Acute mycobacterial flexor tenosynovitis following accidental bacillus Calmette-Guérin inoculation in a health care worker: Case report

Gerhard S. Mundinger, Keith C. Douglas, James Patrick Higgins

Research output: Contribution to journalArticle

Abstract

Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.

Original languageEnglish (US)
Pages (from-to)362-365
Number of pages4
JournalJournal of Hand Surgery
Volume38
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Tenosynovitis
Bacillus
Needlestick Injuries
Delivery of Health Care
Debridement
Mycobacterium bovis
Mycobacterium tuberculosis
Tendons
Fingers
Urinary Bladder
Hand
Anti-Bacterial Agents
Infection
Neoplasms

Keywords

  • Bacillus Calmette-Guérin
  • flexor tenosynovitis
  • mycobacterial infection
  • needlestick
  • self-inoculation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Acute mycobacterial flexor tenosynovitis following accidental bacillus Calmette-Guérin inoculation in a health care worker : Case report. / Mundinger, Gerhard S.; Douglas, Keith C.; Higgins, James Patrick.

In: Journal of Hand Surgery, Vol. 38, No. 2, 02.2013, p. 362-365.

Research output: Contribution to journalArticle

@article{af5b19b8bd0d4faa9fd6dc5f16d3771d,
title = "Acute mycobacterial flexor tenosynovitis following accidental bacillus Calmette-Gu{\'e}rin inoculation in a health care worker: Case report",
abstract = "Solutions containing bacillus Calmette-Gu{\'e}rin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.",
keywords = "Bacillus Calmette-Gu{\'e}rin, flexor tenosynovitis, mycobacterial infection, needlestick, self-inoculation",
author = "Mundinger, {Gerhard S.} and Douglas, {Keith C.} and Higgins, {James Patrick}",
year = "2013",
month = "2",
doi = "10.1016/j.jhsa.2012.11.011",
language = "English (US)",
volume = "38",
pages = "362--365",
journal = "The Hand",
issn = "1753-1934",
publisher = "SAGE Publications Ltd",
number = "2",

}

TY - JOUR

T1 - Acute mycobacterial flexor tenosynovitis following accidental bacillus Calmette-Guérin inoculation in a health care worker

T2 - Case report

AU - Mundinger, Gerhard S.

AU - Douglas, Keith C.

AU - Higgins, James Patrick

PY - 2013/2

Y1 - 2013/2

N2 - Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.

AB - Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected intravesically to treat tumors of the urinary bladder. We report a case of acute mycobacterial flexor tenosynovitis in a health care worker who inadvertently inoculated her finger via needlestick while preparing BCG solution for intravesicular administration. She was treated successfully with immediate operative intervention followed by 6 months of antimycobacterial antibiotics. Of 3 previous reports of hand infections following self-inoculation with BCG solutions, this case is unique owing to rapid onset of acute mycobacterial flexor tenosynovitis and positive intraoperative mycobacterial cultures. Needlesticks with BCG-containing solutions, especially into the flexor tendon sheath, should be treated with timely surgical debridement and appropriate antimycobacterial management.

KW - Bacillus Calmette-Guérin

KW - flexor tenosynovitis

KW - mycobacterial infection

KW - needlestick

KW - self-inoculation

UR - http://www.scopus.com/inward/record.url?scp=84872918103&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872918103&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2012.11.011

DO - 10.1016/j.jhsa.2012.11.011

M3 - Article

C2 - 23294648

AN - SCOPUS:84872918103

VL - 38

SP - 362

EP - 365

JO - The Hand

JF - The Hand

SN - 1753-1934

IS - 2

ER -