1
|
King V, Crouser N, Speeckaert A, Bhatt R. Infection Management for the Hand Surgeon. Hand Clin 2023; 39:465-473. [PMID: 37453773 DOI: 10.1016/j.hcl.2023.04.003] [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] [Indexed: 07/18/2023]
Abstract
Infections of the upper extremity can be challenging to diagnose and treat because of the complex anatomy and range of offending pathogens. Early recognition of infections that require an emergent surgical intervention, such as necrotizing fasciitis and septic joints, is imperative for good clinical outcomes. In addition, prompt diagnosis and intervention for deep closed space infections, such as deep abscesses or flexor tenosynovitis, is necessary to avoid chronic pain and dysfunction. Complicating factors such as underlying osteomyelitis, atypical pathogens, and immunocompromised states of patients should always be considered when treating upper-extremity infections.
Collapse
Affiliation(s)
- Victor King
- Division of Plastic Surgery, Warren Alpert Medical School fo Brown University, Coop Suite 500, 2 Dudley Street, Providence, RI 02905
| | - Nisha Crouser
- Hand & Upper Extremity Center, Wexner Medical Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA
| | - Amy Speeckaert
- Hand & Upper Extremity Center, Wexner Medical Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA
| | - Reena Bhatt
- Division of Plastic Surgery, Warren Alpert Medical School fo Brown University, 235 Plain Street, Suite 203, Providence, RI 02905.
| |
Collapse
|
2
|
Pai G M, Bhat AK, M Acharya A, Reddy SP. Unusual presentation of carpal tunnel syndrome due to Mycobacterium marinum infection of hand. BMJ Case Rep 2022; 15:e251692. [PMID: 36535734 PMCID: PMC9764620 DOI: 10.1136/bcr-2022-251692] [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] [Indexed: 12/23/2022] Open
Abstract
We report a case of a fisherman presenting with a rare and unusual carpal tunnel syndrome due to Mycobacterium marinum infection of the hand and wrist. The infection resulted in severe pain, paresthesia and restriction of movement in the hand.Flexor tenosynovectomy, followed by histological and microbiological studies, indicated the presence of atypical mycobacteria. The patient was started on a combination antimicrobial therapy for 6 months. The patient regained full range of motion and returned to perform daily activities with ease.Diagnosis of M. marinum infection of the hand is challenging as the presentation mimics other conditions and may have nonspecific histological findings. This atypical mycobacterium may also show resistance to commonly used antitubercular drugs. Hand surgeons should maintain a high index of suspicion of M. marinum and adopt a multiteam approach to prevent delay in diagnosis for successful treatment.
Collapse
Affiliation(s)
- Mithun Pai G
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil K Bhat
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwath M Acharya
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shreya Pulli Reddy
- Department of Hand surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
3
|
Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature. World J Clin Cases 2022; 10:11908-11920. [PMID: 36405290 PMCID: PMC9669876 DOI: 10.12998/wjcc.v10.i32.11908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery, and there are still many uncertainties regarding its diagnosis and treatment.
CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature. A total of 43 articles and 61 cases were included in the literature review. Our case had a usual presentation: it was similar to those in the literature. The affected population was mainly older adults, with an average age of 59.43 (range, 3 to 90) years. The male-to-female ratio was 1.54:1 (37/24).Most of them showed limited swelling and pain, only 23.0% had carpal tunnel symptoms, and the average disease duration was 18.03 (0.5-60) mo. Wrist flexor tendon sheath involvement was the most common (95.1%, 58/61), and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis (34.4%, 21/61), non-tuberculous mycobacteria (24.6%, 15/61), idiopathic tenosynovitis (31.1%, 19/61), and others (9.84%, 6/61). There were 10 patients with recurrences; in 6 of them, were due to non-tuberculous mycobacterial infections.
CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation, and established a clinical management algorithm for wrist tenosynovitis with rice bodies, which can provide some reference for our clinical diagnosis and treatment. The symptoms of rice-body bursitis of the wrist are insidious, nonspecific, and difficult to identify. The aetiology is mainly idiopathic tenosynovitis and mycobacterial (tuberculosis or non-tuberculous) infections; the latter are difficult to treat and require long-duration systemic combination antibiotic therapies. Therefore, before a diagnosis of idiopathic tenosynovitis is made, we must exclude other causes, especially mycobacterial infections.
