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Auñon A, Salar-Vidal L, Mahillo-Fernandez I, Almeida F, Pereira P, Lora-Tamayo J, Ferry T, Souèges S, Dinh A, Escudero R, Menéndez Fernández-Miranda C, Rico A, Rossi N, Esteban J. Prosthetic Joint Infections Caused by Mycobacterium tuberculosis Complex-An ESGIAI-ESGMYC Multicenter, Retrospective Study and Literature Review. Microorganisms 2024; 12:849. [PMID: 38792679 PMCID: PMC11123809 DOI: 10.3390/microorganisms12050849] [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: 03/04/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available in the literature of tuberculous PJIs, aiming to detect factors that may influence patient outcomes. METHODS The ESGIAI and ESGMYC study groups were used to collect information on non-published cases of tuberculous prosthetic joint infections (PJIs). Additionally, a literature review of all published cases of tuberculous PJIs was conducted. All identified cases in the retrospective study and in the literature review were merged and included in the statistical analysis, involving both univariate and multivariate analyses. RESULTS Fifteen previously unreported cases of tuberculous prosthetic joint infections (PJIs) from four countries were detailed. Among them, ten patients were female, with a median age of 76 years. The hip was affected in 13 cases. Seven patients experienced co-infection with another microorganism. Treatment approaches varied, with 13 patients undergoing implant removal, one treated with DAIR (debridement, antibiotics, and implant retention), and one case was treated with an unknown treatment method. All patients received antibiotic therapy and achieved a cure. The literature review that was conducted detected 155 published cases. Univariate analysis revealed a statistical significance for previous tuberculosis, joint, and no importance of surgery for cure. CONCLUSIONS Tuberculous prosthetic joint infection (PJI) is a rare condition, typically presenting as a localized chronic infection. Antibiotic treatment is essential for the management of these patients, but neither surgical treatment nor duration of treatment seems to have importance in the outcome.
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Affiliation(s)
- Alvaro Auñon
- IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, 28040 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - Llanos Salar-Vidal
- IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, 28040 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
| | | | | | | | - Jaime Lora-Tamayo
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Tristan Ferry
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- CHU-Hopital Croix Rousse, 69317 Lyon, France
| | | | - Aurélien Dinh
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Ambroise-Paré Hospital, 92104 Paris, France
| | - Rosa Escudero
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Hospital Ramon y Cajal, 28034 Madrid, Spain
| | | | - Alicia Rico
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Nicolo Rossi
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- UOC di Malattie Infettive, Ospedale Guglielmo da Saliceto, AUSL Piacenza, 29121 Piacenza, Italy
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Jaime Esteban
- IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, 28040 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
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Van Le T, Duong TB, Hien KQ, Ton QNQ, Huyn T, Binh TP, Tu DT, Tho PP, Binh LN, Hau HP, Hung TNK. Two-stage revision for treatment of tuberculous prosthetic hip infection: an outcome analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:645-651. [PMID: 35778623 DOI: 10.1007/s00590-022-03317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Prosthetic joint infections (PJI) and especially tuberculosis (TB) PJI are rare diseases and hard to cure. The effectiveness of treatments for tuberculous PJI still remains a problem. The objective of this research was to indicate the success of two-stage revision replacement and also giving the associated criteria. METHODS From 2015 to 2020, five patients with tuberculous PJI were treated with two-stage revision at Cho Ray hospital, Vietnam. We collected the dataset which included demographic data, the interval from the time of joint replacement to reported infection, records of tuberculous PJI, administration of anti-TB medications (duration, months), history of operation(s), duration of follow-up, and specific type(s) of antibiotics loaded in bone cement. The approval for this study was made by the institutional review board from Cho Ray Hospital, Vietnam. We conducted a literature review based on the keywords "PJI" and "TB" on PubMed. RESULTS Five patients [median age 66 years (range 35-84)] had found tuberculous PJI. The median time from arthroplasty to diagnosis was 19 months (range 4-48). The diagnosis was confirmed by joint aspirates or synovial tissue. Positive PCR was also reported in all cases. The average duration of anti-tuberculosis polytherapy administration was 14.4 months. The operative techniques on five patients included debridement and using spacer loaded with 2 g streptomycin (and 2 g vancomycin if they got a coinfection) for 1 pack of bone cement, and revision arthroplasty. In most cases, the outcome of treatment using two-stage revision replacement was 80%. Overall, the auxiliary bacterial infections were recognized in three patients with tuberculous PJI and Staphylococcus aureus. Streptomycin and vancomycin were loaded in a cement spacer to increase the success rate, and tuberculous PJI was controlled for all patients. CONCLUSION Tuberculous PJI can be controlled with two-stage revision replacement with an antibiotic-loaded cement spacer that is molded intraoperatively with custom mold and prolonged anti-tuberculosis treatment in all cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tuan Van Le
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Tran Binh Duong
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Kha Quang Hien
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | | | - Tan Huyn
- Faculty of Pharmacy, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Tran Phuoc Binh
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Dao Thanh Tu
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Pham Phuoc Tho
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Le Nguyen Binh
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Huynh Phuoc Hau
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Truong Nguyen Khanh Hung
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam.
