RESUMO
Osteoarticular or skeletal tuberculosis is a clinical manifestation of extrapulmonary tuberculosis, occurring during the lympho-hematogenous spread of Mycobacterium tuberculosis from a pulmonary primary infection or reactivation of latent infection, years or even decades after the initial infection. Bone and joint tuberculosis is a rare disease with non-specific symptoms and radiological characteristics, often delaying diagnosis for more than a year after clinical onset. First-line hospital departments should develop a clinical suspicion when confronted with a subacute inflammatory bone or joint pathology in patients with underlying comorbidities, especially when coming from tuberculosis-endemic countries. We report a clinical case characterized by lumbar and pelvic abscesses, before addressing in detail the different types of skeletal involvement related to tuberculosis, through a review of the literature.
La tuberculose ostéoarticulaire ou osseuse est une manifestation clinique de la tuberculose extra-pulmonaire, apparaissant lors de la dissémination lympho-hématogène de Mycobacterium tuberculosis à la suite d'une infection pulmonaire primaire ou la réactivation d'une infection latente, des années, voire des décennies après une primo-infection. Il s'agit d'une maladie rare dont les symptômes ainsi que les signes radiologiques sont non spécifiques, ce qui retarde souvent le diagnostic de plus d'un an après les premiers signes cliniques. Les services hospitaliers de première ligne doivent suspecter le diagnostic en cas de pathologie inflammatoire subaiguë des os ou des articulations chez des patients avec comorbidités, surtout s'ils sont originaires de régions endémiques pour la tuberculose. Nous rapporterons un cas clinique caractérisé par des abcès lombaires et pelviens avant d'aborder en détail les différents types d'atteintes squelettiques de la tuberculose au travers d'une revue de la littérature.
Assuntos
Tuberculose Osteoarticular/diagnóstico , Abscesso/microbiologia , Adulto , Músculos do Dorso/microbiologia , DNA Bacteriano/genética , Humanos , Masculino , Mycobacterium tuberculosis/genética , Reação em Cadeia da PolimeraseRESUMO
Background. One of the most plentiful sources for MSCs is the bone marrow; however, it is unknown whether MSC yield differs among different bone marrow sites. In this study, we quantified cellular yield and evaluated resident MSC population from five bone marrow sites in the porcine model. In addition, we assessed the feasibility of a commercially available platelet concentrator (Magellan® MAR01™ Arteriocyte Medical Systems, Hopkinton, MA) as a bedside stem cell concentration device. Methods. Analyses of bone marrow aspirate (BMA) and concentrated bone marrow aspirate (cBMA) included bone marrow volume, platelet and nucleated cell yield, colony-forming unit fibroblast (CFU-F) number, flow cytometry, and assessment of differentiation potential. Results. Following processing, the concentration of platelets and nucleated cells significantly increased but was not significantly different between sites. The iliac crest had significantly less bone marrow volume; however, it yielded significantly more CFUs compared to the other bone marrow sites. Culture-expanded cells from all tested sites expressed high levels of MSC surface markers and demonstrated adipogenic and osteogenic differentiation potential. Conclusions. All anatomical bone marrow sites contained MSCs, but the iliac crest was the most abundant source of MSCs. Additionally, the Magellan can function effectively as a bedside stem cell concentrator.
RESUMO
OBJECTIVES: Complicated fracture healing is often associated with the severity of surrounding muscle tissue trauma. Since inflammation is a primary determinant of musculoskeletal health and regeneration, it is plausible that delayed healing and non-unions are partly caused by compounding local inflammation in response to concomitant muscle trauma. METHODS AND RESULTS: To investigate this possibility, a Lewis rat open fracture model [tibia osteotomy with adjacent tibialis anterior (TA) muscle volumetric muscle loss (VML) injury] was interrogated. We observed that VML injury impaired tibia healing, as indicated by diminished mechanical strength and decreased mineralized bone within the fracture callus, as well as continued presence of cartilage instead of woven bone 28 days post-injury. The VML injured muscle presented innate and adaptive immune responses that were atypical of canonical muscle injury healing. Additionally, the VML injury resulted in a perturbation of the inflammatory phase of fracture healing, as indicated by elevations of CD3(+) lymphocytes and CD68+ macrophages in the fracture callus at 3 and 14d post-injury, respectively. CONCLUSIONS: These data indicate that heightened and sustained innate and adaptive immune responses to traumatized muscle are associated with impaired fracture healing and may be targeted for the prevention of delayed and non-union following musculoskeletal trauma.
