351
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Conway R, Orr C, McCarthy GM. Lesson of the month 1: Septic arthritis with normal acute phase reactants and white cell count in a patient receiving tocilizumab. Clin Med (Lond) 2017; 17:280-281. [PMID: 28572233 PMCID: PMC6297569 DOI: 10.7861/clinmedicine.17-3-280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Septic arthritis represents 8-27% of cases of monoarthritis presenting to the emergency department. Tocilizumab is an interleukin-6 blocking monoclonal antibody with the mechanistic potential to interfere with the body's normal inflammatory response to an infectious insult. We present a case of septic arthritis with a normal white cell count, C-reactive protein, erythrocyte sedimentation rate and fibrinogen in a patient treated with tocilizumab.
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Affiliation(s)
- Richard Conway
- Mater Misericordiae University Hospital and CARD Newman Research Fellow, University College Dublin, Dublin, Ireland
| | - Carl Orr
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Geraldine M McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
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352
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Xiao D, Feng X, Huang H, Quan H. Severe septic arthritis of the temporomandibular joint with pyogenic orofacial infections: A case report and review of the literature. Exp Ther Med 2017; 14:141-6. [PMID: 28672905 DOI: 10.3892/etm.2017.4510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 03/03/2017] [Indexed: 11/10/2022] Open
Abstract
Septic arthritis of the temporomandibular joint (SATMJ) is a rare entity that has only been reported a few dozen times worldwide. However, SATMJ is an acute infectious disease and associated with a high risk for misdiagnosis, which results in severe complications for patients. The present study reported a case of an 83-year-old female patient with severe pyogenic orofacial infections caused by right-side SATMJ, which was not cured by abscess incision drainage and anti-microbial treatment. Finally, the clinical signs were resolved by condylectomy and debridement of the erosive septic TMJ, after which the function of the TMJ was completely restored. In conclusion, a timely and correct diagnosis with early treatment is critical to preventing acute complications and late sequelae of SATMJ. In addition, literature associated with this topic was reviewed and discussed.
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353
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Abstract
Acute septic arthritis in children is usually hematogenous. It is more common in boys, and it most often affects the large joints of the lower limb. Diagnosis is based on cultures obtained from the infected joint and is supported by C-reactive protein blood test or ultrasound imaging. Staphylococcus aureus is the most common causative agent and is the primary target for empiric treatment. First-generation cephalosporins and clindamycin are suitable antibiotics. Vancomycin is utilized in areas with high rates of clindamycin- and methicillin-resistant S. aureus. After a short intravenous administration of 2–4 days, a total course of 2 weeks is sufficient in uncomplicated cases. Early antibiotic treatment has significantly improved the prognosis in high-income settings, but uncomplicated recovery is compromised if the treatment is delayed. Complications such as symptomatic osteoarthritis or avascular necrosis of the femoral head develop slowly. A long follow-up of 1–2 years is required to detect all possible sequelae.
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Affiliation(s)
- Markus Pääkkönen
- Department of Pediatric Orthopaedic Surgery.,Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
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354
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Bertumen JB, Schell WA, Joyce M, Alley C, Woods CW. Diagnostic difficulty identifying Apophysomyces trapeziformis septic arthritis in a patient with multiple myeloma. JMM Case Rep 2017; 3:e005075. [PMID: 28348796 PMCID: PMC5343124 DOI: 10.1099/jmmcr.0.005075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction: Mucormycosis is a rare fungal infection, but can cause substantial morbidity and mortality in both immunocompromised and immunocompetent patients. Apophysomyces is a mucormycetes species ubiquitous in nature, particularly in soil, decaying wood and other organic matter. Apophysomyces is known to cause cutaneous fungal infections, particularly after penetrating trauma. Septic arthritis is a rare clinical manifestation. Case presentation: We describe a case of Apophysomyces trapeziformis causing septic arthritis of the knee of a patient with multiple myeloma. He was treated multiple times for bacterial septic arthritis with minimal improvement. Surgical tissue specimens finally grew mucoraceous mould, and DNA sequencing and morphological assessment of spores identified the mould as A. trapeziformis. The patient was treated with amphotericin B and posaconazole, but ultimately required an above-the-knee amputation for definitive treatment. Conclusion: This case illustrates the need to evaluate for fungal infection in a persistent septic arthritis that is culture negative and refractory to empiric antibiotics, particularly in an immunocompromised individual. It also shows the importance of a thorough social history and adequate tissue specimens for culture.
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Affiliation(s)
- J Bradford Bertumen
- Duke University Medical Center, 2100 Erwin Road, Durham, NC 27710, USA; Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA
| | - Wiley A Schell
- Duke University Medical Center , 2100 Erwin Road, Durham, NC 27710 , USA
| | - Maria Joyce
- Durham VA Medical Center , 508 Fulton Street, Durham, NC 27705 , USA
| | - Christopher Alley
- Durham VA Medical Center , 508 Fulton Street, Durham, NC 27705 , USA
| | - Christopher W Woods
- Duke University Medical Center, 2100 Erwin Road, Durham, NC 27710, USA; Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA
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355
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Meier R, Wirth T, Hahn F, Vögelin E, Sendi P. Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration? Open Forum Infect Dis 2017; 4:ofx058. [PMID: 28491895 PMCID: PMC5419293 DOI: 10.1093/ofid/ofx058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
Background Pyogenic arthritis of the small joints of the hand and wrist is a known but poorly described entity. The objective of this work was to characterize the clinical presentation, antimicrobial treatment, and surgical interventions of native small joint arthritis (SJA) treated in our tertiary center. Methods According to predefined variables, medical records of adult patients with SJA treated in a Swiss university hospital between 2005 and 2013 were retrospectively analyzed. Results The median age of 97 patients (101 joints) was 52 years (interquartile range [IQR], 38–68 years); 52% had no comorbidity. Small joint arthritis of the second and third fingers accounted for 53% of infections, with metacarpal-phalangeal and proximal interphalangeal joints most commonly involved. Of 86 (89%) episodes with an exogenous source, 63 (65%) followed a trauma. The most commonly isolated microorganism was Staphylococcus aureus (38%), followed by β-hemolytic streptococci (13%) and Pasteurella spp (11%). Eighty-seven episodes (89 joints) in patients with follow-up examinations were included in treatment and outcome analyses. Up to 2 surgical interventions were required to cure infection in 74 (83%) joints. Median antimicrobial treatment duration was 14 days (IQR, 12–28 days), with amoxicillin/clavulanate administered in 74 (85%) episodes. At follow up, cure of infection was noted in all episodes and good functional outcome in 79% of episodes. Conclusions Small joint arthritis shows considerable differences from clinical patterns reported for larger joints. In our series, the outcome was good with no more than 2 surgical interventions and median treatment duration of 14 days in 79% of episodes.
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Affiliation(s)
| | - Thomas Wirth
- Department of General Surgery, Inselgruppe Aarberg, Switzerland
| | - Frederik Hahn
- Division of Hand Surgery, Department of Orthopedics, University of Zurich, Switzerland
| | | | - Parham Sendi
- Infectious Diseases, Inselspital, Bern University Hospital and.,Institute of Infectious Diseases, University of Bern, Switzerland
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356
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Abstract
Despite advances in understanding and management, paediatric osteoarticular infections continue to pose diagnostic difficulties for clinicians. Delays in diagnosis can lead to potentially devastating morbidity.No single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively paediatric bone and joint infection. Diagnosis should be based on a combination of clinical signs, imaging and laboratory investigations. Algorithms should supplement, and not replace, clinical decision making in all cases.The roles of aspiration, arthrotomy and arthroscopy in the treatment of septic arthritis are not clearly defined. There is a very limited role for surgery in the management of acute haematogenous osteomyelitis.The ideal duration and mode of administration of antibiotic therapy for osteoarticular paediatric infection is not yet fully defined but there is increasing evidence that shorter courses (three weeks) and early conversion (day four) to oral administration is safe and effective in appropriate cases. Clear and concise antibiotic guidelines should be available based on local population characteristics, pathogens and their sensitivities.Kingella kingae is increasingly identified through polymerase chain reaction and is now recognised as the commonest pathogen in children aged under four years. Methicillin-resistant Staphylococcus aureus and Panton-Valentine leukocidin-producing strains of Staph. aureus are being increasingly reported.A multidisciplinary integrated evidence-based approach is required to optimise outcomes.Further large-scale, multicentre studies are needed to delineate the optimal management of paediatric osteoarticular infection. Cite this article: EFORT Open Rev 2017;1:7-12. DOI: 10.1302/2058-5241.2.160027.
