[A Rare Localization of Tuberculosis: Talus Tuberculosis (Observation of a Female Patient from Marrakech Region, Morocco)]. / La tuberculose du talus : une localisation rare (observation chez une patiente de la région de Marrakech, Maroc).

Osteoarticular localization is rare and dominated by spinal disease. The talus localization of tuberculosis is rarely described in the literature; it can be secondary of direct inoculation or results from hematogenous dissemination, most of the time from lung tuberculosis. Its diagnosis is difficult; the imaging is very suggestive, but the confirmation is bacteriological and/or histological. The prognosis depends on a rapid diagnosis and the precocity of the treatment which is essentially medical.

La localisation ostéoarticulaire de la tuberculose est rare et dominée par l'atteinte vertébrale. L'ostéoarthrite tuberculeuse du talus est peu décrite dans la littérature. Elle peut être secondaire à une inoculation directe ou résulter d'une dissémination hématogène à partir d'un foyer le plus souvent pulmonaire. Son diagnostic est difficile, l'imagerie est très évocatrice, mais la confirmation est bactériologique et/ou histologique. Le pronostic dépend de la rapidité du diagnostic et de la précocité du traitement qui est essentiellement médical.

Osteological, biomolecular and geochemical examination of an early anglo-saxon case of lepromatous leprosy.

We have examined a 5th to 6th century inhumation from Great Chesterford, Essex, UK. The incomplete remains are those of a young male, aged around 21-35 years at death. The remains show osteological evidence of lepromatous leprosy (LL) and this was confirmed by lipid biomarker analysis and ancient DNA (aDNA) analysis, which provided evidence for both multi-copy and single copy loci from the Mycobacterium leprae genome. Genotyping showed the strain belonged to the 3I lineage, but the Great Chesterford isolate appeared to be ancestral to 3I strains found in later medieval cases in southern Britain and also continental Europe. While a number of contemporaneous cases exist, at present, this case of leprosy is the earliest radiocarbon dated case in Britain confirmed by both aDNA and lipid biomarkers. Importantly, Strontium and Oxygen isotope analysis suggest that the individual is likely to have originated from outside Britain. This potentially sheds light on the origins of the strain in Britain and its subsequent spread to other parts of the world, including the Americas where the 3I lineage of M. leprae is still found in some southern states of America.

Primary subacute osteomyelitis of the talus in children: a case series and review.

Subacute haematogenous osteomyelitis of the talus in children is a rare condition. All previously reported cases have been managed by hospital admission with surgical debridement and antibiotics or by intravenous antibiotic therapy followed by oral antibiotics. This case series documents the management of the condition at our institution and reviews the current published literature. We conclude that with appropriate patient selection, primary subacute haematogenous osteomyelitis of the paediatric talus can be managed on an out-patient basis with oral antibiotic therapy.

Tuberculosis of the foot and ankle in children.

PURPOSE: To report manifestations and management of tuberculosis of the foot and ankle in 21 children. METHODS: Records of 12 girls and 9 boys aged 3 to 14 (mean, 7) years with tuberculosis of the foot and ankle were reviewed. The mean delay in presentation was 4.7 (range, 0.5-14) months. All the patients had local swelling, tenderness, and antalgic gait; 16 were limping; 5 had an antecedent trauma; 11 had an abscess; and 6 had a discharging sinus. The diagnosis was based on a smear positive for acid-fast bacilli (n=2), histopathology (n=15), or clinicoradiological findings (n=4). Nine patients had osteoarticular tuberculosis in other parts of the body. None had evidence of pulmonary tuberculosis. Lesions were classified into synovial (articular) and osseous. All 3 synovial lesions occurred in the ankle, 2 of which were at an advanced stage. Osseous lesions occurred in the calcaneus (n=5), metatarsal (n=5), talus (n=3), cuboid (n=3), medial cuneiform (n=1), and phalanx (n=1), and were sub-classified into stages 1 (n=3), 2 (n=5), and 3 (n=10) according to disease progression. All the patients were treated conservatively with splintage and chemotherapy. RESULTS: The mean follow-up period was 21 (range, 7-51) months. All the 3 patients with stage 1 osseous lesions showed healing within 6 weeks and had complete recovery of function. Four of the 5 patients with stage 2 lesions also showed complete recovery of function and reformation of bony trabeculations; radiological incorporation of sequestrum was obvious by 6 months in most patients. In patients with stage 3 lesions, healing was delayed and there was residual alteration in bony architecture and joint changes. Sclerotic changes and joint involvement also increased the likelihood of poor outcomes. However, none of our patients had any residual tenderness or foot deformity at the final follow-up. CONCLUSION: Outcome after non-operative treatment is good, provided the lesions are treated early.

