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Soverina S, Gilliland HN, Olive AJ. Pathogenicity and virulence of Mycobacterium abscessus. Virulence 2025; 16:2508813. [PMID: 40415550 PMCID: PMC12118445 DOI: 10.1080/21505594.2025.2508813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 05/07/2025] [Accepted: 05/15/2025] [Indexed: 05/27/2025] Open
Abstract
Non-tuberculous mycobacteria (NTM), such as Mycobacterium abscessus (Mab) are an increasing cause of human disease. While the majority of immunocompetent hosts control Mab infections, the robust survival of Mab within the environment has shaped survival in human cells to help drive persistence and cause inflammatory damage in susceptible individuals. With high intrinsic resistance to antibiotics, there is an important need to fully understand how Mab causes infection, define protective host pathways that control disease, and develop new strategies to treat those at high risk. This review will examine the existing literature related to host-Mab interactions with a focus on virulence, the host response, and therapy development. The goal is to highlight key gaps in our understanding and describe novel approaches to encourage new research avenues that better define the pathogenesis and host response against this increasingly important human pathogen.
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Affiliation(s)
- Soledad Soverina
- Department of Microbiology, Genetics, and Immunology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Haleigh N. Gilliland
- Department of Microbiology, Genetics, and Immunology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Andrew J. Olive
- Department of Microbiology, Genetics, and Immunology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
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Hanada S, Wajima T, Takata M, Morozumi M, Sato Y, Sasaki J, Iwata S, Ubukata K. Additional biomarkers and emm types associated with group A streptococcal toxic shock syndrome: a Japanese nationwide observational study. Eur J Clin Microbiol Infect Dis 2025; 44:1471-1480. [PMID: 40193020 PMCID: PMC12116948 DOI: 10.1007/s10096-025-05116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 03/26/2025] [Indexed: 05/28/2025]
Abstract
PURPOSE The incidence of invasive Group A Streptococcus (iGAS) infection and streptococcal toxic shock syndrome (STSS) is increasing. Early detection and diagnosis of cases that may progress to STSS are currently difficult. In this study, we aimed to identify biomarkers and emm type, one of the virulence factors, associated with STSS development. METHODS In this multicentre observational study including patients with iGAS infection (n = 305), we investigated the relative associations of host factors, clinical manifestations, biomarkers, and emm type with STSS. RESULTS The overall mortality rate was 15.4%; the fatality rate within 28 days of admission was higher in patients with STSS (67.9%, 38/56) than in those without (3.6%, 9/249). The most predominant type was emm1 (38%), detected in 73.2% of the patients with STSS. Risk factors for STSS identified by multivariable analysis included underlying kidney disease (odds ratio [OR], 10.7; 95% confidence interval [CI], 2.1-54.0, p = 0.004), bacteraemia without primary focus (OR, 3.6; 95% CI 1.2-11.1, p = 0.023), necrotizing fasciitis (OR, 8.7; 95% CI 2.6-29.4, p < 0.001), white blood cell count (WBC) < 4,000/µL (OR, 7.8; 95% CI 2.4-25.6, p = 0.001), serum creatine kinase (CK) ≥ 300 U/L (OR, 7.5; 95% CI 2.8-19.8, p < 0.001), and emm1 (OR, 5.2; 95% CI 2.0-13.4, p = 0.001). CONCLUSION WBC < 4,000/µL and CK level ≥ 300 U/L on admission are additional relevant biomarkers for STSS prediction. The most predominant iGAS type, emm1, was significantly associated with STSS.
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Affiliation(s)
- Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
| | - Takeaki Wajima
- Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Misako Takata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Miyuki Morozumi
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Yukio Sato
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Iwata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Kimiko Ubukata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
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Hewlett AL, Kildow BJ, Cortés-Penfield NW. Periprosthetic Joint Infections. Infect Dis Clin North Am 2025:S0891-5520(25)00015-7. [PMID: 40413113 DOI: 10.1016/j.idc.2025.02.010] [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: 05/27/2025]
Abstract
Periprosthetic joint infection (PJI) is a dreaded and devastating complication of total joint arthroplasty. The clinical presentation of PJI is dependent on multiple factors, but typically involves pain, swelling, warmth and erythema of the affected joint. The management of PJI is complex, with both the medical and surgical approach being scenario specific. The importance of interdisciplinary collaboration to manage these complicated infections cannot be overstated. This review, aimed at the practicing infectious diseases clinician, details the background, microbiology, clinical presentation, diagnosis and both surgical and medical treatment of PJI.
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Affiliation(s)
- Angela L Hewlett
- Department of Internal Medicine, Division of Infectious Diseases, Section of Orthopedic Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198-5400, USA.
| | - Beau J Kildow
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 981080 Nebraska Medical Center, Omaha, NE 68198-1080, USA
| | - Nicolás W Cortés-Penfield
- Department of Internal Medicine, Division of Infectious Diseases, Section of Orthopedic Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198-5400, USA
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Coda R, Waller S, Vopat B. Nontuberculosis Mycobacterium Infections in Orthopaedic Surgery: Review of the Epidemiology, Pathogenesis, Diagnosis, and Treatment Guidelines. J Am Acad Orthop Surg Glob Res Rev 2025; 9:01979360-202505000-00001. [PMID: 40326997 PMCID: PMC12043345 DOI: 10.5435/jaaosglobal-d-24-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 02/14/2025] [Accepted: 03/04/2025] [Indexed: 05/07/2025]
Abstract
Nontuberculosis Mycobacterium infections are rare but devastating infections in orthopaedic surgery. The complexity of treatment and the high rate of treatment failure for nontuberculosis Mycobacterium infections illustrate their unique pathogenesis and success at evading normal immune responses. To date, there is no formal treatment algorithm developed for managing these infections in orthopaedic surgery. Successful eradication relies on prolonged culture-specific antibiotic therapies coupled with surgical resection, implant/prosthesis removal, and occasionally amputations. These multidrug therapies often have a high rate of complications, drug-drug interactions, and poor tolerance, further increasing the complexity of treatment. Outlining the epidemiology, pathogenesis, diagnosis, and treatment guidelines of these rare but detrimental infections is essential to improving treatment success.
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Affiliation(s)
- Reed Coda
- From the The University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen Waller
- From the The University of Kansas Medical Center, Kansas City, Kansas
| | - Bryan Vopat
- From the The University of Kansas Medical Center, Kansas City, Kansas
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Crowley PD, Vaillant JJ, Shirley JD, Wengenack NL, Jo Kasten M. Rapidly growing knowledge of Mycobacterium smegmatis: A case series and review of antimicrobial susceptibility patterns. J Clin Tuberc Other Mycobact Dis 2024; 37:100489. [PMID: 39525346 PMCID: PMC11550012 DOI: 10.1016/j.jctube.2024.100489] [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] [Indexed: 11/16/2024] Open
Abstract
Mycobacterium smegmatis is a rapidly growing nontuberculous mycobacterium that is rarely isolated from clinical specimens and is frequently considered to be a contaminant. We conducted a retrospective review of mycobacterial cultures positive for M. smegmatis from 1998 to 2023 at our institution to evaluate the clinical significance of recovering this mycobacterium. Antimicrobial susceptibility patterns were also determined. Twenty-two M. smegmatis isolates were identified from 17 patients, 12 of whom met criteria for clinical chart review. M. smegmatis was deemed a cause of infection in 5/5 isolates from skin or soft tissue, 3/3 from bone, 1/1 from blood, and 0/3 from respiratory specimens. All cases thought to be significant were treated with at least 2 active agents for periods varying from 2 weeks up to 8 months. 18 isolates had antimicrobial susceptibility testing performed and all were susceptible to doxycycline, imipenem, linezolid, moxifloxacin, trimethoprim/sulfamethoxazole, and tobramycin while all isolates were resistant to clarithromycin. When recovered in culture, the presence of M. smegmatis should be correlated with clinical presentation as it may represent a true infection.