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Affiliation(s)
- Alexios D Iliadis
- Centre for Orthopaedics, The Royal London and Barts and The London Children's Hospitals, Barts Health NHS Trust, London, UK
| | - Manoj Ramachandran
- Centre for Orthopaedics, The Royal London and Barts and The London Children's Hospitals, Barts Health NHS Trust, London, UK
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357
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An TJ, Benvenuti MA, Mignemi ME, Martus J, Wood JB, Thomsen IP, Schoenecker JG. Similar Clinical Severity and Outcomes for Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Pediatric Musculoskeletal Infections. Open Forum Infect Dis 2017; 4:ofx013. [PMID: 28480284 PMCID: PMC5414090 DOI: 10.1093/ofid/ofx013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prior studies of pediatric musculoskeletal infection have suggested that methicillin-resistant Staphylococcus aureus (MRSA) infections result in worse outcomes compared with infections with methicillin-susceptible S aureus (MSSA) strains. Based on these results, clinical prediction algorithms have been developed to differentiate between MRSA and MSSA early in a patient's clinical course. This study compares hospital outcomes for pediatric patients with MRSA and MSSA musculoskeletal infection presenting to the emergency department at a large tertiary care children's hospital. METHODS A retrospective study identified pediatric patients with S aureus musculoskeletal infection over a 5-year period (2008-2013) by sequential review of all pediatric orthopedic consults. Relevant demographic information, laboratory values, and clinical outcomes were obtained from the electronic medical record. RESULTS Of the 91 identified cases of S aureus pediatric musculoskeletal infection, there were 49 cases of MRSA infection (53%) and 42 cases of MSSA infection (47%). There were no significant differences between MRSA and MSSA infections in median hospital length of stay (4.8 vs 5.7 days, P = .50), febrile days (0.0 vs 1.5 days, P = .10), and antibiotic duration (28 vs 34 days, P = .18). Methicillin-resistant S aureus infections were more likely to require operative intervention than MSSA infection (85% vs 62%, P = .15). A logistic regression model based on C-reactive protein, temperature, white blood cell count, pulse, and respiratory rate at presentation demonstrated poor ability to differentiate between MRSA and MSSA infection. CONCLUSIONS The results demonstrated no significant differences between MSSA and MRSA musculoskeletal infections for most hospital outcomes measured. However, MRSA infections required more operative interventions than MSSA infections. In addition, a predictive model based on severity markers obtained at presentation was unable to effectively differentiate between MRSA and MSSA infection. The clinical utility and capacity for early differentiation of MRSA and MSSA depends on virulence patterns that may vary temporally and geographically.
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Affiliation(s)
- Thomas J An
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Megan E Mignemi
- Vanderbilt University Medical Center, Departments of Orthopaedics
| | - Jeffrey Martus
- Vanderbilt University Medical Center, Departments of Orthopaedics
| | - James B Wood
- Pediatrics, Nashville, Tennessee
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isaac P Thomsen
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Pediatrics, Nashville, Tennessee
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G Schoenecker
- Vanderbilt University Medical Center, Departments of Orthopaedics
- Pediatrics, Nashville, Tennessee
- Vanderbilt University Medical Center, Departments of Pharmacology
- Pathology, Nashville, Tennessee
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358
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Bachmann Holzinger II, Höhn T. [Not Available]. Praxis (Bern 1994) 2017; 106:181-186. [PMID: 28211747 DOI: 10.1024/1661-8157/a002598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Hinken ist ein häufiger Vorstellungsgrund in der pädiatrischen Praxis und stellt wegen der vielfältigen Differenzialdiagnosen, der teilweise schwierigen Anamnese und den möglicherweise sehr unspezifischen klinischen Befunden eine diagnostische Herausforderung dar. Die Kunst besteht darin, bei häufigen und selbstlimitierenden, harmlosen Krankheitsbildern (z.B. Coxitis fugax, Myositis) die diagnostischen Untersuchungen zurückhaltend einzusetzen und gleichzeitig potenziell schwerwiegende Ursachen (z.B. septische Arthritis, Epiphysiolysis capitis femoris) nicht zu verpassen. Eine sorgfältige Anamnese und körperliche Untersuchung grenzen die umfangreiche Liste der Differenzialdiagnosen entscheidend ein und helfen bei der Wahl allenfalls nötiger Zusatzuntersuchungen wie Bluttest oder bildgebender Verfahren.
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Affiliation(s)
| | - Tobias Höhn
- 1 Interdisziplinäre Notfallstation, Universitätskinderspital Zürich
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359
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Fox-Lewis A, Eades CP, Manson JJ, Morris-Jones S, Miller RF. Neisseria meningitidis serogroup C sepsis and septic arthritis in an HIV-positive man. Int J STD AIDS 2017; 28:943-946. [PMID: 28120645 DOI: 10.1177/0956462417691439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A patient with well-controlled HIV-1 infection presented with fever and rigors, a widespread maculopapular rash, and severe generalised arthralgia. Sepsis of unknown aetiology was diagnosed, and treatment with broad-spectrum antimicrobials commenced. Following initial clinical improvement, a right knee septic arthritis developed. Microscopy and culture of the joint aspirate were negative for organisms but 16S rDNA PCR identified Neisseria meningitidis DNA, subsequently verified as capsular genogroup C, thus confirming a diagnosis of disseminated meningococcal sepsis with secondary septic arthritis.
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Affiliation(s)
- A Fox-Lewis
- 1 T8 Ward, University College London Hospitals NHS Foundation Trust, London, UK.,2 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - C P Eades
- 1 T8 Ward, University College London Hospitals NHS Foundation Trust, London, UK.,2 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - J J Manson
- 1 T8 Ward, University College London Hospitals NHS Foundation Trust, London, UK.,3 Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Morris-Jones
- 4 Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - R F Miller
- 1 T8 Ward, University College London Hospitals NHS Foundation Trust, London, UK.,2 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.,5 Research Department of Infection and Population Health, University College London, London, UK.,6 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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360
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Abstract
BACKGROUND We hypothesized that leucocyte esterase strip test can aid in diagnosing septic arthritis in native synovial fluid because leucocyte esterase concentrations would be elevated at the infection site because of secretion by recruited neutrophils. METHOD The cohort included 27 patients (suspected septic arthritis and normal subjects). A standard chemical test strip (graded as negative, trace, +, ++ or +++) was used to detect the presence of leucocyte esterase. Fluid leucocyte count, Gram staining, culture, erythrocyte sedimentation rate and C-reactive protein were also assessed. RESULTS The leucocyte esterase test with a threshold of ++/+++ had a sensitivity of 79.2% (95% CI [confidence interval], 65.9% to 89.2%), specificity of 80.8% (95% CI, 73.3% to 87.1%), positive predictive value (PPV) of 61.8% (95% CI, 49.2% to 73.3%) and negative predictive value (NPV) of 90.1% (95% CI, 84.3% to 95.4%). CONCLUSION The leucocyte esterase strip test yielded a high specificity, PPV, NPV, high sensitivity and high diagnostic accuracy. Leucocyte esterase is an accurate, quick and bedside test for septic arthritis and can be used effectively for diagnosing periprosthetic joint infections along with other battery of tests according to the Musculoskeletal Infection Society criteria.
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Affiliation(s)
- V K Gautam
- 1 Department of Orthopedics Lok Nayak Hospital, New Delhi, India
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361
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Abstract
According to the Centers for Disease Control and Prevention, from being nonendemic for melioidosis, India has now become endemic for the disease since 2012. Until then, melioidosis cases were being reported sporadically from India. There have been isolated case reports from few states across the country for the past few years. Most of the times, Burkholderia pseudomallei may be misreported as Pseudomonas species, especially in resource-poor laboratories. Due to its varied clinical presentation, the specific clinical diagnosis can be difficult, thereby making laboratory diagnosis mandatory. This could make a huge impact on patient care as this organism has a different treatment protocol as well as virulence determinants which influence the course of management. Although known for its endemicity in Australia, Thailand, and other Southeast Asian countries, B. pseudomallei has emerged in new areas such as India, Southern China, Brazil, and Malawi. We present a rare case of melioidosis with rapid disease progression to fatal outcome from Chennai, South India.
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Affiliation(s)
- Isabella Princess
- Department of Microbiology, Apollo Speciality Hospitals, Vanagaram, Tamil Nadu, India
| | - R Ebenezer
- Department of Critical Care Medicine, Apollo Speciality Hospitals, Vanagaram, Tamil Nadu, India
| | - Nagarajan Ramakrishnan
- Department of Critical Care Medicine, Apollo Hospitals, Greams Road, Chennai, Tamil Nadu, India
| | - Arun Kumar Daniel
- Department of Biochemistry, Apollo Speciality Hospitals, Vanagaram, Tamil Nadu, India
| | - S Nandini
- Department of Microbiology, Apollo Hospitals, Greams Road, Chennai, Tamil Nadu, India
| | - M A Thirunarayan
- Department of Microbiology, Apollo Hospitals, Greams Road, Chennai, Tamil Nadu, India
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362
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Helito CP, Teixeira PRL, de Oliveira PR, de Carvalho VC, Pécora JR, Camanho GL, Demange MK, Lima ALM. Septic arthritis of the knee: clinical and laboratory comparison of groups with different etiologies. Clinics (Sao Paulo) 2016; 71:715-719. [PMID: 28076516 PMCID: PMC5175290 DOI: 10.6061/clinics/2016(12)07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/08/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES: To clinically and epidemiologically characterize a population diagnosed with and treated for septic arthritis of the knee, to evaluate the treatment results and to analyze the differences between patients with positive and negative culture results, patients with Gram-positive and Gram-negative bacterial isolates and patients with S. aureus- and non-S. aureus-related infections. METHODS: One hundred and five patients with septic knee arthritis were included in this study. The clinical and epidemiological data were evaluated. Statistical analysis was performed to compare patients with and without an isolated causative agent, patients with Gram-positive and Gram-negative pathogens and patients with S. aureus-related and non S. aureus-related infections. RESULTS: Causative agents were isolated in 81 patients. Gram-positive bacteria were isolated in 65 patients and Gram-negative bacteria were isolated in 16 patients. The most commonly isolated bacterium was S. aureus. Comparing cases with an isolated pathogen to cases without an isolated pathogen, no differences between the studied variables were found except for the longer hospital stays of patients in whom an etiological agent was identified. When comparing Gram-positive bacteria with Gram-negative bacteria, patients with Gram-positive-related infections exhibited higher leukocyte counts. Patients with S. aureus-related infections were more frequently associated with healthcare-related environmental encounters. CONCLUSION: S. aureus is the most common pathogen of septic knee arthritis. Major differences were not observed between infections with isolated and non-isolated pathogens and between infections with Gram-positive and Gram-negative bacteria. S. aureus infections were more likely to be associated with a prior healthcare environment exposure.