[Tarsal osteoarthritis: a rare localisation of tuberculosis]. / Ostéoarthrite tarsienne: une localisation rare de la tuberculose.

We report the case of a 39-year-old woman with an uneventful medical history who presented an inflammatory left foot with no notion of trauma or fever. The plain x-ray and magnetic resonance imaging demonstrated talonavicular and subtalar osteoarthritis. A surgical biopsy with excision of inflammatory and necrotic tissue and removal of a fistular tract was performed. Histology revealed the presence of granulomas with caseous central necrosis suggesting tuberculosis of the bone. The diagnosis was confirmed when bacteriology samples grew Mycobacterium tuberculosis. Antituberculosis drugs were administered for twelve months. At 24 months, the patient presents a painful stiff rear foot after the development of secondary talonavicular degeneration. This case illustrates a particular clinical presentation of tuberculosis. This diagnosis should be considered in the presence of atypical bony lesions with a chronic course. Early diagnosis enables proper therapeutic management. Useful diagnostic imaging techniques include plain x-rays, computed tomography, and magnetic resonance imaging. Certain diagnosis is based on bacteriological and histological examinations.

Candida albicans osteomyelitis: case report and literature review.

OBJECTIVE: Osteomyelitis due to Candida species is an unusual but recognized entity. However, with the increasing occurrence of factors predisposing to candidemia and invasive candidiasis, candidal osteomyelitis is being diagnosed more frequently. An unusual case of Candida albicans osteomyelitis is reported here, along with a review of the published literature on previously reported cases of this disease. METHODS: Report of the case and literature review. RESULTS: In this case, Candida albicans was isolated from the talus; however, the diagnosis was made after several cultures were performed. Only one other case of Candida osteomyelitis located in foot bones was found in the review. CONCLUSIONS: It is thought that this is the first case reported in Venezuela, and only the second in international literature.

Isolated tuberculosis of talus without ankle and subtalar joint involvement.

This case has been reported because of its rarity and atypical clinical presentation. An 8-year-old boy presented with a gradually increasing swelling localised on the antero-medial aspect of the foot haemogram, erythrocyte sedimentation rate (ESR), Mantoux and X-ray chest were normal. An irregular lytic lesion of the talus was seen on the x-ray of the affected part. Ziehl Nelson staining of the aspirated fluid revealed acid-fast bacilli. Material obtained after curettage and bone grafting was sent for histopathological examination which confirmed the diagnosis of tuberculosis. Post operatively a below knee cast was given for 12 weeks and anti tubercular treatment was given for 20 months. At the end of the treatment patient had full and painless motion at the ankle and subtalar joint. The lytic lesion had healed on X-ray.

Chronic localized osteomyelitis caused by atypical infection with Blastomyces dermatitidis in a dog.

A 4-year-old male Golden Retriever was evaluated because of chronic non-weight-bearing lameness of the right hind limb associated with penetrating tarsal wounds. Arthritis of the tarsal joint and osteomyelitis of the talus were initially evident. Tarsal arthrodesis was performed 7 months after initial injury, but the lameness persisted. Ten months later, blastomycosis was diagnosed on the basis of results of histologic examination of bone biopsy specimens and serologic tests. No other site of involvement was detected. The limb was amputated, and Blastomyces dermatitidis was isolated from the affected bone. Adjuvant antifungal treatment was not given. Ten months after amputation, the dog was in good health, and the antibody titer for B dermatitidis was low, indicating resolution of the infection. Localized bone infection with B dermatitidis is rare in dogs. In this dog, it was believed that blastomycosis was contracted through direct inoculation of the organism, because the lesion was associated with puncture wounds and other sites of involvement were not found.