scholarly journals Non-tuberculous Mycobacterial Infection of the Musculoskeletal System Detected at Two Tertiary Medical Centres in Henan, China, 2016–2020

2021 ◽  
Vol 12 ◽  
Author(s):  
Qiong Ma ◽  
Rende Chen ◽  
Enhui Yang ◽  
Youhua Yuan ◽  
Yongfu Tian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Median Duration ◽  
Musculoskeletal System ◽  
Granulomatous Inflammation ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Diagnostic Methods ◽  
Mycobacterium Fortuitum ◽  
Specific Symptoms

Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal system is rare but poses a grave threat to public health. These infections yield non-specific symptoms that remain undetected until the development of the later stages of the disease. In this study, we performed a retrospective review of 25 cases of musculoskeletal NTM infection at two tertiary medical centres over a 5-year period to determine the clinical features and improve the current clinical diagnosis and treatment. The most common mycobacterial species detected were Mycobacterium fortuitum in eleven patients, Mycobacterium abscessus in eight patients, Mycobacterium houstonense in three patients, Mycobacterium avium in two patients, and Mycobacterium smegmatis in one patient. The sites of infection included the limbs and joints, most commonly the knee (ten patients) and foot (six patients). The median duration from the onset of symptoms to diagnosis was 2.5 months (0.8–13.5 months). Deep sinus tracts extending to the surgical site were observed in 60% of the patients (15/25), and granulomatous inflammation and granulomatous inflammation with necrosis occurred in 60% of the patients (15/25). All patients underwent surgical treatment for infection control, and all patients, except one, received antimycobacterial therapy based on drug sensitivity assays. The median duration of the antimicrobial chemotherapy was 5 months (range: 3–20 months). At the final follow-up, 24 patients presented with absence of recurrence and one patient succumbed owing to heart failure after debridement. Our findings highlight the importance of vigilance and improvements in the diagnostic methods for musculoskeletal NTM infection. Aggressive surgical treatment and antimycobacterial drug treatment can help achieve satisfactory results.

scholarly journals A Current Microbiological Picture of Mycobacterium Isolates from Istanbul, Turkey

2020 ◽  
Vol 69 (2) ◽  
pp. 185-191
Author(s):  
BILGE SUMBUL ◽  
MEHMET ZIYA DOYMAZ
Keyword(s):  
Multidrug Resistant ◽  
Mycobacterium Abscessus ◽  
Diagnostic Methods ◽  
Current Status ◽  
Clinical Samples ◽  
Mycobacterium Fortuitum ◽  
Mycobacterium Species ◽  
Full Spectrum ◽  
Number Of Patients ◽  
Lowenstein Jensen

Despite advances in diagnosis and treatment, tuberculosis (TB) continues to be one of the essential health problems throughout the world. Turkey is considered to be endemic for TB. In this study, we analyzed the distribution of Mycobacterium species, compare the diagnostic methods, and susceptibilities to anti-tuberculosis drugs of TB isolates. The aim was to document the current status and to provide a frame of reference for future studies. In this study, 278 Mycobacterium species isolated from 7,480 patients between September 2015 and June 2019 were included. Löwenstein-Jensen medium (LJ) and MGIT 960 were used for the isolation of strains. Susceptibility to 1st-line anti-tuberculosis drugs was determined. Positivity rates in clinical samples were as follows: 1.4% for direct microscopic acid-fast bacilli (AFB) detection, 3.4% for growth on the LJ, and 3.7% for growth on MGIT-960. Two hundred thirty-three isolates were identified as Mycobacterium tuberculosis complex (MTBC) and 45 were non-tuberculous mycobacteria (NTMs). Eleven of the NTMs (24.4%) were Mycobacterium fortuitum group isolates, and eight NTMs (17.7%) were Mycobacterium abscessus complex isolates. A number of patients diagnosed with tuberculosis peaked twice between the ages of 20–31 and 60–71. A hundred and eighty-two MTBC isolates (78.1%) were susceptible to all 1st-line anti-tuberculosis drugs, while 51 isolates (21.9%) were resistant to at least one drug tested. The multidrug-resistant tuberculosis rate was 13.7% among resistant strains and 3% in all strains. The liquid cultures were better for detection of both MTBC and NTMs isolates. The data demonstrate that MTBC continues to be challenge for this country and indicates the need for continued surveillance and full-spectrum services of mycobacteriology laboratory and infectious diseases.