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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3
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Lo CKL, Chen L, Varma S, Wood GCA, Grant J, Wilson EW. Management of Mycobacterium tuberculosis Prosthetic Joint Infection: 2 Cases and Literature Review. Open Forum Infect Dis 2021; 8:ofab451. [PMID: 34631919 PMCID: PMC8496762 DOI: 10.1093/ofid/ofab451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
Prosthetic joint infection caused by Mycobacterium tuberculosis (TBPJI) is uncommon but can be encountered in immunocompromised patients or those from tuberculosis-endemic regions. A lack of clinical suspicion and experience with TBPJI often leads to a delay in diagnosis. We report 2 cases of TBPJI in a Hungarian-Canadian and Iranian-Canadian immigrant, respectively. Both were treated with concurrent surgical and medical therapy. We also performed a literature review on TBPJI case reports, outlining their diagnosis and management.
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Affiliation(s)
- Carson K L Lo
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Lina Chen
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sonal Varma
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Gavin C A Wood
- Department of Surgery (Orthopedics), Queen’s University, Kingston, Ontario, Canada
| | - Jennifer Grant
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Evan W Wilson
- Division of Infectious Diseases, Queen’s University, Kingston, Ontario, Canada
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4
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Hwang BH, Lee SC, Ong A, Ahn HS, Moon SH. Mycobacterial periprosthetic joint infection after primary total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2021; 45:3055-3062. [PMID: 33829307 DOI: 10.1007/s00264-021-05029-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Mycobacterial periprosthetic joint infection (PJI) is very rare and is generally associated with an immunosuppressive environment. Few large-scale studies of this unusual PJI have been conducted. The current study was performed to assess the clinical features and outcomes following two-stage re-implantation for mycobacterial PJI after primary total knee arthroplasty (TKA). METHODS We conducted a retrospective review of data collected from our database involving ten cases of two-stage re-implantation manifesting mycobacterial PJI. Patients were followed for at least five years or until recurrent infection. The mean follow-up duration in patients who remained free of infection was 7.5 years (range 5-9.5 years). RESULTS Seven patients (70%) belonged to the American Society of Anesthesiologists' grade 3 or 4. The surgical protocol entailed resection arthroplasty and cement spacer insertion with vigorous debridement, followed by at least six weeks of systemic antimicrobial therapy and delayed re-implantation in all patients. The median duration from resection arthroplasty to re-implantation was 5.3 months (range 2-10.5 months). Following re-implantation, five patients with Mycobacterium fortuitum were treated with amikacin for six weeks and oral clarithromycin for three months. Five patients infected with M. tuberculosis received anti-tuberculosis medications immediately after pathogen isolation, for a period of 12 months. CONCLUSION Mycobacterial PJI can be treated successfully via resection arthroplasty and delayed re-implantation combined with proper antimicrobial agents. Suspicious infection or loosening after primary TKA, particularly in an immunosuppressive environment, warrants the attention of an orthopedic surgeon to consider the possibility of unusual PJI.