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Affiliation(s)
- Patrick D. Crowley
- Division of Public Health, Infectious Diseases, and Occupational Medicine; Section of Infectious diseases, Mayo Clinic, Rochester MN, United States
| | - James J. Vaillant
- Division of Public Health, Infectious Diseases, and Occupational Medicine; Section of Infectious diseases, Mayo Clinic, Rochester MN, United States
- Division of Clinical Microbiology, Mayo Clinic, Rochester MN, United States
| | - Joshua D. Shirley
- Division of Clinical Microbiology, Mayo Clinic, Rochester MN, United States
| | - Nancy L. Wengenack
- Division of Clinical Microbiology, Mayo Clinic, Rochester MN, United States
| | - Mary Jo Kasten
- Division of Public Health, Infectious Diseases, and Occupational Medicine; Section of Infectious diseases, Mayo Clinic, Rochester MN, United States
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Bémer P, Aubry A, Schramm F, Koebel C, Revillet H, Baltes V, Le Brun C, 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] [MESH Headings] [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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Mori G, Scarpellini P, Masera F, Torri S, Castagna A, Guffanti M. Management of M. abscessus subsp. abscessus early-onset prosthetic joint infection: Case report and literature review. J Clin Tuberc Other Mycobact Dis 2024; 35:100440. [PMID: 38694253 PMCID: PMC11061329 DOI: 10.1016/j.jctube.2024.100440] [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] [Indexed: 05/04/2024] Open
Abstract
Nontuberculous mycobacteria are a rare but still emerging cause of difficult-to-treat prosthetic joint infection. To our knowledge only 17 cases of M. abscessus complex prosthetic joint infection are reported in literature, of which only 1 is by M. abscessus subps. abscessus. No guidelines are available for this clinical scenario. We describe a 68-years-old female patient with an early-onset M. abscessus subsp. abscessus prosthetic joint infection, successfully treated with a tailored medical-surgical strategy, and present an overview of cases currently available in the literature to assist physicians in the management of these uncommon infections.
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Affiliation(s)
- Giovanni Mori
- Università Vita-Salute San Raffaele, Milano, Italy
- Unit of Infectious Diseases, Ospedale Santa Chiara, Trento, Italy
| | - Paolo Scarpellini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Masera
- Traumatology and Orthopedic Clinic, Istituto Clinico Città Studi, Milan, Italy
| | - Stefania Torri
- Unit of Microbiology and Virology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonella Castagna
- Università Vita-Salute San Raffaele, Milano, Italy
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Guffanti
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Damronglerd P, Higgins E, Fida M, Tai D, Tande A, Abdel M, Abu Saleh O. Characteristics and management of periprosthetic joint infections caused by rapidly growing mycobacteria: a retrospective study and a review of the literature. J Bone Jt Infect 2024; 9:99-106. [PMID: 38601002 PMCID: PMC11002937 DOI: 10.5194/jbji-9-99-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/21/2024] [Indexed: 04/12/2024] Open
Abstract
Background: Periprosthetic joint infection (PJI) following total joint arthroplasty is a serious complication associated with significant morbidity. While Gram-positive cocci are the predominant causative organisms, PJIs caused by rapidly growing mycobacteria (RGM) have been reported, albeit at a lower frequency. This study aimed to investigate the characteristics and management of PJI caused by RGM. Methods: A retrospective review was conducted using an institutional PJI database to identify patients diagnosed with PJI due to RGM from January 2010 to December 2021. Clinical data, including demographics, symptoms, comorbidity information, laboratory parameters, surgical procedures, medical treatment and outcomes, were collected and analyzed. Results: A total of eight patients were identified with PJI caused by RGM during the study period. The median age was 66 years old, and most cases occurred in patients with total knee arthroplasty (n = 6 ). The isolated RGM species included Mycobacterium abscessus (three cases), M. fortuitum (three cases), and one case each of M. immunogenum and M. mageritense. Surgical debridement was performed in all cases, with six patients undergoing two-stage revision and two patients requiring amputation. Combination antimicrobial therapy was administered based on antimicrobial susceptibility testing, and the median duration of treatment was 7.5 months. Adverse events related to therapy occurred in 75 % of cases. No relapses were observed during the median follow-up period of 39.6 months. Conclusions: PJI caused by RGM is a rare complication of total joint arthroplasty. Surgical debridement and combination antimicrobial therapy are the mainstays of treatment. Although clinical cure rates are high, amputation may be required in severe cases.
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Affiliation(s)
- Pansachee Damronglerd
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Eibhlin Higgins
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA
| | - Madiha Fida
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA
| | - Don Bambino Geno Tai
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M. Abu Saleh
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA
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Holleb P, De S, Antony S. Mycobacterium flavescens Infection - An Unusual Case of Prosthetic Joint Infection. Infect Disord Drug Targets 2024; 24:e170124225744. [PMID: 38314682 DOI: 10.2174/0118715265274138231229070757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION The onset of prosthetic joint infections (PJIs) is characterized by early onset defined as within 90 days of the procedure, delayed onset defined as within 3 to 12 months, and late onset defined as over 12 months. In only a scant number of case reports, Mycobacterium flavescens associated infections are typically found in sputum cultures and associated with various forms of penetrating joint traumas, particularly post-surgical interventions. Due to its rarity in presentation among cases of PJIs, we have presented a case of PJI caused by Mycobacterium flavescens. CASE PRESENTATION We have, herein, reported a case of a 70-year-old male presenting with stabbing left knee pain over the past several months along with accompanying erythema and swelling with the presence of purulent discharge. Outpatient cultures have shown the growth of Mycobacterium flavescent; subsequently, the patient underwent a 2-stage revision arthroplasty and was treated with a three-drug regimen and implant 5 months later. Although being an atypical cause of PJIs, we emphasize the importance of considering NTM as a differential for immunocompromised patients, especially those with prior surgical intervention. DISCUSSION Mycobacterium spp. related PJIs manifest clinical features similar to other bacteriacausing PJIs, such as warm, indurated edema at the surgical site resulting in wound dehiscence and joint effusion. Diagnosis of Mycobacterium spp. related PJIs includes history and physical examination findings, serum inflammatory markers, synovial fluid analysis, and culture. Concurrently with surgical interventions, utilization of antimicrobial agents provides additional control in Mycobacterium- related PJI. Mycobacterium flavescens should be included among other NTMs as a possible cause of PJIs.