scholarly journals Alveolar Echinococcosis in Children

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Emilija Jonaitytė ◽  
Martynas Judickas ◽  
Eglė Tamulevičienė ◽  
Milda Šeškutė
Keyword(s):  
Surgical Treatment ◽  
Current Literature ◽  
Echinococcus Multilocularis ◽  
Cystic Echinococcosis ◽  
Alveolar Echinococcosis ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnostic Methods

Alveolar echinococcosis (AE) is an infectious zoonotic disease that is caused by Echinococcus multilocularis. The disease is generally identified accidentally because of the long asymptomatic period, has a malignant behaviour, and mainly occurs in the liver. Usually it is diagnosed in adults and is very rare in pediatric patients. We report two cases of AE and 1 differential case between AE and cystic echinococcosis (CE) in children: two of them had lesions in the liver and one had rare extrahepatic presentation of a cyst in the spleen. All our patients received chemotherapy with albendazole because surgical treatment was not recommended. The children were followed-up from 10 to 30 months and no significant improvement was seen. In this report we discuss the difficulties we faced in the treatment and follow-up of these patients. We also review the main clinical manifestations, general diagnostic methods, and treatment options of AE according to the current literature.

Surgical Treatment of Childhood Inflammatory Myofibroblastic Tumors

2016 ◽  
Vol 27 (04) ◽  
pp. 319-323 ◽  
Author(s):  
Beril Talim ◽  
İbrahim Karnak ◽  
Saniye Ekinci ◽  
Fatih Andiran ◽  
Arbay Çiftçi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lower Lobe ◽  
Diagnostic Methods ◽  
Incomplete Resection ◽  
Total Resection ◽  
Presenting Symptoms ◽  
Inflammatory Myofibroblastic Tumors ◽  
The Mean

Aim A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives of childhood inflammatory myofibroblastic tumors (IMTs). Patients and Methods Patients who underwent surgical treatment for IMT between 2000 and 2015 were evaluated for age, sex, presenting symptoms, physical examination findings, diagnostic methods, treatment modalities, histopathologic findings, and results of surgical treatment during long-term follow-up. Results Eleven patients who underwent surgical treatment were included in the study. Male:female ratio was 7:4 and the mean age of the patients was 6.09 years (1–10 years). Presenting symptoms were respiratory difficulty, cough (n = 7, 63.3%), abdominal pain, vomiting (n = 2, 18.8%), loss of body weight (n = 1, 9.09%), palpable mass (n = 1, 9.09%), and rectal bleeding (n = 1, 9.09%). Ultrasonography (n = 4, 36.3%) and computed tomography (n = 9, 81.1%) were used for diagnosis. Localizations of tumors were lungs (n = 5, 45.4%), mediastinum (n = 2, 18.1%), spleen (n = 1, 9.09%), neck (n = 1, 9.09%), colon (n = 1, 9.09%), and rectum (n = 1, 9.09%). The mean size of mass was 6.6 cm (2–12 cm) and six patients were diagnosed with preoperative biopsy. Lung lobectomy (right lower lobe; n = 3, right middle and lower lobe; n = 2), total resection of mass with adjacent bowel (n = 2), partial splenectomy (n = 1), total resection of neck mass (n = 1), and incomplete resection (n = 2) were the choice of surgical treatment. Incomplete resection was performed in masses closely adjacent to atrium and mediastinal structures. In histopathologic evaluation, surgical margins were free of tumor in four cases, positive in six cases, and were not reported in one case. Anaplastic lymphoma kinase (ALK) positivity was detected in six cases, negative in two cases, and was not evaluated in three cases. Two cases who had residual mass with positive ALK received chemotherapy. Mean follow-up time was 68.2 months (5 months to 12 years). During follow-up, there was no recurrence or distant metastasis. Ten patients survived and one patient was lost to follow-up. Conclusion IMT is a rare tumor of childhood with a spectrum of clinical findings because of variable localization. Surgical treatment is the first choice of treatment. Patients with residual mass and ALK positivity may require medical treatment. In our series, long-term survival of patients was favorable in patients with total resection.

scholarly journals National Medical Research Center for Children’s Health

2021 ◽  
pp. 118-123
Author(s):  
E. A. Okulov ◽  
A. V. Dotsenko ◽  
E. I. Dyakonova ◽  
S. P. Yatsyk ◽  
S. P. Yatsyk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Period ◽  
Anorectal Malformation ◽  
Diagnostic Methods ◽  
Functional Study ◽  
Perineal Ultrasound ◽  
Reliable Determination ◽  
Intestinal Tube ◽  
Rectovestibular Fistula