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Affiliation(s)
- Camilo Partezani Helito
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Cirurgia do Joelho, São Paulo/, SP, Brazil
- E-mail:
| | - Paulo Renan Lima Teixeira
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Cirurgia do Joelho, São Paulo/, SP, Brazil
| | - Priscila Rosalba de Oliveira
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Doenças Infecciosas, São Paulo/, SP, Brazil
| | - Vladimir Cordeiro de Carvalho
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Doenças Infecciosas, São Paulo/, SP, Brazil
| | - José Ricardo Pécora
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Cirurgia do Joelho, São Paulo/, SP, Brazil
| | - Gilberto Luis Camanho
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Cirurgia do Joelho, São Paulo/, SP, Brazil
| | - Marco Kawamura Demange
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Cirurgia do Joelho, São Paulo/, SP, Brazil
| | - Ana Lucia Munhoz Lima
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Ortopedia e Traumatologia, Divisão de Doenças Infecciosas, São Paulo/, SP, Brazil
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363
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Abstract
There is still controversy on the management of septic arthritis in neonates. This study aims to investigate the treatment of septic arthritis in neonates.We reviewed 52 neonates (37 males and 15 females) with septic arthritis in our hospital during 2004 to 2015. The mean age at onset of infection was 17.5 ± 7.6 days, mean age at admission was 32.6 ± 10.7 days. A total of 56 joints were involved (22 knees, 18 shoulders, 13 hips, and 3 other joints). Thiryt-six patients underwent surgical drainage, 14 patients were treated nonoperatively, 2 families refused treatment. Forty-four patients (48 joints) were followed for 4.5 ± 1.2 years. Based on treatment, these 48 joints were divided into an operative group and a nonoperative group. Clinical presentations, imaging examination results, treatments, and outcomes were analyzed.Among the patients who were followed-up, the time from onset to treatment in the operatively managed group (12.7 ± 8.1 days) was significantly shorter than that in the conservatively managed group (20.0 ± 8.2 days). There were no significant differences between both groups on the age at onset, age at admission, imaging score, length of hospital stay, WBC counts, and intravenous medication time. Thirty-five sites (72.9%) recovered completely. There was no significant difference on recovery rate between operative and nonoperative group. Only 33.3% of the hips recovered, this was significantly lower than that of knee/ankle (85.0%) and shoulder/elbow (78.9%). Sequels were found in 13 joints. Logistic regression indicated that sex, imaging score, and hip joint involvement were predictors of sequel. One point of imaging score increased the risk of sequels by a factor of 2.960, and hip joint involvement increased the risk of sequels by a factor of 12.712. Females were more likely to have sequels than males.Surgical drainage is recommended for early diagnosed neonatal septic arthritis and hip infections. A conservative approach may be more efficient for patients whose diagnosis and treatment had been delayed for more than 2 weeks. Antibiotics should be administered intravenously for 2 weeks and then orally for another 2 weeks. First-generation cephalosporin and clindamycin are recommended empirical antibiotics before causative agent and its resistance pattern are known.
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364
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Abstract
Introduction: Incidence rates of invasive Haemophilus influenzae serotype b disease have decreased significantly since the introduction of the Hib vaccine; however, the rates in indigenous populations remain disproportionately high, specifically in the paediatric population. Additionally, with the decline of type b invasive infections, there has been a rebound in the incidence of invasive infections caused by other strains of H. influenzae, particularly serotype a. Case presentation: We present a paediatric case of septic arthritis caused by H. influenzae type a in a toddler that was fully resolved following antibiotic therapy. This report adds to other reports of septic arthritis in indigenous populations as shown through a review of recently documented H. influenzae type a septic arthritis cases. Conclusion: Socio-economic risk factors for invasive H. influenzae type a disease, such as poverty, poor housing conditions, overcrowding, smoking and substance abuse during pregnancy, as well as the need for H. influenzae type a immunization of vulnerable populations, are discussed.
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Affiliation(s)
- Joelle Thorgrimson
- Northern Ontario School of Medicine , 955 Oliver Road, Thunder Bay, ON P7B 5E1 , Canada
| | - Marina Ulanova
- Northern Ontario School of Medicine , 955 Oliver Road, Thunder Bay, ON P7B 5E1 , Canada
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365
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Palmer MP, Melton-Kreft R, Nistico L, Hiller NL, Kim LHJ, Altman GT, Altman DT, Sotereanos NG, Hu FZ, De Meo PJ, Ehrlich GD. Polymerase Chain Reaction-Electrospray-Time-of-Flight Mass Spectrometry Versus Culture for Bacterial Detection in Septic Arthritis and Osteoarthritis. Genet Test Mol Biomarkers 2016; 20:721-731. [PMID: 27749085 PMCID: PMC5180073 DOI: 10.1089/gtmb.2016.0080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Preliminary studies have identified known bacterial pathogens in the knees of patients with osteoarthritis (OA) before arthroplasty. Aims: The current study was designed to determine the incidence and types of bacteria present in the synovial fluid of native knee joints from adult patients with diagnoses of septic arthritis and OA. Patients and Methods: Patients were enrolled between October 2010 and January 2013. Synovial fluid samples from the affected knee were collected and evaluated with both traditional microbial culture and polymerase chain reaction–electrospray ionization–time-of-flight mass spectrometry (molecular diagnostics [MDx]) to prospectively characterize the microbial content. Patients were grouped by diagnosis into one of two cohorts, those with clinical suspicion of septic arthritis (n = 44) and those undergoing primary arthroplasty of the knee for OA (n = 21). In all cases where discrepant culture and MDx results were obtained, we performed species-specific 16S rRNA fluorescence in situ hybridization (FISH) as a confirmatory test. Results: MDx testing identified bacteria in 50% of the suspected septic arthritis cases and 29% of the arthroplasty cases, whereas culture detected bacteria in only 16% of the former and 0% of the latter group. The overall difference in detection rates for culture and MDx was very highly significant, p-value = 2.384 × 10−7. All of the culture-positive cases were typed as Staphylococcus aureus. Two of the septic arthritis cases were polymicrobial as was one of the OA cases by MDx. FISH testing of the specimens with discordant results supported the MDx findings in 91% (19/21) of the cases, including one case where culture detected S. aureus and MDx detected Streptococcus agalactiae.Conclusions: MDx were more sensitive than culture, as confirmed by FISH. FISH only identifies bacteria that are embedded or infiltrated within the tissue and is thus not susceptible to contamination. Not all suspected cases of septic arthritis contain bacteria, but a significant percent of patients with OA, and no signs of infection, have FISH-confirmed bacterial biofilms present in the knee.
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Affiliation(s)
- Michael P Palmer
- 1 88th Surgical Operations Squadron, Orthopedic Surgery , Wright-Patterson Airforce Base, Dayton, Ohio
| | - Rachael Melton-Kreft
- 2 Center of Excellence in Biofilm Research , Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Laura Nistico
- 2 Center of Excellence in Biofilm Research , Allegheny Health Network, Pittsburgh, Pennsylvania
| | - N Louisa Hiller
- 3 Department of Biological Sciences, Carnegie Mellon University , Pittsburgh, Pennsylvania
| | - Leon H J Kim
- 3 Department of Biological Sciences, Carnegie Mellon University , Pittsburgh, Pennsylvania
| | - Gregory T Altman
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Daniel T Altman
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Nicholas G Sotereanos
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Fen Z Hu
- 5 Institute for Molecular Medicine and Infectious Disease, Center for Genomic Sciences, Drexel University College of Medicine , Philadelphia, Pennsylvania
| | - Patrick J De Meo
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Garth D Ehrlich
- 5 Institute for Molecular Medicine and Infectious Disease, Center for Genomic Sciences, Drexel University College of Medicine , Philadelphia, Pennsylvania.,6 Institute for Molecular Medicine and Infectious Disease, Center for Advanced Microbial Processing, Drexel University College of Medicine , Philadelphia, Pennsylvania.,7 Department of Microbiology and Immunology, Drexel University College of Medicine , Philadelphia, Pennsylvania.,8 Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine , Philadelphia, Pennsylvania
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366
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Nguyen M, Moffatt-Bruce SD, Merritt RE, D'Souza DM. Clinical Effectiveness of Negative Pressure Wound Therapy Following Surgical Resection of Sternoclavicular Joint Infection: A Case Report. Cureus 2016; 8:e815. [PMID: 27843733 PMCID: PMC5101108 DOI: 10.7759/cureus.815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition accounting for 0.5% of bone and joint infections. The majority of cases require joint resection and advancement flaps to provide coverage to the resulting wound defect. However, in the setting of an infected wound space, surgeons are often inclined to allow wound healing by secondary intention. Negative pressure wound therapy (NPWT) can be an important adjunct to promote and shorten wound healing time following SCJ resection.
