Achilles tendon infection due to Mycobacterium chelonae

Failed Surgery for Achilles Tendinopathy

Treatments of Achilles tendinopathy continue to evolve. The body of literature is inadequate to provide a comprehensive guide to evaluation and treat failed surgeries. Issues related to failed surgical treatment may be divided into infection/wound issue, mechanical failure, and persistent pain. Awareness of the potential problems described in this article will allow surgeons to have a foundation in clinical assessment and making accurate diagnoses. Various surgical treatment options are available and should be executed carefully to treat individualized patient conditions.

Reconstruction with a free temporoparietal fascia flap for intractable flexor tenosynovitis of the wrist accompanied by a soft tissue defect: a case report

We herein report a case of intractable flexor tenosynovitis. The inflamed synovium was debrided twice because of suspected infectious tenosynovitis. However, it relapsed and caused a soft tissue defect. Reconstruction with a free temporoparietal fascia (TPF) flap was performed. Recurrence has not been detected in the six years after surgery.

Case Series and Review of the Literature of Mycobacterium chelonae Infections of the Lower Extremities

Mycobacterium chelonae infections involving the lower extremities are rare clinical entities that present a diagnostic challenge given its diverse clinical presentations ranging from superficial (e.g., cellulitis, painful vesicular lesions) to deep (e.g., tenosynovitis) infections. We present 1 cases of M chelonae infections of the feet diagnosed 6 to 12 months after initial symptoms representing the difficulty of diagnosing this condition. Both cases were successfully managed with aggressive surgical debridement and long durations of antibiotic therapy with long-term care. A comprehensive review of the literature of M chelonae infections of the lower extremities was performed to provide summary data on the presenting symptoms, examination findings, predisposing conditions, and management approaches of this rare, but emerging clinical entity. Our cases and comprehensive review serve to raise awareness of atypical mycobacterial infections, including M chelonae, and advocate for the early consideration of mycobacterial cultures in the diagnostic workup of chronic lower extremity infections especially in the setting of poor initial response to standard antibacterial therapies.

Role of arthroscopy and endoscopy in management of tuberculosis of the foot and ankle

Tuberculosis of the foot and ankle is rare but destructive. It can affect bones, joints and soft tissue and can mimic a wide range of acute and chronic infections or tumorous conditions. The primary treatment objectives for osteoarticular TB include curing the infection, limiting deformity, maintaining mobility, and reducing discomfort. Chemotherapy remains the mainstay of treatment in acute stage. Indications of surgery include biopsy and debridement in early stages to reduce the tuberculosis load and enable better penetration of anti-tuberculous drugs. Other reported indications for surgery in early stage of TB foot and ankle include resection of lesion not responding to chemotherapy and debridement of lesions close to the articular surface, as surgical debridement might halt progression and joint invasion, avoiding worsening of the prognosis. The success of arthroscopic treatment for infectious arthritis with decreased morbidity and postoperative pain makes arthroscopy an excellent alternative to open surgery. The advantages such as minor trauma, short hospitalization time and short post operative rehabilitation period as well as good cosmetic and therapeutic results should lead to a more frequent use of arthroscopy as early as possible as an adjuvant for the tuberculous joint. However, tuberculosis can involve any joints, bone and soft tissue (tendon) of the foot and ankle and surgeons should equip with various arthroscopic and endoscopic techniques in order to deal with the various situations of tuberculosis of the foot and ankle.

Infectious Tenosynovitis of the Tibialis Anterior Due to Mycobacterium chelonae After Intravenous Heroin Injection

Mycobacterium chelonae is a ubiquitous Gram-positive, acid-fast, non-spore-forming bacterium commonly encountered in nature associated with aquatic animals, soil, and water, including tap water. Nontuberculous mycobacterial tenosynovitis infections caused by M. chelonae in the lower extremity are uncommon, leading to a paucity of literature documenting the diagnosis and treatment of such cases. This report is of a 65-year-old male patient who was found to have an M. chelonae infection along the tibialis anterior tendon after injecting himself with heroin into the dorsal foot veins. This review covers the diagnosis and treatment as well as a case report on the outcome of infectious tenosynovitis of the tibialis anterior associated with M. chelonae. To date, this is the only reported case of tibialis anterior infectious tenosynovitis caused by M. chelonae after intravenous heroin injection.

What Is the Treatment "Algorithm" for Infection After Achilles Tendon Repair/Reconstruction?

RECOMMENDATION

The initial treatment of an infected Achilles tendon reconstruction should include thorough debridement of all infected tissues with the removal of retained sutures or foreign material. Cultures should be taken at the time of debridement, and antibiotic administration should be dictated by the result of culture and continued until inflammatory markers and clinical symptoms normalize. If significant soft tissue defect in the overlying area remains, the choice of tendon reconstruction and/or transfer with soft tissue coverage should be left up to the discretion of the treating surgeon based on preference and expertise. Revision reconstruction should be delayed until the infection is cleared.

LEVEL OF EVIDENCE

Moderate.

DELEGATE VOTE

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

Mycobacterium chelonae-abscessus Complex Infection After Flatfoot Reconstruction

Mycobacterium infections involving tuberculosis in the foot are rare but cases are readily available in published studies. Atypical or nontuberculosis mycobacterium foot infections are rare, especially those involving the soft tissue and bone, and have been infrequently reported. To date, no case reports involving atypical mycobacterium infection after elective foot surgery have been reported. We present the case of a 49-year-old female who underwent flatfoot reconstruction, with a resultant Mycobacterium chelonae-abscessus infection and osteomyelitis postoperatively. The patient ultimately underwent hardware removal with multiple debridements. The patient was treated ultimately with a 6-week course of intravenous antibiotics and 5 months of oral antibiotics for the mycobacterium infection and osteomyelitis. At the last follow-up examination, the patient remained healed with a satisfactory outcome. We also provide a literature review of mycobacterium infections in the foot.