ABSTRACT
Prosthetic joint infection with Mycobacterium tuberculosis usually involves the hips or knees and can result from either local reactivation, or less often from hematogenous spread. Predisposing conditions include rheumatoid arthritis, chronic steroid use and pulmonary diseases. The most common symptom at presentation is pain, and the most common physical finding is joint swelling and/or a draining sinus tract. The sedimentation rate is helpful when elevated but is nonspecific, and initial skin testing is only helpful when positive. The diagnosis depends on culture and histologic examination of tissue. Removal of the joint combined with oral antituberculous treatment is necessary when the infection is discovered greater than six weeks post joint replacement. Early diagnosis leads to decreased morbidity. Tuberculous infection of prosthetic joints is a rare disease and its diagnosis depends on a high degree of clinical suspicion.
Subject(s)
Knee Joint , Knee Prosthesis/adverse effects , Mycobacterium tuberculosis/isolation & purification , Prosthesis-Related Infections/microbiology , Tuberculosis, Osteoarticular/microbiology , Aged , Antitubercular Agents/therapeutic use , Device Removal , Female , Humans , Knee Prosthesis/microbiology , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/surgery , Tuberculosis, Osteoarticular/drug therapy , Tuberculosis, Osteoarticular/surgeryABSTRACT
Central nervous system (CNS) infection with Morganella morganii is very rare. We describe a 38-year-old female patient with frontal brain abscess caused by M morganii who was unsuccessfully treated. We also review all reported cases of Morganella CNS infections with an emphasis on treatment modalities and outcomes. Aggressive surgical management and appropriate antimicrobial therapy can lead to cure, but the mortality rate for these infections remains high.
Subject(s)
Central Nervous System Infections/diagnosis , Enterobacteriaceae Infections/diagnosis , Morganella morganii/pathogenicity , Adult , Aged , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use , Central Nervous System Infections/diagnostic imaging , Central Nervous System Infections/drug therapy , Central Nervous System Infections/microbiology , Enterobacteriaceae Infections/diagnostic imaging , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/microbiology , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Male , Microbial Sensitivity Tests , Middle Aged , Morganella morganii/drug effects , Tomography, X-Ray ComputedABSTRACT
Nonmenstrual toxic shock syndrome (TSS) due to Staphylococcus aureus can lead to significant morbidity and mortality. While drotrecogin alfa (DA) has been employed in patients with Methicillin-resistant Staphylococcus aureus (MRSA) severe sepsis and septic shock, its utility in TSS remains unclear. The authors report a case of severe sepsis in the setting of MRSA-associated TSS that responded to treatment with DA. This case illustrates a potential role for DA in the treatment of toxic shock syndromes and emphasizes the importance of aggressive diagnostic and therapeutic modalities in approaching these conditions.
