Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient

Marschall, Jonas; Evison, John; Droz, Sara; Studer, U. C.; Zimmerli, Stefan

doi:10.1007/s15010-007-7011-1

Cited by 25 publications

(13 citation statements)

References 27 publications

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“…3 Lack of clinical suspicion, inability to confirm the diagnosis even if clinically suspected, and coinfection with pyogenic bacteria from a chronically discharging sinus often lead to a delay in diagnosis. 11 Due to the rare nature of these infections and the lack of clear evidence, formulating treatment guidelines for these prosthetic joint infections are difficult. 2,9,10,12,13 The aim of this study was to report a rare presentation of lateonset of tubercular reactivation following TKA in a patient who was treated previously for latent tuberculous infection.…”

Section: Discussionmentioning

confidence: 99%

Tubercular Prosthetic Knee Joint Infection

et al. 2013

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This article reports a rare case of late-onset tubercular infection following total knee arthroplasty in a 60-year-old woman who had been treated with a full course of antitubercular therapy for latent tuberculosis almost 25 years ago. Because no clear guidelines exist for optimal management of disease reactivation in the prosthetic knee joint, the authors performed a literature review and attempted to provide a treatment algorithm based on the time of presentation. Two modes of presentation were identified for unsuspected tubercular prosthetic joint infections based on the onset of symptoms and time to diagnosis: an early-onset presentation that occurs within the first 6 to 8 weeks postoperatively and a late-onset presentation that usually manifests after 8 weeks. Early-onset presentations often can be treated with standard antitubercular chemotherapy alone, whereas late-onset presentation may require 2-stage reimplantation under cover of antitubercular medications. This report also highlights the fact that despite adequate treatment of latent tuberculosis, patients may remain at risk of prosthetic joint infection following total knee arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Tubercular Prosthetic Knee Joint Infection

et al. 2013

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“…The initial database queries produced 191 reports; 162 articles were excluded, including those that were duplicates (43), reviews or meta‐analyses (24), descriptions of general periprosthetic joint infections (25), descriptions of hip replacements (14), descriptions of non‐tuberculous mycobacterium infections (all case reports, 14), articles on knee joint tuberculosis replacements (23), and non‐English reports (19) 13–41 . We identified 44 cases of TBPJI described in the 29 selected articles.…”

Section: Methodsmentioning

confidence: 99%

“…Generally, patients with TBPJI demonstrate weakened immune systems due to their being elderly, having autoimmune diseases (e.g. rheumatoid arthritis), using hormones, having undergone cancer chemotherapy, having AIDS, etc., making them susceptible to infection 26 . The average age of our four patients was 59.5 years, and the 44 patients with TBPJI reported in the literature had an average age of 70.14 years.…”

Section: Causes Of Missed or Misdiagnosed Joint Tuberculosismentioning

confidence: 99%

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Wei

Sun²,

Zhang

et al. 2020

Orthopaedic Surgery

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Objectives: To provide a case series and systematic review that explores the clinical manifestations, treatments, and methods for defining tuberculosis diagnoses in patients who have undergone total knee arthroplasty (TKA). Methods: Four patients (three women, one man; average age, 59.5 ± 8.89 years; range, 48-69 years) underwent TKA and were subsequently treated for previously unsuspected knee tuberculosis between January 2013 and December 2019. We also reviewed published cases of tuberculous periprosthetic joint infections (TBPJIs) following TKA through databases of MEDLINE/PubMed, the Cochrane Library, and EMBASE. We reviewed studies that were published between January 1980 and December 2019. Results: In our four cases, the preoperative diagnoses were osteoarthritis (n = 2), rheumatoid arthritis (one case), and Charcot's arthropathy (one case). The main clinical manifestations were knee swelling and pain, without fever, weakness, or weight loss. Comorbidities included multiple joints with rheumatoid arthritis or Charcot's arthropathy, diabetes mellitus, and uremia. One patient had a history of lumbar tuberculosis treated with debridement and intervertebral fusion. Preoperative elevated erythrocyte sedimentation rates (ESRs) were detected in all cases, and elevated C-reactive protein (CRP) levels were observed in three cases. The tuberculosis diagnoses were confirmed via histopathologic analysis (three cases) and second-generation sequencing (one case). Three patients received antituberculosis therapy for 1 year, without surgical intervention. Two-stage exchange arthroplasty was performed in one patient because of prosthesis loosening. Within an average follow-up period of 24.75 months, tuberculosis reactivation was not observed and overall functional improvement was demonstrated. Forty-four TBPJI cases were reported in the literature between January 1980 and December 2019. Most (59.09%) occurred within the first year after the index arthroplasty, and the diagnoses were confirmed by culturing Mycobacterium tuberculosis in 88.64% of cases. Favorable outcomes were achieved in 90.91% of the patients who did not undergo surgery, 71.43% of those treated with debridement, 93.33% undergoing revision arthroplasty, and in 90.91% of those undergoing resection and arthrodesis. Conclusions: Clinical manifestations of knee tuberculosis and TBPJI are atypical. Thus, attention should be paid to finding the causes of increased ESRs and CRP levels, particularly in patients with weakened immune functioning, before performing TKA. Pathological examination is an effective method for diagnosing tuberculosis, although sending multiple specimens for pathological examination is necessary.

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“…Patients with underlying causes of immunocompromise, history of tuberculosis infection, or patients with tuberculosis risk factors should consider the possibility of postoperative tuberculosis infection prophylaxis [13]. Marschall et al [21] reported about a 48-year-old male patient with a history of HIV and CD4+ count of 7/uL, who presented with painless swelling of the joint six months after TKA. He was diagnosed with TBPJI at nine months and passed away one month after diagnosis.…”

Section: Reviewmentioning

confidence: 99%

Mycobacterium tuberculosis as a Cause of Periprosthetic Joint Infection After Total Knee Arthroplasty: A Review of the Literature

et al. 2019

Cureus

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Total knee arthroplasty (TKA) has become one of the most popular and successful surgeries performed in the world. Infection remains one of the most dreaded complications following TKA, and while rare, tuberculosis as a microbial etiology remains difficult to both diagnose and treat. A review was performed using PubMed, the Cochrane Database of Systematic Reviews, and EMBASE to identify literature pertinent to Mycobacterium tuberculosis infection, TKAs, periprosthetic joint infections, and any combination of the three. The diagnosis of tuberculosis infection after TKA is difficult due to nonspecific signs and symptoms and diagnostic testing. The surgeon should use a comprehensive approach to incorporate the patient’s medical history, physical exam, and blood and imaging diagnostics. Among these, bacterial culture and histopathological examination remain the gold standard of diagnosis, but Polymerase chain reaction technology offers another, more sensitive and rapid option. Treatment strategy centers around on the cornerstone of anti-tuberculosis medical therapy and surgery depending on the clinical situation. While there is a lack of primary literature and standardized guidelines for the diagnosis and treatment of tuberculosis infection after TKA, the overarching principles of the treatment of tuberculosis and the treatment of the periprosthetic infection can be implemented together. There remains room for original research and improvements in both diagnostic testing and treatment.

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Disseminated Tuberculosis Following Total Knee Arthroplasty in an HIV Patient

Cited by 25 publications

References 27 publications

Tubercular Prosthetic Knee Joint Infection

Tubercular Prosthetic Knee Joint Infection

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Mycobacterium tuberculosis as a Cause of Periprosthetic Joint Infection After Total Knee Arthroplasty: A Review of the Literature

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