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Wang Z, Hu J, Zhao Z, Sun J, Li J, Qian X, Cheng Z. Delayed sternal Mycobacterium tuberculosis infection after left ventricular assist device implantation: A case report. Int J Artif Organs 2024; 47:217-222. [PMID: 38362751 DOI: 10.1177/03913988241229957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The incidence of Mycobacterium tuberculosis (Mtb) infection in patients with mechanical circulatory support devices is extremely rare. We present a case involving a 38-year-old male who experienced a delayed sternal Mtb infection following left ventricular assist device (LVAD) implantation. More than 5 months post-surgery, the patient was readmitted to the hospital presenting a subxiphoid abscess. The incision site displayed an unsatisfactory healing process after the incision and drainage of the abscess. Despite engaging in a rigorous treatment protocol, which included anti-infective therapy, vacuum-assisted closure, and surgical debridement, the patient's wound remained unhealed. Ultimately, after pus gene sequencing confirmed the diagnosis, the patient was administered a regimen combining anti-tuberculosis and anti-infective therapy, which culminated in the successful healing of the wound. This singular case study not only reveals the clinical progression of an unexpected Mtb infection post-implantation but also emphasizes the challenges encountered in diagnosis and management.
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Affiliation(s)
- Zhihua Wang
- Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junlong Hu
- Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zeyuan Zhao
- Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junjie Sun
- Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianchao Li
- Department of Extracorporeal Circulation, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoliang Qian
- Department of Extracorporeal Circulation, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhaoyun Cheng
- Department of Cardiac Surgery, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
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2
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Chandanwale SS, Raj A, Singh M, Kundlia A. Sternoclavicular Tuberculosis: An Unusual Presentation. J Glob Infect Dis 2024; 16:33-35. [PMID: 38680750 PMCID: PMC11045152 DOI: 10.4103/jgid.jgid_64_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/01/2024] Open
Abstract
Extra pulmonary tuberculosis is on the rise worldwide, and younger patients, are females. And people from Asia and Africa are at high risk. Sternoclavicular TB is extremely rare, even in countries that have a high prevalence of TB. It can be in the absence of pulmonary TB. It has a varied clinical presentation. Painless chest wall swelling can be the presenting symptom of sternoclavicular diagnosis. Ultrasonography and high-resolution computed tomography can identify the nature of the lesion and the extent of bone involvement. Aspiration from the swelling or histopathology examination is mandatory for diagnosis. Caseous necrosis is diagnostic of TB. Detection of acid-fast bacilli in smears or tissue or molecular methods is required for definitive diagnosis. A high degree of clinical suspicion is required for early diagnosis. The treatment of thoracic TB is the subject of controversy. Anti-tubercular drugs are the mainstay of treatment. Surgical intervention is basically for flattening cold abscesses and removing infected tissue, including affected bones and cartilage.
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Affiliation(s)
| | - Akshi Raj
- Department of Pathology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Madhuri Singh
- Department of Pathology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Aakriti Kundlia
- Department of Pathology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
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3
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Feng H, Ma J, Zhao Y, Zheng R, Wang W. Sarcoidosis with Severe Bone Involvement: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:2990. [PMID: 37761357 PMCID: PMC10528272 DOI: 10.3390/diagnostics13182990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of the lungs that commonly involves intrathoracic lymph nodes. Here, we report the case of a 68-year-old woman who complained of shortness of breath and had suffered from the enlargement of intrathoracic lymph nodes for 12 years, swelling of the right middle finger for 7 years, and nasal obstruction for 2 years. The damage to the phalange was aggravated continuously and a malignant lesion could not be excluded, thus leading to amputation of the right middle finger. Pathological data indicated chronic inflammatory granulomatous disease and anti-acid staining was negative. Examination of the paranasal sinuses indicated destruction of the sinonasal bone and the swollen mucosa. Combined with the elevated ratio of CD4+/CD8+ T cells in bronchoalveolar lavage fluid and other results, the patient was finally diagnosed with sarcoidosis and received corticosteroid therapy. The shortness of breath and abnormality of the nose were significantly improved after treatment. Our case demonstrated the process of differential diagnosis for systemic granulomatous diseases, indicating the necessity of corticosteroid therapy for systematic sarcoidosis.
