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Bone and joint infections due to opportunistic mycobacteria, a review of French experience
International Journal of Mycobacteriology
H O S T E D BY
4 (2015) 8
Available at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/IJMYCO
Bone and joint infections due to opportunistic mycobacteria, a review of French experience Ve´ronique Vincent Independent Consultant, Paris, France
A R T I C L E I N F O
A B S T R A C T
Article history:
Aims and objectives: Bone and joint infections due to environmental mycobacteria are rare
Received 25 August 2014
and can develop very slowly. The source for these outbreaks is generally tap water supplies.
Accepted 28 August 2014
In the present review, the focus is on a large outbreak of Mycobacterium xenopi spinal
Available online 27 September 2014
infections in patients who had undergone surgical microdiscectomy for disc hernia in a French hospital. Surprisingly, a patient was diagnosed with a M. xenopi discitis with
Keywords:
secondary extension to the sacroiliac joint 15 years after spinal surgery. The findings of a
Opportunistic mycobacteria
national investigation launched by health authorities to determine the number of the bone
Bone and joint infections
and joint infections due to opportunistic mycobacteria are described in this study.
Tap water
Methods: National health authorities launched a retrospective investigation in patients
Iatrogenic infections
who were exposed to M. xenopi contamination in that hospital. Moreover, a national survey was conducted across all French laboratories to collect information on bone and joint cases due to opportunistic mycobacteria. The National Reference Center for Mycobacteria investigated hospital tap water supplies and developed a species-specific probe for the rapid identification of M. xenopi. Results: Bone and joint infections, with the exception of the episode of the clinic where the large M. xenopi outbreak occurred, are rare in France. A very small number of cases, all sporadic, were detected and linked to an invasive procedure. In addition to M. xenopi, mycobacterial species involved are Mycobacterium marinum, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium avium and Mycobacterium kansasii. Despite awareness of laboratories to mycobacterial infections, no significant increase in iatrogenic infections has been demonstrated in care facilities. The source of infection of the large outbreak of spondylitis due to M. xenopi was traced to deficient hygiene practices and a high concentration of M. xenopi in the hospital tap water. Conclusions: Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly when symptoms develop. Ó 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
E-mail address: [email protected] http://dx.doi.org/10.1016/j.ijmyco.2014.08.010 2212-5531/Ó 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
H O S T E D BY
4 (2015) 8
Available at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/IJMYCO
Bone and joint infections due to opportunistic mycobacteria, a review of French experience Ve´ronique Vincent Independent Consultant, Paris, France
A R T I C L E I N F O
A B S T R A C T
Article history:
Aims and objectives: Bone and joint infections due to environmental mycobacteria are rare
Received 25 August 2014
and can develop very slowly. The source for these outbreaks is generally tap water supplies.
Accepted 28 August 2014
In the present review, the focus is on a large outbreak of Mycobacterium xenopi spinal
Available online 27 September 2014
infections in patients who had undergone surgical microdiscectomy for disc hernia in a French hospital. Surprisingly, a patient was diagnosed with a M. xenopi discitis with
Keywords:
secondary extension to the sacroiliac joint 15 years after spinal surgery. The findings of a
Opportunistic mycobacteria
national investigation launched by health authorities to determine the number of the bone
Bone and joint infections
and joint infections due to opportunistic mycobacteria are described in this study.
Tap water
Methods: National health authorities launched a retrospective investigation in patients
Iatrogenic infections
who were exposed to M. xenopi contamination in that hospital. Moreover, a national survey was conducted across all French laboratories to collect information on bone and joint cases due to opportunistic mycobacteria. The National Reference Center for Mycobacteria investigated hospital tap water supplies and developed a species-specific probe for the rapid identification of M. xenopi. Results: Bone and joint infections, with the exception of the episode of the clinic where the large M. xenopi outbreak occurred, are rare in France. A very small number of cases, all sporadic, were detected and linked to an invasive procedure. In addition to M. xenopi, mycobacterial species involved are Mycobacterium marinum, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium avium and Mycobacterium kansasii. Despite awareness of laboratories to mycobacterial infections, no significant increase in iatrogenic infections has been demonstrated in care facilities. The source of infection of the large outbreak of spondylitis due to M. xenopi was traced to deficient hygiene practices and a high concentration of M. xenopi in the hospital tap water. Conclusions: Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly when symptoms develop. Ó 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
E-mail address: [email protected] http://dx.doi.org/10.1016/j.ijmyco.2014.08.010 2212-5531/Ó 2014 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.