Sternal wound tuberculosis following cardiac operations: a review

Abstract

ObjectiveThe diagnosis and treatment of sternal wound infections with mycobacteria are challenging. Such an infection is often associated with a delayed diagnosis and improper treatment that may lead to a worsened clinical outcome. The present study is designed to highlight its clinical features so as to facilitate a prompt diagnosis and timely treatment.MethodsMEDLINE, Highwire Press, and Google search engine were searched for publications in the English language, with no time limit, reporting on sternal wound infection caused by tuberculosis after cardiac surgery.ResultsA total of 12 articles reporting on 14 patients were included in this study. Coronary artery bypass grafting was the underlying surgical procedure in more than half of the cases. Purulent discharge and cold abscess were the two main presenting symptoms. Diagnosis of sternal wound infection was evidenced in all 14 patients by different investigations, with culture of samples being the most sensitive method of identifying the pathogen. Good response to first-line anti-tuberculous agents was noted. Almost all patients required surgical debridement/resection and, sometimes, sternal reconstruction. A delayed diagnosis of sternal wound infection may lead to repeated recurrences. A comparison between patients with sternal wound infection due to tuberculosis and non-tuberculous mycobacterial infections showed that the former infections took an even longer period of time. Comparisons also revealed patients with sternal tuberculosis infection had a significantly higher mortality than patients with sternal non-tuberculous infection (29.2% vs. 0%, P=0.051).ConclusionSternal infection caused by tuberculosis after cardiac surgery has a longer latency, better response to first-line drugs, and better outcomes in comparison with non-tuberculous sternal infection. Early diagnosis and early anti-tuberculous treatment can surely improve the patients' prognosis.

Deep Sternal Wound Tuberculosis with Hypo-gamma-globulinemia

“…The administration of human monoclonal antibodies reduced the dissemination of tuberculosis in mice ( 15 ). However, one-quarter of patients developed recurrence of deep sternal wound tuberculosis within two years ( 6 ). Since our patient started immunoglobulin therapy, the pulmonary and deep sternal wound tuberculosis has not recurred, and the sternal wires have not needed to be removed.…”

“…As immunosuppressive therapy and human immune deficiency virus (HIV) infection have become more common, more patients are now at risk of extrapulmonary tuberculosis. Deep sternal wound tuberculosis infections after cardiac surgery are an extremely rare type of extrapulmonary tuberculosis ( 3 - 6 ). Common pathogens of deep wound infection after cardiac surgeries are Staphylococcus aureus , Escherichia coli and Enterobacter spp.…”

“…Common pathogens of deep wound infection after cardiac surgeries are Staphylococcus aureus , Escherichia coli and Enterobacter spp. ( 6 ). Only 15 patients with deep sternal wound tuberculosis after cardiac surgery have been reported worldwide ( 6 ).…”

“…( 6 ). Only 15 patients with deep sternal wound tuberculosis after cardiac surgery have been reported worldwide ( 6 ). While tuberculosis patients have received attention for their cell-mediated immunity status ( 7 ), humoral immunity dysfunction, such as hypo-gamma-globulinemia, in tuberculosis protection has not been described.…”

Anterior Minithoracotomy: a Safe Approach for Surgical ASD Closure & ASD Device Retrieval

“…Minimally invasive congenital cardiac surgery is a developing field [ 5 ] . Presently, mini-invasive approach is preferred for elective surgical closure of ASD as it provides the cosmetic advantage and avoids sternal complications [ 6 - 8 ] . However, patients who develop complications due to transcatheter management are preferably operated through midline sternotomy due to the apprehension of worsening a complicated condition.…”