Melioidosis is a significant public health problem in endemic regions such as India. Lack of awareness, predominant empiric antibiotic use reducing culture yields, morphotypic variability of cultures and frequent misidentification by automated blood culture systems, pose myriad challenges in diagnosis and treatment. Through this series, we present our experience of Hematogenous Osteomyelitis with This was a single centre, retrospective, observational study performed at a tertiary case hospital in Mumbai, India from June 2011 to June 2021.Aim
Method
Management of infection after osteosynthesis (IAO) poses a significant challenge in the setting of multidrug resistant organisms (MDRo). We have analysed whether IAO with MDRo has an adverse outcome. We have retrospectively analysed patients with IAO from January 2001 to November 2016 with a minimum follow up of 12 months after the discontinuation of antibiotics.Aim
Method
The insidious and occult characteristics of psoas abscess and clinical features similar to conditions like lumbar strain, abdominal/urologic disorders sometimes cause diagnostic delays; resulting in considerably high morbidity and mortality. Chronic inflammatory conditions of the digestive tract and tuberculosis of spine are the commonest source of secondary abscess in the developed and developing countries, respectively [1]. We report a case of an 86 year with a psoas abscess secondary to mucinous adenocarcinoma of colon. 86 year old female presented with right thigh pain in February 2014. CT scan confirmed the clinical suspicion of right psoas abscess which was drained surgically. Intraoperatively, we found pus mixed with mucinous material coming from a small opening in a rounded structure lateral to psoas which could not be identified. The abscess recurred within 2 days. Culture grew Pseudomonas aerugenosa and streptococcus viridans and histopathology showed metastatsis of mucin secreting adenocarcinoma infiltrating the muscle with pyogenic abscess. Repeat CT scan showed abscess communicating with tumor in the colon(Fig 1). Abscess was drained, but tumor was not addressed considering patients age. The infection resolved with 6 weeks of oral linezolid, however the patient expired after 8 months. Cultures in secondary psoas abscess are often mixed, with E. coli and Bacteroides spp predominating. One must rule out gastrointestinal/genitourinary pathology in cases where the CT/ USG guided culture reports are suggestive of gram negative infection. The fact that carcinoma of the colon could be a cause of psoas abscess should be considered when an unexplained psoas abscess is diagnosed [2]. None of the authors received payments or services, either directly or indirectly from a third party in support of any aspect of this work that could be perceived to influence what is written.Acknowledgements
Non-tuberculous mycobacteria (NTM)—previously considered as saprophytic organisms—are now increasingly recognized as human pathogens [1, 2]. Although humans are routinely exposed to NTM, clinical infection rates are low; further, these infections typically occur in immunocompromised patients. However, an increasing incidence of NTM infections in immunocompetent hosts—caused by direct inoculation, such as contamination from surgical procedures or penetrating trauma—has been noted [1]. Clinically and histopathologically, musculoskeletal infections caused by NTM resemble those caused by Mycobacteria tuberculosis; however, they are largely resistant to routine anti-tuberculosis agents [3,4]. Therefore, NTM infections can either be missed or even regarded as drug resistant tuberculosis, causing a significant delay in diagnosis. Here, we present the features and outcomes of 6 immunocompetent patients with musculoskeletal infections caused by NTM. We retrospectively analyzed the outcomes of musculoskeletal infections caused by NTM in 6 healthy, immunocompetent hosts admitted between 2004 and 2015. The etiology was traced, and available culture reports were reviewed. NTM inoculation was traced to open fractures in 2 patients (1, patella; 1, humerus), intra-articular injection in 2 patients (1, hip; 1, shoulder), local steroid injection to the calcaneum in 1 patient, and an arthroscopic procedure in the knee joint in 1 patient. Histopathological analyses revealed chronic granulomatous inflammation, with positive NTM cultures. Following radical debridement and targeted antibiotic therapy for NTM, all 6 patients showed complete resolution over a follow-up period of 8 months to 10 years, with no recurrence. NTM are an uncommon pathogen in immunocompetent patients. In patients with chronic granulomatous infection not responding to standard anti-tuberculous treatment and with a history suggestive of inoculation—namely open fractures, surgical intervention, or injection—the possibility of NTM infection should be considered. Appropriate antibiotic therapy based on drug susceptibility reports gives good outcomes. While the hallmark of M. tuberculosis infections is chronic granulomatous inflammation, not every case of mycobacterial granulomatous inflammation is due to M. tuberculosis.
