Concomitant methicillin-resistant Staphylococcus aureus infection in tubercular sacroiliitis masquerading as anti-tubercular drug resistance: Role for molecular diagnosis.

A 23-year-old female on anti-tubercular therapy for tuberculous sacroiliitis presented with right sided gluteal and thigh abscess. Suspecting treatment failure, surgical evacuation of purulent material was done. The bacteriological isolation showed positivity for methicillin-resistant Staphylococcus aureus. Although the microbiological and histopathology examination of the specimen were negative for tubercular isolates, the cartridge based -nucleic acid amplification tests revealed positive genes for Mycobacterium tuberculosis and additional primers showed sensitivity for rifampicin and isoniazid. She was adequately treated with vancomycin for six weeks and anti-tubercular drugs for eight months and followed till the bony ankyloses at 18 months. This is a rare case based scenario wherein concomitant staphylococcal infection in tubercular sacroiliitis masqueraded as anti-tubercular drug resistance. The cartridge-based nucleic acid amplification test for tuberculosis is a rapid and sensitive modality in identifying mycobacteria even mixed infections and also determine drug resistance. There are fewer consensuses in the literature regarding the drugs and duration of anti-tubercular regime for tuberculous sacroiliitis with most regimes using four drugs between six to eighteen months.

Tuberculous Dactylitis: An Uncommon Presentation of Skeletal Tuberculosis.

BACKGROUND: Skeletal involvement accounts 1-5% of all cases of Tuberculosis. The vertebrae are more commonly affected. The bones of the hands are more affected than the bones of the feet. The term "spina ventosa" has been used to describe this disorder because of its radiographic features of cystic expansion of the involved short tubular bones. Tuberculous dactylitis mainly occurs through lympho-hematogenous spread. The lung is the primary focus in 75% of cases. CASE DETAILS: A 4 years old female child developed a painless swelling on her left index finger two months prior to her presentation. Following an unsuccessful treatment as a case of osteomyelitis with antibiotics, imaging showed an expansile lytic lesion with sclerosis, and fine needle aspiration confirmed tuberculous dactylitis. The child was initiated on anti-tubercular treatment with subsequent marked clinical and radiologic improvement. CONCLUSION: Presence of longstanding finger swelling and pain should alert a clinician to consider active disseminated tuberculosis. Furthermore, proper interpretation of imaging and use of fine needle aspiration has been highlighted.

[Tuberculous arthritis of the temporomandibular joint caused by Mycobacterium bovis. A diagnostic conundrum]. / Artritis temporomandibular por Mycobacterium bovis. Un problema diagnóstico.

Infrequent variants of extrapulmonary tuberculosis pose a challenging public health problem because of the delay in their diagnosis and treatment. Joint involvement is usually encountered in major joints (hip, elbow, knee and ankle). Tuberculous involvement of the temporomandibular joint is extremely uncommon but must be considered in patients with pain, inflammation or joint stiffness not resolved with conventional treatment.

Unusual manifestations of osteoarticular tuberculosis.

Unusual manifestations of osteoarticular tuberculosis, especially tubercular osteomyelitis, are described. Diagnostic problems may arise and lead to delay in treatment if these conditions are not considered in the differential diagnosis. The importance of bacteriologic and histopathologic confirmation of the disease is stressed.

Modulation of the inflammatory response in the rat TMJ with increasing doses of complete Freund's adjuvant.

OBJECTIVES: Acute inflammation stresses the physiological system, which must respond in order to reestablish homeostasis. The purpose of this study was to determine whether bilateral temporomandibular joint (TMJ) injections of different doses of Complete Freund's Adjuvant (CFA) produced dose-dependent changes in biologic markers of acute inflammation. The ability to establish an animal model with varying degrees of joint inflammation would allow evaluation of agents or conditions that could modulate the severity of the disease. DESIGN: The TMJs of three groups of male Sprague-Dawley rats were injected with CFA containing varying doses of Mycobacterium tuberculosis (MT). A group of non-injected and a group of saline injected rats were used as controls. Food intake, body weights, swelling and chromodacryorrhea were recorded daily. Interleukin-1 beta (IL-1 beta) and corticosterone levels were assayed and condylar cartilage thickness was measured 48 h after injections. RESULTS: Twenty-four hours post-injection, bilateral TMJ swelling and chromodacryorrhea were significantly (P< 0.05) increased following 10 microg of MT and further increased with elevated MT dose. In the CFA groups food intake was attenuated (P< 0.01) 24 and 48 h post-injection and negatively correlated with dose at 24 h. Body weight was also negatively correlated with dose. TMJ retrodiscal tissues IL-1 beta was increased (P< 0.05) in a dose-dependent manner. CFA increased corticosterone (P< 0.05), but this elevation was not dose dependent. Condylar cartilage thickness was decreased in a dose-dependent manner. CONCLUSIONS: These data suggest that an intermediate dose of CFA can be used to effect submaximal levels of TMJ inflammation that will allow experimental modulation in future studies.

Osseous manifestations of tuberculosis in children.

Forty-two children with tuberculous osteomyelitis were seen and treated between 1984 and 1999. The age ranged from 1 to 12 years (average 6); there were 31 boys and 11 girls. There were 50 osseous lesions (excluding spinal and synovial). Five children had multifocal bone involvement. There were four basic types of lesions: cystic (n = 26), infiltrative (n = 10), focal erosions (n = 8), and spina ventosa (n = 6). The majority of the lesions were in the metaphyses (n = 25); the remainder were in the diaphysis, epiphysis, short tubular bones, flat bones, and small round bones. The erythrocyte sedimentation rate was normal in seven, and the Mantoux test was negative in four. Bone lesions resembled pyogenic and fungal infections and benign and malignant bone tumors. Histologic confirmation was obtained in all patients. Curettage and antituberculous treatment yielded good results in the majority of patients, with follow-up of 6 months to 9 years. Biopsy is mandatory to confirm the diagnosis.