts. Guidelines recommend a combination of surgical resection and antimicrobials for treatment. This case is the first reported case of nontuberculous mycobacterial olecranon bursitis that resolved without medical or surgical intervention. Case presentation A 67-year-old female developed a painless, fluctuant swelling of the olecranon bursa following blunt trauma to the elbow. Due to persistent bursal swelling, she underwent three separate therapeutic bursal aspirations, two involving intrabursal steroid injection. After the third aspiration, the bursa became erythematous and severely swollen, and bursal fluid grew Mycobacterium avium complex. Triple-drug antimycobacterial therapy was initiated, but discontinued abruptly due to a rash. Surgery was not performed. The patient was observed off antimicrobials, and gradually clinically improved with a compressive dressing. By 14 months after initial presentation, clinical exam revealed complete resolution of the previously erythematous bursal mass. Discussion This is the first reported case of nontuberculous mycobacterial olecranon bursitis managed successfully without surgery or antimicrobials. Musculoskeletal nontuberculous mycobacterial infections are challenging given the lack of clinical data about optimal duration and choice of antimicrobials or the role of surgery. Additionally, the potential toxicity and drug interactions of antimycobacterials are not insignificant and warrant close monitoring if treatment is pursued. Conclusion This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures.
Collapse
|
30
|
Wells D, Strickland C, Schowinsky J, Lindeque B. Nontuberculous Mycobacterial Tenosynovitis:AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2015; 35:493-7. [DOI: 10.1148/rg.352140028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
31
|
Nguyen A, Ipaktchi K, Livermore M, Banegas R. Mycobacterium chelonae infection of the hand presenting as a collar-button abscess. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:149-51. [PMID: 25609291 DOI: 10.1142/s0218810415720041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mycobacterial infections of the hand are extremely rare, with Mycobacterium chelonae being an especially uncommon source of infection. The following is a report of such an infection presenting as a collar-button abscess. The difficulty of isolating the organism, in addition to a low index of suspicion for it, resulted in a significant delay in appropriate treatment. The patient demonstrated an indolent course of infection and unresponsiveness to traditional treatments, both red flags that should raise concern for a mycobacterial cause. Eventually, repeated irrigation and debridement and a prolonged course of antibiotics resulted in the resolution of the patient's symptoms.
Collapse
Affiliation(s)
- Amy Nguyen
- University of Colorado School of Medicine, USA
| | | | | | | |
Collapse
|
32
|
Jing SS, Teare L, Iwuagwu F. Mycobacterium kanasii flexor tenosynovitis of the finger. ACTA ACUST UNITED AC 2014; 19:249-51. [PMID: 24875513 DOI: 10.1142/s0218810414720204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report an extreme case of Mycobacterium kanasii flexor tenosynovitis with flexor tendon rupture in a healthy 65-year-old left-hand dominant Caucasian housewife. This case highlights the diagnostic conundrum of atypical mycobacteria infections due to their insidious presentation, the need for a high index of suspicion to prevent worsening or delaying the diagnosis from inappropriate steroid use and that these infections can occur in otherwise healthy individuals.
Collapse
Affiliation(s)
- S S Jing
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Court Road, CM1 7ET, Chelmsford, Essex, UK
| | | | | |
Collapse
|
33
|
Yano K, Yoshida T, Minoda Y, Horiki M, Denno K, Yoneda M, Tada K. Clinical outcome of the chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterium treated by extensive tenosynovectomy and drugs. J Plast Surg Hand Surg 2013; 47:434-7. [PMID: 23875916 DOI: 10.3109/2000656x.2013.776560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chronic flexor tenosynovitis in the hand caused by non-tuberculous mycobacterial (NTM) infection is uncommon. Although some authors have recommended combining surgical and drug therapy, there are few reports about the timing of drug administration after operation. The purpose of this retrospective study was to analyse the clinical outcome of the protocol, which consisted of extensive tenosynovectomy and drug therapy administered after culture results had been obtained. Four men and one woman were included. Average age was 57.4 years and average follow-up period was 46.7 months. Extensive tenosynovectomy was performed and surgical specimen was examined histopathologically and microbiologically. After a positive culture result had been obtained, three kinds of drugs were administered. Clinical outcome including infectious condition, range of motion, and grip strength was examined. All patients were immunocompetent and had no underlying disease. Three patients were diagnosed at first operation and two were diagnosed at second operation. The average period of drug therapy was 5.5 months. In four patients, infection resolved with combination therapy. In one patient with surgical treatment, only swelling remained. Osteomyelitis of the scaphoid was found in one patient to whom systemic steroid had been administered because of a negative culture result at first operation. For immunocompetent patients, flexor tenosynovitis in the hand caused by NTM was resolved with a combination of surgical and drug treatment. Drug treatment seemed to be essential after a reduction of the infectious lesion and the timing of administration was safe enough to resolve in four patients.
