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1/9. Sternal osteomyelitis caused by mycobacterium tuberculosis: case report and review of the literature.

    Sternal osteomyelitis caused by mycobacterium tuberculosis is rare; since the advent of modern antituberculous therapy, a limited number of detailed cases have been reported. Most patients were relatively young, free of underlying disease, and lived in a country in which tuberculosis is endemic. The disease presented indolently with sternal pain and swelling. Extrasternal disease is detectable in less than half. diagnosis was based on histologic examination of infected tissues and mycobacterial cultures. Most patients recovered after surgical debridement and combination drug therapy. Tuberculous sternal osteomyelitis should be considered in patients with sternal pain and swelling.
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2/9. A case of mycobacterium scrofulaceum osteomyelitis of the right wrist.

    INTRODUCTION: The objective of the case report is to highlight the possibility of osteomyelitis caused by atypical mycobacteria. Such an infection may simulate tuberculous bone infection and yet fail to respond to standard anti-tuberculous drug therapy. CLINICAL PICTURE: A 66-year-old man who suffered from diabetes mellitus presented with osteomyelitis of the right wrist, with extensive synovial swellings of the flexor tendon sheaths. The clinical features, radiological appearances and histology suggested a tuberculous infection, but subsequent culture grew an atypical mycobacterium, mycobacterium scrofulaceum. TREATMENT AND OUTCOME: There was good clinical improvement and control of the infection with a regime of kanamycin, ethambutol and ethionamide to which the organism was sensitive. CONCLUSION: This case illustrates the need to be aware of the possibility of infection with atypical mycobacteria in cases of suspected tuberculosis of the skeletal system which fail to respond to standard treatment.
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3/9. Mycobacterium flavescens vertebral osteomyelitis in an immunocompetent host.

    The aim of this paper is to describe a rare case of vertebral osteomyelitis caused by Mycobacterium flavescens in an immunocompetent patient. Mycobacterium flavescens is a rapidly growing, pigmented, non-tuberculous mycobacterium, usually described as non-pathogenic for humans but occasionally reported as the cause of serious infectious complications recognized in clinical practice. This study stressed the importance of recent reports that describe the occurrence of vertebral osteomyelitis due to non-tuberculous mycobacteria that have also been recognized with an increasing incidence among immunocompetent hosts. A brief review of the current literature on human disease caused by Mycobacterium flavescens is also reported.
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4/9. Tuberculous dactylitis.

    Tuberculous dactylitis is a rare condition and a diagnostic challenge. Tissue biopsies can be negative for microscopy and culture. polymerase chain reaction and dna probes for mycobacterium tuberculosis can provide an earlier diagnosis. Surgery and antimicrobial therapy remain the mainstay of management.
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5/9. Mycobacterial prepatellar bursitis.

    Prepatellar bursitis secondary to infection with an atypical mycobacterium developed in an 88-year-old man. A review of all previously reported cases in the English literature indicates tuberculosis is important in the differential diagnosis of prepatellar bursitis.
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6/9. Septic arthritis associated with mycobacterium avium: a case report and literature review.

    A 58 year old man, with systemic lupus erythematosus, developed septic arthritis due to an atypical mycobacterium, M. avium. The patient's course, as well as 46 cases reviewed from the literature, illustrates the insidious nature of atypical mycobacterial infections. Septic arthritis or peri-arthritis was generally not suspected at initial evaluation, leading or at least 40% of patients receiving intra-articular steroids for non-specific reasons. A diagnosis was eventually obtained in 85% of cases by surgical biopsy and culture. In only15% was a diagnosis made by culture of synovial or bursal fluid. The relative in vitro resistance of "atypicals" to antituberculous drugs and the frequent necessity for surgery to make a diagnosis, led to surgery consituting partial or total therapy in 89% of cases. Whether patients were treated with surgery alone, surgery plus antituberculous drugs, or antituberculous drugs alone, clinical improvement generally occured. Because most patients had limited follow-up and because atypical mycobacterial infections often relapse, none of the cases reviewed should be considered "cures", be but rather instances of clinically inactive disease.
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7/9. Tuberculous tenosynovitis in the elbow joint.

    A 74-year-old woman was noted to have a mass lesion near the right elbow joint during medication for pulmonary tuberculosis. After discontinuation of medication, the mass gradually became enlarged with swelling and tenderness of the joint. Radiological evaluation disclosed tenosynovitis with an encapsulated abscess. Microscopic examination and culture of an aspiration biopsy specimen from the abscess showed no microorganisms. However, DNA extracted from the specimen contained mycobacterium tuberculosis DNA, permitting a diagnosis of tuberculous tenosynovitis. Mycobacterium is not always detected in biopsy specimens of tuberculous arthritis and tenosynovitis. In such cases, genetic diagnosis may be of great use.
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8/9. Osteoarticular mycobacterium tuberculosis.

    Osteoarticular mycobacterium tuberculosis (TB) can present as a subtle insidious infection. Symptoms vary with bone TB. Osteoarticular TB generally responds to proper antimicrobial therapy, affording sufficient treatment and arrest of the disease process. epidemiology, pathogenesis, treatment, and a case review are presented in this article.
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9/9. Multifocal skeletal tuberculosis: bone scan appearances.

    Bone scans are not generally required in the investigation of tuberculosis. The most common reason for the request is bone pain, which may precede the diagnosis of tuberculosis. The finding of multifocal areas of increased uptake on a bone scan may be due to a number of causes, the most common of which is metastatic bone disease. Therefore, there is a risk that those caused by tuberculosis may be misdiagnosed. We report six such bone scans occurring over 5 years which were found to be due to skeletal tuberculosis. Five patients were of Asian descent, four of whom had had bone biopsies confirming the presence of mycobacterium tuberculosis. The sixth patient, a Caucasian, had a bone biopsy which isolated mycobacterium bovis. Although skeletal tuberculosis is generally secondary to a primary pulmonary focus, all six patients had a normal chest X-ray.
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keywords = mycobacterium
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