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Affiliation(s)
- Peter Holleb
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Srijisnu De
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
| | - Suresh Antony
- Department of Internal Medicine, Las Palmas Del Sol Medical Center, El Paso, TX, USA
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Kim SJ, Lee DW, Lee C, Kim JH. Mycobacterium avium complex prosthetic joint infection: A systematic review of the literature and pooled analysis. J Orthop Surg (Hong Kong) 2023; 31:10225536231199392. [PMID: 37878458 DOI: 10.1177/10225536231199392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Mycobacterium avium complex (MAC) prosthetic joint infection (PJI) has been rarely reported. METHODS This study aimed to investigate the epidemiology and outcomes of MAC PJI. A systematic review of the literature regarding the MAC infection following total joint arthroplasty including hip and knee joint was performed. Multiple databases were searched for published English-written articles up to May 2023. Studies that reported cases of PJI by MAC were reviewed. RESULTS A total of 17 patients were identified and analyzed from 11 published studies. All patients presented with joint symptom of pain or swelling prior to the diagnosis and MAC was confirmed by culture. The most of the patients (16/17 patients, 94.1%) were noted to have underlying medical condition(s) that might have affected immunity. Treatment consisted of anti-MAC medication therapy only in two patients and anti-MAC medication therapy plus surgery in 15 patients. Among the patients who underwent surgery, 14 patients (82.3%) had removal of the prosthesis including seven patients who had two-stage surgery to have reimplantation of the prosthesis. No relapse of MAC infection was reported despite of one case of relapse of infection caused by different pyogenic bacteria. The rate of overall mortality was 29.4%, however, identified attributable mortality due to MAC infection was low (5.9%). CONCLUSION PJI by MAC is a rare disease. However, MAC needs to be considered in the differential diagnosis in immunocompromised patients presenting with symptoms of PJI. Two-stage exchange arthroplasty may result in successful treatment outcomes without higher risks of relapse of infection if undertaken in association with appropriate active anti-MAC antibiotic therapy.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital, Seoul, Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, Seoul, Korea
| | - Chaeryoung Lee
- Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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11
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Maimaiti Z, Li Z, Xu C, Fu J, Hao L, Chen J, Li X, Chai W. Non-Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature. Orthop Surg 2023; 15:1488-1497. [PMID: 37154097 PMCID: PMC10235174 DOI: 10.1111/os.13661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Periprosthetic joint infection (PJI) caused by non-tubercular mycobacteria (NTM) is uncommon but catastrophic. However, conclusive clinical data on PJI caused by NTM are lacking. In this case series and systematic review, the clinical manifestations, diagnosis, and management of NTM PJI are summarized and analyzed. METHODS From 2012 to 2020, we retrospectively analyzed consecutive PJI cases caused by NTM in our institution. A literature review was also conducted from January 2000 to December 2021, utilizing the PubMed, MEDLINE, Cochrane Library, and EMBASE databases to identify all reported NTM-induced PJI cases. The clinical characteristics, demographics, pathogen identification, treatment protocols, and prognosis of NTM PJI were summarized and analyzed. RESULTS In this retrospective analysis, seven patients infected with NTM following total joint arthroplasty at our institution were included, including six cases of PJI caused by NTM and one case of septic arthritis (SA) caused by NTM. There were six men and one woman, and their average age was 62.3 years. The average interval between TJA and PJI onset was 4 months. The preoperative serological markers, including the mean ESR (51 mm/h), CRP (4.0 mg/dL), fibrinogen (5.7 g/L), and D-dimer (1.1 g/L), were increased. Six patients underwent staged revision surgery, and one patient with SA received antibiotic-loaded bone cement beads to treat the infection. After an average of 33 months of observation following surgical intervention, none of the patients showed any symptoms of infection recurrence. From 2000 to 2021, 68 patients with NTM PJI were found in 39 studies in the published literature. Reinfections occurred within 1 year after arthroplasty in more than half (53.2%) of the patients. M. fortuitum and M. abscesses were the most prevalent rapidly growing mycobacteria (RGM) in all PJI patients, whereas Mycobacterium avium intracellulare (MAC) was the most prevalent slowly growing mycobacterium (SGM). The corresponding antibiotics were amikacin and ethambutol. The rate of culture-negative without specific clinical symptoms was as high as 36.4% (12/33), while 45% (18/40) utilized additional diagnostic techniques such as NGS. A final clinical follow-up record was available for 59 patients (86.7%; mean follow-up period, 29 months), and 10.1% of patients failed to respond to treatment. CONCLUSION Orthopaedic surgeons should consider NTM in patients with negative routine cultures who are at risk for Mycobacterium infection. Treatment options rely on the accurate result of microbiologic identification and drug sensitivity testing, and to achieve this, it may be necessary to send multiple culture specimens, extend the culture time, and change the culture medium. Every effort should be made to identify NTM and its various subtypes through modern diagnostic tools if necessary.
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Affiliation(s)
- Zulipikaer Maimaiti
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Zhuo Li
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- School of MedicineNankai UniversityTianjinChina
| | - Chi Xu
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Jun Fu
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Libo Hao
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Jiying Chen
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Xiang Li
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Wei Chai
- Senior Department of Orthopaedics, The Fourth Medical CentreChinese PLA General HospitalBeijingChina
- Department of Orthopaedics, The First Medical CentreChinese PLA General HospitalBeijingChina
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
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12
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Cutaneous Infection Caused by Mycobacterium smegmatis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Peng SH, Lee SH, Chen CC, Lin YC, Chang Y, Hsieh PH, Shih HN, Ueng SWN, Chang CH. Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty. J Orthop Surg (Hong Kong) 2022; 30:10225536221140610. [PMID: 36396130 DOI: 10.1177/10225536221140610] [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] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty. MATERIAL AND METHODS From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement. RESULTS Mycobacterium abcessus (n = 6) and Mycobacterium chelonae (n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin. CONCLUSIONS nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday.
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Affiliation(s)
- Shih-Hui Peng
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sheng-Hsun Lee
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Chieh Chen
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chih Lin
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yuhan Chang
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pang-Hsin Hsieh
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Steve W N Ueng
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, 38014Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, 38014Chang Gung University, Taoyuan, Taiwan
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14
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Tuano KR, Yang JH, Kleck CJ, Mathes DW, Chong TW. Multidisciplinary Treatment of Persistent Nontuberculous Mycobacterial Spinal Hardware Infection with a Pedicled Superior Gluteal Artery Perforator Flap. Arch Plast Surg 2022; 49:604-607. [PMID: 36159388 PMCID: PMC9507590 DOI: 10.1055/s-0042-1756287] [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: 10/27/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022] Open
Abstract
Nontuberculous mycobacterial hardware infections are extremely challenging to treat. Multidisciplinary care involving removal of infected hardware, thorough debridement, and durable soft tissue coverage in conjunction with antibiotic therapy is essential for successful management. This case report presents a patient with chronic mycobacterial spinal hardware infection that underwent successful treatment with aggressive serial debridements and reconstruction with a large pedicled superior gluteal artery perforator flap coverage.
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Affiliation(s)
- Krystle R Tuano
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jerry H Yang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christopher J Kleck
- Department of Orthopedic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David W Mathes
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tae W Chong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
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15
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Jameson AP, Barker SM, Urquhart AG, Pack B. Prosthetic Joint Infection Due to Mycobacterium senegalense After Exposure to Zebu Cattle: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00041. [PMID: 36099360 DOI: 10.2106/jbjs.cc.22.00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
CASE A 69-year-old male patient, 5 years after a well-functioning total hip arthroplasty for severe osteoarthritis, presented with a 3-month history of progressive, unrelenting, "burning" pain in his right hip with accompanying fullness of the right thigh. Inflammatory markers were elevated, and imaging revealed a large unilocular fluid collection with communication to the hip joint. Aspiration was positive for Mycobacterium senegalense. A combination of surgical and antibiotic therapy successfully treated this patient. CONCLUSION Mycobacterium senegalense is a rare cause of prosthetic joint infection. A combination of surgical and antimicrobial management is required for effective treatment.
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Affiliation(s)
- Andrew P Jameson
- Mercy Health Saint Mary's Hospital Department of Infectious Diseases, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Seth M Barker
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
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16
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Groenewold MR, Flinchum A, Pillai A, Konkle S, Moulton-Meissner H, Tosh PK, Thoroughman DA. Investigation of a cluster of rapidly growing mycobacteria infections associated with joint replacement surgery in a Kentucky hospital, 2013-2014 with 8-year follow-up. Am J Infect Control 2022; 51:454-460. [PMID: 35732255 PMCID: PMC9896514 DOI: 10.1016/j.ajic.2022.06.013] [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: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND We describe the investigation of a nosocomial outbreak of rapidly growing mycobacteria (RGM) infections and the results of mitigation efforts after 8 years. METHODS A cluster of RGM cases in a Kentucky hospital in 2013 prompted an investigation into RGM surgical site infections following joint replacement surgery. A case-control study was conducted to identify risk factors. RESULTS Eight cases were identified, 5 caused by M. wolinskyi and 3 by M. goodii. The case-control study showed the presence of a particular nurse in the operating room was significantly associated with infection. Environmental sampling at the nurse's home identified an outdoor hot tub as the likely source of M. wolinskyi, confirmed by pulsed-field gel electrophoresis and whole genome sequencing. The hot tub reservoir was eliminated, and hospital policies were revised to correct infection control lapses. No new cases of RGM infections have been identified as of 2021. DISCUSSION Breaches in infection control practices at multiple levels may have led to a chain of infection from a nurse's hot tub to surgical sites via indirect person-to-person transmission from a colonized health care worker (HCW). CONCLUSIONS The multifactorial nature of the outbreak's cause highlights the importance of overlapping or redundant layers of protection preventing patient harm. Future investigations of RGM outbreaks should consider the potential role of colonized HCWs as a transmission vector.
