Sara Veloci1, Jessica Mencarini1, Filippo Lagi1, Giovanni Beltrami2, Domenico Andrea Campanacci2,3, Alessandro Bartoloni1,4, Filippo Bartalesi5. 1. Infectious Diseases Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 2. Orthopaedic Oncology Unit, Careggi Hospital, Florence, Italy. 3. Department of Surgery and Translational Medicine, University of Florence, Florence, Italy. 4. Infectious and Tropical Diseases Unit, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy. 5. Infectious and Tropical Diseases Unit, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy. bartalesif@aou-careggi.toscana.it.
Abstract
PURPOSE: Tubercular prosthetic joint infection (TB-PJI) is an uncommon complication. Lack of evidence of systemic tuberculosis and clinical suspicion could bring a delay in the time of the diagnosis. The aims of this study are to underline the importance of awareness and suspicion of mycobacterial infection in the differential diagnosis in PJI and to evaluate the appropriateness of different therapeutic options. METHODS: Case report and literature review. RESULTS: We report two cases of TB-PJI after total knee arthroplasty in Caucasian patients without prior history of tubercular disease or exposure. In both cases, the diagnosis was obtained years after the onset of symptoms. Despite that, both patients improved during antitubercular treatment (a four-drug regimen consisting of rifampicin, isoniazid, ethambutol, and pyrazinamide for 2 months, followed by rifampicin and isoniazid). Moreover, after an 18-month course of treatment, there was no need for surgical therapy. The result of the literature review allows us to identify 64 cases of TB-PJI. Many differences in both medical and surgical management have been found, among those reviewed cases. CONCLUSIONS: Considering our experience and the literature review, we recommend considering a conservative approach (debridement and adequate antituberculous chemotherapy) as a suitable and safe option.
PURPOSE:Tubercular prosthetic joint infection (TB-PJI) is an uncommon complication. Lack of evidence of systemic tuberculosis and clinical suspicion could bring a delay in the time of the diagnosis. The aims of this study are to underline the importance of awareness and suspicion of mycobacterial infection in the differential diagnosis in PJI and to evaluate the appropriateness of different therapeutic options. METHODS: Case report and literature review. RESULTS: We report two cases of TB-PJI after total knee arthroplasty in Caucasian patients without prior history of tubercular disease or exposure. In both cases, the diagnosis was obtained years after the onset of symptoms. Despite that, both patients improved during antitubercular treatment (a four-drug regimen consisting of rifampicin, isoniazid, ethambutol, and pyrazinamide for 2 months, followed by rifampicin and isoniazid). Moreover, after an 18-month course of treatment, there was no need for surgical therapy. The result of the literature review allows us to identify 64 cases of TB-PJI. Many differences in both medical and surgical management have been found, among those reviewed cases. CONCLUSIONS: Considering our experience and the literature review, we recommend considering a conservative approach (debridement and adequate antituberculous chemotherapy) as a suitable and safe option.
Authors: P W Hermans; A R Schuitema; D Van Soolingen; C P Verstynen; E M Bik; J E Thole; A H Kolk; J D van Embden Journal: J Clin Microbiol Date: 1990-06 Impact factor: 5.948
Authors: Alexei G Titov; Elena B Vyshnevskaya; Sergei I Mazurenko; Seppo Santavirta; Yrjö T Konttinen Journal: Arch Pathol Lab Med Date: 2004-02 Impact factor: 5.534