Collapse
Affiliation(s)
- Yong Tian
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Hong-Bin Zhou
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai Yi
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| | - Kai-Jian Wang
- Department of Orthopedics, Yichang Yiling Hospital, Yichang 443100, Hubei Province, China
| |
Collapse
|
4
|
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
|
5
|
Cataño J, Sanchez-Bautista J. Osteoarticular Tuberculosis. Am J Trop Med Hyg 2022; 106:tpmd211258. [PMID: 35533698 PMCID: PMC9209908 DOI: 10.4269/ajtmh.21-1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/05/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Juan Cataño
- Section of Infectious Diseases, Department of Internal Medicine, University of Antioquia School of Medicine, Medellín, Colombia
| | - Julian Sanchez-Bautista
- Department of Internal Medicine, University of Antioquia School of Medicine, Medellín, Colombia
| |
Collapse
|
6
|
Wang X, Zhao Q, Li J, Liu Y, Ma S, Liu H, Qin J, Zhang F. Evaluation of early manifestations of spreading pattern
Mycobacterium marinum
infection by ultrasonography. Skin Res Technol 2022; 28:489-490. [PMID: 35368124 PMCID: PMC9907635 DOI: 10.1111/srt.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Xuesong Wang
- First Clinical Medical College Shandong University of Traditional Chinese Medicine Shandong China
| | - Qing Zhao
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Shandong Provincial Institute of Dermatology and Venereology Shandong Academy of Medical Sciences Shandong China
| | - Jianke Li
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Shandong Provincial Institute of Dermatology and Venereology Shandong Academy of Medical Sciences Shandong China
| | - Yongxia Liu
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Shandong Provincial Institute of Dermatology and Venereology Shandong Academy of Medical Sciences Shandong China
| | - Shanshan Ma
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Shandong Provincial Institute of Dermatology and Venereology Shandong Academy of Medical Sciences Shandong China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Shandong Provincial Institute of Dermatology and Venereology Shandong Academy of Medical Sciences Shandong China
| | - Jian Qin
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Radiological Department The Second Affiliated Hospital of Shandong First Medical University Shandong China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases Shandong First Medical University Shandong China
- Shandong Provincial Institute of Dermatology and Venereology Shandong Academy of Medical Sciences Shandong China
| |
Collapse
|
7
|
Yang Z, Feng Y, Li D, Pang Z, Wang S, Chen H, Jiang M, Yan H, Li T, Fu H, Xiong H, Shi D. 5-aminolevulinic acid-photodynamic therapy ameliorates cutaneous granuloma by killing drug-resistant Mycobacterium marinum. Photodiagnosis Photodyn Ther 2022; 38:102839. [PMID: 35367615 DOI: 10.1016/j.pdpdt.2022.102839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although 5-aminolevulinic acid photodynamic therapy (ALA-PDT) has been extensively used to treat various skin diseases, its application to the treatment of cutaneous infection caused by Mycobacterium marinum (M. marinum), especially by drug-resistant M. marinum, is still unclear. OBJECTIVES We evaluated the efficacy of ALA-PDT on M. marinum in a mouse infection model and tested its killing effect on M. marinum in vitro. We also investigated the clinical effect of ALA-PDT on cutaneous granuloma caused by drug-resistant M. marinum. MATERIALS AND METHODS A total of 9 M. marinum strains isolated from patients were tested for anti-mycobacterial susceptibility. The effects of ALA-PDT on M. marinum in vitro and in mice model were investigated. Therapeutic efficacy was further assessed in two patients with cutaneous granuloma caused by drug- resistant M. marinum. RESULTS We demonstrated that ALA-PDT directly killed M. marinum in vitro. The cutaneous lesions on mouse paws caused by M. marinum were fully recovered 4 weeks after the ALA-PDT treatment. ALA-PDT was also effective in two patients with cutaneous infection caused by drug-resistant M. marinum. The level of intracellular ROS in M. marinum treated with ALA-PDT was significantly higher than that of M. marinum alone. CONCLUSIONS The results suggest that ALA-PDT is effective in treating M. marinum cutaneous infections by releasing more reactive oxygen species to kill M. marinum directly, and these effects are independent of systemic immune responses. The data highlights that ALA-PDT is a promising therapeutic choice for treatment of M. marinum cutaneous infections, especially drug-resistant M. marinum infections.
Collapse
Affiliation(s)
- Zhiya Yang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China
| | - Yahui Feng
- College of Clinical Medicine, Jining Medical University, Jining 272067, Shandong, China
| | - Dongmei Li
- Department of Microbiology & Immunology, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Zhiping Pang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China
| | - Sisi Wang
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China
| | - Huiqi Chen
- College of Biomedical Engineering, Jining Medical University, Jining 272067, Shandong, China
| | - Mingze Jiang
- College of Biomedical Engineering, Jining Medical University, Jining 272067, Shandong, China
| | - Hongxia Yan
- Department of Dermatology, Jining No.1 People's Hospital, Jining 272001, Shandong, China
| | - Tianhang Li
- Department of Dermatology, Jining No.1 People's Hospital, Jining 272001, Shandong, China
| | - Hongjun Fu
- Department of Dermatology, Jining No.1 People's Hospital, Jining 272001, Shandong, China
| | - Huabao Xiong
- Institute of Immunology and Molecular Medicine, Basic Medical School, Jining Medical University, Jining 272067, China..