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Affiliation(s)
- Matthew R. Groenewold
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Frankfort, KY, USA,Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA,Address correspondence to Matthew R. Groenewold, PhD, MSPH, Centers for Disease Control and Prevention, NIOSH, 1090 Tusculum Ave. MS R-17, Cincinnati, OH 45226.
| | - Andrea Flinchum
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
| | - Aravind Pillai
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
| | - Stacey Konkle
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
| | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pritish K. Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Douglas A. Thoroughman
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Frankfort, KY, USA,Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort, KY, USA
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17
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T405, a New Penem, Exhibits In Vivo Efficacy against M. abscessus and Synergy with β-Lactams Imipenem and Cefditoren. Antimicrob Agents Chemother 2022; 66:e0053622. [PMID: 35638855 PMCID: PMC9211421 DOI: 10.1128/aac.00536-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Mycobacteroides abscessus (Mab) is an emerging environmental microbe that causes chronic lung disease in patients with compromised lung function such as cystic fibrosis and bronchiectasis. It is intrinsically resistant to most antibiotics, therefore there are only few antibiotics that can be repurposed to treat Mab disease. Although current recommendations require daily intake of multiple antibiotics for more than a year, cure rate is low and often associated with significant adverse events. Here, we describe in vivo efficacy of T405, a recently discovered β-lactam antibiotic of the penem subclass, in a mouse model of pulmonary Mab infection. Imipenem, one of the standard-of-care drugs to treat Mab disease, and also a β-lactam antibiotic from a chemical class similar to T405, was included as a comparator. Probenecid was included with both T405 and imipenem to reduce the rate of their renal clearance. T405 exhibited bactericidal activity against Mab from the onset of treatment and reduced Mab lung burden at a rate similar to that exhibited by imipenem. The MIC of T405 against Mab was unaltered after 4 weeks of exposure to T405 in the lungs of mice. Using an in vitro assay, we also demonstrate that T405 in combination with imipenem, cefditoren or avibactam exhibits synergism against Mab. Additionally, we describe a scheme for synthesis and purification of T405 on an industrial scale. These attributes make T405 a promising candidate for further preclinical assessment to treat Mab disease.
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18
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Santoso A, Phatama KY, Rhatomy S, Budhiparama NC. Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review. World J Orthop 2022; 13:503-514. [PMID: 35633748 PMCID: PMC9125004 DOI: 10.5312/wjo.v13.i5.503] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/07/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.
AIM To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.
METHODS A literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.
RESULTS Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.
CONCLUSION At least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.
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Affiliation(s)
- Asep Santoso
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Surakarta and Prof. Dr. R. Soeharso Orthopaedic Hospital, Sukoharjo 57162, Indonesia
| | - Krisna Yuarno Phatama
- Department of Orthopaedic and Traumatology, Universitas Brawijaya, Saiful Anwar General Hospital, Malang 65112, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, Universitas Gadjah Mada, Yogyakarta and Dr. Soeradji Tirtonegoro General Hospital, Klaten 57424, Indonesia
| | - Nicolaas Cyrillus Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation at Medistra Hospital, Jakarta 12950, Indonesia
- Faculty of Medicine, Universitas Airlangga, Jawa Timur 60132, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden 2333, Netherlands
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19
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Sahoo RR, Wakhlu A, Agarwal V. Neglected tropical rheumatic diseases. Clin Rheumatol 2022; 41:1293-1304. [PMID: 35142903 DOI: 10.1007/s10067-022-06090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
The complexities of dealing with rheumatic diseases in tropical countries are diverse and likely due to limited health care infrastructure, lack of diagnostic and therapeutic facilities, impact of dominant prevailing diseases, and the challenges of differentiating from infectious and non-infectious disease mimics. Several tropical diseases present with musculoskeletal and rheumatic manifestations and often pose a diagnostic dilemma to rheumatologists. The diagnosis is often delayed or the disease is misdiagnosed, leading to poor patient outcomes. Endemic tropical diseases like tuberculosis and leprosy have myriad rheumatic presentations and remain important differentials to consider in patients with rheumatic manifestations. Infection with human immunodeficiency virus is a great masquerade and can mimic manifestations of multiple diseases. The role of viral infections in triggering and perpetuating autoimmunity is well known and chikungunya arthritis is a classic example of the same. This review highlights the rheumatic manifestations of tropical diseases and aims to create awareness among the caregivers. Key Points • It is crucial to be aware and identify infectious diseases presenting with rheumatic manifestations in the tropics. • Presentations akin to classic rheumatic syndromes such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus and vasculitis are common.
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Affiliation(s)
- Rasmi Ranjan Sahoo
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology Services, Apollomedics Super Specialty Hospitals, Lucknow, 226012, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India.
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20
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Prosthetic Knee Joint Infection Caused by Mycobacterium kansasii. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00010. [PMID: 35389898 PMCID: PMC8994076 DOI: 10.5435/jaaosglobal-d-21-00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/23/2022] [Indexed: 11/18/2022]
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21
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Golden M, Spichler Moffarah A, Kerantzas C, Rubin L, O’Bryan J. Unnecessary Routine Use of Mycobacterial Cultures in Patients with Periprosthetic Joint Infections. Open Forum Infect Dis 2022; 9:ofac132. [PMID: 35392456 PMCID: PMC8982768 DOI: 10.1093/ofid/ofac132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Accurate diagnosis ensures appropriate therapy of periprosthetic joint infection (PJI). Since mycobacterial PJI is rare, routine testing is inappropriate. We reviewed hip and knee PJI at our institution over 28 months. Mycobacterial cultures were routinely sent with rare positivity. Mycobacterial cultures should be sent only when there is clinical suspicion.
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Affiliation(s)
- Marjorie Golden
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Anne Spichler Moffarah
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Lee Rubin
- Section of Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Care, Yale University School of Medicine, Yale New Haven Health, New Haven, CT, USA
| | - Jane O’Bryan
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA and Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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22
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Unfried RI, Krause LMF, Cezimbra HM, Pacheco LS, Larangeira JA, Ribeiro TA. A Retrospective Observational Cohort Study of Periprosthetic Hip Infection Treated by one-stage Method Including Cases With Bone Graft Reconstruction. CLINICAL MEDICINE INSIGHTS: ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441221090344. [PMID: 35547099 PMCID: PMC9081729 DOI: 10.1177/11795441221090344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Purpose: Prosthetic joint infection (PJI) is a devastating complication that can affect hip arthroplasty. Its treatment is extremely difficult, and issues regarding the optimal treatment remain unanswered. This study intended to show the effectiveness of the one-stage treatment of PJI. Materials and Methods: A retrospective observational cohort study performed from July 2014- August 2018. All patients with suspected PJI were included. Major and minor criteria developed by the International Consensus on Periprosthetic Joint Infection (ICPJI) was used to define infection. Laboratory tests and image exams were performed, and all patients were followed for at least 2 years. Outcomes: Success rate (2018 ICPJI definition to success) in treatment of PJI using one-stage revision method. Clinical and functional outcomes defined by Harris Hip Score (HHS). Results: Thirty-one patients were screened and 18 analyzed. 69.85 ± 9.76 years was the mean age. Mean follow-up time was 63.84 ± 18.55 months. Ten patients had acetabular defects and required bone graft reconstruction. Sixteen patients were classified as Tier 1, 1 as Tier 3D, and as 1 Tier 3E. Almost 90% of patients submitted to one-stage revision with acetabulum graft reconstruction were free of infection. The overall infection survival rate was 78.31±6.34 months. Candida albicans and sinus tract were statistically significant in univariate Cox’s analysis. The predictor of one-stage revision surgery failure that remained final Cox’s regression model was C. albicans (hazard ratio [HR]: 4.47). Conclusion: Treatment through one-stage revision surgery associated with 6 months of antimicrobial is a viable option with acceptable results even when bone graft reconstruction is necessary. C. albicans was a strong predictor of failure in this cohort.