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Affiliation(s)
- Michelle Nguyen
- Department of Surgery, The Ohio State University Medical Center
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367
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Dietvorst M, Roerdink R, Leenders ACAP, Kiel MA, Bom LPA. Acute Mono-Arthritis of the Knee: A Case Report of Infection with Parvimonas Micra and Concomitant Pseudogout. J Bone Jt Infect 2016; 1:65-67. [PMID: 28529856 PMCID: PMC5423566 DOI: 10.7150/jbji.16124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Parvimonas micra is a rare pathogen for septic arthritis and is known for its subacute onset. We report a case of acute arthritis of the knee caused by P. micra and pseudogout. Initially, calcium pyrophosphate crystals were found in the knee, which were successfully treated with a steroid injection. Only anaerobic cultures became positive. A 16S rRNA PCR-analysis was necessary to identify P. micra as causative agent, a method which is never described before in similar cases. The infection was treated with clindamycin for 6 weeks. This is the third case report of a septic arthritis caused by P. micra and the second which also reports concomitant pseudogout.
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Affiliation(s)
| | - Ramon Roerdink
- Jeroen Bosch general hospital, 's-Hertogenbosch, The Netherlands
| | | | - Menno A Kiel
- Erasmus Medical Centre, Rotterdam, The Netherlands
| | - L Paul A Bom
- Jeroen Bosch general hospital, 's-Hertogenbosch, The Netherlands
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368
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Ghazala CG, Fatone E, Bentley R, Rajeev A. Primary Bacterial Gluteal Pyomyositis: A Rare Disease in Temperate Climates Presenting as Suspected Septic Arthritis of the Hip. J Emerg Med 2016; 51:319-21. [PMID: 27369856 DOI: 10.1016/j.jemermed.2016.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/26/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In nations with temperate climates, primary polymyositis is a rare, life-threatening bacterial infection that can mimic various clinical diseases depending on the area involved, leading to delayed diagnosis and management. CASE REPORT We describe a young postpartum woman who presented to the emergency department with hip pain that was initially suspected to be caused by septic arthritis. However, hip arthrocentesis was negative, and a magnetic resonance imaging scan revealed extensive pyomyositis of the gluteal muscles. She underwent surgical debridement and was given parenteral antibiotics with good clinical recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We emphasize that cases of pyomyositis in temperate countries are often diagnosed late and therefore delay life- and potentially limb-saving treatment. For patients who present with hip and thigh pain and clinical features of sepsis, pyomyositis should be considered in the differential diagnosis and an early magnetic resonance imaging scan should be performed to confirm the diagnosis and reduce the high morbidity and mortality associated with this emerging disease.
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Affiliation(s)
- Christopher George Ghazala
- Department of Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, United Kingdom
| | - Elena Fatone
- Department of Radiology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, United Kingdom
| | - Ruth Bentley
- Department of Pathology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, United Kingdom
| | - Aysha Rajeev
- Department of Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, United Kingdom
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369
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Abstract
Introduction: Pigmented villonodular synovitis (PVNS) is a proliferative condition of the synovium, which is composed of nodules and/or villi and has an abundant number of hemosiderin-laden macrophages. Case Report: A 10-year-old boy presented with an acute irritable knee. Emergency arthroscopy showed a nodular PVNS in the intercondylar notch. The symptoms resolved after resection of the lesion. Conclusion: PVNS of the knee in children is a rare entity. It can be one of the causes of acute irritable knee. Complete resection of the nodular PVNS can cure the disease.
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Affiliation(s)
- Cheung Man Hong
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China-
| | - Lui Tun Hing
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, NT, Hong Kong SAR, China-
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370
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Castellazzi L, Mantero M, Esposito S. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis. Int J Mol Sci 2016; 17:E855. [PMID: 27258258 DOI: 10.3390/ijms17060855] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022] Open
Abstract
Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.
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371
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Kishibe S, Okubo Y, Morino S, Hirotaki S, Tame T, Aoki K, Ishii Y, Ota N, Shimomura S, Sakakibara H, Terakawa T, Horikoshi Y. Pediatric hypervirulent Klebsiella pneumoniae septic arthritis. Pediatr Int 2016; 58:382-385. [PMID: 27005513 DOI: 10.1111/ped.12806] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/04/2015] [Accepted: 08/12/2015] [Indexed: 01/02/2023]
Abstract
Cases of infection with hypervirulent Klebsiella pneumoniae are gradually increasing in number, and cause life-threatening community-acquired infection even in immunocompetent patients. A 14-year-old boy developed septic hip arthritis due to hypervirulent K. pneumoniae (sequence type 23, serotype K1, magA positive). The patient initially seemed to have been successfully treated with antibiotics and surgical intervention, but septic arthritis developed into osteomyelitis of the femoral head and myositis, which required long-term antibiotic therapy and additional surgical intervention. This is the first pediatric case of hypervirulent K. pneumoniae septic hip arthritis. Treatment plans should mainly consist of antibiotic therapy and surgical intervention. Clinicians, even pediatricians, in developed countries should be aware of the increasing incidence of hypervirulent Klebsiella pneumoniae infection.
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Affiliation(s)
- Shun Kishibe
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yusuke Okubo
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Department of Quantitative Methods, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Saeko Morino
- Division of Infectious Disease, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shintaro Hirotaki
- Division of Infectious Disease, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tomoyuki Tame
- Division of Laboratory, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kotaro Aoki
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Norikazu Ota
- Division of Orthopedics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satoshi Shimomura
- Division of Orthopedics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiro Terakawa
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuho Horikoshi
- Division of Infectious Disease, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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372
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Scharf VF, Lewis ST, Wellehan JF, Wamsley HL, Richardson R, Sundstrom DA, Lewis DD. Retrospective evaluation of the efficacy of isolating bacteria from synovial fluid in dogs with suspected septic arthritis. Aust Vet J 2016; 93:200-3. [PMID: 26010925 DOI: 10.1111/avj.12328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/06/2014] [Accepted: 11/03/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of synovial fluid culture in obtaining the causative organism from dogs with suspected septic arthritis. METHODS In this retrospective evaluation, synovial fluid cytology and microbiology submissions from dogs with suspected septic arthritis from March 2007 to August 2011 were reviewed. Synovial fluid cytology consistent with joint sepsis was identified. Cultures of synovial fluid from dogs with clinical histories and abnormalities consistent with septic arthritis were used to evaluate the efficacy of bacterial isolation. RESULTS In total, 36 dogs met the inclusion criteria. Initial aerobic cultures of joint fluid yielded bacterial growth in 44% of these dogs. All anaerobic cultures were negative. In 19% of the dogs with positive cultures, antibiotics had been administered prior to arthrocentesis compared with 10% of dogs with negative cultures. There was no association between culture efficacy and the administration of antimicrobial treatment prior to synovial fluid culture or recent surgery involving the affected joint (P=0.637 and P=0.106, respectively). CONCLUSION Culture of synovial fluid from dogs with suspected septic arthritis has a low yield, necessitating a more effective means of identifying bacteria from suspected septic joints in dogs.
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Affiliation(s)
- V F Scharf
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - S T Lewis
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - J F Wellehan
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - H L Wamsley
- Department of Physiologic Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - R Richardson
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - D A Sundstrom
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - D D Lewis
- Department of Small Animal Clinical Sciences College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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373
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Scharf VF, Lewis DD, Wellehan JF, Wamsley HL, Richardson R. Comparison of synovial fluid culture and 16S rRNA PCR in dogs with suspected septic arthritis. Aust Vet J 2016; 93:204-7. [PMID: 26010926 DOI: 10.1111/avj.12329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/15/2014] [Accepted: 09/28/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To prospectively compare the sensitivity and specificity of 16S rRNA PCR with culture for identifying the causative organism in synovial fluid obtained from dogs with suspected septic arthritis. METHODS Synovial fluid cytology, PCR analysis and aerobic, anaerobic and Mycoplasma culture of samples from the affected joints of 18 dogs presenting with suspected septic arthritis were performed. Synovial fluid samples from the corresponding contralateral joints of 7 dogs were also analysed as negative controls. RESULTS There was no significant difference between the sensitivity of bacterial detection via culture (63.2%) versus PCR (73.7%) of synovial fluid (P=0.728) or between culture and combined PCR and culture (89.5%) of synovial fluid (P=0.124). The specificity of PCR (42.9%) was significantly lower than culture specificity (100%) (P=0.07). CONCLUSION Although 16S PCR may hold potential as an ancillary diagnostic test for identifying the causative organism in dogs with septic arthritis, our study failed to demonstrate improved accuracy compared with traditional synovial fluid culture.