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Affiliation(s)
- Bo-Hyun Hwang
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, 07999, Republic of Korea.,Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su-Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, 07999, Republic of Korea.
| | - Alvin Ong
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Hye-Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, 07999, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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5
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Wang D, Sun X, Zhang C, Fang X, Huang Z, Zheng Q, Zhang W. Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature. Orthop Surg 2020; 12:1900-1912. [PMID: 33145983 PMCID: PMC7767691 DOI: 10.1111/os.12852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To provide a case series and systematic review that explores the clinical manifestations, treatments, and methods for defining tuberculosis diagnoses in patients who have undergone total knee arthroplasty (TKA). METHODS Four patients (three women, one man; average age, 59.5 ± 8.89 years; range, 48-69 years) underwent TKA and were subsequently treated for previously unsuspected knee tuberculosis between January 2013 and December 2019. We also reviewed published cases of tuberculous periprosthetic joint infections (TBPJIs) following TKA through databases of MEDLINE/PubMed, the Cochrane Library, and EMBASE. We reviewed studies that were published between January 1980 and December 2019. RESULTS In our four cases, the preoperative diagnoses were osteoarthritis (n = 2), rheumatoid arthritis (one case), and Charcot's arthropathy (one case). The main clinical manifestations were knee swelling and pain, without fever, weakness, or weight loss. Comorbidities included multiple joints with rheumatoid arthritis or Charcot's arthropathy, diabetes mellitus, and uremia. One patient had a history of lumbar tuberculosis treated with debridement and intervertebral fusion. Preoperative elevated erythrocyte sedimentation rates (ESRs) were detected in all cases, and elevated C-reactive protein (CRP) levels were observed in three cases. The tuberculosis diagnoses were confirmed via histopathologic analysis (three cases) and second-generation sequencing (one case). Three patients received antituberculosis therapy for 1 year, without surgical intervention. Two-stage exchange arthroplasty was performed in one patient because of prosthesis loosening. Within an average follow-up period of 24.75 months, tuberculosis reactivation was not observed and overall functional improvement was demonstrated. Forty-four TBPJI cases were reported in the literature between January 1980 and December 2019. Most (59.09%) occurred within the first year after the index arthroplasty, and the diagnoses were confirmed by culturing Mycobacterium tuberculosis in 88.64% of cases. Favorable outcomes were achieved in 90.91% of the patients who did not undergo surgery, 71.43% of those treated with debridement, 93.33% undergoing revision arthroplasty, and in 90.91% of those undergoing resection and arthrodesis. CONCLUSIONS Clinical manifestations of knee tuberculosis and TBPJI are atypical. Thus, attention should be paid to finding the causes of increased ESRs and CRP levels, particularly in patients with weakened immune functioning, before performing TKA. Pathological examination is an effective method for diagnosing tuberculosis, although sending multiple specimens for pathological examination is necessary.
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Affiliation(s)
- Du Wang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xiao‐tang Sun
- Department of Orthopaedics900th Hospital of Joint Logistics Support ForceFuzhouChina
| | - Chao‐fan Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xin‐yu Fang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Zi‐da Huang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Qing‐cong Zheng
- Department of Orthopaedics900th Hospital of Joint Logistics Support ForceFuzhouChina
| | - Wen‐ming Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
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6
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Features of the biochemistry of Mycobacterium smegmatis, as a possible model for Mycobacterium tuberculosis. J Infect Public Health 2020; 13:1255-1264. [PMID: 32674978 DOI: 10.1016/j.jiph.2020.06.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
An alternate host for mycobacteria is Mycobacterium smegmatis which is used frequently. It is a directly budding eco-friendly organism not emulated as human infection. It is mainly useful for the investigation of various microorganisms in the sort of Mycobacteria in cell culture laboratories. Some Mycobacterium species groups that is normal, unsafe ailments, likely to Mycobacterium leprae, Mycobacterium tuberculosis and Mycobacterium bovis. At present, various laboratories are clean and culture this type of species to make an opinion that fascinating route of harmful Mycobacteria. This publication provides aggregate data on cell shape, genome studies, ecology, pathology and utilization of M. smegmatis.
