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Prosthetic joint infection by Mycobacterium tuberculosis: an unusual case report with literature review
Fares J Khater1, Imran Q Samnani, Jay B Mehta
1Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Box 70622, Johnson City, TN 37614, USA.
Abstract:
Prosthetic joint infection with Mycobacterium tuberculosis usually involves the hips or knees and can result from either local reactivation, or less often from hematogenous spread. Predisposing conditions include rheumatoid arthritis, chronic steroid use and pulmonary diseases. The most common symptom at presentation is pain, and the most common physical finding is joint swelling and/or a draining sinus tract. The sedimentation rate is helpful when elevated but is nonspecific, and initial skin testing is only helpful when positive. The diagnosis depends on culture and histologic examination of tissue. Removal of the joint combined with oral antituberculous treatment is necessary when the infection is discovered greater than six weeks post joint replacement. Early diagnosis leads to decreased morbidity. Tuberculous infection of prosthetic joints is a rare disease and its diagnosis depends on a high degree of clinical suspicion.
Insights
Prosthetic joint infections caused by Mycobacterium tuberculosis typically affect hips or knees. Early diagnosis and treatment, including joint removal and antituberculous therapy, are crucial for reducing complications in these rare cases.
Area of Science:
- Orthopedics
- Infectious Diseases
- Rheumatology
Background:
- Tuberculous infection of prosthetic joints is rare.
- It commonly affects hips or knees, stemming from local reactivation or hematogenous spread.
- Predisposing factors include rheumatoid arthritis, chronic steroid use, and pulmonary diseases.
Observation:
- The primary symptom is pain, with joint swelling and/or draining sinus tracts as common findings.
- Elevated sedimentation rate is nonspecific; initial skin tests are only useful if positive.
- Diagnosis relies on tissue culture and histologic examination.
Findings:
- Surgical removal of the prosthetic joint combined with oral antituberculous treatment is essential for infections diagnosed over six weeks post-replacement.
- Early detection significantly decreases patient morbidity.
Implications:
- High clinical suspicion is vital for diagnosing tuberculous prosthetic joint infections.
- Prompt intervention improves outcomes and reduces long-term complications associated with these rare infections.
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