ABSTRACT
OBJECTIVES: We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI). METHODS: Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords 'prosthetic joint', and 'tuberculosis'. RESULTS: During years 1997-2016, 13 patients (8 males, 5 females, median age 79 years [range, 60-86]) had documented M. tuberculosis PJI, involving hip (nâ¯=â¯6), knee (nâ¯=â¯6), or shoulder (nâ¯=â¯1). Median time from arthroplasty to diagnosis was 9 years [0.4-20]. The diagnosis was obtained on joint aspirates (nâ¯=â¯9), or synovial tissue (nâ¯=â¯4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6-32]). Nine patients underwent surgery: debridement (nâ¯=â¯4), resection arthroplasty (nâ¯=â¯3), and revision arthroplasty (1-stage exchange, nâ¯=â¯2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS). CONCLUSIONS: M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.
Subject(s)
Joints/microbiology , Mycobacterium tuberculosis/drug effects , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/drug therapy , Tuberculosis/drug therapy , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Shoulder/adverse effects , Disease Management , Female , Humans , Male , Middle Aged , Prosthesis-Related Infections/microbiology , Retrospective Studies , Surveys and QuestionnairesABSTRACT
Chronic meningococcemia is defined by blood culture(s) positive for Neisseria meningitidis, symptoms duration > 7 days, and neither meningitis nor shock on admission. This series of 26 consecutive cases illustrates that this is a rare disease (< 5% of meningococcemia, < 0.05 cases per 100,000 inhabitants per year), mostly affecting young adults, males, with no predisposing condition. Major symptoms include fever, rash, and arthralgia. Median time between symptoms onset, and diagnosis is 28 days. Most patients fully recover with a 1-week course of parenteral betalactams.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Meningococcal Infections/diagnosis , Meningococcal Infections/drug therapy , beta-Lactams/therapeutic use , Adolescent , Adult , Bacteremia/diagnosis , Bacteremia/drug therapy , Bacteremia/epidemiology , Bacteremia/microbiology , Chronic Disease/epidemiology , Female , France/epidemiology , Humans , Incidence , Infusions, Parenteral , Male , Meningococcal Infections/epidemiology , Meningococcal Infections/microbiology , Middle Aged , Prognosis , Young AdultABSTRACT
We report 4 cases of community-acquired infections due to Staphylococcus aureus producing Panton-Valentin leukocidin (SA-PVL) with uncommon multivisceral localizations. These cases highlight the need to screen for PVL in patients with serious staphylococcal infections. All patients were cured. Two of them received intravenous immunoglobulins in addition to antibiotics.
