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Appelhaus S, Schoenberg SO, Weis M. [Septic arthritis and transient synovitis of the hip]. Radiologie (Heidelb) 2023; 63:729-735. [PMID: 37407747 DOI: 10.1007/s00117-023-01179-8] [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] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
CLINICAL/METHODICAL ISSUE Differentiating between septic arthritis and transient synovitis can be challenging but is very important as a late diagnosis of septic arthritis can lead to sepsis and joint damage. For correct diagnosis and prediction of complications, the right combination of physical examination, laboratory and radiological studies is needed. STANDARD RADIOLOGICAL METHODS Hip ultrasound is easy to learn and has a high sensitivity for joint effusion. Faster diagnosis and therapy are possible due to increasing use of ultrasound. Magnetic resonance imaging (MRI) is primarily used to rule out co-infections (osteomyelitis, pyomyositis) and differential diagnoses. X‑ray is typically nonremarkable in septic arthritis. PRACTICAL RECOMMENDATIONS Routine use of ultrasound in nontraumatic pediatric hip pain. Generous use of MRI in case of elevated inflammatory markers or inconclusive clinical findings. Using only few sequences may be appropriate to avoid sedation, primarily fluid sensitive sequences (fat-saturated T2, TIRM, STIR), in case of positive findings, accompanied by T1-weighted images.
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Affiliation(s)
- S Appelhaus
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - S O Schoenberg
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - M Weis
- Klinik für Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Hoang-Dinh A, Vuong Thu H, Ma MH, Ly KH, Huynh-Van K, Minh Duc N. Value of ultrasound-guided synovial biopsy for the diagnosis of infectious arthritis. Clin Ter 2023; 174:426-431. [PMID: 37674452 DOI: 10.7417/ct.2023.2460] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Objectives To determine the value of ultrasound (US)-guided synovial biopsy for the diagnosis of infectious arthritis that could not be detected by other modalities. Material and methods This descriptive study was conducted among 37 patients with arthritis (3 with shoulder arthritis, 2 with elbow arthritis, 7 with wrist arthritis, 15 with hip arthritis, 4 with knee arthritis, and 5 with ankle arthritis) who underwent US-guided synovial biopsy at Hanoi Medical University Hospital for the diagnosis of infec-tious arthritis that could not be detected by infection laboratory tests, imaging, and/or joint fluid culture. The results of US-guided synovial biopsy were positive for infectious arthritis when those of pathologi-cal analyses, bacterial cultures, and/or polymerase chain reaction test for tuberculosis were positive. The final diagnosis established when the patients were discharged from the hospital was compared with the US-guided synovial biopsy results to calculate the sensitivity and specificity for the diagnosis of infectious arthritis. Results The median age of the patients was 60 years (range: 22-79 years), and two thirds were women. Infectious arthritis was determined as the final diagnosis in 18 patients. There was no significant difference in the infection laboratory test results, synovial thickness, or magnetic resonance imaging features apart from soft tissue abscess between the infectious and non-infectious arthritis groups (P > 0.05). The US-guided synovial biopsy results were positive in 17 patients. Compared with the sensitivity and specificity of the final diagnosis, those of the US-guided synovial biopsy results for the diagnosis of infectious arthritis were 94.4% and 100%, respectively. The Numerical Rating Scale score was ≤3 in most patients. There were neither vascular nor neurologic complications among the patients. Conclusion Imaging features and laboratory test results are non-specific for infectious arthritis. US-guided synovial biopsy is a well-tolerated, safe method that has a high value for the diagnosis of infectious arthritis. This modality should then be recommended for patients with unclassified arthritis.
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Affiliation(s)
- A Hoang-Dinh
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - H Vuong Thu
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - M H Ma
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - K H Ly
- Department of Rheumatology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - K Huynh-Van
- Department of Rheumatology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - N Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Brandao L, Moura R, Tricarico PM, Gratton R, Genovese G, Moltrasio C, Garcovich S, Boniotto M, Crovella S, Marzano AV. Altered keratinization and vitamin D metabolism may be key pathogenetic pathways in syndromic hidradenitis suppurativa: a novel whole exome sequencing approach. J Dermatol Sci 2020; 99:17-22. [PMID: 32518053 DOI: 10.1016/j.jdermsci.2020.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/10/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of pyoderma gangrenosum, acne and hidradenitis suppurativa (PASH) and pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) patients, in spite of recently identified genetic variations, is just clinical, since most patients do not share the same mutations, and the mutations themselves are not informative of the biological pathways commonly disrupted in these patients. OBJECTIVE To reveal genetic changes more closely related to PASH and PAPASH etiopathogenesis, identifying novel common pathways involved in these diseases. METHODS Cohort study on PASH (n = 4) and PAPASH (n = 1) patients conducted using whole exome sequencing (WES) approach and a novel bioinformatic pipeline aimed at discovering potentially candidate genes selected from density mutations and involved in pathways relevant to the disease. RESULTS WES results showed that patients presented 90 genes carrying mutations with deleterious and/or damage impact: 12 genes were in common among the 5 patients and bared 237 ns ExonVar (54 and 183 in homozygosis and heterozygosis, respectively). In the pathway enrichment analysis, only 10 genes were included, allowing us to retrieve 4 pathways shared by all patients: (1) Vitamin D metabolism, (2) keratinization, (3) formation of the cornified envelope and (4) steroid metabolism. Interestingly, all patients had vitamin D levels lower than normal, with a mean value of 10 ng/mL. CONCLUSION Our findings, through a novel strategy for analysing the genetic background of syndromic HS patients, suggested that vitamin D metabolism dysfunctions seem to be crucial in PASH and PAPASH pathogenesis. Based on low vitamin D serum levels, its supplementation is envisaged.