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Affiliation(s)
- Haoshen Feng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jiangwei Ma
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
| | - Yabin Zhao
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
| | - Rui Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China
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Fujiwara T, Yanai H, Hagiya H. Like a shot-through manubrium: A rare presentation of skeletal tuberculosis. Clin Case Rep 2023; 11:e7119. [PMID: 37143459 PMCID: PMC10151589 DOI: 10.1002/ccr3.7119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/07/2022] [Accepted: 11/13/2022] [Indexed: 05/06/2023] Open
Abstract
A 22-year-old Vietnamese woman presented with anterior chest swelling. Computed tomography revealed an osteolytic lesion in the manubrium, whereas MRI showed an extra-osseous expansion. A needle biopsy showed granuloma formation, whereas a 3-week mycobacterial culture indicated Mycobacterium tuberculosis infection. Manubrium/sternum involvement in tuberculosis is extremely rare but should be considered.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Orthopaedic SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama700‐8558Japan
| | - Hiroyuki Yanai
- Department of Diagnostic PathologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama700‐8558Japan
| | - Hideharu Hagiya
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama700‐8558Japan
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5
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Saxena S, Hariharan D. Extrapulmonary tuberculosis presentation in the form of a chest wall abscess with no pulmonary involvement in the UK: a case report. J Surg Case Rep 2022; 2022:rjac421. [PMID: 36158246 PMCID: PMC9491861 DOI: 10.1093/jscr/rjac421] [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: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
The presentation of an extrapulmonary manifestation of tuberculous (TB) infection to a tertiary care facility in the UK is a rare event given its low prevalence. This case report focuses on an atypical presentation of an extrapulmonary tuberculosis (EPTB) infection in the form of a chest wall abscess. This was recognized and managed appropriately. This case however elucidates vital learning as migration from around the globe would contribute to an increasing number of TB/EPTB infections. The wide array and indolent nature of their presentation creates diagnostic and treatment challenges. Appreciation for the epidemiology, risk factors, effective and prompt treatment with follow up protocols would help develop pathways for better care. Within the UK, despite it being a low-risk country for TB, there is need for increased awareness, education with established management pathways and governance for TB and EPTB infections.
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Affiliation(s)
- Shreya Saxena
- General and Hepato-Pancreato-Biliary Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel , London , UK
| | - Deepak Hariharan
- Consultant General and Hepato-Pancreato-Biliary Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel , London , UK
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Meena SP, Acharya N, Kala PC, Rohda M. Isolated Chest Wall Necrotizing Fasciitis: An Unusual Fatal Manifestation of Extrapulmonary Tuberculosis. Cureus 2021; 13:e20585. [PMID: 34956806 PMCID: PMC8692721 DOI: 10.7759/cureus.20585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Primary tuberculosis of the chest wall is a rare disease and very difficult to diagnose without clinical suspicion. Here, we present an unusual case of necrotizing fasciitis due to an aggressive form of chest wall tuberculosis. A 22-year-old male presented in emergency with acute-onset swelling and redness over the right side of the neck and chest wall. He had no history of any drug reaction, trauma, and unknown bite. The patient underwent aggressive debridement followed by split-thickness graft under intensive care monitoring. Radiological imaging and Ziehl-Neelsen (ZN) staining of pleural fluid revealed no evidence of pulmonary tuberculosis. Special investigations such as cartridge-based nucleic acid amplification test and ZN staining from pathological skin or subcutaneous tissue revealed active tuberculosis; therefore, anti-tubercular drugs were started.
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Affiliation(s)
- Satya P Meena
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Netrananda Acharya
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Prakash C Kala
- Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Mahaveer Rohda
- General Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
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Grover DSB, Rai DV, Grover DH, Kumar DD, Kundra DR, Gautam DV, Devra DAG. Imaging diagnosis of sternal tuberculosis- A report of two cases of the ancient disease with a new demeanour. Radiol Case Rep 2021; 16:3125-3133. [PMID: 34457101 PMCID: PMC8377555 DOI: 10.1016/j.radcr.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 02/05/2023] Open
Abstract
Tuberculosis is an ancient disease known to have existed even in the Egyptian civilization. It is estimated that a quarter of the world's population is already infected and 1 million will die of the disease, in the current year. Although tuberculosis may occur in any organ, extra- pulmonary tuberculosis accounts for 10%-14% of all cases of tuberculosis. Skeletal involvement comprises only 1 to 5 % of all types of tuberculosis and the most frequently involved site in the skeleton is the vertebral column, amongst the skeletal structures, the sternum is involved very rarely, accounting for just 1-2% of all bone and joint tuberculosis. We report two cases of sternal tuberculosis,and enumerate the imaging appearances seen at ultrasound, CT and MRI and also highlight a relatively underemphasised complication of mediastinal involvement due to a retrosternal abscess. Rapid diagnosis by imaging studies led to early treatment and prevented catastrophic consequences of diffuse mediastinitis. Awareness of tuberculosis and its atypical skeletal manifestations is important not only in developing countries with endemic disease, but also in developed countries, due to its resurgence by the HIV epidemic and also because extensive international travel and transcontinental migration continues to facilitate greater disease transmission.