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Affiliation(s)
- Ricardo Issler Unfried
- Department of and Traumatology, University Hospital of Santa Maria (SOT-HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Master’s Course in Health and Life Sciences, Universidade Franciscana (UFN), Santa Maria, Brazil
| | | | - Helen Minussi Cezimbra
- Department of Infectious Diseases, University Hospital of Santa Maria, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Liliane Souto Pacheco
- Medicine School, Hospital São Francisco de Assis (HSFA), Universidade Franciscana (UFN), Santa Maria, Brazil
- Department of Infectious Diseases, University Hospital of Santa Maria, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - João Alberto Larangeira
- Department of and Traumatology, University Hospital of Santa Maria (SOT-HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Tiango Aguiar Ribeiro
- Department of and Traumatology, University Hospital of Santa Maria (SOT-HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Master’s Course in Health and Life Sciences, Universidade Franciscana (UFN), Santa Maria, Brazil
- Medicine School, Hospital São Francisco de Assis (HSFA), Universidade Franciscana (UFN), Santa Maria, Brazil
- Postgraduate Program of Health Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Department of Surgery in Orthopaedic, Medicine School, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
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23
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Genovese N, Auld T, Dever LL, Rossman SR. Mycobacterium abscessus Periprosthetic Hip Infection Complicated by Superimposed Polymicrobial Infection: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00055. [PMID: 34798649 DOI: 10.2106/jbjs.cc.21.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 79-year-old man developed Mycobacterium abscessus prosthetic joint infection (PJI) after hip hemiarthroplasty that was complicated by polymicrobial infection. He was ultimately treated with resection arthroplasty and chronic suppressive therapy. He has had no evidence of recurrent infection after 2 years of follow-up. CONCLUSION As far as we know, this is the first reported case of M. abscessus hip PJI complicated by superimposed polymicrobial infection. This case demonstrates the challenge of treating M. abscessus infection, the need for a multidisciplinary approach with aggressive surgical intervention, and prolonged combination antimicrobial therapy for a successful outcome.
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Affiliation(s)
- Nicholas Genovese
- Rutgers New Jersey Medical School, Department of Orthopaedic Surgery, Newark, New Jersey
| | - Thomas Auld
- Rutgers New Jersey Medical School, Department of Orthopaedic Surgery, Newark, New Jersey
| | - Lisa L Dever
- Rutgers New Jersey Medical School, Department of Infectious Disease, Newark, New Jersey
| | - Stephen R Rossman
- Hackensack University Medical Center, Department of Orthopaedic Surgery, Hackensack, New Jersey
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24
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Next-Generation Sequencing Quickly Identifies Mycobacterium smegmatis in Spine Implant Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Fida M, Beam E, Wengenack NL. Misidentification of Mycobacterium smegmatis as Mycobacterium fortuitum by DNA line probe assay. J Clin Tuberc Other Mycobact Dis 2021; 25:100268. [PMID: 34522793 PMCID: PMC8426554 DOI: 10.1016/j.jctube.2021.100268] [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] [Indexed: 11/24/2022] Open
Abstract
Optimal management of infection with mycobacterial species requires accurate identification down to complex/species level due to variations in outcomes. Over the last few decades, there have been significant advances in laboratory diagnostics with development of newer and rapid molecular methods. Here we describe a case of Mycobacterium smegmatis that was misidentified as Mycobacterium fortuitum by DNA line probe assay.
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Affiliation(s)
- Madiha Fida
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, USA
| | - Elena Beam
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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26
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Ramanathan M, Ayoade F. A case of Mycobacterium fortuitum prosthetic joint infection successfully treated medically without prosthesis explantation or joint debridement. BMJ Case Rep 2021; 14:e243675. [PMID: 34404656 PMCID: PMC8372788 DOI: 10.1136/bcr-2021-243675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive for Mycobacterium fortuitum He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due to M. fortuitum can be managed medically without having to remove the prosthesis or debride the joint.
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Affiliation(s)
- Maya Ramanathan
- Infectious Diseases, University of Miami School of Medicine, Miami, Florida, USA
- Infectious Diseases, Jackson Memorial Hospital, Miami, Florida, USA
| | - Folusakin Ayoade
- Infectious Diseases, University of Miami School of Medicine, Miami, Florida, USA
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27
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Tsuruyama Y, Mori N, Fujisawa T, Katayama M. Disseminated Mycobacterium abscessus subspecies massiliense infection and subsequent prosthetic joint infection in a hemodialysis patient: A case report. J Infect Chemother 2021; 27:1504-1507. [PMID: 34052111 DOI: 10.1016/j.jiac.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
A 74-year-old man with diabetic nephropathy undergoing dialysis after total knee arthroplasty presented to our hospital with dyspnea and abnormal behavior such as wearing his pants on his head. The patient was in shock with ventricular tachycardia. Urine and blood cultures showed MAM with sterile pyuria. We administered amikacin and imipenem cilastatin, but repeated cultures were persistently positive. Although we initially chose not to administer azithromycin because of a higher risk of fatal arrhythmia, we had no choice but to administer azithromycin because of treatment failure. Upon close monitoring, we observed no arrhythmia, and the blood cultures became negative. The patient was discharged on day 106 without any symptoms. However, 2 months after discontinuation of antibiotics, he was readmitted and diagnosed with prosthetic joint infection due to MAM. He could not undergo total knee arthroplasty resection because of his low tolerance to surgery. We re-administered same antibiotics, and repeated draining and cleaning of his left knee for several weeks. The inflammation in the knee joint gradually improved, and the patient was discharged while treatment with azithromycin and amikacin was continued. After being discharged, the patient did not experience recurrent disease for at least 6 months. Our case suggests that MAM can cause sterile pyuria and infection in a patient with diabetic nephropathy. The macrolide agent is a key drug for MAM infection, and repeated joint lavage in addition to administering antibiotics may be an alternative treatment for prosthetic joint infection in patients with intolerance to surgery.
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Affiliation(s)
- Yu Tsuruyama
- Department of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Nobuaki Mori
- Department of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.
| | - Tokuo Fujisawa
- Department of Emergency Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Mitsuya Katayama
- Department of General Internal Medicine and Infectious Diseases, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
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28
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Fix WC, Sheth NP, Braffman MN. Mycobacterium fortuitum Prosthetic Joint Infection After Total Hip Arthroplasty: A Case Report. JBJS Case Connect 2021; 10:e0343. [PMID: 32649134 DOI: 10.2106/jbjs.cc.18.00343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CASE A 57-year-old man presented with a Mycobacterium fortuitum prosthetic joint infection (PJI) after right total hip arthroplasty refractory to the initial revision surgery and cement spacer placement. The patient was subsequently treated with 2-stage total joint arthroplasty revision surgery using an antibiotic-laden spacer customized to include meropenem and delayed reimplantation to allow for prolonged, systemic antimicrobial treatment with multiple antimicrobials, including levofloxacin and linezolid. CONCLUSIONS There is little evidence to guide practitioners in the diagnosis and treatment of PJI caused by rare, rapidly growing mycobacteria (RGM) such as M. fortuitum. This case demonstrates a successful strategy for the treatment of RGM PJI.
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Affiliation(s)
- William C Fix
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 2Department of Orthopaedic Surgery, Adult Hip and Knee Reconstruction, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 3Section of Infectious Diseases, Pennsylvania Hospital, Philadelphia, Pennsylvania
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29
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Singh D, Johnson M, Kitchens CS, Boone A. Challenges in Treating Mycobacterium chelonae/abscessus Prosthetic Joint Infection. J Pharm Pract 2020; 35:492-494. [PMID: 33280512 DOI: 10.1177/0897190020977757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prosthetic joint infections (PJIs) remain a major complication of arthroplasty, most of which are caused by Staphylococcus aureus and gram-negative bacteria. Unfortunately, cultures are false negative in upward of 7 percent of patients with suspected PJIs, and commonly in infections caused by rare rapidly growing mycobacterium (RGM) species. Guidelines recommend 6 months of antimycobacterial therapy for bone diseases caused by RGM, with empiric therapy consists of an oral macrolide (clarithromycin or azithromycin) plus tobramycin and imipenem-cilastatin. Definitive treatment of PJI due to RGM should be guided by antimicrobial susceptibility, however, most microbiology laboratories are unable to differentiate between M. chelonae and M. abscessus. Furthermore, treatment of M. chelonae PJI is challenging due to multidrug resistance and the dearth of oral antibiotics for therapy. This case report investigates a patient with PJI caused by M. chelonae and M. abscessus. The initial treatment with imipenem-cilastatin was complicated by drug induced seizures, further limiting therapy options.
