[A rare case of tubercular tenosynovitis in hospital surgeon as a result of an occupational accident caused by puncture with an infected needle. Prevention aspects and legal-medical evaluation]. / Un raro caso di tenosinovite tubercolare in operatore sanitario a seguito di incidente occupazionale per puntura da ago cavo infetto. Aspetti di prevenzione e valutazione medico legale.

BACKGROUND: The subject was a hospital surgeon who, in the course of routine outpatient surgery with aspiration to collect right lumbar material in a patient with suspected TB infection, accidentally punctured the fifth finger of the left hand with the needle used for this procedure. This led to involvement of the fifth finger of the left hand restricted to the soft tissue with preservation of joint and bone and tenosynovial involvement of the entire extremity. OBJECTIVES: To draw attention to the repercussions for insurance with resulting absence from work for 126 days and an assessment of biological impairment of 2% by the Insurance Institute (INAIL). METHODS: A case report is described of rare occupational tubercular synovitis. CONCLUSIONS: A rare event is reported that occurred in a senior staff member with particular insurance repercussions.

Non-respiratory tuberculosis with Mycobacterium tuberculosis after penetrating lesions of the skin: five case histories.

Tuberculosis is primarily transmitted from person to person via the respiratory route. We describe five cases of patients who developed tuberculosis at the site of a skin injury: three after being treated repeatedly with local corticosteroids via intramuscular injections, and two who cut themselves accidentally with a knife. All cultures yielded normal-sensitive Mycobacterium tuberculosis, and all patients responded well to anti-tuberculosis treatment. These unusual manifestations of non-respiratory tuberculosis may support the assumption that persistent, painful, reddish and/or fistulous areas of the skin might also indicate an infection caused by M. tuberculosis, via either reactivation of pulmonary tuberculosis or primary infection with M. tuberculosis by cutaneous transmission.

Osteoarticular tuberculosis.

Over the past several years there has been a dramatic rise in the incidence of tuberculosis. Peripheral skeletal tuberculosis is, more often than not, misdiagnosed as osteoarthritis or pyogenic osteomyelitis. Tuberculosis is no longer a "zebra" among differential diagnoses. This article reviews the pathogenesis, along with practical tips for the diagnosis and treatment of osteoarticular tuberculosis.

[A case of posterior tuberculous spondylitis of the lumbar vertebra with the skull inoculated by acupuncture].

A 77-year-old male consulted an orthopedist with complaints of lumbago and a lumbar swelling, and was treated with acupuncture. As the symptoms deteriorated, and smear of a specimen aspirated from the lumbar swelling was positive for acid fast bacilli which were later identified as Mycobacterium tuberculosis, he was hospitalized in the National Chiba Higashi Hospital. On admission to our hospital, CT-scan of lumbar vertebrae showed the destructive change of spinous process of the third lumbar vertebra accompanied by the abscess formation, and an occipital swelling with the destructive change of skull was also detected. Whole body examinations with CT-scan and bronchoscopy did not reveal any other abnormal findings suspective of tuberculous lesions. The above lesions were both gradually improved by antituberculous chemotherapy with INH, RFP, and EB. He was finally diagnosed as posterior tuberculous spondylitis of the lumbar vertebra with cold abscess, and also clinically diagnosed as skull tuberculosis caused presumably by the inoculation of tubercle bacilli from the lumbar lesion by acupuncture.

Mycobacterium marinum disease in Anne Arundel County: 1995 update.

A retrospective survey of 41 cases of culture-positive Mycobacterium marinum disease in Anne Arundel County, Maryland, showed that most infection was related to recreational exposure to the Chesapeake Bay and its tributaries. Three quarters of cases consisted of skin or joint/tendon infection of the upper extremity, particularly the hand. An empiric drug regimen for a granulomatous soft tissue infection in this context should include rifampin and ethambutol or cotrimoxazole (trimethoprim/sulfamethoxazole). A reactive tuberculin skin test in Anne Arundel County is more likely to represent M. marinum infection than tuberculous infection.

[Extrapulmonary tuberculosis in childhood. Case reports from a pediatric specialty hospital]. / Extrapulmonale Tuberkulose im Kindesalter. Fallberichte aus einem pädiatrischen Schwerpunktkrankenhaus.

The immigration of people from countries with high incidence of tuberculosis has led to an increased number of cases of tuberculosis in Austria. The number of cases of extrapulmonary tuberculosis has increased too. The variability of the clinical presentation of extrapulmonary tuberculosis which can affect almost every organ system makes it essential to include it in the differential diagnosis of any infectious disease. Early identification and rapid onset of therapy are most important for recovering without complications and avoidance of longterm sequelae. 9 cases of extrapulmonary tuberculosis in the Gottfried von Preyer Children's hospital from 1989 to 1992 show the different clinical features of this disease. 3 cases of tuberculous lymphadenitis, 1 case of tuberculosis of the adenoids, 1 case of tuberclulous pleurits, 3 cases of gastrointestinal tuberculosis and 1 case of a tuberculous meningitis and osteomyelitis are described. All 9 children recovered with antituberculous treatment without complications or sequelae.

Mycobacterium fortuitum infections of the hand. Report of five cases.

Five cases are reported of infection due to Mycobacterium fortuitum involving the hand following contaminated injection or traumatic wounds. Synovectomy, debridement, or amputation together with prolonged chemotherapy using kanamycin or amikacin were required. Doxycycline and sulphamethoxasole also seemed to be the effective antibiotics for this organism. A high index of suspicion is important in order to obtain the correct diagnosis.