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Prosthetic joint infection due to Mycobacterium tuberculosis: report of three cases
J I Tokumoto1, S E Follansbee, R A Jacobs
1Department of Medicine, University of California, San Francisco, USA.
Abstract:
Prosthetic joint infection due to Mycobacterium tuberculosis is uncommon. We describe three patients with delayed tuberculous prosthetic joint infection and review the eight other cases reported in the English-language literature. Infection results from local reactivation, which can occur up to 40 years after the initial infection, or from hematogenous spread. The diagnosis is often delayed because it is not considered in the initial evaluation, because it is difficult to confirm microbiologically, or because other bacteria may be isolated from the synovial fluid and thus be considered the etiology of the infection. Treatment usually consists of removal of the prosthesis in addition to administration of antituberculous agents.
Insights
Tuberculosis can cause uncommon prosthetic joint infections years after initial infection, often from reactivation or spread. Diagnosis is challenging, requiring prosthesis removal and antituberculous treatment for effective management.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Prosthetic joint infections (PJIs) are serious complications of joint replacement surgery.
- Tuberculous PJI is rare but can present with significant diagnostic challenges.
Observation:
- This study details three cases of delayed tuberculous PJI.
- A review of English-language literature identified eight additional cases.
Findings:
- Tuberculous PJI can arise from local reactivation (up to 40 years post-infection) or hematogenous spread.
- Delayed diagnosis is common due to low suspicion, microbiological confirmation difficulties, and co-isolation of other bacteria.
- Treatment typically involves prosthesis removal and antituberculous chemotherapy.
Implications:
- Increased awareness of tuberculous PJI is crucial for timely diagnosis and effective treatment.
- Diagnostic protocols should consider tuberculosis in cases of prosthetic joint infections, especially with delayed or atypical presentations.
- Multidisciplinary management combining orthopedic surgery and infectious disease expertise is essential for favorable outcomes.