Mycobacterium tuberculosis Infection After Grafting of Infected Bone: A Case Series of Four Patients

Back pain is one of the commonly reported medical symptoms, and the mainstay of treatment is conservative care and rehabilitation, but in severe cases with nerve compression from herniated discs, spondylolisthesis, fractures, or spinal canal stenosis, surgery can be helpful. The use of donor bone grafting is common but associated with some complications, including infection.  We present a case series of four patients who underwent spinal surgery with allograft bone transplantation and developed Mycobacterium tuberculosis (MTB) disease due to infected bone grafts. Each patient required 12 months of therapy for MTB disease and had various complications from the required anti-mycobacterial treatment.  After the first outbreak of MTB infection from donor bone grafting in 2021, the tissue procurement organizations implemented the use of nucleic acid amplification testing for MTB in the bone allografts, but this is not the most sensitive test available. This test did not detect the MTB in the tissue that was implicated in the second outbreak, and cultures for MTB did not become positive until the bone had already been distributed and grafted into 36 patients.  In response to both outbreaks, the American Association of Tissue Banks (AATB) has recently published new guidelines, which include recommended criteria and literature reviews to aid with screening out cases that may have MTB and improving safety measures for recipient patients.