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頁籤選單縮合
題名 | Mycobacterial Infection of the Upper Extremities=上肢之分枝桿菌感染症 |
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作 者 | 王貞棣; 孫瑞昇; 侯勝茂; | 書刊名 | 臺灣醫學會雜誌 |
卷期 | 99:9 2000.09[民89.09] |
頁次 | 頁710-715 |
分類號 | 414.83 |
關鍵詞 | 上肢; 分枝桿菌感染症; Mycobacterial infection; Upper extremity; Mycobacterium tuberculosis; Nontuberculous mycobacteria; |
語文 | 英文(English) |
英文摘要 | Background and purpose: Mycobacterial infection of the upper extremities is extremely rare. To make an early accurate diagnosis is often difficult, and the treatment is therefore, frequently delayed in clinical practice. This paper describes the diagnosis and treatment of mycobacterial infection of the upper extremities in a series of patients treated at National Taiwan University Hospital. Methods: The medical records of 15 patients with mycobacterial infection of the upper extremities treated between 1985 and 1988 were retrospectively analyzed. The diagnosis of mycobacterial infection was established by positive culture results, the presence of acid-fast bacilli, or characteristic histopathologic findings. Results: Mycobacterial infection was suspected on initial examination in only two patients. The duration between the onset of sympotoms and correct diagnosis averaged 37.5 months (range, 3 wk to 209 mo). The involved sites of mycobacterial infection included the wrist in nine patients, the elbow in two, the hand in two , the humerus in two, the forearm in one, and the shoulder in one. Three patients suffered from multifocal musculoskeletal mycobacterial infection. Microbiologic studies identified Mycobacterium tuberculosis in four patients and nontubercuious mycobacteria (NTM) in four. Characteristic histopathologic findings of mycobacterial infection including caseation, granulomatous inflammation, eosinophilic epithellold cells, Langhan's giant cells, and lymphocytic aggregates were noted in all 15 patients. All patients received chemotherapy and 14 patients underwent surgical treatment. The mean duration of follow-up was 46 months (range, 15-97 months). Treatment failed in two of the patients with multifocal NTM infection and in one patient whose my-cobacterial infection was identified by histopathology. Conclusions: Mycobacterial infection should be included in the differential diagnosis of infection of the upper extremities. Treatment failures are more frequent in patients with multifocal NTM infection. |
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