Mycobacterial Infections of the Hand.

BACKGROUND: Hand infections caused by mycobacteria are relatively uncommon compared to infections caused by other pathogens; therefore, much of the available literature consists of case reports and limited case series. Broadly categorized into tuberculous and nontuberculous mycobacterial (NTM) infections, both tuberculous and NTM infections are typically insidious with long incubation periods and with the ability to remain dormant for prolonged periods. METHODS: We reviewed the most current literature on the epidemiology, presentations, treatment methods, and resistance patterns of mycobacterial infections of the hand focusing on the indications and outcomes of nonoperative as well as operative interventions. RESULTS: The worldwide burden of tuberculosis remains high and while the overall rate of new diagnosis drug resistant tuberculosis has been on the decline some regions of the world have demonstrated staggeringly high resistance rates to first-line tuberculosis therapies. Signs and symptoms of mycobacterial hand infection are typically inconsistent, and highly dependent on the specific structures of the hand that are affected; therefore, these infections may mimic other infections of the hand like tenosynovitis, joint space infections, and cutaneous infections. The main stay of treatment remains antimycobacterial therapies including but not limited to rifampin, isoniazid, pyrazinamide, and ethambutol. CONCLUSIONS: The complications associated with mycobacterial hand infections can be significant. Prompt evaluation, including a thorough history to evaluate for potential exposures to infectious sources, followed by appropriate antibiotic choice and duration, with surgical management as needed, is key to reducing the chance that patients experience lasting effects of the infection.

Diagnosis and Management of Common Hand Infections.

While many hand infections are superficial, diligent evaluation, diagnosis, and treatment of these infections are central for preventing disability and morbidity. Maintaining a wide differential diagnosis is important as some hand infections may mimic others. In geographic areas with more than a 10% to 15% prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) hand infections, empiric antibiotics should adequately cover MRSA. Once culture results are available, antibiotic regimens should be narrowed to reduce the development of resistant pathogens.

How prior testing impacts misinformation processing: A dual-task approach.

Research suggests that testing prior to the presentation of misinformation influences how that misinformation is processed. The present study examined the relationship between testing, the demands of misinformation narrative processing, and memory for original and post-event information. Using response latencies to a secondary task, we tested whether prior testing influenced the available resources for secondary task processing. Additionally, we investigated whether changes in narrative processing were specific to critical details tested earlier. Participants engaged in an eyewitness memory paradigm in which half were tested prior to receiving the post-event narrative. Participants responded to the secondary task at specified time points during the narrative. All participants took a final memory test after listening to the post-event narrative. We found that testing interacted with the placement of the secondary task. When responding on the secondary task was closely linked to the presentation of previously tested critical details in the narrative, retrieval-enhanced suggestibility was reduced on tests of event memory (Experiment 1) and increased post-event information learning was revealed on tests of narrative memory (Experiment 2).