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Affiliation(s)
- V F Scharf
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - D D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - J F Wellehan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - H L Wamsley
- Department of Physiologic Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - R Richardson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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374
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Yazıcı A, Kayan G, Yaylacı S, Demir MV, Karakeçe E, Tamer A, Karabay O. Tuberculous arthritis of the elbow joint: A case report. Eur J Rheumatol 2016; 3:142-143. [PMID: 27733947 DOI: 10.5152/eurjrheum.2015.0062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/18/2015] [Indexed: 11/22/2022] Open
Abstract
Tuberculous arthritis of the elbow joint is rare. A 57-year-old male patient presented with swelling, pain, and redness of the elbow. The symptoms first appeared one month ago; he was given antibiotic treatment after the diagnosis of septic arthritis at another center. The patient who did not improve with treatment was diagnosed with tuberculous arthritis according to the culture and was started on antituberculosis treatment. Tuberculous arthritis usually presents with chronic arthritis. However, it can also present in patients with septic arthritis.
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Affiliation(s)
- Ayten Yazıcı
- Department of Internal Medicine, Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Gökçen Kayan
- Clinic of Infection Diseases, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Selçuk Yaylacı
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Mustafa Volkan Demir
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Engin Karakeçe
- Department of Clinic Microbiology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Ali Tamer
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Oğuz Karabay
- Clinic of Infection Diseases, Sakarya Training and Research Hospital, Sakarya, Turkey
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375
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Abstract
Septic arthritis is the result of bacterial infection of the hip joint and is often found in infants and toddlers. It is the most common septic joint condition during growth and may cause the most devastating complications without prompt and proper treatment. Early diagnosis and intervention are required to avoid irreversible complications. This review documents the systematic approach to diagnosis and management of septic arthritis in children.
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Affiliation(s)
- Gang Xu
- Department of Pediatric Orthopedic, Beijing Jishuitan Hospital, 100035 Beijing, China; Department of Pediatric Orthopedic, University Children's Hospital, UKBB, CH-4031 Basel, Switzerland,
| | - Muriel Spoerri
- Department of Pediatric Orthopedic, University Children's Hospital, UKBB, CH-4031 Basel, Switzerland
| | - Erich Rutz
- Department of Pediatric Orthopedic, University Children's Hospital, UKBB, CH-4031 Basel, Switzerland
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376
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Zegzulková K, Forejtová Š. [Differential diagnosis of monoarthritis]. Cas Lek Cesk 2016; 155:299-304. [PMID: 27917633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Making the diagnosis of monoarthritis can be quite difficult, because in contrast with polyarthritis just a few clinical data is available and wide diagnostic spectrum is present.The diagnosis of inflammatory rheumatic disease is usually in responsibility of a rheumatologist, but we know from experience that is necessary to carry out the basal differential diagnostic assessment as soon as possible to begin the optimal therapy. General practitioners and orthopaedists are usually first to face this problem.Monoarthritis can be divided into non-inflammatory arthritis where activated osteoarthritis and trauma belongs and inflammatory arthritis, which include gouty arthritis, chondrocalcinosis, infectious arthritis, juvenile idiopathic arthritis, spondylitis, incipient rheumatoid arthritis and many others.The article also focuses on the management of patients with monoarthritis where detailed history, careful clinical joint examination and the nature of arthritis assessment is necessary for differential diagnostic considerations. Our balance sheet further facilitate imaging, arthrocentesis with the analysis of synovial fluid and of course the laboratory examination.
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377
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Abstract
Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male.
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Affiliation(s)
| | - Ivan Nikiforov
- Department of Internal Medicine, Pinnacle Health Systems, Harrisburg PA, United States
| | - Qurat Mansoora
- Department of Internal Medicine, Pinnacle Health Systems, Harrisburg PA, United States
| | - John Goldman
- Department of Internal Medicine, Pinnacle Health Systems, Harrisburg PA, United States
| | - Pramil Cheriyath
- Department of Internal Medicine, Pinnacle Health Systems, Harrisburg PA, United States
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378
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Colavite PM, Ishikawa LLW, Zorzella-Pezavento SFG, Oliveira LRCD, França TGD, da Rosa LC, Chiuso-Minicucci F, Vieira AE, Francisconi CF, da Cunha MDLRDS, Garlet GP, Sartori A. Cloxacillin control of experimental arthritis induced by SEC(+) Staphylococcus aureus is associated with downmodulation of local and systemic cytokines. Cell Microbiol 2015; 18:998-1008. [PMID: 26695535 DOI: 10.1111/cmi.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 11/23/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Abstract
Staphylococcus aureus is the most common agent of septic arthritis (SA) that is a severe, rapidly progressive and erosive disease. In this work we investigated the clinical, histopathological and immunological characteristics of the SA triggered by an enterotoxin C producer S. aureus strain. The effect of a β-lactamic antibiotic over disease evolution and cytokine production was also evaluated. After confirmation that ATCC 19095 SEC(+) strain preserved its ability to produce enterotoxin C, this bacteria was used to infect C57BL/6 male mice. Body weight, clinical score and disease prevalence were daily evaluated during 14 days. Cytokine production by splenocytes, cytokine mRNA expression in arthritic lesions, transcription factors mRNA expression in inguinal lymph nodes and histopathological analysis were performed 7 and 14 days after infection. ATCC 19095 SEC(+) strain caused a severe arthritis characterized by weight loss, high clinical scores and a 100% disease prevalence. Histopathological analysis revealed inflammation, pannus formation and bone erosion. Arthritis aggravation was associated with elevated production of pro-inflammatory cytokines, higher local mRNA expression of these cytokines and also higher mRNA expression of T-bet, ROR-γ and GATA-3. Disease control by cloxacillin was associated with decreased production of pro-inflammatory cytokines but not of IL-10. These findings indicate that the ATCC 19095 SEC(+) strain is able to initiate a severe septic arthritis in mice associated with elevated cytokine production that can be, however, controlled by cloxacillin.
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Affiliation(s)
- Priscila Maria Colavite
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Larissa Lumi Watanabe Ishikawa
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - Larissa Ragozo Cardoso de Oliveira
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Thaís Graziela Donegá França
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Larissa Camargo da Rosa
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Fernanda Chiuso-Minicucci
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Andreia Espíndola Vieira
- Department of Biological Sciences, School of Dentistry of Bauru, São Paulo University-FOB/USP, Bauru, São Paulo, Brazil
| | - Carolina Fávaro Francisconi
- Department of Biological Sciences, School of Dentistry of Bauru, São Paulo University-FOB/USP, Bauru, São Paulo, Brazil
| | | | - Gustavo Pompermaier Garlet
- Department of Biological Sciences, School of Dentistry of Bauru, São Paulo University-FOB/USP, Bauru, São Paulo, Brazil
| | - Alexandrina Sartori
- Department of Microbiology and Immunology, Institute of Biosciences of Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
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379
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Abstract
A case of rarely encountered nontyphoidal Salmonella septic arthritis of the elbow in an infant with no preexisting disease is reported. Salmonella etiology was not suspected in this case, and the diagnosis was made only after bacterial isolation. Aspiration of the infected joint with radiological guidance initially failed to give a good clinical response. Arthrotomy was done with intravenous cefotaxime for 4 weeks followed by 2 weeks oral ciprofloxacin therapy to which the child responded favorably. Up to our knowledge this is the first case of nontyphoidal salmonella elbow septic arthritis in an infant in Saudi Arabia to be reported in the English literature.
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380
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Schuster P, Schulz M, Immendoerfer M, Mayer P, Schlumberger M, Richter J. Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction: Evaluation of an Arthroscopic Graft-Retaining Treatment Protocol. Am J Sports Med 2015; 43:3005-12. [PMID: 26403209 DOI: 10.1177/0363546515603054] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but severe complication. Treatment regimens differ, and optimal management has not been established. PURPOSE To determine the incidence of postoperative infections after ACL reconstruction, to identify the microbiological spectrum, and to evaluate a standardized graft-retaining treatment protocol consisting of sequential arthroscopic irrigation and debridement (I&D) procedures and antibiotic therapy until C-reactive protein levels are within normal range. STUDY DESIGN Case series; Level of evidence, 4. METHODS From January 2004 to June 2014, a total of 7096 consecutive arthroscopic ACL reconstructions were performed at a single institution (5907 primary and 1189 revision reconstructions). Thirty-six cases with postoperative septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical presentation, time to and number of arthroscopic reoperations, and microbiological findings. The follow-up examination consisted of a clinical examination, instrumeted measurement of laxity (KT-1000 arthrometer), classification according to objective and subjective International Knee Documentation Committee (IKDC) scores, and radiological evaluation. RESULTS The incidence of septic arthritis was 0.51% (n = 36), with 0.41% (n = 24) in primary and 1.01% (n = 12) in revision reconstructions (odds ratio, 2.5; P = .008). The first I&D was performed a mean (± SD) of 19.6 ± 10.6 days after the index procedure. Eradication was achieved in all patients after a mean of 2.25 ± 1.22 procedures, with graft retention in all but 1 patient (97.2%). The mean duration of antibiotic treatment was 5.4 ± 2.3 weeks (range, 2.1-12.9 weeks) and ≤ 4 weeks in 13 patients (36%). No recurrence of infections was seen. Coagulase-negative staphylococci (62.5%) and Staphylococcus aureus (21.9%) were the most frequent pathogens. Twenty-nine patients were available for follow-up (80.6%) after a mean 4.7 ± 3.2 years (range, 0.7-11.2 years). Two patients suffered recurrent nontraumatic ACL insufficiency (6.9%), and all others (93.1%) had an intact graft, with a mean KT-1000 arthrometer side-to-side difference of 1.4 ± 0.9 mm. The mean subjective IKDC score was 80.4 ± 11.2. No emergence or deterioration of osteoarthritis related to infections was seen. CONCLUSION Postoperative septic arthritis is rare but serious after arthroscopic ACL reconstruction. Graft retention and good to excellent clinical results can be obtained with an arthroscopic treatment protocol. The duration of antibiotic therapy should be based on the individual course.
