Infección tuberculosa de localización infrecuente / Tuberculosis infection in an unusual location

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Tuberculosis of the elbow: A rare form of presentation of extrapulmonary tuberculosis / Osteoartritis tuberculosa del codo: forma poco frecuente de presentación de tuberculosis extrapulmonar

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The location of Australian Buruli ulcer lesions-Implications for unravelling disease transmission.

BACKGROUND: Buruli ulcer (BU), caused by Mycobacterium ulcerans, is increasing in incidence in Victoria, Australia. To improve understanding of disease transmission, we aimed to map the location of BU lesions on the human body. METHODS: Using notification data and clinical records review, we conducted a retrospective observational study of patients diagnosed with BU in Victoria from 1998-2015. We created electronic density maps of lesion locations using spatial analysis software and compared lesion distribution by age, gender, presence of multiple lesions and month of infection. FINDINGS: We examined 579 patients with 649 lesions; 32 (5.5%) patients had multiple lesions. Lesions were predominantly located on lower (70.0%) and upper (27.1%) limbs, and showed a non-random distribution with strong predilection for the ankles, elbows and calves. When stratified by gender, upper limb lesions were more common (OR 1·97, 95% CI 1·38-2·82, p<0·001) while lower limb lesions were less common in men than in women (OR 0·48, 95% CI 0·34-0·68, p<0·001). Patients aged ≥ 65 years (OR 3·13, 95% CI 1·52-6·43, p = 0·001) and those with a lesion on the ankle (OR 2·49, 95% CI 1·14-5·43, p = 0·02) were more likely to have multiple lesions. Most infections (71.3%) were likely acquired in the warmer 6 months of the year. INTERPRETATION: Comparison with published work in Cameroon, Africa, showed similar lesion distribution and suggests the mode of M. ulcerans transmission may be the same across the globe. Our findings also aid clinical diagnosis and provide quantitative background information for further research investigating disease transmission.

Monoarticular coccidioidal synovitis in a pediatric patient.

Isolated monoarticular synovitis is a rare presentation of coccidioidal disease and has, to our knowledge, never previously been described in the English language pediatric literature. Coccidioidal seropositivity is increasing in incidence in the Southwestern United States. It is critical to rule out Coccidioides infection when evaluating arthritis in the context of residence in or travel to high prevalence areas, even in otherwise healthy patients and especially before administering biologic immunosuppressive therapy.

Calvarial tuberculosis with parenchymal involvement.

Tuberculosis is an infectious disease caused by the acid-fast bacilli Mycobacterium tuberculosis that usually affects the lungs although it may affect any organ. Tuberculous osteitis of the cranial bones is an uncommon manifestation of disseminated tuberculosis known as calvarial tuberculosis. Cases with parenchymal involvement are infrequent in the literature. We report a case of a patient with multiple osteolytic cranial lesions and a tuberculoma.

Septic arthritis due to a Sneathia species most closely related to Sneathia sanguinegens.

Sneathia sanguinegens is an infrequent bacterium in clinical specimens. We describe a case of right elbow septic arthritis due to a Sneathia species most closely related to S. sanguinegens in a young immunocompetent woman. S. sanguinegens has never been implicated in osteoarticular infections.

Good's syndrome (hypogammaglobulinemia with thymoma) presenting intractable opportunistic infections and hyperkeratotic lichen planus.

Good's syndrome (GS) is a rare acquired combined T- and B-cell immunodeficiency accompanying thymoma. This report concerns a case of a 57-year-old man with GS manifesting intractable opportunistic infections and hyperkeratotic lichen planus. He had a past history of extended thymectomy for removal of thymoma. He consulted us about scaly and exudative intractable erythematous plaque on his right forearm. The histology was compatible with phlegmon coexisting with lichen planus. Laboratory examination results indicated hypogammaglobulinemia accompanied by complete absence of B cells, which is consistent with GS. Combined treatment with immunoglobulin replacement and administration of antibiotics and antifungal drugs was effective for the phlegmon and overlying fungal infection. The patient also presented with hyperkeratotic lichen planus on both knees and the right elbow, suggesting that intractable opportunistic infection and lichen planus may be associated with GS.

Sporotrichoid-like tuberculosis.

