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Bémer P, Aubry A, Schramm F, Koebel C, Revillet H, Baltes V, Brun CL, Chazerain P, Zeller V, Hamdad F, Morand PC, Guillouzouic A, Piau C, Roux AL, Soueges S, Martin C, Gaudart A, Hüssler S, Fihman V, Carricajo A, Caruba CG, Bador J, Dauchy FA, Dutronc H, Vignals C, Peuchant O. Clinical features and treatment outcomes of bone and joint nontuberculous mycobacterial infections according to immune status: a 9-year retrospective observational cohort. Int J Infect Dis 2024; 146:107122. [PMID: 38823623 DOI: 10.1016/j.ijid.2024.107122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVES Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status. METHODS We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period. We collected the clinical and microbiological characteristics, management, and clinical outcomes of the patients. RESULTS Overall, 95 patients were included, of whom 50.5% (48/95) were immunosuppressed. Tenosynovitis was more frequent in the immunocompetent group, and native arthritis more common in the immunosuppressed group. Mycobacerium marinum and M. abscessus complex were significantly more frequent in the immunocompetent group, and M. avium and M. xenopi were significantly more frequent in the immunosuppressed group. The combination of antibiotherapy with surgery tended to be more frequent in the immunocompetent than the immunosuppressed group (63.8% (30/47) vs 47.8% (22/46), respectively); of the latter, 45.7% (21/46) received antimicrobial therapy alone, a higher frequency than in the immunocompetent group (23.4%, 11/47). The median duration of antimicrobial treatment was similar in the two groups (11 months). Mortality was significantly higher in the immunosuppressed group. CONCLUSIONS Although the clinical presentations and the NTM species involved in BJI differed according to immune status, most recovered completely after treatment.
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Affiliation(s)
- Pascale Bémer
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Alexandra Aubry
- Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
| | - Frédéric Schramm
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Christelle Koebel
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Hélène Revillet
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Baltes
- Service d'infectiologie, AP-HP, Hôpital Cochin, Paris, France
| | - Cécile Le Brun
- Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Pascal Chazerain
- Service de rhumatologie, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Farida Hamdad
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Philippe C Morand
- Université Paris Cité, CNRS, Inserm, Institut Cochin, Paris, France; Service de Bactériologie, AP-HP, Hôpital Cochin, Paris, France
| | - Aurélie Guillouzouic
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Caroline Piau
- Service de Bactériologie-Hygiène Hospitalière, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Anne-Laure Roux
- Service de microbiologie, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Sarah Soueges
- Service de Maladies Infectieuses et Tropicales de l'Hôpital de la Croix-Rousse, Centre de Référence des Infections Ostéo-Articulaires Complexes de Lyon (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Christian Martin
- Laboratoire de Bactériologie, Virologie, Hygiène, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Alice Gaudart
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Sophie Hüssler
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Vincent Fihman
- Unité de Bactériologie, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Anne Carricajo
- Laboratoire des agents infectieux et Hygiène, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | | | - Julien Bador
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Frédéric-Antoine Dauchy
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Hervé Dutronc
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Carole Vignals
- Service des Maladies Infectieuses et Tropicales, Centre de Référence CRIOAc GSO, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivia Peuchant
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
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Jabbouri S, Halperin SJ, Pathak N, Wilhelm CV, Ng M, Arsoy D. Knee Arthrodesis for Mycobacterium avium Complex Native-Knee Septic Arthritis in a Patient with Dermatomyositis: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00008. [PMID: 35833648 DOI: 10.2106/jbjs.cc.22.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 43-year-old woman with dermatomyositis presented with Mycobacterium avium complex (MAC) knee septic arthritis with superimposed polymicrobial infection. After poor infection control with antibiotic therapy, she underwent debridement and antibiotic cement spacer placement, followed by knee arthrodesis 6 months later. At 2-year follow-up, she had no pain and was ambulating without assistive devices. CONCLUSION As far as we know, this is the first reported case of MAC native-knee septic arthritis successfully treated with antibiotic cement spacer followed by knee arthrodesis. This case sheds insight on treatment strategies for a rare native-knee infection.
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Affiliation(s)
- Sahir Jabbouri
- Yale New Haven Hospital Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | | | - Neil Pathak
- Yale New Haven Hospital Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | - Christopher V Wilhelm
- Yale New Haven Hospital Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | - Mitchell Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Diren Arsoy
- Yale New Haven Hospital Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
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Nontuberculous mycobacterial skin and soft tissue infection in Hawai'i. BMC Infect Dis 2022; 22:360. [PMID: 35410188 PMCID: PMC9004129 DOI: 10.1186/s12879-022-07345-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 11/27/2022] Open
Abstract
Background Hawaiʻi has the highest nontuberculous mycobacterial (NTM) lung infection prevalence in the United States. Limited data regarding skin and soft tissue infections (SSTI) due to NTM in Hawaiʻi exists. This study describes patient demographics, clinical courses of infection, treatment patterns, and clinical outcomes of NTM SSTIs in Hawaiʻi.
Methods A retrospective chart review (n = 50) of patients diagnosed and treated at Hawaiʻi Pacific Health facilities for NTM SSTIs between January 2010 and July 2021 was conducted. Patient demographics, clinical course, and treatment data were collected from electronic medical records.
Results Half of the patient population consisted of females, and the average age of patients during infection was 49 years (SD = 25.6). The majority of cases (80%) were caused by rapidly growing mycobacteria (RGM), most commonly Mycobacterium abscessus. NTM SSTI by race were Asian (48%), White (28%), and Native Hawaiian and Other Pacific Islanders (16%). Almost all Asian patients with NTM SSTI were Filipino or Japanese. Diagnosis was frequently delayed. The average time to diagnosis was 116 days. Most patients achieved complete resolution (72%) following a prolonged course of antimicrobial treatment (mean = 196 days) with surgical debridement. Conclusion Increased awareness among physicians and the community of non-mycobacterial skin infections is essential in Hawaiʻi due to the high prevalence of NTM and the high percentage of predisposed populations. Increased awareness of NTM could reduce delayed diagnosis and improve patient care. Further studies are required to inform optimal treatment and diagnostic strategies, improve patient outcomes, and aid public health surveillance efforts.
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Saha B, Young K, Kahili-Heede M, Lim SY. Septic Arthritis of the Right Wrist Due to Mycobacterium avium Complex in an Immunocompetent Patient. Cureus 2021; 13:e17129. [PMID: 34532171 PMCID: PMC8436997 DOI: 10.7759/cureus.17129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Abstract
Septic arthritis due to Mycobacterium avium complex (MAC) is extremely rare. While MAC infection is classically associated with HIV/AIDS and immunosuppressed states, it may occur in immunocompetent individuals. We report a case of MAC septic arthritis of a native wrist joint in an immunocompetent host. The diagnosis of septic arthritis due to MAC is commonly delayed and initially misdiagnosed, warranting a high level of suspicion to make an accurate and timely diagnosis. Suspecting the diagnosis when there are atypical features present in the clinical history may be crucial in identifying affected patients.
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Affiliation(s)
- Bibek Saha
- Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Kurtis Young
- Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Melissa Kahili-Heede
- Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Sian Yik Lim
- Rheumatology, Pali Momi Medical Center, Aiea, USA
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