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題名 | Experience in Surgical Management of Musculoskeletal Mycobacterial Infection--A Report of Two Cases=骨骼肌肉系統分枝桿菌感染之外科處置經驗--兩個案例之病例報告 |
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作者 | 林祁岷; 王天祥; 馬旭; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 24:3 2015.09[民104.09] |
頁次 | 頁272-280 |
分類號 | 416.26 |
關鍵詞 | 骨骼肌肉組織; 分枝桿菌感染; Mycobacterial infection; Nontuberculosis mycobacterialtenosynovitis; Extrapulmonary tuberculosis; |
語文 | 英文(English) |
中文摘要 | 背景:在肌腱或軟骨等結締組織感染疾病中,分枝桿菌屬病原體的感染案例數較少。而此類感染較常見的病原體是結核桿菌,非結核分枝桿菌的感染也逐漸增加。由於案例稀少、臨床表現具多變性及培養較不容易,因此診斷這類感染較為困難,若延誤診斷會造成病患進一步的損傷;除此之外,免疫功能不全的病人常會表現出非典型或散發型的病徵,臨床醫師更須提高警覺。目的及目標:我們報告兩例免疫功能正常的患者,分別因分枝桿菌屬病原體所造成的肌腱與肋骨感染及其治療結果,並回顧文獻以討論其治療計畫。材料及方法:第一例是37歲女性患者被魚刺刺到右手食指後,逐漸進展成右手腕的非結核分枝桿菌性肌腱滑液囊炎,在感染源確認後進行積極的清創治療並以抗結核菌藥物治療12個月,經治療後傷口復原良好。第二例是61歲男性,由不明原因造成的左下胸壁膿瘍,病理組織檢驗發現有肉芽性發炎現象且嗜酸性染色也發現了分枝桿菌的存在,檢體培養結果為結核菌感染,病灶經投予經驗性抗結核菌藥物與積極清創手術治療後得到良好控制。結 果:第一例病患經五年後追蹤,傷口癒合良好,但右手腕活動度受限,無法負重。第二例患者經一年半後追蹤,除局部偶爾輕微痛感外,傷口癒合良好,並未留下任何後遺症。結論:分枝桿菌造成的肌肉骨骼組織感染較難早期診斷與治療。因此,這一類感染需要臨床醫師提高警覺與積極的手術清創,並提早投予經驗性的抗結核菌藥物以及後續依據分枝桿菌感受性測試的完整藥物治療,可能可以得到理想的結果。 |
英文摘要 | Background: Musculoskeletal mycobacterial infections are rare. Among these infections, that caused by Mycobacterium tuberculosis is the most common. Nontuberculosis mycobacterial (NTM) infection also affects connective tissue. Diagnosis of mycobacterial infection can be challenging due to its rarity, diverse clinical presentations, and low yield from cultured specimens. In addition, immunocompromised patients may present with atypical or disseminated disease. Misdiagnosis of mycobacterial infection and delayed treatment may result in severe sequelae. Clinicians should pay special attention to extrapulmonary mycobacterial infections. Aims and Objectives: We report 2 immunocompetentcases of mycobacterial infection in the tendon and cartilage, along with their clinical presentations, and discuss treatment strategies and outcomes. Materials and Methods: The first case was a 37-year-old woman who sustained a penetrating fishbone injury of the right index finger that progressed to tenosynovitis of the right wrist. NTM infection was identified, and treatment included aggressive surgical intervention and antimycobacterial medication for 12 months. The second case was a 61-year-old man with an abscess of unknown cause on the left lower chest wall. Mycobacterial infection was suspected based on pathologic findings, and treatment included empirical antimycobacterial medication and aggressive surgical intervention. Results: In the first case, the wound on the right wrist healed well. However, at the 5-year follow-up, range of motion was limited and the patient was unable to lift heavy loads with the right hand. No obvious sequelae occurred in the second patient, and the wound on his chest wall healed well. Conclusion: Mycobacterial infections of musculoskeletal tissue are difficult to diagnose and treat. Early diagnosis of such infection, empirical medical treatment prior to pathogen identification, aggressive surgical intervention, and a complete course of antimycobacterial medication according to the susceptibility of the pathogen may lead to a better outcome. |
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