Collapse
Affiliation(s)
- Koichi Yano
- Department of Orthopaedic Surgery, Kansai Rosai Hospital , Amagasaki City, Hyogo , Japan
| | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Mycobacterium terrae is an unusual, ubiquitous organism that can cause clinical disease in both immunocompetent and immunocompromised hosts and can be difficult to diagnose and treat. We report a case of a 61-year-old man with a septic knee whose arthroscopy cultures grew M. terrae. The patient was successfully treated using a 6-month regimen of clarithromycin and sulfamethoxazole. Mycobacterium terrae should be considered in the differential diagnoses for monoarticular swelling and pain of unknown etiology, especially in the setting of initially negative routine microbiological cultures.
Collapse
|
35
|
Lee EY, Ip JWY, Fung BKK, Ted U E. MYCOBACTERIUM CHELONAE HAND INFECTION: A REVIEW. ACTA ACUST UNITED AC 2011; 14:7-13. [PMID: 19598315 DOI: 10.1142/s0218810409004219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 03/16/2009] [Accepted: 04/10/2009] [Indexed: 11/18/2022]
Abstract
Six cases of culture-proven Mycobacterium chelonae tenosynovitis were identified through retrospective chart review. Fifteen cases were identified using computerised Medline search. Clinical features, treatment and outcome were described. Infection control was achieved in our patients with an average of 3.2 surgeries each and antibiotic treatment for six months to one year. Eleven published cases were managed by combined surgery and systemic antibiotics, with an average of 1.73 surgeries per patient and seven weeks to 24 months of antibiotics. All our patients were disease free on final follow-up. Thirteen cases were resolved. Functional outcomes were reported for eight cases. Comparison of functional outcome was not possible because different parameters were used in different reports. Aggressive debridement, susceptibility-guided antibiotics, and supervised rehabilitation resulted in infection control and acceptable hand function for our patients. Standardised data collection on subsequent cases would facilitate outcome monitoring and formulation of a treatment guideline for this disease.
Collapse
Affiliation(s)
- Ellen Y. Lee
- Division of Hand and Foot Surgery, Department of Orthopaedics and Traumatology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Josephine Wing-Yuk Ip
- Division of Hand and Foot Surgery, Department of Orthopaedics and Traumatology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Boris Kwok Keung Fung
- Division of Hand and Foot Surgery, Department of Orthopaedics and Traumatology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Edmond Ted U
- Division of Hand and Foot Surgery, Department of Orthopaedics and Traumatology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| |
Collapse
|
36
|
|
37
|
Moores CD, Grewal R. Radical surgical debridement alone for treatment of carpal tunnel syndrome caused by mycobacterium avium complex flexor tenosynovitis: case report. J Hand Surg Am 2011; 36:1047-51. [PMID: 21571445 DOI: 10.1016/j.jhsa.2011.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 03/08/2011] [Accepted: 03/08/2011] [Indexed: 02/02/2023]
Abstract
We present a case of proliferative flexor tenosynovitis caused by Mycobacterium avium complex resulting in recurrent symptoms of median nerve compression. The patient was treated with radical tenosynovectomy and release of the carpal tunnel without antimicrobial therapy. She remains symptom-free and is apparently disease-free more than 2 years after surgery.
Collapse
Affiliation(s)
- Carl D Moores
- Department of Orthopedic Surgery, Memorial University of Newfoundland, Newfoundland
| | | |
Collapse
|
38
|
Kang GH, Kim SH, Lee HY, Seo HW, Song EH, Lee KW, Kim SS. A Case of Arthritis due to Mycobacterium Intracellulare in a Immunocompetent Patient. JOURNAL OF RHEUMATIC DISEASES 2011. [DOI: 10.4078/jrd.2011.18.2.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gyung-Hoon Kang
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sung-Hoon Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hong-Yeul Lee
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyun-Woong Seo
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Eun-Hee Song
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Ki-Won Lee
- Department of Orthopedics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sung-Soo Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| |
Collapse
|
39
|
Kang GCW, Gan AWT, Yam A, Tan ABH, Tay SC. Mycobacterium abscessus Hand Infections in Immunocompetent Fish Handlers: Case Report. J Hand Surg Am 2010; 35:1142-5. [PMID: 20610060 DOI: 10.1016/j.jhsa.2010.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 04/10/2010] [Accepted: 04/14/2010] [Indexed: 02/02/2023]
Abstract
Mycobacterium abscessus hand infections are rare and usually occur in immunocompromised patients or after injection with contaminated injectables. This article describes 2 cases of M abscessus infection of the hand in otherwise healthy fish handlers. Mycobacterium abscessus can cause severe chronic tenosynovitis even in immunocompetent patients and should be suspected alongside the more common M marinum as a cause of nontuberculous mycobacterial hand infections in patients with aquatic and fish exposure.