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining 272000, Shandong, China.; Department of Dermatology, Jining No.1 People's Hospital, Jining 272001, Shandong, China.
| |
Collapse
|
8
|
A Rare Presentation of Hand TB Extending to the Space of Parona. Plast Reconstr Surg Glob Open 2022; 10:e4156. [PMID: 35317454 PMCID: PMC8929517 DOI: 10.1097/gox.0000000000004156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Most cases of hand infections are caused by gram-positive cocci and gram-negative bacilli. Atypical hand infections are rare and are caused by uncommon pathogens like Mycobacterium tuberculosis (TB). Musculoskeletal tuberculosis accounts for 20% of TB cases, and only 2% of these cases involve the hand and foot. In this article, we describe a case of hand TB that had spread from the thenar space to the space of Parona. The patient was treated with a combined surgical and medical approach. A 29-year-old male patient presented to our clinic with the complaint of pain and swelling of the right hand that had been worsening for 4 months before presentation. It was associated with mild weakness and night sweats. On physical examination, he had two separate swellings: one at the thenar eminence and one at the volar side of the wrist. He was taken for incision, which showed caseous material on both sites. It was sent for culture that revealed mycobacterium tuberculosis. The patient was placed on anti-TB medications for a total of 6 months. Tuberculous infection of the hand is a rare condition; the most common musculoskeletal sites are the spine, hip, and knee. Early diagnosis and treatment of TB infection in hand are essential for retaining optimal function. The diagnosis usually depends on the clinical presentation supported by laboratory tests and imaging studies. Treatment consists of medical, surgical, or combined treatment. Surgical intervention should aim to remove all the infected material in addition to debridement of the involved tissues.
Collapse
|
9
|
Wu M, Lan X, Lin S, Lai T, Lin W, Wu H. Synovial tuberculosis in wrist diagnosed based on metagenomic next-generation sequencing: A case report. EUR J INFLAMM 2022. [DOI: 10.1177/20587392221075507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Synovial tuberculosis in the wrist is a rare disease that is usually misdiagnosed at the early stage. In this case, we presented a 67-year-old male with wrist joint tuberculosis who presented repeated left wrist joint edema for more than 2 years. The patient received surgery twice. During the second surgery, the combination of metagenomic next-generation sequencing (mNGS) and pathological analysis contributed to the detection of Mycobacterium tuberculosis in lesion tissues. Conventional anti-tubercular therapy confirmed the diagnosis of synovial tuberculosis in the wrist joint. In conclusion, mNGS contributed to the rapid and accurate detection of tubercle bacillus.
Collapse
Affiliation(s)
- Meimei Wu
- Department of Digestive System, Fuzhou Second Hospital, Fuzhou, China
| | - Xianfeng Lan
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Shibei Lin
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Tian Lai
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Weiguo Lin
- Department of Digestive System, Fuzhou Second Hospital, Fuzhou, China
| | - Hao Wu
- Department of Hand Surgery, Fuzhou Second Hospital, Fuzhou, China
| |
Collapse
|
10
|
Eichenauer F, Kim S, Hakimi M, Eisenschenk A, Weber S. [Infections of the Hand after Bite Injuries]. HANDCHIR MIKROCHIR P 2021; 53:237-244. [PMID: 34134156 DOI: 10.1055/a-1382-8093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Bite injuries are common. Along with the resulting complications, they represent approximately 1-2 % of all emergency department visits. In over 75 %, the hands are affected. In Northern Europe, bites and subsequent infections are mainly caused by dogs and cats but also by humans.Up to 40 % of all hand infections are caused to bite injuries. Due to the multiple and complex compartments as well as the low soft tissue coverage of functionally relevant structures, even the smallest and most superficial bite injuries of the hand lead to infections. Any bite injury to the hand may subsequently may result in a fulminant infection and, rarely, even death.The spectrum of pathogens from the oral flora of the biting animal or person is diverse and includes aerobic and anaerobic bacterial strains. Bite injuries represent a major challenge for both the injured person and the attending physician. The rate of complications has been shown to increase with delayed medical consultation, lack of medical care and inadequate wound care. In this review, we discuss the types and complications of bite wounds, their potential risk of infection, their pathogen spectrum and appearance, and their effective treatment.
Collapse
Affiliation(s)
- Frank Eichenauer
- Unfallkrankenhaus Berlin; Abteilung für Hand-, Replantations-und Mikrochirurgie
| | - Simon Kim
- Ernst-Moritz-Arndt-Universität Greifswald; Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin
| | - Mohssen Hakimi
- Vivantes Klinikum Am Urban; Klinik für Unfallchirurgie, Orthopädie und Handchirurgie Berlin
| | - Andreas Eisenschenk
- Unfallkrankenhaus Berlin; Abteilung für Hand-, Replantations-und Mikrochirurgie
| | - Stefan Weber
- Unfallkrankenhaus Berlin; Abteilung für Hand-, Replantations-und Mikrochirurgie
| |
Collapse
|
11
|
Mühldorfer-Fodor M, Fodor SG. [Atypical bacterial Infections of the Hand]. HANDCHIR MIKROCHIR P 2021; 53:302-311. [PMID: 34134162 DOI: 10.1055/a-1408-4425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atypical infections of the hand are rare and often misdiagnosed. Delay of treatment can lead to irreversible damage, even life-threatening sepsis. The article provides a survey of some of the most frequent atypical infections and their appearance on the hand (Mykobakteria, Vibriones, Francisella, Actinomycetoma), illustrated by two case reports. Knowing the pathogenesis of the most frequent atypical infections allows considering them in the daily practice for differential diagnosis, initiate specific testing, and administer an adequate therapy at an early stage.
Collapse
|