Lara-Oya A, Liébana-Martos M C, Rodríguez-Granger J, Sampedro-Martínez A, Aliaga-Martínez L, Gutierrez-Fernández J, Navarro-Marí J M
Javier Rodríguez-Granger, Servicio de Microbiología. Hospital Universitario Virgen de las Nieves. Avda. Fuerzas Armadas s/n. 180014. Granada, Spain.
Rev Esp Quimioter. 2016 Aug;29(4):214-9. Epub 2016 Jun 22.
Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized.
Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014.
Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.
人工关节晚期感染发生在手术后第二个月,由另一来源的血行播散引起。人工关节结核感染是一种罕见的并发症,其临床管理尚无标准化方案。
一名77岁患者,除糖尿病外无个人病史,三年前因骨关节炎接受了右膝人工关节置换术。患者因右膝疼痛6个月前往医院急诊,伴有机械性炎症体征,但无发热。5天后复诊,临床症状恶化,膝关节抽吸物中培养出结核分枝杆菌,遂开始进行9个月的抗结核治疗。核磁共振成像研究也在该患者的临床背景下证实了脊柱结核的诊断。手术后,术中样本再次分离出结核分枝杆菌,因此患者又接受了一批9个月的治疗。经过一年的监测,病情发展尚可,但几个月后,患者因心血管原因死亡。在文献综述中,1980年至2014年共发现15篇文献,报道了17例人工关节结核感染的临床病例。
人工关节结核性关节炎虽然是一种罕见的表现,但应予以关注,尤其是在有结核感染病史的易感患者中。