Collapse
Affiliation(s)
- Gavin C W Kang
- Department of Hand Surgery, Singapore General Hospital, Singapore.
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Abrams R, Savoia M, Vinetz J, Dacus AR. Indolent infectious tenosynovitis afflicting rheumatoid patients treated with tumor necrosis factor inhibitors: case report. J Hand Surg Am 2010; 35:909-12. [PMID: 20350799 DOI: 10.1016/j.jhsa.2010.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 01/24/2010] [Accepted: 01/26/2010] [Indexed: 02/02/2023]
Abstract
Tumor necrosis factor (TNF) is a cytokine associated with the pathogenesis of rheumatoid arthritis. Tumor necrosis factor inhibitors have become important biological treatments that favorably alter the natural history of rheumatoid disease. Side effects include an increased risk of malignancy and infection, particularly tuberculosis. We present 2 patients with rheumatoid arthritis on TNF inhibitors in whom flares of wrist tenosynovitis, initially diagnosed as rheumatoid disease exacerbations, were caused by infections with uncommon opportunistic pathogens. Diagnostic and treatment recommendations for this subset of rheumatoid patients are discussed.
Collapse
Affiliation(s)
- Reid Abrams
- Department of Orthopaedic Surgery, University of California, San Diego, School of Medicine, San Diego, CA 92103-8894, USA.
| | | | | | | |
Collapse
|
42
|
Rust PA, Bennett T. An uncommon cause for a common complaint. ACTA ACUST UNITED AC 2010; 14:131-4. [PMID: 20135741 DOI: 10.1142/s0218810409004360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 08/10/2009] [Accepted: 10/19/2009] [Indexed: 11/18/2022]
Abstract
Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.
Collapse
Affiliation(s)
- P A Rust
- Victorian Hand Surgery Associates, St. Vincent's Hospital, Fitzroy, Australia.
| | | |
Collapse
|
43
|
Bauer AS, Blazar PE, Earp BE, Simmons BP. Mycobacterial hand infections occurring postoperatively in patients treated with tumor necrosis factor-alpha inhibitors for inflammatory arthritis: report of three cases. J Hand Surg Am 2010; 35:104-8. [PMID: 20117311 DOI: 10.1016/j.jhsa.2009.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 09/19/2009] [Accepted: 09/25/2009] [Indexed: 02/02/2023]
Abstract
Tumor necrosis factor-alpha inhibitors are potent anti-rheumatic drugs, but there is evidence that the high level of immunosuppression they provide may also lead to a higher risk of infections. At our institution, 3 patients with inflammatory arthritis treated with tumor necrosis factor-alpha inhibitors developed mycobacterial soft tissue infections after routine hand surgery. All 3 patients required multiple surgical procedures, inpatient hospitalizations, and prolonged antibiotic multidrug therapy to clear the infections.
Collapse
Affiliation(s)
- Andrea S Bauer
- Division of Hand Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | | | | |
Collapse
|
44
|
Garrigues GE, Aldridge JM, Toth AP, Stout JE. Nontuberculous mycobacterial olecranon bursitis: case reports and literature review. J Shoulder Elbow Surg 2008; 18:e1-5. [PMID: 19019704 DOI: 10.1016/j.jse.2008.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/30/2008] [Accepted: 07/12/2008] [Indexed: 02/01/2023]
Affiliation(s)
- Grant E Garrigues
- Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | |
Collapse
|
45
|
Abstract
We report three cases of mycobacterium marinum infection, characterized by the long duration before a proper diagnosis was made. Mycobacterium marinum is a so-called atypical non-tuberculous mycobacterium, found in salt and fresh water, occasionally infecting humans. Most of the infections involve the fingers and hand, after exposure to contaminated water. It is commonly called fish tank infection. The clinical pictures can be very different: from a small cutaneous lesion to deep-seated infections of the tendon sheet or joint. Special transport and culture techniques are required for proper diagnosis. Besides surgical treatment of chronic skin lesions and deep infections, prolonged treatment with appropriate antibiotics is required.