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7
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Tsai Y, Chang CH, Lin YC, Lee SH, Hsieh PH, Chang Y. Different microbiological profiles between hip and knee prosthetic joint infections. J Orthop Surg (Hong Kong) 2020; 27:2309499019847768. [PMID: 31117922 DOI: 10.1177/2309499019847768] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The study aims to analyze the demographics and microbiological profiles of hip and knee prosthetic joint infection (PJI) and to compare the microbiological differences between hip and knee PJI. METHODS We performed a retrospective study of all PJI cases between January 2006 and December 2014 at a referral medical center in Taiwan. RESULTS A total of 294 PJI cases were collected: 159 were identified as hip PJI and 135 as knee PJI. The most common causative pathogen was Staphylococcus aureus (78 cases, 27%), followed by coagulase-negative staphylococci (CoNS, 42 cases, 14%). Methicillin-resistant staphylococci (MRS) accounted for 21% of all PJI cases. Fungus and mycobacterium were only involved in 12 cases (4.1%) of all PJI cases. Polymicrobial pathogens, anaerobes, and enteric gram-negative bacilli (GNB) were more likely to occur in hip joint prostheses than in knee joint prostheses (22 vs. 6 cases, p = 0.006; 11 vs. 0 cases; p = 0.002; 20 vs. 6 cases; p = 0.014, respectively). CONCLUSION The prevalence of polymicrobial pathogens, anaerobes, and enteric GNB was higher in the prosthetic hip infection than in the prosthetic knee infection. The high prevalence of MRS, including Methicillin-resistant (MR) S. aureus and MR-CoNS in PJI, may warrant the need for empiric antibiotic therapy with broader coverage while pending the culture result of PJI. Although fungal and mycobacterial PJI cases are rare, the incidence of these infections is relatively high in Taiwan. Fungus and mycobacterium should also be taken into consideration whenever a persistent PJI case is encountered.
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Affiliation(s)
- Yifang Tsai
- 1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.,2 School of Medicine, Chang Gung University, Taoyuan
| | - Chih-Hsiang Chang
- 1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.,2 School of Medicine, Chang Gung University, Taoyuan
| | - Yu-Chih Lin
- 1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.,2 School of Medicine, Chang Gung University, Taoyuan
| | - Sheng-Hsun Lee
- 1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.,2 School of Medicine, Chang Gung University, Taoyuan
| | - Pang-Hsin Hsieh
- 1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.,2 School of Medicine, Chang Gung University, Taoyuan
| | - Yuhan Chang
- 1 Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan.,2 School of Medicine, Chang Gung University, Taoyuan.,3 Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan
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Barry M, Akkielah L, Askar MA, Bin Nasser AS. Miliary tuberculosis with delayed-onset total knee arthroplasty Mycobacteria tuberculosis infection successfully treated with medical therapy alone: A case report and literature review. Knee 2019; 26:1152-1158. [PMID: 31427242 DOI: 10.1016/j.knee.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) affecting a prosthetic knee is an unusual and diagnostically challenging presentation of this disease. This study reported a case of an 80-year-old man with a left total knee arthroplasty (TKA) performed eight years before his presentation. He presented with left knee swelling and pain for one month. Knee X-rays showed a normal joint space with no loosening of his prosthesis. His chest X-ray showed miliary disease, and microbiological studies of his sputum and synovial fluid aspirate grew Mycobacteria tuberculosis complex. He was successfully medically treated with anti-tuberculous therapy alone for one year. His knee hardware was retained, and he did not require debridement, resection, or revision. It is believed that this is the first reported case of miliary TB with delayed-onset TKA prosthetic joint infection (PJI) in which the prosthesis was successfully retained. Thirty-eight published TB TKA PJI cases in medical literature were also reviewed.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Layan Akkielah
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manar A Askar
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S Bin Nasser
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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9
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Mycobacterium tuberculosis infection of reverse shoulder arthroplasty: a case report. J Shoulder Elbow Surg 2019; 28:e271-e274. [PMID: 31327396 DOI: 10.1016/j.jse.2019.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023]
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10
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Prosthetic Joint Infection of the Knee Due to Mycobacterium tuberculosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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11
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Bi AS, Li D, Ma Y, Wu D, Ma Y. Mycobacterium tuberculosis as a Cause of Periprosthetic Joint Infection After Total Knee Arthroplasty: A Review of the Literature. Cureus 2019; 11:e4325. [PMID: 31183304 PMCID: PMC6538407 DOI: 10.7759/cureus.4325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Total knee arthroplasty (TKA) has become one of the most popular and successful surgeries performed in the world. Infection remains one of the most dreaded complications following TKA, and while rare, tuberculosis as a microbial etiology remains difficult to both diagnose and treat. A review was performed using PubMed, the Cochrane Database of Systematic Reviews, and EMBASE to identify literature pertinent to Mycobacterium tuberculosis infection, TKAs, periprosthetic joint infections, and any combination of the three. The diagnosis of tuberculosis infection after TKA is difficult due to nonspecific signs and symptoms and diagnostic testing. The surgeon should use a comprehensive approach to incorporate the patient’s medical history, physical exam, and blood and imaging diagnostics. Among these, bacterial culture and histopathological examination remain the gold standard of diagnosis, but Polymerase chain reaction technology offers another, more sensitive and rapid option. Treatment strategy centers around on the cornerstone of anti-tuberculosis medical therapy and surgery depending on the clinical situation. While there is a lack of primary literature and standardized guidelines for the diagnosis and treatment of tuberculosis infection after TKA, the overarching principles of the treatment of tuberculosis and the treatment of the periprosthetic infection can be implemented together. There remains room for original research and improvements in both diagnostic testing and treatment.
