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Article Summary:

The article discusses the pathogenesis, host risk factors, clinical manifestations, and diagnosis of musculoskeletal infections caused by mycobacteria. Mycobacteria have evolved mechanisms to evade the immune system and establish infections in the host. They infect macrophages and interfere with immune responses. Certain factors, such as immunodeficiencies and the use of immunomodulatory medications, increase the risk of mycobacterial infections. Musculoskeletal infections can occur via hematogenous spread or direct inoculation, and various sources of contamination can lead to infections. Tuberculosis commonly affects the spine, while nontuberculous mycobacteria (NTM) infections are less common but can cause septic arthritis and tenosynovitis. The diagnosis of mycobacterial infections requires microbiological confirmation, which may involve culturing and drug-susceptibility testing. Laboratory tests and imaging studies can provide supportive evidence, but more invasive diagnostics, such as synovial fluid aspiration, are often necessary. Therapy depends on the type of mycobacterial infection involved, and often requires a multidisciplinary care team. Those on immunomodulatory therapy should strongly consider decrease or holding immunosuppression, particularly TNF alpha inhibitors.