Infectious Disease

M. Tuberculosis infection of the prosthetic joint is rare but possible in some patients

September 18, 2021

Read for 2 minutes

Source / information

Published by:

Disclosure:
Lo does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action = subscribe> Subscribe

We could not process your request. Please try again later. If this problem persists, please contact customerservice@slackinc.com.

Back to Healio

Although prosthetic joint infections caused by Mycobacterium tuberculosis are rare, they can occur in immunocompromised patients or in people from regions where tuberculosis is endemic, researchers reported in a recent study.

Such infections are rare, “clinical suspicions should be raised in people with epidemiological and clinical risk factors for active tuberculosis infection, and may include non-response to previous antibiotics to treat” prosthetic joint infections, they wrote.

Source: Adobe Stock.

An infection of the joint prosthesis caused by Mycobacterium tuberculosis is rare, but can occur in immunocompromised patients or in people from tuberculosis endemic areas. Source: Adobe Stock.

Carson KL Lo

“While there is existing literature to support optimal treatment for tuberculosis, there is little to none that has been published on the treatment of prosthetic joint infections due to Mycobacterium tuberculosis.” automobileS.on KL Lo, MD, a researcher in McMaster University’s infectious disease residency program, said Healio. “We have tried to collect the information presented in case reports or series about what others have tried and failed to successfully diagnose and treat this infection.”

Lo and colleagues studied two cases of prosthetic joint infections caused by M. tuberculosis. The first was in a 71-year-old immunocompetent, nondiabetic woman who had reported pain in her left hip since 2013. According to the study, in April 2017 the woman reported increasing difficulty walking and had radiological signs of severe arthropathy that led to surgery. Two months after surgery and multiple hip aspirates, one aspirate was positive for M. tuberculosis.

Lo and colleagues found that the patient was treated with isoniazid, rifampin, and ethambutol for 2 months, followed by isoniazid and rifampin for an additional 10 months. In September 2018, she underwent a total revision arthroplasty to improve mobility and remained clinically healthy.

The second case involved a 50-year-old man with limited mobility who was unable to work after a hip prosthesis infection in 2016. According to the study, his medical history included osteomyelitis as a child, complicated by osteoarthritis that required multiple surgeries.

Finally, in 2013, at the age of 47, he underwent total hip arthroplasty. In 2014 he underwent a joint washout with ceftriaxone, vancomycin and rifampin for 6 weeks because of a culture-negative prosthetic joint infection and continued the rifampin monotherapy until the re-examination in June 2016.

According to the study, he was treated with isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and rifampin for an additional 7 months. He responded well to treatments and rehabilitation and remained clinically healthy.

Lo explained that based on these two cases and a subsequent literature review, the clinical presentation of prosthetic TB joint infection is often unspecific with different onset of symptoms. Lo added that while most are still based on mycobacterial culture of tissue or fluid samples from a joint, there may be interest in rapid molecular diagnostics if it is available.

“Although prosthetic joint tuberculosis infection is a rare manifestation of tuberculosis, this should be taken into account in the differential diagnosis if a patient presents with a prosthetic joint infection that does not respond to initial empirical antibiotic therapy and / or has joint cultures that are negative for bacterial growth are “, called Lo. “Treatment remains” [on] on a case-by-case basis, but often involves both antifungal drugs and surgical management. “

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action = subscribe> Subscribe

We could not process your request. Please try again later. If this problem persists, please contact customerservice@slackinc.com.

Back to Healio

Related Articles