Tuberculous osteomyelitis masked by concomitant staphylococcal infection

A systematic and easily reproduced bone protocol was used over a 14-month period to evaluate bone histologically and by mycobacterial culture in patients with chronic osteomyelitis. On examination of 140 bone specimens, we found four patients with unsuspected tuberculous osteomyelitis whose diagnosis was obscured by a concomitant staphylococcal osteomyelitis. Three of the patients had axial skeleton involvement, and one had disease of the femur. No patient had a history of a positive skin test or of tuberculous disease, and none had coexistent pulmonary disease. The underlying granulomatous infection was initially revealed in one patient by histologic examination of bone and in three others only by mycobacterial culture of bone. Concomitant osseous tuberculosis should be excluded in patients with staphylococcal osteomyelitis. Evaluation using a bone protocol with histologic study and culture on L?wenstein-Jensen medium is effective in diagnosing occult osseous tuberculosis.     

Tuberculous infection in a large urban population

A positive tuberculin reaction, which indicates tuberculous infection, is known to correlate with increased rates of tuberculous disease, but current data concerning possible relationships with factors such as ethnic group, socioeconomic status, age, and sex are unpublished or unavailable. Current background rates of tuberculous infection are also generally not available, so that expected prevalence rates of tuberculous infection in urban areas have not been confidently established. In 1973/74, the New York City Health Code presented an opportunity to study these factors in more than 50,000 employees of the Board of Education. For the first time, a specific index was used to quantitate socioeconomic status. The relative effect of each of these variables on reactor rate was measured. It was found that tuberculous infection was related to race or ethnic group, socioeconomic status, age, and sex, in that order. The over-all data presented a recent picture of the prevalence of tuberculous infection in an urban population.     

Tuberculous pericarditis in Tanzanian patients with and without HIV infection

Setting: Large academic medical center in Tanzania.Objectives: To determine the etiologies and outcomes of large pericardial effusions in HIV-infected and uninfected patients.Design: Prospective cohort study of patients admitted with new large pericardial effusions, confirmed echocardiographically. Patients had pericardial biopsies and drainage with extensive analysis of tissue and fluid specimens, and were followed with clinical and echocardiographic examinations.Results: Of 28 patients with large pericardial effusions, 19 were infected with HIV-1. 22 had invasive diagnostic procedures: 14 of 14 HIV-infected patients, but only 4 of 8 non-HIV-infected patients, had tuberculous pericarditis (P = 0.01). All but 1 of the HIV-infected patients had strongly positive tuberculin skin tests, and shortterm outcomes were similar in the 2 groups.Conclusion: TB is the predominant cause of large pericardial effusion in HIV-infected patients in this setting; non-HIV-infected patients are more likely to have other etiologies. These patients were at an early stage of HIV infection and responded well to treatment. In settings where microbiological studies are not routinely available, HIV-infected patients with large pericardial effusions may be treated empirically for tuberculosis and monitored for improvement. If improvement does not follow within 2–4 weeks further studies are indicated. HIV-negative patients should undergo diagnostic evaluation initially.     

Tuberculous brain abscess in a patient with HIV infection

Tuberculous Brain Abscess (TBA) is a rare manifestation of CNS tuberculosis. Only a few cases have been reported in literature. A twenty six year old male presented with high grade fever, throbbing headache and altered sensorium. Examination revealed neck stiffness and papilloedema. His chest X-ray showed evidence of healed pulmonary tuberculosis. MRI Brain showed a well circumscribed hyper intense lesion in the left parietal region with perilesional edema and mass effects. Stereotactic aspiration of the abscess yielded frank creamy pus. PCR for Mycobacterium tuberculosis MPB 64 was positive which confirmed the lesion to be of tuberculous etiology. Patient responded well to four-drug regimen of antitubercular treatment.     

Tuberculous infection in student nurses in Madrid, Spain.

To determine the incidence of tuberculous infection in student nurses we performed a 3-year study in our hospital. Before training was initiated, 18.75% of males and 5.7% of females were Mantoux-positive (P = 0.09). During the following two years, 9.2% of the previously Mantoux-negative students became positive. No differences were found between males and females. We conclude that student nurses must be considered at risk for tuberculous infection in our hospital, and that stricter isolation procedures for tuberculous patients must be implemented.     

Tuberculous meningitis in patients with and without human immunodeficiency virus infection.

OBJECTIVE: To characterize the symptoms, signs, laboratory findings, and outcome of culture-proven meningitis due to Mycobacterium tuberculosis in patients with and without human immunodeficiency virus (HIV) infection. DESIGN: Retrospective chart review. SETTING: Urban public general hospital in the United States. PATIENTS: Fifteen patients with and 16 without HIV infection. MEASUREMENTS: Demographics, symptoms, physical exam findings, serum sodium, complete blood cell count, CD4+ cell count, cerebrospinal fluid findings, imaging data, and in-hospital mortality. MAIN RESULTS: Symptoms, signs, chest radiograph appearance, cerebrospinal fluid cell counts and chemistries, and mortality were similar in both groups (p = NS). Median CD4+ cell counts were lower in HIV-infected patients (median 99/mm3, range 7 to 251, versus 384/mm3, range 171 to 724 in those without HIV infection, p = 0.007). Intracerebral mass lesions were more common in the HIV-infected group (60% versus 14% in the uninfected group, p = 0.01), although the presence of a mass did not correlate with focal neurologic deficits, altered level of consciousness, or mortality. CONCLUSION: With the exception of an increased incidence of intracerebral mass lesions in HIV-infected individuals, HIV infection appears to have little impact on the findings and in-hospital mortality of tuberculous meningitis.     

Exit-site infection prevention and treatment protocol

Infections are universally known as one of the main causes of drop-out in peritoneal dialysis. Exit-site infections are often a problem, as they are difficult to treat, tend to become chronic and may lead to the development of continuity peritonitis, resulting in the need for removal of the peritoneal catheter. The purpose of this paper is to describe the application of an exit-site infection prevention and treatment protocol.     

Management and prevention of prosthetic joint infection

Prosthetic joint infection (PJI) is a serious complication of total joint arthroplasty (TJA) that can negatively affect functional status and quality of life. This article examines the epidemiology of PJI and reviews current diagnostic, treatment, and management strategies. Diagnosis can be challenging because presenting symptoms are often nonspecific and there is no simple gold standard diagnostic test. Successful treatment of PJI requires a combination of medical and surgical strategies. Given the devastating nature of PJI and the increasing numbers of TJAs performed, prevention efforts remain critical.