Sternal mycobacterial infections

Abstract

Sternal mycobacterial infections are rare. Due to the rarity, its clinical characteristics, diagnoses, and regular management strategies are still scanty. A total of 76 articles on this topic were obtained by a comprehensive literature collection. The clinical features, diagnosis, management strategies and prognosis were carefully analyzed. There were totally 159 patients including 152 (95%) cases of tuberculosis (TB) and seven (5%) cases of non-TB sternal infections. Sternal mycobacterial infections can be categorized into three types: Primary, secondary, and postoperative, according to the pathogenesis; and categorized into isolated, peristernal, and multifocal, according to the extent of the lesions. Microbiological investigation is more sensitive than medical imaging and Mantoux tuberculin skin test in the diagnosis of sternal infections. Most patients show good responses to the standard four-drug regimen and a surgical intervention was necessary in 28.3% patients. The prognoses of the patients are good with a very low mortality. A delayed diagnosis of sternal mycobacterial infections may bring about recurrent sternal infections and sustained incurability. An early diagnosis and prompt antibiotic regimens may significantly improve the patients' outcomes.

Isolated primary cold abscess of the sternum: a case report

“…This implies that India accounts for about a quarter of the world’s cases of TB [6]. The rate of extrapulmonary TB (EPTB) worldwide has become 10–15% with young patients, females, and people from Africa or Asia seeming to have a higher risk [5]. Out of all cases of EPTB, 10–25% have musculoskeletal TB with the most common affected site being the spine (50–69%), followed by the hip, knee, and ankle/foot (10–13% each) [7].…”

“…Sternal mycobacterial infections have been categorized into three types: primary (67.3%), secondary (20.8%), and acquired postoperatively (11.9%) [5]. Tuli and Sinha reported 14 cases of sternal TB in a series of 980 cases of osteoarticular TB (1.5%) [3].…”

“…It mainly involves young males with a mean age of 36 years (range 11 to 59 years), although cases have been found in the pediatric population too [10]. The incidence in males is 65% whereas in females it is 34% [5]. Eyer et al reviewed 27 articles reporting 32 cases from 1966 to 2013 and found that primary sternal TB was more common in men (76%) and occurred at a relatively young age [11].…”

“…The reactivation of latent loci formed during hematogenous or lymphatic dissemination of primary TB is the primary cause for tubercular sternal osteomyelitis. Direct extension from contiguous mediastinal lymph nodes or infection of retrosternal lymph nodes that erode into the sternum over time are other mechanisms [5, 9, 10, 12, 13]. Thoracic TB disease most commonly involves the shafts of the ribs or the costovertebral or costochondral junctions whereas lesions of the sternum when found are more common in the manubrium (almost 70%) than of the body [5].…”

“…Primary tuberculous sternal osteomyelitis accounts for approximately 0.3% of all types of tubercular osteomyelitis and the probable source appears to be extension from paratracheal or hilar lymph nodes [2]. This pattern of disease has been scarcely reported even from the endemic countries with high disease burden [3–5]. We present our experience of a young woman with large dumb-bell-shaped collection originating from the sternum as an isolated primary cold abscess of the sternum.…”