Tenosynovitis due to mycobacteria other than tuberculosis: a hazard of water sports and hobbies

Abstract

Tenosynovitis is defined as inflammation of a tendon sheath. In established cases it often presents as painful swelling associated with gradual loss of movement and palpable synovial thickening with nodularity and crepitus in the affected tendons. The cause of such inflammation may include autoimmune phenomena as in rheumatoid arthritis, bacterial infection and in the following cases, mycobacterial infection with mycobacteria other than tuberculosis (MO-l-f). Infections of soft tissue and joints with MOTT have been previously described (14) in addition to pulmonary and other extra-pulmonary sites. Mycobacterium marinum infection has been identified as a hazard of leisure pursuits (5,6) and cutaneous mycobacteriosis (7,8) such as ‘fish tank granuloma’. This organism is less often reported involving deeper tissues such as the tendon sheaths in tenosynovitis (9,lO). Mycobacterium kansasii has been reported in pulmonary disease (11,12) but is much less often implicated in chronic bone and joint infection, especially of the wrist and hand (1,13). Both organisms share similar microbiological characteristics; both are slow growing photochromogens (M. marinum optimally cultures at 30°C; M. kansasii at 37°C) (14). These organisms have been isolated from both domestic and environmental water sources (15-17) and can be difficult to demonstrate on direct staining (1). Both organisms share sensitivities to rifampicin and resistance to pyrazinamide, and choice of an optimal second therapeutic agent can be difficult.