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Affiliation(s)
- Andrew S Bi
- Orthopaedics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Daniel Li
- Orthopaedics, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Yunlong Ma
- Orthopaedics, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
| | - Decheng Wu
- Orthopaedics, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
| | - Yuangzheng Ma
- Orthopaedics, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, CHN
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Meyssonnier V, Zeller V, Malbos S, Heym B, Lhotellier L, Desplaces N, Marmor S, Ziza JM. Prosthetic joint infections due to Mycobacterium tuberculosis: A retrospective study. Joint Bone Spine 2019; 86:239-243. [DOI: 10.1016/j.jbspin.2018.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 01/08/2023]
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13
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Boyle KK, Kuo FC, Horcajada JP, Hughes H, Cavagnaro L, Marculescu C, McLaren A, Nodzo SR, Riccio G, Sendi P, Silibovsky R, Stammers J, Tan TL, Wimmer M. General Assembly, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S225-S237. [PMID: 30360976 DOI: 10.1016/j.arth.2018.09.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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15
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Chang CH, Hu CC, Chang Y, Hsieh PH, Shih HN, Ueng SWN. Two-stage revision arthroplasty for Mycobacterium Tuberculosis periprosthetic joint infection: An outcome analysis. PLoS One 2018; 13:e0203585. [PMID: 30192830 PMCID: PMC6128604 DOI: 10.1371/journal.pone.0203585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/23/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycobacterium tuberculosis periprosthetic joint infection (TBPJI) is a rare complication of hip/knee joint arthroplasty. The outcomes of hip/knee TBPJI treatment are still unreported. The objective of this study was to investigate the outcomes of hip/knee TBPJI following treatment with two-stage exchange arthroplasty. MATERIALS AND METHODS From 2003 to 2013, 11 patients with TBPJI (six hips and five knees) were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidities, microbiological data, duration of symptoms, and types of antibiotic used in bone cement. RESULTS At the most recent follow-up, the success rate of two-stage exchange arthroplasty was 63.3% (7 of 11). All five knee treatments resulted in infection eradication and successful prosthesis reimplantation. However, only two hip TBPJI treatments resulted in successful outcomes; two patients died and two experienced chronic infection. Overall, secondary bacterial infections were common in patients with TBPJI (5 of 11 cases, 45.5%). Streptomycin in bone cement increased the success rate (83.33% vs. 40%). CONCLUSION More than one third of the patients treated with two-stage exchange arthroplasty for TBPJI showed infection relapse or uncontrolled infection. Streptomycin-loaded interim cement spacers appeared to help ensure successful treatment. Routine M. tuberculosis culture is recommended when treating TBPJI in areas of high tuberculosis prevalence.
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Affiliation(s)
- Chih-Hsiang Chang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chien Hu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuhan Chang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Hsin Hsieh
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Nung Shih
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Steve Wen-Neng Ueng
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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16
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Uhel F, Corvaisier G, Poinsignon Y, Chirouze C, Beraud G, Grossi O, Varache N, Arvieux C, Berre RL, Tattevin P. Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review. J Infect 2018; 78:27-34. [PMID: 30138639 DOI: 10.1016/j.jinf.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI). METHODS Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords 'prosthetic joint', and 'tuberculosis'. RESULTS During years 1997-2016, 13 patients (8 males, 5 females, median age 79 years [range, 60-86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4-20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6-32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS). CONCLUSIONS M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.