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Affiliation(s)
- Philipp Schuster
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Martin Schulz
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Micha Immendoerfer
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Philipp Mayer
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Michael Schlumberger
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Joerg Richter
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
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381
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Humphrey JM, Lacaille SNJ, Patel K, Thompson E, Tulumba S, Healey JH, Gilhuley KA, Babady NE, Kamboj M, Mead PA. Prosthetic-Joint-Associated Bordetella holmesii Infection. Open Forum Infect Dis 2015; 2:ofv169. [PMID: 26688826 PMCID: PMC4682186 DOI: 10.1093/ofid/ofv169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/03/2015] [Indexed: 11/24/2022] Open
Abstract
Bordetella holmesii is a globally distributed pathogen that is increasingly recognized as a cause of both pertussis-like respiratory infections and invasive disease. In this study, we describe a case of an immunocompetent man who developed B holmesii infection of his femoral prosthesis—the fifth B holmesii orthopedic infection reported in literature to date. This article highlights the potentially underrecognized role of B holmesii in orthopedic infections by reviewing these previously reported cases in the context of the current literature.
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Affiliation(s)
- John M Humphrey
- Division of Infectious Diseases, Department of Medicine , Weill Cornell Medical College
| | - Sherard N J Lacaille
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine
| | - Krutika Patel
- Clinical Microbiology Service, Department of Laboratory Medicine
| | - Erin Thompson
- Clinical Microbiology Service, Department of Laboratory Medicine
| | - Steve Tulumba
- Clinical Microbiology Service, Department of Laboratory Medicine
| | | | | | - N Esther Babady
- Clinical Microbiology Service, Department of Laboratory Medicine
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York, New York
| | - Peter A Mead
- Infectious Disease Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York, New York
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382
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Westley BP, Horazdovsky RD, Michaels DL, Brown DR. Identification of a Novel Mycoplasma Species in a Patient With Septic Arthritis of the Hip and Seal Finger. Clin Infect Dis 2015; 62:491-3. [PMID: 26449564 DOI: 10.1093/cid/civ875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/24/2015] [Indexed: 11/12/2022] Open
Abstract
An Alaska Native hunter developed fever, swollen finger, and septic hips after harvesting seals. Evaluation of hip tissue by 16S rRNA gene polymerase chain reaction and sequencing revealed a putative novel mycoplasma species. We report the identification of this organism and describe the first known case of disseminated seal finger mycoplasmosis.
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Affiliation(s)
| | | | - Dina L Michaels
- Department of Infectious Diseases and Pathology, University of Florida, Gainesville
| | - Daniel R Brown
- Department of Infectious Diseases and Pathology, University of Florida, Gainesville
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383
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Shewring DJ, Trickett RW, Subramanian KN, Hnyda R. The management of clenched fist 'fight bite' injuries of the hand. J Hand Surg Eur Vol 2015; 40:819-24. [PMID: 25770897 DOI: 10.1177/1753193415576249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/12/2015] [Indexed: 02/03/2023]
Abstract
We present a prospective study outlining the management of clenched fist 'fight bite' injuries. Over a 4-year period all patients with such injuries had surgical exploration with further débridements as necessary. For metacarpophalangeal joint injuries, a midline tendon-splitting approach was used. For proximal interphalangeal joint injuries, an approach was made between the lateral band and central slip of the extensor mechanism. A total of 147 patients with 159 joint injuries were treated, with 130 metacarpophalangeal joint and 29 proximal interphalangeal joint injuries. The joint was penetrated in 96% of joints overall. The number of débridements ranged from two to eight. Twenty patients defaulted within 1 week of surgery and were not included in the analysis of the results. All patients with metacarpophalangeal joint injury had satisfactory or good outcomes. A total of 42% of patients with proximal interphalangeal joint injuries had poor results, four requiring amputation and one a fusion. The tendon-splitting approach to the metacarpophalangeal joint allows excellent access and avoids damage to the sagittal bands and consequent instability of the extensor mechanism.
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Affiliation(s)
- D J Shewring
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - R W Trickett
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - K N Subramanian
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
| | - R Hnyda
- Department of Trauma and Orthopaedic Surgery, University Hospital of Wales, Cardiff, UK
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384
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Abstract
Mycobacterium kansasii is a nontuberculous mycobacterium that primarily causes pulmonary disease in AIDS patients, however it has also been known, rarely, to result in skeletal infection. When skeletal infection occurs, the time from onset of symptoms to diagnosis is up to 5 years in previously reported cases. We describe a 48-year-old woman with HIV/AIDS who presented with chronic, isolated left knee pain and swelling of over two decades which had recently worsened. Radiographs and magnetic resonance imaging demonstrated marked subarticular erosions, synovial thickening, and bone marrow edema, which had progressed compared with prior imaging done seven years earlier. Synovial biopsy grew Mycobacterium kansasii. Following the presentation of our case, clinical and imaging findings, including the differential diagnosis, of monoarticular arthritis caused by Mycobacterium kansasii are reviewed and discussed.
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Affiliation(s)
- Leo Menashe
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Leslie Dubin Kerr
- Division of Rheumatology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - George Hermann
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
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385
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Patel PK, von Keudell A, Moroder P, Appleton P, Wigmore R, Rodriguez EK. Recurrent Septic Arthritis Due to Achromobacter xylosoxidans in a Patient With Granulomatosis With Polyangiitis. Open Forum Infect Dis 2015; 2:ofv145. [PMID: 26566537 PMCID: PMC4631257 DOI: 10.1093/ofid/ofv145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/24/2015] [Indexed: 11/14/2022] Open
Abstract
We report a case of recurrent Achromobacter xylosoxidans infections including bacteremia, sepsis, septic joints and endocarditis in a 72 year old female with granulomatosis with polyangiitis. Achromobacter xylosoxidans is a gram negative bacteria increasingly identified in immunocompromised patients. Surgical and medical therapy may need to be combined.
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Affiliation(s)
- Payal K Patel
- Department of Internal Medicine, Division of Infectious Diseases , University of Michigan Medical School ; Department of Medicine, Division of Infectious Diseases , Veterans Affairs Ann Arbor Healthcare System , Michigan
| | - Arvind von Keudell
- Department of Orthopedics, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston, Massachusetts
| | - Philipp Moroder
- Department of Traumatology , Paracelsus Medical University , Salzburg , Austria
| | - Paul Appleton
- Department of Orthopedics, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston, Massachusetts
| | - Robin Wigmore
- Department of Medicine, Division of Infectious Diseases , Beth Israel Deaconess Medical Center, Harvard Medical School , Lowry Medical Office Building, Boston, Massachusetts
| | - Edward K Rodriguez
- Department of Orthopedics, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston, Massachusetts
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386
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Lin WT, Tang HJ, Lai CC, Chao CM. Clinical manifestations and bacteriological features of culture-proven Gram-negative bacterial arthritis. J Microbiol Immunol Infect 2015; 50:527-531. [PMID: 26455489 DOI: 10.1016/j.jmii.2015.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/PURPOSE To investigate the clinical manifestations and bacteriological features of culture-proven, Gram-negative bacterial arthritis. METHODS This study was conducted at the Chi Mei Medical Center, a 1300-bed teaching hospital located in southern Taiwan. Patients with synovial fluid cultures positive for Gram-negative bacilli (GNB) during the period January 2009 to May 2014 were identified from the hospital's computerized microbiology database. RESULTS During the study period, a total of 48 patients with culture-confirmed, GNB septic arthritis were identified. In the majority of patients (n = 33, 68.8%), the knee was the most commonly involved joint. The most common causative pathogen was Pseudomonas spp. (n = 16, 33.3%), followed by Escherichia coli (n = 13, 28.1%). Among the 29 clinical isolates of Enterobacteriaceae, eight (27.6%) were resistant to ceftriaxone and six (20.7%) were resistant to cefpirome. Three E. coli isolates and three Klebsiella pneumoniae isolates were extended-spectrum beta-lactamase producers (n = 6, 20.7%). Among the nonfermenting GNB (NFGNB), 21.1% were resistant to ceftazidime, 21.1% were resistant to ciprofloxacin, 26.3% were resistant to piperacillin-tazobactam, and 15.8% were resistant to imipenem. The overall mortality rate was 10.4%, and the significant risk factors for death were concomitant bacteremia [odds ratio (OR): 14.6, 95% confidence interval (CI): 1.9-115.2, p = 0.011] and liver cirrhosis (OR: 20.0, 95% CI: 2.4-169.9, p = 0.006). CONCLUSION Approximately 25% of cases of septic arthritis were due to GNB and resistance to commonly used antimicrobial agents was common. Liver cirrhosis and concomitant bacteremia were significant risk factors for death.
