Management of Mycobacterium tuberculosis Prosthetic Joint Infection: 2 Cases and Literature Review

Abstract

Prosthetic joint infection caused by Mycobacterium tuberculosis (TBPJI) is uncommon but can be encountered in immunocompromised patients or those from tuberculosis endemic regions. A lack of clinical suspicion and experience with TBPJI often leads to a delay in diagnosis. We report 2 cases of TBPJI in a Hungarian-Canadian and Iranian-Canadian immigrant, respectively. Both were treated with concurrent surgical and medical therapy. We also performed a literature review on TBPJI case reports outlining their diagnosis and management.

Delayed Diagnosis of Mycobacterium bovis bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty

“…However, in extrapulmonary infections, including bone and joint, culture sensitivity varies widely, ranging from 20% to 80% [ 24 ]. Due to the paucibacillary nature of MTB complex disease in PJI, culture sensitivity is reduced to approximately 60%-75%, with greater detection from synovial biopsies than synovial fluid aspiration [ 26 ]. In addition, co-existing bacterial infection may interfere with or obscure growth of MTB complex in culture, and as such, negative culture results do not rule out a diagnosis of MTB complex PJI.…”

“…Nucleic acid amplification testing (NAAT) has proven to be highly effective in detecting extrapulmonary MTB complex infections, with higher sensitivity compared to culture-based diagnostics [ [26] , [27] , [28] , [29] ]. The Xpert MTB/RIF assay has revolutionized tuberculosis diagnostics with rapid detection of MTB complex and the rpoB gene mutation that predicts rifampin resistance.…”

Unnecessary Routine Use of Mycobacterial Cultures in Patients With Periprosthetic Joint Infections

“…Among patients with PJI, mycobacterial cultures should only be sent in select circumstances, such as patients receiving immunosuppressive therapy and those with CNPJI or failure to respond to antibacterial therapy [ 3 , 4 , 10 , 11 ]. In addition, patients with PJI and epidemiologic risk factors for tuberculosis should have specimens sent for mycobacterial culture [ 12 ]. A history of trauma, corticosteroid injection, and certain environmental exposures (example: hot tub exposures or gardening) may be considered as risk factors for mycobacterial infection.…”