Cutaneous tuberculosis (TB) is a rare presentation of tuberculosis infection in childhood, especially in developed countries. The commonest forms of cutaneous TB, in declining order, are scrofuloderma, lupus vulgaris, lichen scrofulosorum, and TB verrucosa cutis. We described 2 cases of sporotrichoid-like cutaneous tuberculosis infection, 1 localized to a limb and regional nodes and 1 associated with disseminated disease.

Delay in diagnosis: trauma- and coinfection-related cutaneous leishmaniasis because of Leishmania guyanensis infection.

Trauma can trigger the onset of some lesions of cutaneous leishmaniasis (CL). In this study, we present the case of a 65-year-old man who developed persistent, ulcerative, nodular lymphangiitis at the site of elbow abrasions from a fall during a trip to northeastern Brazil. Skin and lymph node biopsy showed tuberculoid granulomatous inflammation and Grocott-methamine silver-positive yeast forms consistent with Sporothrix and Staphylococcus lugdunensis was identified from tissue culture. Antibacterial and antifungal treatment produced short-term healing. Crusted papules recurred at the sites of injury 3 months later and persisted despite therapy. After 15 months, two punch biopsies showed scarring and granulomatous inflammation; cultures and histochemical stains were negative for microorganisms. Because of refractory disease, multiple polymerase chain reaction (PCR) assays for infectious agents on DNA extracted from the biopsy specimens were performed, and Leishmania guyanensis was detected in all specimens. The patient refused pentavalent antimonial therapy and elected for excision of the CL lesions. After 2 years of follow up, he is without disease. CL should be considered in the differential diagnosis in patients who present with ulcerative, nodular lymphangiitis; have a history of travel to endemic regions; and describe a traumatic insult to the affected region. PCR methods for infectious agents increase the sensitivity and specificity of detecting causative agents in these patients who are negative by routine methods. In some, leishmaniasis may be an occult infection whose presence is heralded by trauma. Coinfection, by altering the immune response, may have facilitated the clinical acquisition of CL.

Tuberculosis of the elbow in children.

Ten children with tuberculosis of the elbow treated over a 21-year period from 1979 to 1999 were reviewed retrospectively. At presentation, they had pain and swelling of the joint mainly due to synovitis, and the median symptom duration was 10 weeks. All had a decreased range of movement. All were treated with 9 months of antituberculous chemotherapy without synovectomy. The radiologic stage at presentation, rather than duration of symptoms, predicted outcome. Of the 9 patients with stage 1 or 2 disease (synovitis), 8 had an excellent or good outcome. One stage 2 patient had a posterior dislocation of the radial head and had a fair outcome. The one stage 3 (arthritic) patient had a poor outcome.

Brucellosis of the spine with a synchronous Staphylococcus aureus pyogenic elbow infection.

Staphylococcus aureus osteomyelitis and pyogenic arthritis has a different pattern in the elderly than in the young. The axial skeleton is the most frequent site of infection and treatment is usually by intravenous antibiotics. We report a case of Staph. aureus septic arthritis of the elbow with concomitant osteomyelitis of the spine that was thought to be due to Staph. aureus, but culture of debrided material from the lesion grew Brucella in culture. We suggest that in the elderly it is advisable to obtain a tissue culture diagnosis and not to instigate therapy based on positive blood cultures or a concomitant infection.

[Skin flora of the hands, elbow-hollow and fore-arm (author's transl)]. / Etude de la flore cutanée normale des mains, du pli du coude et de l'avant-bras.

During five years, the values of the skin flora of the hands, fore-arm and elbow-hollow were studied on volunteers, especially five of them. Samples were taken according to the washing method. Results show important quantitative variations of the flora between the differents volunteers and even for a same volunteer. In the five long term followed subjects, the differences were: 2.17 log 10 for aerobic flora and 1.97 log 10 for aeroanaerobic flora of the hands, 3.90 log 10 for aerobic flora and 3.88 log 10 for aero-anaerobic flora of the fore-arm, 2.95 log 10 for aerobic flora and 3.35 log 10 for aero-anaerobic flora of the elbow-hollow. These variations remained independent of the season. According to these variations, already notified by others authors it is suggested first to standardize sampling and bacteriological methods, second to develop multicentric programs in view to increase the number of subjects to be included in the study.