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Affiliation(s)
- Dr Shabnam Bhandari Grover
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
- Corresponding author.
| | - Dr Vikrant Rai
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Hemal Grover
- Department of Radiology & Imaging, Ichan School of Medicine at Mount Sinai West, New York
| | - Dr Dev Kumar
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Rohit Kundra
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr V.K. Gautam
- Department of Orthopedic Surgery, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
| | - Dr Anshu Gupta Devra
- Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
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Tordjman M, Pouchelon C, Canouï E, Omri M, Dion E. Sternal mass caused by Mycobacterium tuberculosis in an immunocompetent young adult. J Travel Med 2021; 28:6134593. [PMID: 33580959 DOI: 10.1093/jtm/taab021] [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: 01/16/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 11/14/2022]
Abstract
Differential diagnosis of sternal masses in migrant patients should include tuberculosis. Imaging characteristics on computed tomography scan and magnetic resonance imaging are of great interest. Sternal tuberculous abscess exhibits a slightly hyperintense rim on T1-weighted pre-contrast images that can be associated with osteomyelitis of the sternum.
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Affiliation(s)
- Mickael Tordjman
- Department of Radiology, Hôtel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Clara Pouchelon
- Department of Internal medicine, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Etienne Canouï
- Antimicrobial Stewardship Team GH Paris Centre, Cochin Hospital, APHP, Paris, France
| | - Manel Omri
- Department of Radiology, Hôtel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Elisabeth Dion
- Department of Radiology, Hôtel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
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Asija K, Sutter M, Kerfeld CA. A Survey of Bacterial Microcompartment Distribution in the Human Microbiome. Front Microbiol 2021; 12:669024. [PMID: 34054778 PMCID: PMC8156839 DOI: 10.3389/fmicb.2021.669024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 01/04/2023] Open
Abstract
Bacterial microcompartments (BMCs) are protein-based organelles that expand the metabolic potential of many bacteria by sequestering segments of enzymatic pathways in a selectively permeable protein shell. Sixty-eight different types/subtypes of BMCs have been bioinformatically identified based on the encapsulated enzymes and shell proteins encoded in genomic loci. BMCs are found across bacterial phyla. The organisms that contain them, rather than strictly correlating with specific lineages, tend to reflect the metabolic landscape of the environmental niches they occupy. From our recent comprehensive bioinformatic survey of BMCs found in genome sequence data, we find many in members of the human microbiome. Here we survey the distribution of BMCs in the different biotopes of the human body. Given their amenability to be horizontally transferred and bioengineered they hold promise as metabolic modules that could be used to probiotically alter microbiomes or treat dysbiosis.
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Affiliation(s)
- Kunica Asija
- Environmental Genomics and Systems Biology Division, Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
| | - Markus Sutter
- Environmental Genomics and Systems Biology Division, Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- Michigan State University-U.S. Department of Energy (MSU-DOE) Plant Research Laboratory, Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, United States
| | - Cheryl A. Kerfeld
- Environmental Genomics and Systems Biology Division, Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- Michigan State University-U.S. Department of Energy (MSU-DOE) Plant Research Laboratory, Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, United States
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Kabiri EH, Alassane EA, Kamdem MK, Bhairis M, Amraoui M, El Oueriachi F, El Hammoumi M. Tuberculous cold abscess of the chest wall: A clinical and surgical experience. Report of 16 cases(Case series). Ann Med Surg (Lond) 2020; 51:54-58. [PMID: 32099646 PMCID: PMC7029049 DOI: 10.1016/j.amsu.2020.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis is a public health problem in developing countries. Tuberculosis of the chest wall is rare and often presents as cold abscess (to differentiate from pyogenic abscess) or pseudotumoral mass whose diagnosis is difficult and often requires a surgical biopsy. Patients and methods The medical series of 16 patients with cold chest wall abscess treated with surgery in association to anti-tubercular therapy were analysed retrospectively for the period of 7 years between January 2011 to December 2017 at Mohamed V Military Teaching Hospital – Rabat - Morocco. Results The clinical examination provided a correct preoperative diagnosis of the abscess in all cases. Five patients had a past history of pulmonary tuberculosis and three patients had concomitant active infection. There were 6 cases on the left side, 9 cases on the right side and one case on the anterior chest wall. All patients underwent surgical drainage and debridement with specimens for bacteriology and histology. It was not necessary to resect ribs or sternum in all cases (sample costal or sternal curettage in one case each). Anti-tubercular treatment was routinely administered (6–9 months) with drug combinations of Isoniaside, Rifampicin, Pyrazinamide and Ethambutol. The evolution was favorable in all cases without complications or recurrences. Conclusion Drainage of chest wall abscess and complete debridement provide adequate treatment. Post-operative anti-bacillary therapy should be combined with surgical procedures to minimize local complications and recurrence of infection. Tuberculous abscesses of the chest wall well be associated pulmonary disease or primary location. Chest CT scan is the best exam to diagnosis and the procedure to do. Debridement must be large and in association with antituberculosis chemotherapy.
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Affiliation(s)
- El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco.,Faculty of medicine -Mohamed V University, Rabat, Morocco
| | | | | | - Mohamed Bhairis
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Mouad Amraoui
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Faycal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco
| | - Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military Teaching Hospital, Morocco.,Faculty of medicine -Mohamed V University, Rabat, Morocco
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