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Affiliation(s)
- Divita Singh
- Pharmacy Practice, 306709Howard University College of Pharmacy, Washington, DC, USA
| | | | | | - Andrew Boone
- 20814Howard University Hospital, Washington, DC, USA
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30
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Mycobacterium mageritense Prosthetic Joint Infection. Case Rep Infect Dis 2020; 2020:8845430. [PMID: 32733720 PMCID: PMC7369673 DOI: 10.1155/2020/8845430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
Prosthetic joint infections (PJI) complicate up to 2% of arthroplasties and are usually caused by typical bacterial agents (e.g., staphylococci and streptococci). Although an infrequent cause of PJI, mycobacterial species are difficult to eradicate, as they adhere to hardware, form biofilms, and have high rates of antimicrobial resistance. Mycobacterium mageritense is a rapidly growing Mycobacterium that has been infrequently described as a cause of surgical and device-related infections. We herein described a case of prosthetic knee infection due to M. mageritense. The patient was treated with removal of hardware, antimicrobials, and prosthetic knee reimplantation with a good outcome. To our knowledge, M. mageritense has not been previously described as a cause of PJI in the medical literature.
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31
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Novack TA, Hoskins T, Patel JN, Mazzei C, Goyette D, Zeedyk K, Wittig JC. Nail Salon a Potential Source of a Rare Mycobacterium Fortuitum Infection In Proximal Tibia Megaprosthesis? A Case Report. J Bone Jt Infect 2020; 5:133-136. [PMID: 32566452 PMCID: PMC7295650 DOI: 10.7150/jbji.43023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 11/05/2022] Open
Abstract
Mycobacterium Fortuitum (M. Fortuitum) is a type of opportunistic pathogen commonly found in water/soil and belongs to the nontuberculosis mycobacteria (NTM) family. Prosthetic joint infection due to M. Fortuitum is extremely rare. We present a case of a 21-year-old female with an infection following a radical resection of the proximal tibia due to a parosteal osteosarcoma.
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Affiliation(s)
- Thomas A Novack
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ.,Department of Orthopedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ
| | - Tyler Hoskins
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | - Jay N Patel
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | - Christopher Mazzei
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | - David Goyette
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | - Kaitlin Zeedyk
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
| | - James C Wittig
- Department of Orthopedic Surgery, Morristown Medical Center, Morristown, NJ
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32
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Singh J, Antony SJ. Prosthetic joint infection due to Mycobacterium moriokaense in an immunocompetent patient after a total knee replacement. Proc (Bayl Univ Med Cent) 2020; 33:97-99. [DOI: 10.1080/08998280.2019.1674089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Joya Singh
- Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico
| | - Suresh J. Antony
- Department of Medicine, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico
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33
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Goldstein N, St Clair JB, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis 2019. [PMID: 31107224 PMCID: PMC6537735 DOI: 10.3201/eid2506.181041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Early identification and aggressive treatment are crucial for patients with these
infections. Nontuberculous mycobacteria represent an uncommon but important cause of
infection of the musculoskeletal system. Such infections require aggressive
medical and surgical treatment, and cases are often complicated by delayed
diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous
mycobacterial musculoskeletal infections treated over 6 years by orthopedic
surgeons at a university-affiliated tertiary referral center. All patients
required multiple antimicrobial agents along with aggressive surgical treatment;
13 of 14 patients ultimately achieved cure. Four patients required amputation to
control the infection. Half these patients were immunosuppressed by medications
or other medical illness when they sought care at the referral center. Six cases
involved joint prostheses; all ultimately required hardware removal and
placement of an antimicrobial spacer for eradication of infection. Our findings
highlight the importance of vigilance for nontuberculous mycobacterial
musculoskeletal infection, particularly in patients who are immunosuppressed or
have a history of musculoskeletal surgery.
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34
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Goldstein N, St Clair JB, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis 2019; 25:1075-1083. [PMID: 31107224 DOI: 10.3201/eid2406.181041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients required multiple antimicrobial agents along with aggressive surgical treatment; 13 of 14 patients ultimately achieved cure. Four patients required amputation to control the infection. Half these patients were immunosuppressed by medications or other medical illness when they sought care at the referral center. Six cases involved joint prostheses; all ultimately required hardware removal and placement of an antimicrobial spacer for eradication of infection. Our findings highlight the importance of vigilance for nontuberculous mycobacterial musculoskeletal infection, particularly in patients who are immunosuppressed or have a history of musculoskeletal surgery.
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35
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Sardiña LA, Kaw U, Jour G, Knabel D, Dyck RM, Procop GW, Bergfeld WF, Harrington S, Demkowicz R, Piliang MP. Diagnosis of Mycobacterium abscessus/chelonae complex cutaneous infection: Correlation of tissue culture and skin biopsy. J Cutan Pathol 2019; 47:321-327. [PMID: 31804711 DOI: 10.1111/cup.13623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/06/2019] [Accepted: 11/15/2019] [Indexed: 01/05/2023]
Abstract
Mycobacterium abscessus and M. chelonae belong to the rapid-growing nontuberculous mycobacteria (NTM) group, which are defined by their ability to form visible colonies on agar within 7 days of subculture. Cutaneous infections by this complex show a heterogeneous clinical presentation with varied histopathologic findings. However, the presence of vacuoles in many specimens has been reported as a specific histologic finding. Herein, we correlate the histopathology of patients with tissue-culture positive M. abscessus/M. chelonae complex in order to identify features that may prompt a rapid categorization of the infectious etiology. The cohort includes 33 skin punch biopsy specimens from 28 patients who had associated positive tissue cultures. The most frequent clinical presentation was a single or multiple nodule. Twenty-seven specimens (81.81%) were found to have vacuoles. The observation of certain histologic features (ie, polymorphonuclear microabscesses and epithelioid granuloma formation) should raise the possibility of infection by NTM. In addition to these findings, we believe the presence of vacuoles in the dermal and subcutaneous inflammation should raise suspicion for NTM.
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Affiliation(s)
- Luis A Sardiña
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Urvashi Kaw
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - George Jour
- Department of Pathology and Dermatology, New York Langone Medical Center, New York, New York
| | - Daniel Knabel
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Rayna M Dyck
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Skin Wellness Center Of Alabama, Birmingham, Alabama
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wilma F Bergfeld
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Susan Harrington
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan Demkowicz
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Melissa P Piliang
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
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36
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Treating Primary Arthroprosthesis Infection Caused by Mycobacterium abscessus subsp. a bscessus. Case Rep Infect Dis 2019; 2019:5892913. [PMID: 31929923 PMCID: PMC6942737 DOI: 10.1155/2019/5892913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
Prosthetic joint infections (PJI) caused by nontuberculous mycobacteria are very rare, and results of treatment can be unpredictable. A 72-year-old female underwent hip replacement after an accidental fall in a local hospital in Santo Domingo. The postoperative period was uneventful except for a traumatic wound near the surgical scar. PJI caused by Mycobacterium abscessus subsp. abscessus was diagnosed 6 months later. A two-stage reimplantation was performed after a 3-month period of aetiology-directed therapy, including amikacin, imipenem, and clarithromycin. M. abscessus isolate was reported to be resistant to clarithromycin when incubation was protracted for 14 days and to harbour the gene erm(41). The patient manifested major side effects to tigecycline. At reimplant, microbiologic investigations resulted negative. Overall, medical treatment was continued for a 7-month period. When discontinued and at 6-month follow-up, the patient was clinically well, inflammatory markers were normal, and the radiography showed well-positioned prosthesis. Mycobacterium abscessus subsp. abscessus is a very rare cause of PJI, yet it must be included in the differential diagnosis, especially when routine bacteria cultures are reported being negative. Further investigations are needed to determine any correlations between clinical results and in vitro susceptibility tests, as well as the clinical implications of M. abscessus subsp. abscessus harbouring the functional gene erm(41). Moreover, investigations are needed for determine optimal timings of surgery and lengths of medical therapy to improve patient outcome.
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37
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Mycobacterium bovis infection of total hip arthroplasty after intravesicular Bacillus Calmette-Guérin. Arthroplast Today 2019; 5:416-420. [PMID: 31886382 PMCID: PMC6920732 DOI: 10.1016/j.artd.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/09/2019] [Accepted: 08/10/2019] [Indexed: 01/27/2023] Open
Abstract
Intravesicular application of Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is effective in the treatment of bladder cancer. However, systemic dissemination and subsequent infection of implants have been reported. We present a case of M. bovis infection of a total hip arthroplasty 5 years after BCG instillation for bladder cancer. He was treated with debridement, antibiotics, irrigation, and prosthesis retention with appropriate antituberculous therapy. At 4 years after surgery and 3 years after cessation of treatment, he has had no recurrence of infection with a good functional outcome. This case highlights the need to consider Mycobacteria infection in patients who have received intravesicular BCG. Debridement and retention of well-fixed implants can be successful in combination with appropriate antituberculous therapy.
