rifampin and Carpal-Tunnel-Syndrome

This study aimed to describe the first two microbiologically confirmed cases of cutaneous and soft tissue Mycobacterium marinum infection in Bulgaria. The isolation of the Nontuberculous Mycobacteria (NTM) strains and their species identification was performed at NRL TB, NCIPD using specific media and cultivation conditions, and PCR based Line Probe Assay (LPA) from the positive cultures. The two patients had closely related jobs to fishes and water reservoirs and both of them had a similar clinical manifestation of M. mari-num infection known as "swimming pool" or "fish tank" granuloma. The prolonged specific treatment with at least two-drug combina-tion of rifampicin plus ethambutol and some complications were a big challenge for clinicians as well as the patients.

Topics: Adult; Antitubercular Agents; Bulgaria; Carpal Tunnel Syndrome; Culture Techniques; Delayed Diagnosis; DNA, Bacterial; Ethambutol; Female; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Occupational Diseases; Rifampin; Soft Tissue Infections

Infective tenosynovitis is an uncommon cause of a common condition namely carpal tunnel syndrome. Following an extensive review of the literature, we report what we understand to be the first published case of Mycobacterium kansasii (M. kansasii) causing tenosynovitis of flexor tendons resulting in carpal tunnel syndrome in Australia. Our case highlights the need for a high level of suspension, histology and appropriate culture with specific microbiological tests for atypical mycobacteria where tenosynovitis is present at carpal tunnel surgery, even in patients who do not appear to have risk factors.

Topics: Anti-Bacterial Agents; Carpal Tunnel Syndrome; Clarithromycin; DNA, Bacterial; Ethambutol; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Occupational Exposure; Rifampin; Rivers; Tenosynovitis

Topics: Carpal Tunnel Syndrome; Gene Expression Regulation; Immunosuppressive Agents; NF-kappa B; Nucleic Acid Synthesis Inhibitors; Oligopeptides; Protein Serine-Threonine Kinases; Receptor, Transforming Growth Factor-beta Type I; Receptors, Transforming Growth Factor beta; Rifampin; Smad2 Protein; Smad3 Protein; Transcription Factor AP-1; Transforming Growth Factor beta

We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.

Topics: Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Carpal Tunnel Syndrome; Combined Modality Therapy; Ethambutol; Female; Hand; Humans; Isoniazid; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Rifampin; Tenosynovitis; Tuberculosis

Mycobacterium szulgai, a scotochromogenic mycobacterium, is a newly recognized pathogen of man and has been reported to cause pulmonary infections, olecranon bursitis and cervical adenitis. We isolated M. szulfai from granulomatous tissue removed at surgery from a young florist with the carpal tunnel syndrome. The organism was susceptible to ethambutol and rifampin but resistant to isoniazid. Cure was achieved by debridement and chemotherapy with ethambutol and rifampin. Neither the source in our patient nor the natural habitat of M. szulgai is known. Because it resembles M. gordonae and M. flavescens, common scotochromogenic mycobacteria in tapwater, care must be taken to avoid dismissing M. szulgai as a contaminant when it is isolated from tissue.

Topics: Adult; Carpal Tunnel Syndrome; Debridement; Ethambutol; Hand; Humans; Male; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Rifampin; Tenosynovitis