Arthroscopic treatment of Mycobacterium massiliense septic arthritis outbreak after intra-articular injection: A case-series report and literature review.

ABSTRACT: Non-tuberculous mycobacteria (NTM) comprise mycobacteria, with the exceptions of Mycobacterium (M.) leprae and the M. tuberculosis complex. Septic arthritis caused by NTM is so rare that there is no standardized treatment.Between April and September 2012, 27 patients were infected with M. massiliense in a single clinic following injection of steroid in the knee joint. Clinical data of 9 patients who received arthroscopic treatment in Seoul Hospital of Soonchunhyang University were analyzed retrospectively.Arthroscopic irrigation and debridement were performed average 2.6 times (1-3 times). As 6 out of 9 cases (67%) had joint contracture of the knee joint, arthroscopic adhesiolysis, and brisement were performed. After surgical procedures, Hospital for Special Surgery and Lysholm knee score showed improvement compared before the surgery, but a radiographic result evaluated by Kellgren-Lawrence revealed that 6 cases got deteriorated to stage 4 in the 4-year follow-up.NTM septic arthritis had a higher recurrence and a higher contracture incidence than septic arthritis caused by tuberculous mycobacteria or other bacteria. Treatment was possible with repeated arthroscopic debridement and intravenous antibiotics.

Mycobacterium ulcerans ulcers: a proposed surgical management algorithm.

Mycobacterium ulcerans (MU) is the third common mycobacterial infection after tuberculosis and leprosy. In endemic areas, MU ulcers should be considered in the differential diagnosis of any unusual or nonhealing lesion or ulcer. Diagnosis and treatment should be instigated promptly. Delay may lead to disfiguring or disabling scars. Surgical management, therefore, should aim towards early excision, with clear margins of the ulcer. We present 4 consecutive patients treated by our department within a 6-month period for MU ulcers. The presentation, diagnosis and surgical management are described. Based on our experience and after reviewing the literature, we have developed a surgical algorithm for the management of MU ulcers.

Systemic suppression of interferon-gamma responses in Buruli ulcer patients resolves after surgical excision of the lesions caused by the extracellular pathogen Mycobacterium ulcerans.

Buruli ulcer (BU), caused by Mycobacterium ulcerans, is the third most common mycobacterial infection in immunocompetent humans besides tuberculosis and leprosy. We have compared by ex vivo enzyme-linked immunospot analysis interferon-gamma (IFN-gamma) responses in peripheral blood mononuclear cells (PBMC) from BU patients, household contacts, and individuals living in an adjacent M. ulcerans nonendemic region. PBMC were stimulated with purified protein derivative (PPD) and nonmycobacterial antigens such as reconstituted influenza virus particles and isopentenyl-pyrophosphate. With all three antigens, the number of IFN-gamma spot-forming units was reduced significantly in BU patients compared with the controls from a nonendemic area. This demonstrates for the first time that M. ulcerans infection-associated systemic reduction in IFN-gamma responses is not confined to stimulation with live or dead mycobacteria and their products but extends to other antigens. Interleukin (IL)-12 secretion by PPD-stimulated PBMC was not reduced in BU patients, indicating that reduction in IFN-gamma responses was not caused by diminished IL-12 production. Several months after surgical excision of BU lesions, IFN-gamma responses of BU patients against all antigens used for stimulation recovered significantly, indicating that the measured systemic immunosuppression was not the consequence of a genetic defect in T cell function predisposing for BU but is rather related to the presence of M. ulcerans bacteria.

[Treatment of Buruli ulcer desease by excision and skin graft]. / Traitement de l'ulcère de Buruli par excision-greffe: à propos de 118 observations.

INTRODUCTION: Buruli ulcer is the most common mycobacteria disease after leprosy and tuberculosis. The purpose of our study is to make our contribution to the surgical treatment of Buruli ulcer and to asses our results. METHOD: One hundred eighteen patients presenting progressive Buruli ulcers were operated on. The surgical procedure included excisions for necrotic lesions and grafts for clean wounds. The results were estimated on the time of hospitalization and appearance of complications. RESULTS: Seventy-three patients (62%) were subjected to excision followed by thin skin grafts and 35 patients (30%) were subjected to grafts only. The number of excision times varies from 1 to 7 per patient and from 1 to 4 for the skin grafts. All our patients heal within a period of 120 days with extremes going from 14 to 265 days. We deplored 26 complications (22%): eight new focus, seven infectious complications, six recurrences, five stiffnesses and ankyloses. CONCLUSION: The treatment of Buruli ulcer by excision and grafts is efficient but does not prevent recurrences and new focus from happening and for their prevention, it is necessary to discover pharmaceutical molecules that are efficient on Mycobacterium ulcerans.

[Buruli ulcer--Africa's latest mycobacterial scourge]. / Burulisåret--Afrikas senaste mykobakteriella gissel.

Buruliulcer is an extensive ulceration usually on the extremities. The ulcer can spread to subcutaneous fat, muscle and even bone causing osteomyelitis and death. It is the the third most common mycobacterial disease in humans after tuberculosis and leprosy. The bacterium grows in still standing water and infects children through small ulcerations in their skin. Mycobacterium ulcerans may also be transmitted by the bite of aquatic bugs (Naucordiae), which harbor the bacterium in their salivary glands. The disease affects poor people in rural, tropical areas where deforestation has led to flooding rivers, stagnant bodies of water and marsh. Benin, Cote d'Ivoire and Ghana in West Africa are seriously hit. Skin transplantation is the treatment of choice. Treatment with antibiotics has been disappointing.

Mycobacterium ulcerans infection (Buruli ulcer): a case report of the disseminated nonulcerative form.

The World Health Organization recognizes Mycobacterium ulcerans infection (Buruli ulcer) as a reemerging disease. Classically, lesions are indolent, undermined ulcers of the skin. The characteristic histopathologic changes are provoked by a soluble toxin of M ulcerans that is necrotizing and immunosuppressive. After tuberculosis and leprosy, Buruli ulcer is the third most common mycobacterial disease in humans. We report Buruli ulcer in a patient in Benin, West Africa, with widespread edema and diffuse induration of approximately one half of the skin of the trunk. There was no ulceration. The tissue studied was a 16-cm portion excised from the center of the large surgical specimen. Histopathologic analysis showed massive contiguous necrosis of the dermis and subcutis in sections of biopsy specimens from the center, at 2-cm intervals in two radii from the center to the periphery, and at 5-cm intervals around the margin. Acid-fast bacilli infiltrated all specimens except at one peripheral site. Samples of the entire surgical specimen taken from seven sites before fixation were polymerase chain reaction and culture positive for M ulcerans. The disseminated nonulcerative form of M ulcerans infection is well known, but is now increasingly frequent in some highly endemic areas, especially in West Africa. This patient died within 48 hours postsurgery, but cause of death was not established. The only regularly effective treatment for advanced lesions is surgical excision of all infected tissue. Estimation of the lateral limits of invasion by M ulcerans may help the surgeon establish the optimal extent of excision. Refinement of the basic concept we used and adaptation to preoperative assessment of the limit of bacterial invasion are urgently needed, especially for massive lesions.