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38
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Nengue L, Diaz MAA, Sherman CE, Bhasin A, Libertin CR. Mycobacterium abscessus Prosthetic Joint Infections of the Knee. J Bone Jt Infect 2019; 4:223-226. [PMID: 31700770 PMCID: PMC6831809 DOI: 10.7150/jbji.36286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/04/2019] [Indexed: 01/24/2023] Open
Abstract
M. abscessus complex prosthetic joint infections (PJI) of the knee are rare. We present a patient with an M. abscessus subsp. massiliense, a nontuberculous mycobacterium (NTM), peri-prosthetic knee infection who presented with wound drainage followed by sepsis. The published peer-reviewed literature on knee PJIs due to this organism is reviewed to highlight its clinical presentation,symptomatology, microbiology, surgical interventions, antimicrobial regimens, and outcomes.
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Affiliation(s)
- Lydie Nengue
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Courtney E Sherman
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Arveen Bhasin
- Division of Allergy, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
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39
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Sigler R, Newman JR. Mycobacterium Avium Prosthetic Hip Infection on Abatacept Presenting as Fever of Unknown Origin. J Bone Jt Infect 2019; 4:194-197. [PMID: 31555506 PMCID: PMC6757007 DOI: 10.7150/jbji.35703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022] Open
Abstract
Non-tuberculous mycobacteria (NTM) are well-described pulmonary pathogens in patients with underlying lung disease. Extra-pulmonary infections with NTM are rare. We describe a prosthetic hip infection with Mycobacterium avium complex. Increased immunosuppressing medications and number of total joint replacements are expected to increase the prevalence of NTM infections in the future.
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Affiliation(s)
- Rachel Sigler
- Department of Internal Medicine, University of Kansas Medical Center
| | - Jessica R Newman
- Division of Infectious Diseases, University of Kansas Medical Center
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40
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Mycobacterium smegmatis causing a granulomatous cardiomediastinal mass. IDCases 2019; 18:e00608. [PMID: 31440449 PMCID: PMC6699471 DOI: 10.1016/j.idcr.2019.e00608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 11/21/2022] Open
Abstract
Non-tuberculous mycobacterial species are uncommon human pathogens. They are divided into slow and rapid growing mycobacteria (RGM) with Mycobacterium smegmatis group as an uncommon pathogen among the RGM. A 19 years old male presented with a 1 month history of dyspnea, orthopnea, unintentional weight loss, palpitation, flu-like symptoms and dry cough. Physical examination revealed tachycardia, distended superficial chest veins with a decrease in breath sounds at the right lower lung with fine crepitations. CT of the chest showed a large anterior mediastinal mass infiltrating the pericardium and three chambers of the myocardium that was confirmed using echocardiography. Despite negative workup for tuberculosis, the patient was treated successfully using first-line anti-TB treatment, which was begun before the tissue culture grew M. smegmatis. To our knowledge, this is the first case in the literature of M. smegmatis infection mimicking cardiomediastinal tuberculoma, and RGM should be suspected in similar presentations with negative TB workup, even in an immunocompetent patient. This is also the first patient to be treated using only first-line anti-tuberculous treatment successfully in the literature.
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41
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Bhatnagar N, Poojary A, Maniar A, Contractor A, Rohra S, Kumar G. Mycobacterium wolinskyi: A Rare Strain Isolated in a Persistent Prosthetic Knee Joint Infection: A Case Report. JBJS Case Connect 2019; 9:e0315. [PMID: 31373914 DOI: 10.2106/jbjs.cc.18.00315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A patient who underwent first-stage revision procedure elsewhere for prosthetic joint infection (PJI) of the knee with Kocuria rosea presented to us 9 months after the index surgery, with persistent infection. First-stage revision surgery was repeated and Mycobacterium wolinskyi, a rare rapidly growing nontuberculous mycobacterium (RGM), was isolated from samples obtained by sonication of the cement spacer. After a prolonged antibiotic course, definitive implantation surgery was done. One-year postimplantation, patient remains infection free. CONCLUSIONS This is only the second known case of knee PJI caused by M. wolinskyi. This case highlights the possibility of RGM getting masked by other organisms.
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Affiliation(s)
- Nishit Bhatnagar
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Aruna Poojary
- Department of Pathology and Microbiology, Breach Candy Hospital, Mumbai, India
| | - Adit Maniar
- Lilavati Hospital & Research Centre and Breach Candy Hospital, Mumbai, India
| | | | - Seema Rohra
- Department of Pathology and Microbiology, Breach Candy Hospital, Mumbai, India
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Rodari P, Marocco S, Buonfrate D, Beltrame A, Piubelli C, Orza P, Fittipaldo VA, Bisoffi Z. Prosthetic joint infection due to Mycobacterium xenopi: a review of the literature with a new case report. Infection 2019; 48:165-171. [PMID: 31098926 DOI: 10.1007/s15010-019-01318-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/07/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE Extrapulmonary infections due to M. xenopi, particularly osteoarticular localizations, are rare. The purpose of this paper is to describe a case of prosthetic hip infection and to review the published literature on cases of M. xenopi osteoarticular infections. METHODS Literature search was performed in the following databases: MEDLINE (PubMed), Embase, Central (the Cochrane Library 2019, Issue 1), LILACS (BIREME) (Latin American and Caribbean Health Science Information database) and Clinical Trials databases (14th August 2018). We included all case reports and case series on adult patients diagnosed with bone or joint infection by M. xenopi for whom the treatment and outcome were specified. RESULTS We retrieved 30 cases published between 1982 and 2012, among which 25 (83.3%) were reported from Europe. The two most common infection sites were spine (12/30, 40%) and knee (9/30, 30%). Risk factors for infection were previous invasive procedures (11/30, 36.7%), autoimmune disease (8/30, 26.7%), AIDS (4/30, 13.3%) and other comorbidities (2/30, 6.7%); five patients had no past medical history. All patients were treated with antibiotic combinations, but composition and duration of regimens hugely varied. Surgical intervention was performed in 16 patients (53.3%). Only 11 patients obtained full recovery of articular mobility after treatment. CONCLUSION This work highlights the difficulties in diagnosing and treating M. xenopi osteoarticular infections. Globally, evidence supporting the best practice for diagnosis and treatment of this infection is scanty.
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Affiliation(s)
- Paola Rodari
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Stefania Marocco
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Dora Buonfrate
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Anna Beltrame
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Chiara Piubelli
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Pierantonio Orza
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Veronica Andrea Fittipaldo
- Unità di Revisioni Sistematiche e Linee Guida, Dipartimento di Oncologia, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Zeno Bisoffi
- Dipartimento di Malattie Infettive-Tropicali e Microbiologia, Centro per le Malattie Tropicali, IRCCS Ospedale Sacro Cuore Don Calabria, Via Sempreboni 5, 37024, Negrar, Verona, Italy
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Malhotra R, Bala K, Gautam D, Bhattacharya A, Xess AB, Pandey P, Verma S, Singh UB. Mycobacterium abscessus Periprosthetic joint infection following bilateral Total Knee arthroplasty. IDCases 2019; 17:e00542. [PMID: 31080734 PMCID: PMC6505037 DOI: 10.1016/j.idcr.2019.e00542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 01/19/2023] Open
Abstract
Periprosthetic joint infection (PJI) can be protracted, incapacitating, needing multiple interventions and could even lead to mortality. Early post-operative PJI has been ascribed to peri-operative introduction of highly virulent bacteria, while delayed post-operative to low-virulence bacteria. Non-tuberculous mycobacteria (NTM) do not figure in the usual list of etiological agents. We report a case of difficult diagnosis of bilateral PJI caused by Mycobacterium abscessus, following bilateral total knee arthroplasty in an elderly male, but treated successfully despite prolonged infection. M. abscessus complex comprises a group of rapidly growing, multidrug-resistant NTM, capable of forming biofilms on prostheses, responsible for wide spectrum of hospital acquired infections. M. abscessus as a cause of PJI is not reported widely. There are a few cases described in literature worldwide. There are no policy guidelines available for treating such cases. High clinical suspicion, with a concerted effort to grow and identify the causal pathogen is important. Standard anti-tubercular therapy is not recommended for treatment due to inherent resistance. Complete excision of infected tissues and removal of prosthesis along with prolonged combination antimicrobial regimen is the treatment of choice.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Kiran Bala
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ashit Bhusan Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Santosh Verma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Urvashi B. Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
- Corresponding author.
