Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review

• Published in: The Journal of infection Vol. 78; no. 1; pp. 27 - 34
• Main Authors: Uhel, Fabrice, Corvaisier, Gregory, Poinsignon, Yves, Chirouze, Catherine, Beraud, Guillaume, Grossi, Olivier, Varache, Nicolas, Arvieux, Cédric, Berre, Rozenn Le, Tattevin, Pierre
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2019; WB Saunders
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antituberculosis drug; Arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Shoulder - adverse effects; Debridement; Disease Management; Female; Human health and pathology; Humans; Infectious diseases; Joints - microbiology; Life Sciences; Male; Middle Aged; Mycobacterium tuberculosis; Mycobacterium tuberculosis - drug effects; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Prosthetic joint; Retrospective Studies; Surveys and Questionnaires; Tuberculosis - drug therapy; Prosthetic joint; Debridement; Arthroplasty; Mycobacterium tuberculosis; Antituberculosis drug; debridement; antituberculosis drug; arthroplasty
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2018.08.008

We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI).
Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords ‘prosthetic joint’, and ‘tuberculosis’.
During years 1997–2016, 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS).
M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.