Abstract Introduction. Anorectal malformations are one of the most numerous groups of proctologic pathology in children. The incidence is 1 per 5,000 live births. Perineal ultrasound, distal colostography, and MRI of the pelvic organs and sacrococcygeal region are used to clarify the anatomico-topographic features of the malformation and identify concomitant malformations (presacral masses, distal spinal cord pathology). This article presents a clinical case of surgical treatment of an 11-year-old girl who underwent primary surgery for anorectal malformation with rectovestibular fistula in infancy. In the postoperative period for 10 years, the parents practically did not carry out rehabilitation therapy. These factors led to persistent decompensation of the lower intestine in the form of a giant megarectum, which required repeated anorectoplasty with resection of pathologically dilated parts of the intestinal tube. The article presents description of the repeated surgery with intraoperative electromyoidentification of the perineal muscles, data of follow-up 9 months after the repeated anorectoplasty with instrumental diagnostic methods (irrigography, functional study of the closing apparatus of the rectum).Discussion. This clinical observation illustrates complications following surgical treatment of anorectal malformation with rectovestibular fistula. Lack of intraoperative electromyoidentification of the muscles during primary anorectoplasty often resulted in ectopia of the neoanus relative to the center of the perineal muscle center. This circumstance was one of the causes of persistent chronic constipation in the postoperative period.Conclusion. The use of electromyostimulation during primary proctoplasty for reliable determination of the sphincter-levator complex topography is mandatory. Long sequential rehabilitation in the postoperative period including neoanus bougienage, provision of regular full defecation, physiotherapeutic treatment, as well as regular follow-up examination in the in-patient department is also an integral part of the treatment.

scholarly journals Melioidosis of the Musculoskeletal System

2019 ◽  
Vol 29 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Rajamani Perumal ◽  
Abel Livingston ◽  
Sumant Samuel ◽  
Santhosh Kumar Govindaraju
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Septic Arthritis ◽  
Musculoskeletal System ◽  
Medical Management ◽  
Clinical Presentation ◽  
Treatment Modalities ◽  
Soft Tissue Abscess ◽  
Musculoskeletal Involvement

Objective: Recent studies indicate that India is an endemic region for Burkholderia pseudomallei infection. We aimed to describe the clinical presentation of B. pseudomallei infection of the musculoskeletal system and summarise the various treatment modalities used in our clinical practice. Subjects and Methods: Patients with confirmed microbiological diagnosis of B. pseudomallei infection involving the musculoskeletal system treated from January 2007 to December 2016 with a minimum follow-up of 1 year were included. A retrospective review of medical records was carried out and patients’ demographic data, co-morbidities, clinical presentation, and details of medical and surgical treatment were documented. Results: Of 342 patients diagnosed with B. pseudomallei infection, 37 (9.2%) had musculoskeletal involvement; 26 patients (23 males) followed up for at least a year were included in the study. Four patients (15%) had multisystem involvement and 10 (37%) had multiple musculoskeletal foci of infection; 15 patients (58%) had osteomyelitis, 10 (38%) had septic arthritis with or without osteomyelitis, and 1 patient (4%) presented with only soft tissue abscess. All patients required surgical intervention in addition to medical management. Surgical treatment varied from soft tissue abscess drainage, arthrotomy for septic arthritis, decompression and curettage for osteomyelitis, and/or use of antibiotic (meropenem or ceftazidime)-loaded polymethylmethacrylate bone cement for local drug delivery. At final follow-up (average: 37 months, range: 12–120), all patients were disease free. Conclusion: We found the rate of musculoskeletal involvement in B. pseudomallei infection to be 9.2%. Appropriate surgical treatment in addition to medical management resulted in resolution of disease in all our patients.

Non-Tuberculous Mycobacterial Infections Related to Peritoneal Dialysis

2017 ◽  
Vol 38 (2) ◽  
pp. 147-149 ◽  
Author(s):  
Hiroyuki Inoue ◽  
Naoki Washida ◽  
Kohkichi Morimoto ◽  
Keisuke Shinozuka ◽  
Takahiro Kasai ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Mycobacterium Chelonae ◽  
Exit Site Infection ◽  
Mycobacterial Infections ◽  
Tunnel Infection ◽  
Multi Agent ◽  
Catheter Replacement

