Case Report

A Blind Smear From LJ Medium Revealing Pseudomonas aeruginosa Talus Osteomyelits Afer Seeking for Osteotuberculosis in a 13-Year-Old Teenager: A Case Report

Abstract

The Lowenstein-Jensen is an egg-based microbiology medium that was designed for selective isolation of Mycobacterium spp. The main inhibitory composition in this medium is a synthetic dye called malachite green. Mycobacterium spp. is resistant to the dye by de-colorization and oxidation of it. Some non-tuberculosis organisms may also overcome this inhibitory ingredient by similar enzymatic activity. In the final inspection of the bone TB culture of a teenage patient, the blind smear revealed the Pseudomonas talus osteomyelitis. According to the present and similar experiences, the preparation of 1-2 blind smears from TB culture- negative specimens taken from sterile sites of the body may unmask mycobacteria with the atypical colony and non-tuberculosis microorganisms.

[1] Alshammari AN, Alotaibi MH, Abouelnaga MA, Almohammadi AM. Primary subacute osteomyelitis of the talus in a child. Journal of Musculoskeletal Surgery and Research. 2018; 2:34-7. [DOI:10.4103/ jmsr.jmsr_36_17]
[2] Holland TS, Sangster MJ, Paton RW, Ormerod LP. Bone and joint tuberculosis in children in the Blackburn area since 2006: A case series. Journal of Children's Orthopaedics. 2010; 4(1):67-71. [DOI:10.1007/s11832-009-0232-3] [PMID] [PMCID]
[3] Teklali Y, Alami ZFE, Madhi TE , Gourinda H, Miri A. Tuberculosis of the talus in the child. European Journal of Orthopaedic Surgery and Traumatology. 2003; 13:52-4. [DOI:10.1007/s00590-003-0061-x]
[4] Kassaza K, Orikiriza P, Llosa A, Bazira J, Nyehangane D, Page AL, et al. Lowenstein-Jensen selective medium for reducing contamination in mycobacterium tuberculosis culture. Journal of Clinical Microbiolog. 2014; 52(7):2671-3. [DOI:10.1128/JCM.00749-14] [PMID] [PMCID]
[5] Tille PM. Mycobacteria. Baily & Scott’s Diagnostic Microbiology. 14th ed. Missouri USA: Elsevier; 2017.
[6] Du LN, Wang S, Li G, Wang B, Jia XM , Zhao YH , et al. Biodegrada- tion of malachite green by Pseudomonas sp. strain DY1 under aero- bic condition: Characteristics, degradation products, enzyme analy- sis and phytotoxicity. Ecotoxicology. 2011; 20:438-46. [DOI:10.1007/ s10646-011-0595-3] [PMID]
[7] Forbes BA, Hall GS, Miller MB, Novak SM, Rowlinson MC, Salfinger M, et al. Practice guidelines for clinical microbiology laboratories: Mycobacteria. Clinical Microbiology Reviews. 2018; 31(2):e00038- 17. [DOI:10.1128/CMR.00038-17] [PMID] [PMCID]
[8] Banaei N, Kincaid EZ, Lin SYG, Desmond E, Jacobs WR, Joel D, et al. Lipoprotein processing is essential for resistance of mycobacterium tu- berculosis to malachite green. Antimicrobial agents and chemotherapy 2009; 53(9):3799-802. [DOI:10.1128/AAC.00647-09] [PMID] [PMCID]
[9] Natsis K, Grammatikopoulou D, Kokkinos P, Fouka E, Totlis T. Iso- lated tuberculosis arthritis of the ankle: A case report and review of the literature. Hippokratia. 2017; 21(2):97-100. [PMID] [PMCID]
[10] Narang S. Pseudomonas osteomyelitis of the talus: Review of the pathophysiology and report of a rare case. The Journal Of Foot & Ankle Surgery. 2009; 48(6):672-6. [DOI:10.1053/j.jfas.2009.07.012] [PMID]
[11] Godlewska EZ, Przystaś W, Sota EG. Dcolourisation of different dyes by two pseudomonas strains under various growth conditions. Water, Air, Soil, & Pollution. 2014; 225:1846. [DOI:10.1007/s11270- 013-1846-0] [PMID] [PMCID]
[12] Mattman LH. Cell wall deficient forms: Stealth pathogens. 3rd edi- tion. Boca Raton, London, New York, Washington DC: CRC Press. 2001. P.196- 197. [DOI:10.1201/b16928] [PMID]
[13] Mcclean M, Stanley T, Stanley SH, Maeda Y, Goldsmith CE, Shep- herd R, et al. Identification and characterization of breakthrough contaminants associated with the conventional isolation of My- cobacterium tuberculosis. Journal of Medical Microbiology. 2011; 60:1292-8. [DOI:10.1099/jmm.0.030619-0] [PMID]
Files
IssueVol 5 No 4 (2020): Autumn QRcode
SectionCase Report(s)
Published2021-01-16
DOI https://doi.org/10.18502/crcp.v5i4.5058
Keywords
Talus; Lowenstein Jensen (LJ Pseudomonas Osteomyelits Malachite green

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Eftekhari N, Rezaeizadeh R, Shahabinejad S. A Blind Smear From LJ Medium Revealing Pseudomonas aeruginosa Talus Osteomyelits Afer Seeking for Osteotuberculosis in a 13-Year-Old Teenager: A Case Report. CRCP. 5(4):124-127.