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Affiliation(s)
- Wei-Ting Lin
- Department of Trauma, Chi Mei Medical Center, Tainan, Taiwan; Department of Physical Therapy, Shu Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
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387
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Parikh SN, Lykissas MG, Roshdy M, Mineo RC, Wall EJ. Pin tract infection of operatively treated supracondylar fractures in children: long-term functional outcomes and anatomical study. J Child Orthop 2015; 9:295-302. [PMID: 26255147 DOI: 10.1007/s11832-015-0674-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/24/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of our study was to determine the long-term functional outcomes of pin tract infection after percutaneous pinning of displaced supracondylar humeral fractures in children, and to evaluate the potential for intracapsular pin placement based on pin configuration in cadaveric elbows. METHODS We conducted a retrospective review of all patients requiring percutaneous pinning in a single institution over a 19-year period. The functional outcome assessment consisted of a telephone interview using the Disabilities of the Arm, Shoulder and Hand (DASH)] Outcome Measure and the Patient-Rated Elbow Evaluation (PREE) questionnaires. The risk of intracapsular pin placement was studied in cadaveric elbows for the three most common pin configurations: divergent lateral, parallel lateral, and medial and lateral crossed pins. RESULTS Of 490 children, 21 (4.3 %) developed pin tract infection. There were 15 (3.1 %) superficial and six (1.2 %) deep infections (osteomyelitis and septic arthritis). Both DASH and PREE scores were excellent at a mean of 18 years post-surgery. The risk of intracapsular pin placement using parallel lateral pins was found to be greater (p < 0.05) than either crossed or divergent lateral pinning configurations. CONCLUSIONS Most infections after pinning of supracondylar humerus fractures are superficial and can be managed with pin removal, oral antibiotics, and local wound care. Septic arthritis and osteomyelitis are rare complications; when they do occur, they seem to be associated with parallel lateral pin configuration, though a causal relationship could not be established from the current study. Satisfactory long-term outcomes of these deep infections can be expected when treated aggressively with surgical debridement and intravenous antibiotics.
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388
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Schmale GA, Bompadre V. Aspirations of the ilium and proximal femur increase the likelihood of culturing an organism in patients with presumed septic arthritis of the hip. J Child Orthop 2015; 9:313-8. [PMID: 26169257 PMCID: PMC4549341 DOI: 10.1007/s11832-015-0669-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/27/2015] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To test the hypothesis that collecting material for culture from metaphyseal bone of the ilium and proximal femur at the time of a hip aspiration will increase the sensitivity to detect an infectious organism in patients with presumed septic arthritis of the hip. METHODS We retrospectively reviewed a series of 36 patients with presumed septic arthritis of the hip, based on clinical exam and serum inflammatory markers, who underwent aspirations of hip synovial fluid as well as blood from the ilium and proximal femur. Culture results from aspirates of synovial fluid and bone and tissue from capsule were compared to determine the sensitivities and specificities of a synovial aspirate alone versus synovial aspirate plus aspirates of the ilium and proximal femur to detect infection. RESULTS The sensitivity of hip synovial fluid aspirates to detect infection via positive culture was only 63 %, though this increased significantly to 100 % when the results of cultures of aspirates of the ilium and proximal femur were included. The specificities were equivalent in both modalities (≥90 %). We conclude that obtaining aspirates of the ilium and proximal femur at the time of hip synovial fluid aspiration increases the likelihood that the procedure will return an infectious organism. CONCLUSION Positive cultures from a child with a septic hip or peri-articular hip infection help to efficiently and effectively guide antibiotic treatment. The child with a septic hip or peri-articular hip infection and positive cultures is likely to receive more narrow-spectrum therapy, potentially decreasing the overuse of broad-spectrum antibiotics. LEVEL OF EVIDENCE DIAGNOSTIC STUDY LEVEL III: Development of diagnostic criteria on the basis of a series of non-consecutive patients (with universally applied reference "gold standard").
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Affiliation(s)
- Gregory A Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OA.9.120, Seattle, WA, 98105, USA,
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389
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Monsalve J, Kan JH, Schallert EK, Bisset GS, Zhang W, Rosenfeld SB. Septic arthritis in children: frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management. AJR Am J Roentgenol 2015; 204:1289-95. [PMID: 26001240 DOI: 10.2214/AJR.14.12891] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Osteomyelitis and septic arthritis clinically present at any age with overlapping signs and symptoms. The purposes of this study were to evaluate the demographic distribution of septic arthritis and osteomyelitis in children and to explore optimal imaging guidelines for these patients. MATERIALS AND METHODS We performed a retrospective study of children up to 18 years old who were treated for osteomyelitis or septic arthritis between January 2011 and September 2013. All patients underwent MRI without previous intervention. Studies were reviewed to determine the incidence of septic arthritis or superimposed osteomyelitis. The reference diagnosis was based on the combined review by the orthopedic surgeon and infectious disease notes, discharge summary, operative report, and MRI examination. RESULTS One hundred sixty-two children who underwent 177 MRI examinations were diagnosed with acute musculoskeletal infection. One hundred three patients were included in the septic arthritis category, of whom 70 (68%) had septic arthritis with osteomyelitis. Seventy-four (42.1%) patients had isolated osteomyelitis without septic arthritis. Children under 2 years old were more likely to have septic arthritis (either isolated or with osteomyelitis) than isolated osteomyelitis compared with older children (p = 0.0003). CONCLUSION In children who underwent MRI for suspected musculoskeletal infection, septic arthritis was more prevalent in children under the age of 2 years than in older children. However, both septic arthritis and osteomyelitis were found frequently in older children. Musculoskeletal infection imaging workup guidelines for children of all ages should address the frequent association of osteomyelitis and septic arthritis. We recommend that MRI should be used in the evaluation of suspected musculoskeletal infections in children, and the nearest joint should always be included to evaluate the extent of articular disease.
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390
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Chuk R, Arvier J, Laing B, Coman D. Septic Arthritis of the Temporomandibular Joint in an Infant. Clin Pract 2015; 5:736. [PMID: 26236452 PMCID: PMC4500874 DOI: 10.4081/cp.2015.736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/06/2015] [Accepted: 03/11/2015] [Indexed: 11/23/2022] Open
Abstract
Infantile temporomandibular joint septic arthritis is an uncommon paediatric infection, but one which carries the potential for severe morbidity and mortality. Early diagnosis and aggressive medical and possibly surgical management is indicated for the best outcomes. The presenting clinical features are non-specific in a neonate and an infant; as such a high degree of clinical suspicion is required. We present the case of an eleven-month-old boy who has made a full recovery from an acute temporomandibular joint septic arthritis and review the relevant literature.
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Affiliation(s)
- Raymond Chuk
- Discipline of Paediatrics, UnitingCare Health Clinical School, The Wesley Hospital , Brisbane ; Department of Paediatrics, The Wesley Hospital , Brisbane
| | - John Arvier
- Discipline of Paediatrics, UnitingCare Health Clinical School, The Wesley Hospital , Brisbane ; Maxillofacial Surgery, The Wesley Hospital , Brisbane
| | - Barbara Laing
- Discipline of Paediatrics, UnitingCare Health Clinical School, The Wesley Hospital , Brisbane ; Wesley Medical Imaging, The Wesley Hospital , Brisbane
| | - David Coman
- Discipline of Paediatrics, UnitingCare Health Clinical School, The Wesley Hospital , Brisbane ; Department of Paediatrics, The Wesley Hospital , Brisbane
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391
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Abstract
Fevers are relatively common in rheumatic disease, largely due to the fact that the inflammatory process is driven by inflammatory mediators that function as endogenous pyrogens. Since the immune system's sensors cannot accurately distinguish between endogenous and exogenous (pathogen-derived) pyrogens a major challenge for physicians and rheumatologists has been to decipher patterns of clinical signs and symptoms to inform clinical decision making. Here we describe some of the common pitfalls and clinical challenges, and highlight the importance of a systematic approach to investigating the rheumatic disease patient presenting with fever.
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Affiliation(s)
- James Galloway
- Academic Department of Rheumatology, King's College London, London, UK
| | - Andrew P Cope
- Academic Department of Rheumatology, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK
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392
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Abstract
There is increasing demand for prosthetic joint surgery and patients are becoming more challenging due to an ageing population often with comorbidities and immunosuppression. While prosthetic joint infection (PJI) rates are generally low, infection can be catastrophic for the patient and hence prevention of infection is critical. Infection, when it does occur, is further complicated by the global rise in antimicrobial resistance. This article introduces a series of papers on the epidemiology of PJI, its diagnosis, use of novel inflammatory markers and molecular techniques, clinical presentation, importance of biofilms, treatment guidelines and, finally, various strategies and novel antibiotic treatment regimens.