Most infections related to peritoneal dialysis (PD) are caused by common bacteria, and non-tuberculous mycobacteria are rare. The clinical characteristics and prognosis of PD patients with non-tuberculous mycobacterial infections were investigated at our hospital. Non-tuberculous mycobacteria were detected in 11 patients (exit-site infection, tunnel infection, and peritonitis in 3, 5, and 3 patients, respectively). Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus were identified in 4, 2, and 2 patients, respectively. Most patients with peritonitis or tunnel infection required catheter removal. During the study period (2007 – 2017), peritonitis occurred in 44 patients, including 3 patients (6.8%) with non-tuberculous mycobacterial peritonitis. When non-tuberculous mycobacterial infection occurs, multi-agent antibiotic therapy, unroofing surgery, and/or catheter replacement should be performed to prevent peritonitis.

scholarly journals The Changing Pattern of Nontuberculous Mycobacterial Disease

2003 ◽  
Vol 14 (5) ◽  
pp. 281-286 ◽  
Author(s):  
Joseph O Falkinham
Keyword(s):  
Pulmonary Disease ◽  
Nontuberculous Mycobacteria ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Older Individuals ◽  
Mycobacterial Disease ◽  
Cervical Lymphadenitis ◽  
Source Of Infection ◽  
Increased Risk

Nontuberculous mycobacteria are human opportunistic pathogens whose source of infection is the environment. These include both slow-growing (eg,Mycobacterium kansasii and Mycobacterium avium) and rapid-growing (eg,Mycobacterium abscessusandMycobacterium fortuitum) species. Transmission is through ingestion or inhalation of water, particulate matter or aerosols, or through trauma. The historic presentation of pulmonary disease in older individuals with predisposing lung conditions and in children has been changing. Pulmonary disease in elderly individuals who lack the classic predisposing lung conditions is increasing. Pulmonary disease and hypersensitivity pneumonitis have been linked with occupational or home exposures to nontuberculous mycobacteria. There has been a shift fromMycobacterium scrofulaceumtoM aviumin children with cervical lymphadenitis. Further, individuals who are immunosuppressed due to therapy or HIV-infection are at a greatly increased risk for nontuberculous mycobacterial infection. The changing pattern of nontuberculous mycobacterial disease is due in part to the ability of these pathogens to survive and proliferate in habitats that they share with humans, such as drinking water. The advent of an aging population and an increase in the proportion of immunosuppressed individuals suggest that the prevalence of nontuberculous mycobacterial disease will increase.

scholarly journals Spontaneous pneumothorax in cocaine users

QJM ◽  
2019 ◽  
Vol 112 (7) ◽  
pp. 519-522 ◽  
Author(s):  
P Ciriaco ◽  
F Rossetti ◽  
A Carretta ◽  
M Sant’Angelo ◽  
G Arrigoni ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Foreign Body ◽  
Ct Scan ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Granulomatous Inflammation ◽  
Visceral Pleura ◽  
Long Term Follow Up ◽  
Pulmonary Parenchyma

Abstract Background Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment. Aim We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax. Design Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution. Results Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120–239). All subjects are now well, with no evidence of pneumothorax. Conclusions Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.

Otomastoiditis caused by non-tuberculous mycobacteria: report of 16 cases, 3 with infection intracranially

2015 ◽  
Vol 129 (7) ◽  
pp. 644-655 ◽  
Author(s):  
L Lundman ◽  
H Edvardsson ◽  
K Ängeby
Keyword(s):  
Antibiotic Treatment ◽  
Relevant Literature ◽  
Mycobacterial Infection ◽  
Mycobacterium Abscessus ◽  
Mycobacterium Fortuitum ◽  
Case Review ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Medical Interventions

AbstractObjective:To analyse the clinical presentation, treatment and outcome in patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria.Methods:A retrospective case review of 16 patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria from 2000 to 2012 was conducted in a hospital and tertiary referral centre in Sweden. The main outcome measures were microbiology findings, and surgical and medical interventions and outcomes. In addition, the relevant literature was reviewed.Results:In three patients with otomastoiditis, the disease had spread intracranially. The bacteriological findings revealed Mycobacterium abscessus (n = 12), Mycobacterium fortuitum (n = 2) and Mycobacterium avium complex (n = 2). Surgical treatment was undertaken in all but three patients, including exploration of the temporal lobe in one patient. Systemic antibiotic treatment was given to all but one patient. Eight patients healed completely. Eight patients developed hearing loss. Two patients had relapse of the mycobacterial infection several months after the antibiotic treatment had been discontinued.Conclusion:Non-tuberculous otomastoiditis is a severe ear disease with challenging considerations, and should be treated aggressively in order to avoid morbidity.

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