Collapse
Affiliation(s)
- L. De Smet
- Department of Orthopaedic Surgery, U.Z. Pellenberg, Lubbeek, Belgium
| |
Collapse
|
46
|
|
47
|
Taieb A, Ikeguchi R, Yu VL, Rihs JD, Sharma M, Wolfe J, Wollstein R. Mycobacterium monacense: a mycobacterial pathogen that causes infection of the hand. J Hand Surg Am 2008; 33:94-6. [PMID: 18261672 DOI: 10.1016/j.jhsa.2007.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 07/31/2007] [Accepted: 10/23/2007] [Indexed: 02/02/2023]
Abstract
We present a report of a diabetic patient with an infection of his left thumb and thenar eminence. Standard cultures of drainage and tissue biopsy were unrevealing. The infection progressed despite empiric antibacterial agent therapy and multiple debridements. Two intraoperative tissue biopsies revealed a yellow-pigmented, rapidly growing Mycobacterial nontuberculous species. The organism was identified as Mycobacterium monacense, a newly described species. The patient was cured with a 6-week course of clarithromycin and levofloxacin.
Collapse
Affiliation(s)
- Aurele Taieb
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Lorenz HM, Dalpke AH, Deboben A, Ho AD, Greiner A, Jung M, Fiehn C. Mycobacterium kansasii tenosynovitis in a rheumatoid arthritis patient with long-term therapeutic immunosuppression. ACTA ACUST UNITED AC 2008; 59:900-3. [DOI: 10.1002/art.23717] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
49
|
Tsai HC, Kunin CM, Lee SSJ, Chen YS, Wann SR, Liu YW, Liu YC. Fish gambler's tenosynovitis caused by Mycobacterium marinum: environmental investigation of a fishing pond in Southern Taiwan. Diagn Microbiol Infect Dis 2007; 59:227-30. [PMID: 17572037 DOI: 10.1016/j.diagmicrobio.2007.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 03/28/2007] [Accepted: 04/16/2007] [Indexed: 10/23/2022]
Abstract
We describe a patient with Mycobacterium marinum tenosynovitis associated with a fish spine injury acquired at a gambling fishing pond in southern Taiwan and identify the source of the infection. M. marinum was isolated from fishing ponds and underground water and wastewater at the site. The isolates shared the same pulsed-field gel electrophoresis pattern as the patient. M. marinum was not detected in 54 samples obtained from 27 fish. Mycobacterium gordonae was isolated from 24 samples collected from the fish. Mycobacterium abscessus was isolated from 3 fish samples (Lateolabrax japonicus 1 and Sciaenops ocellatus 2). M. abscessus and M. gordonae were isolated from all water samples. This investigation provides strong evidence that the predisposing factor for the M. marinum infection was with a fish spine injury acquired at a gambling fishing pond. The source of the infection was the contaminated pond water.
Collapse
Affiliation(s)
- Hung-Chin Tsai
- Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, 81362, Taiwan, Republic of China
| | | | | | | | | | | | | |
Collapse
|
50
|
Murdoch DM, McDonald JR. Mycobacterium avium-intracellulare cellulitis occurring with septic arthritis after joint injection: a case report. BMC Infect Dis 2007; 7:9. [PMID: 17324257 PMCID: PMC1829162 DOI: 10.1186/1471-2334-7-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/26/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cellulitis caused by Mycobacterium avium-intracellulare has rarely been described. Mycobacterium avium-intracellulare is a rare cause of septic arthritis after intra-articular injection, though the causative role of injection is difficult to ascertain in such cases. CASE PRESENTATION A 57-year-old with rheumatoid arthritis treated with prednisone and azathioprine developed bilateral painful degenerative shoulder arthritis. After corticosteroid injections into both acromioclavicular joints, he developed bilateral cellulitis centered over the injection sites. Skin biopsy showed non-caseating granulomas, and culture grew Mycobacterium avium-intracellulare. Joint aspiration also revealed Mycobacterium avium-intracellulare infection. CONCLUSION Although rare, skin and joint infections caused by Mycobacterium avium-intracellulare should be considered in any immunocompromised host, particularly after intra-articular injection. Stains for acid-fast bacilli may be negative in pathologic samples even in the presence of infection; cultures of tissue specimens should always be obtained.
Collapse
Affiliation(s)
- David M Murdoch
- School of Public Health, CB#7435, McGravran – Greenberg Hall – 2104H, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Division of Pulmonary & Critical Care Medicine, Box 3221, Duke University Medical Center, Durham, NC 27710 USA
| | - Jay R McDonald
- Division of Infectious Diseases, Box 3824, Duke University Medical Center, Durham, NC 27710 USA
| |
Collapse
|