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      Mycobacterium avium intracellulare complex causing olecranon bursitis and prosthetic joint infection in an immunocompromised host

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          Abstract

          Case

          A 73-year-old immunocompromised male presented with recurrent left elbow swelling due to Mycobacterium avium intracellulare complex (MAC) olecranon bursitis. 3 years after completing MAC treatment, he underwent right total knee arthroplasty (TKA). 1 year later, he developed TKA pain and swelling and was diagnosed with MAC prosthetic joint infection (PJI). He underwent TKA resection, reimplantation, and 12 months of anti-MAC therapy. This patient is the seventh case report of MAC olecranon bursitis and the third case report of MAC PJI. He is the only report of both MAC olecranon bursitis and PJI occurring in the same patient.

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          This patient was informed and agreed to the publication of this material.

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          Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States.

          Vinay Aggarwal, Hooman Bakhshi, Niklas Unter Ecker … (2014)
          Infecting microorganism is a strong predictor of treatment success for periprosthetic joint infection (PJI). The purpose of this study was to compare the infecting pathogens causing PJI at two large infection referral centers in the United States and in Europe. In this study, 898 consecutive cases of PJI were identified at the HELIOS ENDO-Klinik Hamburg in Europe and 772 cases were identified at the Rothman Institute in the United States. The incidence of organisms at the HELIOS ENDO-Klinik Hamburg versus the Rothman Institute was: coagulase-negative Staphylococcus (39.3 vs. 20.2%), S. aureus (13.0 vs. 31.0%), Streptococcus (6.5 vs. 5.8%), Enterococcus (7.0 vs. 3.9%), anaerobic (9.0 vs. 0.9%), fungal (0.3 vs. 2.3%), mycobacterial (0 vs. 0.6%), polymicrobial (3.4 vs. 7.4%), culture negative (16.1 vs. 15.8%), and other organisms (0.9 vs. 5.4%). The percentage of methicillin-resistant S. aureus was significantly higher at the American center than at the European center (48.1 vs. 12.8%; p < 0.0001). Our findings show higher virulence and resistance organisms are more prevalent at a referral center in the United States compared with one in Europe.
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            What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee?

            S Sporer, Joseph Ward, Craig J Della Valle … (2011)
            Two-stage exchange arthroplasty is the gold standard for treatment of infected TKA. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count with differential are often used to determine treatment response; however, it is unclear whether these tests can answer the critical question of whether joint sepsis has been controlled between stages and if reimplantation is indicated. We therefore asked if (1) these serologies respond between stage one explantation and stage two reimplantation during two-stage knee reconstruction for infection; and (2) changes in the values of these serologies are predictive of resolution of joint infection. We retrospectively reviewed the serologies of 76 infected patients treated with a two-stage exchange protocol. The ESR, CRP, and aspiration were repeated a minimum of 2 weeks following antibiotic cessation and prior to second stage reoperation. Comparisons were made to identify trends in these serologies between the first and second stage procedures. Eight knees (12%) were persistently infected at the time of second stage reoperation. The ESR remained persistently elevated in 37 knees (54%), and the CRP remained elevated in 14 knees (21%) where infection had been controlled. We were unable to identify an optimum cutoff value for the ESR, CRP, or the two combined. The best test for confirmation of infection control was the synovial fluid WBC count. Although the ESR, CRP, and synovial fluid WBC counts decreased in cases of infection control, these values frequently remained elevated. We were unable to identify any patterns in these tests indicative of persistent infection. Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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              Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature.

              Douglas R Osmon, Irene G Sia, J Eid … (2007)
              Prosthetic joint infection (PJI) due to rapidly growing mycobacteria (RGM) is only occasionally encountered in clinical practice. Therefore, the optimal clinical management for this condition is unknown. The medical records of patients who had PJI due to RGM during 1969-2006 were reviewed to summarize its clinical characteristics, treatment, and outcome. Eight patients developed 9 episodes of PJI (7 episodes involving the knee and 1 each involving the hip or elbow) due to RGM at a median of 312 weeks (range, 1-170 weeks) after prosthesis implantation. Patients presented with joint pain (7 patients), joint swelling (7 patients), and fever (3 patients), accompanied by an elevated erythrocyte sedimentation rate (median, 70.5 mm/h) and C-reactive protein level (median, 6 mg/dL). Mycobacterium chelonae (n=3), Mycobacterium abscessus (n=2), Mycobacterium fortuitum (n=3), and Mycobacterium smegmatis (n=1) were isolated from the 9 infected joints. Seven of 9 prostheses were resected, whereas 2 were retained after surgical debridement. Six of 8 patients received > or = 1 active antimicrobial agent for at least 6 months. During a median follow-up period of 33 weeks (range, 2.6-326 weeks) after surgical intervention, no clinical or microbiological relapses were observed. Reimplantation was performed successfully for 2 of 6 patients who underwent resection arthroplasty. The 2 patients with retained prosthesis continued to receive prolonged courses of suppressive antimicrobial therapy. RGM is a rare cause of PJI that should be suspected in patients with negative results of routine bacterial cultures. The combination of resection arthroplasty and antimicrobial therapy is the preferred approach. However, in cases involving retained prosthetic components, RGM infection may be suppressed with lifelong courses of effective antibiotic therapy.
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                Author and article information

                Contributors
                Eugene M. Tan
                Jasmine R. Marcelin
                Erin Mason
                Abinash Virk
                Journal
                Journal ID (nlm-ta): J Clin Tuberc Other Mycobact Dis
                Journal ID (iso-abbrev): J Clin Tuberc Other Mycobact Dis
                Title: Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
                Publisher: Elsevier
                ISSN (Electronic): 2405-5794
                Publication date PMC-release: 03 December 2015
                Publication date Collection: January 2016
                Publication date (Electronic): 03 December 2015
                Volume: 2
                Pages: 1-4
                Affiliations
                [a ]Department of Medicine, Mayo Clinic, 200 First Street SW Rochester, MN 55905, USA
                [b ]Division of Infectious Diseases, Mayo Clinic, 200 First Street, SW Rochester, MN 55905, USA
                Author notes
                [* ]Corresponding author. Tel.: +1 507 284 9456. Tan.Eugene@ 123456mayo.edu
                [1]

                Tel.: +1 507 284 3309.

                [2]

                Tel.: +1 507 284 3309.

                [3]

                Tel.: +1 507 538 0030.

                Article
                Publisher ID: S2405-5794(15)30005-X
                DOI: 10.1016/j.jctube.2015.11.003
                PMC ID: 6850247
                PubMed ID: 31723678
                SO-VID: c2fac6e4-5dd6-46ea-a75e-a398c6942ae1
                Copyright © © 2015 Published by Elsevier Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 June 2015
                Date revision received : 10 November 2015
                Date accepted : 25 November 2015
                Categories
                Subject: Article

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