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Affiliation(s)
- Matthew Dryden
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester SO22 5DG, UK
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393
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Abstract
Prosthetic joint infection (PJI) complicates ∼1% of arthroplasties but accounts for considerable morbidity. Both the timing and features of PJI can vary widely. Patients may present with early (≤3 months post-operatively), delayed (3-24 months) or late disease (>24 months). They may be acutely unwell with systemic signs of sepsis or describe only a chronically painful joint with or without sinus formation. Diagnostic criteria as proposed by the Infectious Diseases Society of America and the Musculoskeletal Infection Society highlight the importance of joint sampling to obtain histological and robust microbiological evidence. Staphylococcus aureus and coagulase-negative staphylococci account for >50% of infections. Early infections are likely to have been acquired intra- or peri-operatively, whereas late infection is usually haematogenous in origin. Acute joint inflammation suggests the presence of intra-articular free-living bacteria, whereas chronic infections are associated with the formation of biofilm at the bone-cement or bone-prosthesis interface. The most significant risk factors predisposing to PJI are previous operation on the index joint, previous arthroplasty at a different site, American Society of Anesthesiologists' grade 2, 3 or 4, body mass index >25, malignancy and procedure duration <2 or >4 h.
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Affiliation(s)
- Lucinda Barrett
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
| | - Bridget Atkins
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
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394
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Ali A, Welin A, Schwarze JC, Svensson MND, Na M, Jarneborn A, Magnusson M, Mohammad M, Kwiecinski J, Josefsson E, Bylund J, Pullerits R, Jin T. CTLA4 Immunoglobulin but Not Anti-Tumor Necrosis Factor Therapy Promotes Staphylococcal Septic Arthritis in Mice. J Infect Dis 2015; 212:1308-16. [PMID: 25838268 DOI: 10.1093/infdis/jiv212] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The development of biologics has greatly increased the quality of life and the life expectancy of many patients with rheumatoid arthritis. However, a large number of these patients have an increased risk of developing serious infections. The aim of this study was to examine differential effects of anti-tumor necrosis factor (TNF) treatment and CTLA4 immunoglobulin (Ig) treatment on both immunological response and host defense in a murine model of septic arthritis. METHODS Abatacept (CTLA4-Ig), etanercept (anti-TNF), or phosphate-buffered saline were given to NMRI mice intravenously inoculated with Staphylococcus aureus. The clinical course of septic arthritis and histopathological and radiological changes of joints were compared among the groups. RESULTS Mice receiving CTLA4-Ig treatment had more-severe septic arthritis, compared with controls and mice receiving anti-TNF treatment. Anti-TNF treatment led to more-severe weight loss and kidney abscesses, as well as a higher bacterial burden in the kidneys. Mice receiving CTLA4-Ig therapy had lower serum levels of interleukin 4, whereas mice receiving anti-TNF therapy had higher levels of TNF-α. Both iNOS and arginase-1 expression were reduced in peritoneal macrophages from mice receiving CTLA4-Ig, compared with expression in the anti-TNF group. CONCLUSIONS CTLA4-Ig therapy significantly increased the susceptibility to S. aureus septic arthritis in mice, whereas anti-TNF therapy deteriorated host bacterial clearance, resulting in more-severe weight loss and kidney abscesses.
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Affiliation(s)
- Abukar Ali
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Amanda Welin
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jan-Christoph Schwarze
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Mattias N D Svensson
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Manli Na
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anders Jarneborn
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Malin Magnusson
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Majd Mohammad
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jakub Kwiecinski
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Elisabet Josefsson
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Johan Bylund
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rille Pullerits
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Tao Jin
- Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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395
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Abstract
PURPOSE To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. METHODS Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. RESULTS Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2-23] vs. 4 [1-29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4-7] vs. 4.7 [1-8] weeks, p=0.586). CONCLUSION Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.
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396
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Couderc M, Pereira B, Mathieu S, Schmidt J, Lesens O, Bonnet R, Soubrier M, Dubost JJ. Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis. CAN J EMERG MED 2015; 17:403-10. [PMID: 25819038 DOI: 10.1017/cem.2014.56] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the sensitivity and specificity of clinical and laboratory signs for the diagnosis of septic arthritis (SA). Patients and methods This prospective study included all adult patients with suspected SA seen in the emergency department or rheumatology department at the University Hospital, Clermont-Ferrand, France, over a period of 18 months. RESULTS In total, 105 patients with suspected SA were included, 38 (36%) presenting with SA (29 [28%] with bacteriologically documented SA). In the univariate analysis, chills (p=0.015), gradual onset (p=0.04), local redness (p=0.01), as well as an entry site for infection (p=0.01) were most often identified in SA. A history of crystal-induced arthritis (p=0.004) was more frequent in non-SA cases. An erythrocyte sedimentation rate (ESR)>50 mm (p=0.005), a C-reactive protein (CRP) level >100 mg/L (p=0.019), and radiological signs suggestive of SA (p=0.001) were more frequent in the SA cases. Synovial fluid appearance: purulent (p50,000/μL (p < 0.001), differentiated between SA and non-SA. In multivariate analysis, only chills (odds ration [OR]=4.7, 95% confidence interval [CI] 1.3-17.1), a history of crystal-induced arthritis (OR=0.09, 95% CI 0.01-0.9), purulent appearance of the joint fluid (OR=8.4, 95% CI 2.4-28.5), synovial WBC count >50,000/mm3 (OR=6.8, 95% CI 1.3-36), and radiological findings (OR=7.1, 95% CI 13-37.9) remained significant. CONCLUSION No clinical sign or laboratory test (excluding bacteriological test), taken alone, is conclusive for the differentiation between SA and non-SA, but the association of several signs, notably chills, history of crystal-induced arthritis, radiological findings, and the appearance and cellularity of joint fluid may be suggestive.
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Ichiseki T, Ueda S, Matsumoto T. Rare coexistence of gouty and septic arthritis after arthroscopic rotator cuff repair: a case report. Int J Clin Exp Med 2015; 8:4718-4720. [PMID: 26064411 PMCID: PMC4443245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
Coexistence of septic arthritis and gouty arthritis is rare. In particular, no reports have described the development of both gouty and septic arthritis after arthroscopic shoulder surgery. The patient was an 83-year-old man who underwent arthroscopic rotator cuff repair. He had a history of diabetes mellitus (HbA1c: 7.4%), but not of gout, and the GFR was decreased (GFR=46). During the postoperative course fever suddenly developed and joint fluid retention was found. Uric acid crystals were detected when the joint fluid was aspirated, after which when the culture results became available sepsis due to methicillin sensitive Staphylococcus aureus (MSSA) was diagnosed. On the 2(nd) day after fever onset, lavage and debridement were performed under arthroscopy, with the subsequent course uneventful with no recurrence of the infection or gouty arthritis and no joint destruction. When uric acid crystals are found in aspirated joint fluid, gouty arthritis tends to be diagnosed, but like in the present case if infection also supervenes, joint destruction and a poor general state may result if appropriate intervention is not initiated swiftly. Accordingly, even if uric acid crystals are found, the possibility of coexistence of septic arthritis and gouty arthritis should be kept in mind.
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399
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Pop C, Calagiu D, Jantea P, Nemes R. Septic knee arthritis in Crohn's disease biological therapy-free patient. Case report. J Med Life 2015; 8:492-5. [PMID: 26664477 PMCID: PMC4656959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED A 52-year-old woman with Crohn's disease presented with septic arthrtis of the knee. This condition coincided with a symptomatic flare of her Crohn's disease due to an ileal inflammatory stenosis, manifested as a phlegmonous mass palpable in the right lower quadrant and a small bowel obstruction. Results of synovial fluid cultures showed the presence of Gram-negative bacillus, Klebsiella pneumoniae and the CT scan images were highly suggestive of abdominal abscess within Crohn's disease. The patient's condition improved after following an antibiotic treatment and after the initiation of Anti-TNF-alpha agent Adalimumab, with no further exacerbation. Septic arthritis in Crohn's disease should be considered to have a communicating source of sepsis consisting of an abdominal abscess or fistula. ABBREVIATIONS Anti-TNF-alpha agent = anti tumor necrosis factor alpha agent, 5-ASA = 5-aminosalicylic acid.
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Affiliation(s)
- C Pop
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,Medical Clinic and Gastroenterology, University Emergency Hospital, Bucharest, Romania
| | - D Calagiu
- Medical Clinic and Gastroenterology, University Emergency Hospital, Bucharest, Romania
| | - P Jantea
- Medical Clinic and Gastroenterology, University Emergency Hospital, Bucharest, Romania
| | - R Nemes
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
,”Marius Nasta” National Institute of Pneumology, Bucharest, Romania
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Helito CP, Zanon BB, Miyahara HDS, Pecora JR, Lima ALM, Oliveira PRD, Vicente JRND, Demange MK, Camanho GL. Clinical and epidemiological differences between septic arthritis of the knee and hip caused by oxacillin-sensitive and -resistant s. aureus. Clinics (Sao Paulo) 2015; 70:30-3. [PMID: 25672426 PMCID: PMC4311124 DOI: 10.6061/clinics/2015(01)06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 11/12/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data. METHODS All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA). RESULTS S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001). CONCLUSION Provenance from a health service-related environment was associated with a higher incidence of MRSA-related septic arthritis, suggesting that this agent should be considered in the initial choice of antibiotic treatment. Previous surgeries of the knee or affected limb and the absence of leukocytes might also be related to infection with this agent.
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Affiliation(s)
- Camilo Partezani Helito
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Bruno Bonganha Zanon
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Helder de Souza Miyahara
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Jose Ricardo Pecora
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Ana Lucia Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Priscila Rosalba de Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Jose Ricardo Negreiros de Vicente
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Marco Kawamura Demange
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
| | - Gilberto Luis Camanho
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, São Paulo, Brazil
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