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Affiliation(s)
- Fabrice Uhel
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, U1236, F-35043 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France
| | | | - Yves Poinsignon
- Médecine Interne, CH Bretagne Atlantique, F-56017 Vannes, France
| | - Catherine Chirouze
- CNRS 6249, Université de Bourgogne-Franche-Comté, CHRU Besançon, F-25030 Besançon, France
| | | | - Olivier Grossi
- Médecine Interne - Infectiologie, Nouvelles Cliniques Nantaises, F-44277 Nantes, France
| | - Nicolas Varache
- Maladies Infectieuses et Tropicales, CH Le Mans, F-72037 Le Mans, France
| | - Cédric Arvieux
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France
| | - Rozenn Le Berre
- Médecine Interne et Pneumologie, CHRU de la Cavale Blanche, F-29609 Brest, France
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France.
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17
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Veloci S, Mencarini J, Lagi F, Beltrami G, Campanacci DA, Bartoloni A, Bartalesi F. Tubercular prosthetic joint infection: two case reports and literature review. Infection 2017; 46:55-68. [PMID: 29086355 DOI: 10.1007/s15010-017-1085-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/20/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Tubercular prosthetic joint infection (TB-PJI) is an uncommon complication. Lack of evidence of systemic tuberculosis and clinical suspicion could bring a delay in the time of the diagnosis. The aims of this study are to underline the importance of awareness and suspicion of mycobacterial infection in the differential diagnosis in PJI and to evaluate the appropriateness of different therapeutic options. METHODS Case report and literature review. RESULTS We report two cases of TB-PJI after total knee arthroplasty in Caucasian patients without prior history of tubercular disease or exposure. In both cases, the diagnosis was obtained years after the onset of symptoms. Despite that, both patients improved during antitubercular treatment (a four-drug regimen consisting of rifampicin, isoniazid, ethambutol, and pyrazinamide for 2 months, followed by rifampicin and isoniazid). Moreover, after an 18-month course of treatment, there was no need for surgical therapy. The result of the literature review allows us to identify 64 cases of TB-PJI. Many differences in both medical and surgical management have been found, among those reviewed cases. CONCLUSIONS Considering our experience and the literature review, we recommend considering a conservative approach (debridement and adequate antituberculous chemotherapy) as a suitable and safe option.
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Affiliation(s)
- Sara Veloci
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jessica Mencarini
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Domenico Andrea Campanacci
- Orthopaedic Oncology Unit, Careggi Hospital, Florence, Italy.,Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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18
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Lin J, Yang W, Pan J, Luo M, Cao X, Liu J. [Diagnosis and treatment strategy of tuberculosis infection after total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1127-1130. [PMID: 29798573 DOI: 10.7507/1002-1892.201703074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the diagnosis and treatment of tuberculosis infection after total knee arthro-plasty (TKA). Methods The recent literature concerning the diagnosis and treatment of tuberculosis infection after TKA were extensively reviewed and summarized. Results The diagnosis of tuberculosis infection after TKA is difficult. It should be combined with the patient's medical history, symptoms, signs, blood examinations, and imaging examinations, among which the bacterial culture and histopathological examination are the gold standard of diagnosis. Treatment strategy is combined with the drug treatment and a variety of surgical procedures that depends on the clinical situation. Conclusion At present, there is no guideline for the diagnosis and treatment of tuberculosis infection after TKA, it still needs further study and improvement.
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Affiliation(s)
- Jiongtong Lin
- Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China
| | - Weiyi Yang
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510120, P.R.China
| | - Jianke Pan
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510120, P.R.China
| | - Minghui Luo
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510120, P.R.China
| | - Xuewei Cao
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510120, P.R.China
| | - Jun Liu
- Department of Orthopaedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510120,
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19
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Malhotra R, Gautam D, Wahal N. Tuberculous periprosthetic infection precipitated by infliximab therapy. BMJ Case Rep 2017; 2017:bcr-2016-218726. [PMID: 28270399 DOI: 10.1136/bcr-2016-218726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Biological therapy with TNF-α inhibitors have been increasingly used in the treatment of inflammatory arthritis. Systemic tuberculosis infections are often known to occur following treatment with these biological agents. However, no case of periprosthetic tuberculous infection of the hip following this therapy has been reported. We report a case of a 45-year-old man who developed periprosthetic tuberculous infection soon after infliximab injection. We also discuss the need of pretreatment awareness, high index of suspicion, early diagnosis and management of such case.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Deepak Gautam
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Naman Wahal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, Delhi, India
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20
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Microbiological Diagnosis of Implant-Related Infections: Scientific Evidence and Cost/Benefit Analysis of Routine Antibiofilm Processing. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 971:51-67. [PMID: 27815925 DOI: 10.1007/5584_2016_154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prosthetic joint infection is one of the most severe complication following joint arthroplasty, producing a significant worsening of patient's quality of life. Management of PJIs requires extended courses of antimicrobial therapy, multiple surgical interventions and prolonged hospital stay, with a consequent economic burden, which is thought to markedly increase in the next years due to the expected burden in total joint arthroplasties. The present review summarizes the present knowledge on microbiological diagnosis of prosthetic joint infections, focusing on aethiological agents and discussing pros and cons of the available strategies for their diagnosis.Intra-operative clinical diagnosis and pathogen identification is considered the diagnostic benchmark, however the presence of bacterial biofilm makes pathogen detection with traditional microbiological techniques highly ineffective. Diagnosis of PJIs is a rather complex challenge for orthopedics and requires a strict collaboration between different specialists: orthopaedics, infectivologists, microbiologists, pathologists and radiologists. Diagnostic criteria have been described by national and international association and scientific societies. Clinicians should be trained on how to use it, but more importantly they should know potential and limitation of the available tests in order to use them appropriately.