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Butt S, Tirmizi A. Mycobacterium smegmatis bacteremia in an immunocompetent host. IDCases 2019; 15:e00523. [PMID: 30937286 PMCID: PMC6430072 DOI: 10.1016/j.idcr.2019.e00523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 11/20/2022] Open
Abstract
Non-tuberculous mycobacteria can cause catheter associated blood stream infections. The causative agents are generally rapid growers that belong to the Mycobacterium fortuitum and Mycobacterium mucogenicum groups. A 65 year hospitalized patient with temporary central venous catheter who developed Mycobacterium smegmatis bacteremia. Bacteremia cleared after removal of the catheter. Patient was treated initially with 4 weeks of intravenous amikacin, intravenous meropenem, oral doxycycline and oral ethambutol and then deescalated to oral doxycycline and oral ciprofloxacin for 8 weeks. He improved clinically and remained stable. A literature search identified total of 22 articles that reported 47 unique cases of Mycobacterium smegmatis infection. To our knowledge, this is the first case of Mycobacterium smegmatis central venous catheter associated bacteremia in an immunocompetent host.
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Affiliation(s)
- Saira Butt
- Indiana University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States
| | - Amir Tirmizi
- Infectious Diseases Consultant, Columbus Regional Hospital, Columbus, IN, United States
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Sukeik M, Haddad FS. Periprosthetic joint infections after total hip replacement: an algorithmic approach. SICOT J 2019; 5:5. [PMID: 30816089 PMCID: PMC6394232 DOI: 10.1051/sicotj/2019004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/28/2019] [Indexed: 12/25/2022] Open
Abstract
An algorithm for managing periprosthetic joint infections (PJIs) after total hip replacement (THR) surgery using a multidisciplinary approach and a clearly defined protocol may improve infection eradication rates. In this article, we present an algorithm for the management of different types of PJIs including the acutely infected cemented and cementless THRs where the components are well-fixed postoperatively and when the infection is secondary to haematogenous spread in previously well-functioning and well-fixed implants. For chronic PJIs where the components are often loose, the standard treatment includes a two-stage revision procedure. However, in a highly selected subset of patients, a single-stage approach has been utilised with high rates of eradicating infections.
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Affiliation(s)
- Mohamed Sukeik
- Foothills Medical Centre 1403 29 St NW Calgary AB T2N 2T9 Canada
| | - Fares Sami Haddad
- University College London Hospital 235 Euston Road London NW1 2BU UK
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Anemüller R, Belden K, Brause B, Citak M, Del Pozo JL, Frommelt L, Gehrke T, Hewlett A, Higuera CA, Hughes H, Kheir M, Kim KI, Konan S, Lausmann C, Marculescu C, Morata L, Ramirez I, Rossmann M, Silibovsky R, Soriano A, Suh GA, Vogely C, Volpin A, Yombi J, Zahar A, Zimmerli W. Hip and Knee Section, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S463-S475. [PMID: 30348582 DOI: 10.1016/j.arth.2018.09.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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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Ascione T, Barrack R, Benito N, Blevins K, Brause B, Cornu O, Frommelt L, Gant V, Goswami K, Hu R, Klement MR, Komnos G, Malhotra R, Mirza Y, Munhoz Lima AL, Nelson C, Noor SS, O'Malley M, Oussedik S, Portillo ME, Prieto H, Saxena A, Sessa G. General Assembly, Diagnosis, Pathogen Isolation - Culture Matters: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S197-S206. [PMID: 30360977 DOI: 10.1016/j.arth.2018.09.071] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Abstract
Although less common as causes of musculoskeletal infection than pyogenic bacteria, both Mycobacterium tuberculosis and nontuberculous mycobacteria can infect bones and joints. Although tuberculous arthritis and osteomyelitis have been recognized for millennia, infections caused by nontuberculous mycobacteria are being identified more often, likely because of a more susceptible host population and improvements in diagnostic capabilities. Despite advances in modern medicine, mycobacterial infections of the musculoskeletal system remain particularly challenging to diagnose and manage. This article discusses clinical manifestations of musculoskeletal infections caused by Mycobacterium tuberculosis and nontuberculous mycobacteria. Pathogenesis, unique risk factors, and diagnostic and therapeutic approaches are reviewed.
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Affiliation(s)
- John I Hogan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Rocío M Hurtado
- Mycobacterial Diseases Center, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandra B Nelson
- Program in Musculoskeletal Infections, Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Cox Building, 5th Floor, 55 Fruit Street, Boston, MA 02114, USA.
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Garcia-Coca M, Rodriguez-Sevilla G, Muñoz-Egea MC, Perez-Jorge C, Carrasco-Anton N, Esteban J. Historical evolution of the diseases caused by non-pigmented rapidly growing mycobacteria in a University Hospital. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:451-457. [PMID: 31535542 PMCID: PMC6790884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Non-pigmented rapidly growing mycobacteria (NPRGM) are a group of organisms of increasing interest due to the growing number of potential patients and the difficulties for a proper treatment in many of them. However, the evolution of these diseases in a long period of time and its evolutionary changes has been described only in a scanty number of reports. METHODS We performed a retrospective study between January 1st 2004 and December 31st 2017 in order to evaluate the clinical significance and types of diseases caused by NPRGM. Patients with isolates of NPRGM during this period were selected for the study, and clinical charts were reviewed using a predefined protocol. RESULTS During this period we identified 59 patients (76 clinical samples) with isolates of NPRGM, with 12 cases of clinical disease and one patient with doubtful significance (including 6 respiratory tract infections, 2 catheter infections, 1 skin and soft tissue infection, 1 disseminated infection, 1 conjunctivitis, 1 prosthetic joint infection and 1 mastitis). Fifty percent of M. chelonae isolates, 37.5% of M. abscessus isolates and 23.33% of M. fortuitum isolates were clinically significant. None of the isolates of other species were significant. CONCLUSIONS Most isolates in respiratory samples were contaminants/colonizations. M. abscessus was the main etiological agent in respiratory syndromes, whereas M. chelonae and M. fortuitum were more frequently associated with other infections, especially clinical devices and skin and soft tissue infections.
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Affiliation(s)
- Marta Garcia-Coca
- Departments of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM. Madrid, Spain
| | | | | | | | | | - Jaime Esteban
- Departments of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM. Madrid, Spain,Correspondencia: Jaime Esteban Dept. Of Clinical Microbiology. IIS-Fundación Jiménez Díaz. Av. Reyes Católicos 2. 28040-Madrid (Spain). Phone: +34915504900. E-mail: ;
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Abstract
Nontuberculous mycobacteria (NTM) diseases mainly manifest as pulmonary illnesses, but 20 -30% of NTM isolates originate from extrapulmonary diseases. These diseases cause a variety of clinical syndromes, including skin and soft-tissue infections, musculoskeletal infections, lymphadenitis, and disseminated disease. In skin and soft-tissue infections, musculoskeletal infections, prolonged treatment with combinations of antibiotics is effective in the treatment of NTM diseases, with surgery as an important complementary tool. The recommended duration of therapy for skin and soft-tissue infection is usually 2 – 4 months for mild disease and 6 months for severe disease, while treatment of musculoskeletal NTM disease usually requires at least 6 - 12 months. Management options of NTM lymphadenitis include surgical intervention, medical therapy, or observation. Treatment of disseminated NTM disease generally requires 6 to 12 months after immune restoration. However, despite a considerable increase in knowledge about NTM diseases, determining optimal treatment approaches remains a complex and challenging task.
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Affiliation(s)
- Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea.
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