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21
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Mahale YJ, Aga N. Implant-associated mycobacterium tuberculosis infection following surgical management of fractures: a retrospective observational study. Bone Joint J 2015; 97-B:1279-83. [PMID: 26330597 DOI: 10.1302/0301-620x.97b9.35227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this retrospective observational cohort study, we describe 17 patients out of 1775 treated for various fractures who developed mycobacterium tuberculosis (MTB) infection after surgery. The cohort comprised 15 men and two women with a mean age of 40 years (24 to 70). A total of ten fractures were open and seven were closed. Of these, seven patients underwent intramedullary nailing of a fracture of the long bone, seven had fractures fixed with plates, two with Kirschner-wires and screws, and one had a hemiarthroplasty of the hip with an Austin Moore prosthesis. All patients were followed-up for two years. In all patients, the infection resolved, and in 14 the fractures united. Nonunion was seen in two patients one of whom underwent two-stage total hip arthroplasty (THA) and the other patient was treated using excision arthoplasty. Another patient was treated using two-stage THA. With only sporadic case reports in the literature, MTB infection is rarely clinically suspected, even in underdeveloped and developing countries, where pulmonary and other forms of TB are endemic. In developed countries there is also an increased incidence among immunocompromised patients. In this paper we discuss the pathogenesis and incidence of MTB infection after surgical management of fractures and suggest protocols for early diagnosis and management.
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Affiliation(s)
- Y J Mahale
- JMFs ACPM Medical College, Morane, Sakri Road, Dhule, 424001 Post Box No 145, Maharashtra, India
| | - N Aga
- JMFs ACPM Medical College, Morane, Sakri Road, Dhule, 424001 Post Box No 145, Maharashtra, India
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22
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Abstract
Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.
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Affiliation(s)
- Aaron J. Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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23
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Mycobacterium tuberculosis as cause of therapeutic failure in prosthetic joint infections. Enferm Infecc Microbiol Clin 2014; 32:204-5. [DOI: 10.1016/j.eimc.2013.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/21/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
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Abstract
This article reports a rare case of late-onset tubercular infection following total knee arthroplasty in a 60-year-old woman who had been treated with a full course of antitubercular therapy for latent tuberculosis almost 25 years ago. Because no clear guidelines exist for optimal management of disease reactivation in the prosthetic knee joint, the authors performed a literature review and attempted to provide a treatment algorithm based on the time of presentation. Two modes of presentation were identified for unsuspected tubercular prosthetic joint infections based on the onset of symptoms and time to diagnosis: an early-onset presentation that occurs within the first 6 to 8 weeks postoperatively and a late-onset presentation that usually manifests after 8 weeks. Early-onset presentations often can be treated with standard antitubercular chemotherapy alone, whereas late-onset presentation may require 2-stage reimplantation under cover of antitubercular medications. This report also highlights the fact that despite adequate treatment of latent tuberculosis, patients may remain at risk of prosthetic joint infection following total knee arthroplasty.
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25
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Periprosthetic joint infections: clinical and bench research. ScientificWorldJournal 2013; 2013:549091. [PMID: 24288493 PMCID: PMC3826319 DOI: 10.1155/2013/549091] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/01/2013] [Indexed: 01/27/2023] Open
Abstract
Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.
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