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Affiliation(s)
- Lucas Brandao
- Department of Pathology, Federal University of Pernambuco, Recife, Brazil
| | - Ronald Moura
- Department of Genetics, Federal University of Pernambuco, Recife, Brazil
| | | | - Rossella Gratton
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Physiopathology and Transplantation, Università degli Studi di Milano Via Pace 9, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Physiopathology and Transplantation, Università degli Studi di Milano Via Pace 9, Milan, Italy
| | - Simone Garcovich
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Boniotto
- INSERM U955 Eq. 16, Faculté de Médecine, Institut Mondor de Recherche Biomédicale and Université Paris Est- Créteil (UPEC), Créteil, France
| | - Sergio Crovella
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Physiopathology and Transplantation, Università degli Studi di Milano Via Pace 9, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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Roelsgaard IK, Esbensen BA, Østergaard M, Rollefstad S, Semb AG, Christensen R, Thomsen T. Smoking cessation intervention for reducing disease activity in chronic autoimmune inflammatory joint diseases. Cochrane Database Syst Rev 2019; 9:CD012958. [PMID: 31476270 PMCID: PMC6718206 DOI: 10.1002/14651858.cd012958.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic inflammatory joint diseases (IJDs) affect 1% to 2% of the population in developed countries. IJDs include rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and other forms of spondyloarthritis (SpA). Tobacco smoking is considered a significant environmental risk factor for developing IJDs. There are indications that smoking exacerbates the symptoms and worsens disease outcomes. OBJECTIVES The objective of this review was to investigate the evidence for effects of smoking cessation interventions on smoking cessation and disease activity in smokers with IJD. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library; PubMed/MEDLINE; Embase; PsycINFO; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); and three trials registers to October 2018. SELECTION CRITERIA We included randomised controlled trials testing any form of smoking cessation intervention for adult daily smokers with a diagnosis of IJD, and measuring smoking cessation at least six months after baseline. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included two studies with 57 smokers with a diagnosis of rheumatoid arthritis (RA). We identified no studies including other IJDs. One pilot study compared a smoking cessation intervention specifically for people with RA with a less intensive, generic smoking cessation intervention. People included in the study had a mean age of 56.5 years and a disease duration of 7.7 years (mean). The second study tested effects of an eight-week cognitive-behavioural patient education intervention on cardiovascular disease (CVD) risk for people with RA and compared this with information on CVD risk only. The intervention encouraged participants to address multiple behaviours impacting CVD risk, including smoking cessation, but did not target smoking cessation alone. People included in the study had a mean age of 62.2 years (intervention group) and 60.8 years (control group), and disease duration of 11.6 years (intervention group) and 14.1 years (control group). It was not appropriate to perform a meta-analysis of abstinence data from the two studies due to clinical heterogeneity between interventions. Neither of the studies individually provided evidence to show benefit of the interventions tested. Only one study reported on adverse effects. These effects were non-serious, and numbers were comparable between trial arms. Neither of the studies assessed or reported disease activity or any of the predefined secondary outcomes. We assessed the overall certainty of evidence as very low due to indirectness, imprecision, and high risk of detection bias based on GRADE. AUTHORS' CONCLUSIONS We found very little research investigating the efficacy of smoking cessation intervention specifically in people with IJD. Included studies are limited by imprecision, risk of bias, and indirectness. Neither of the included studies investigated whether smoking cessation intervention reduced disease activity among people with IJD. High-quality, adequately powered studies are warranted. In particular, researchers should ensure that they measure disease markers and quality of life, in addition to long-term smoking cessation.
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Affiliation(s)
- Ida K Roelsgaard
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
| | - Bente A Esbensen
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
- University of CopenhagenDepartment of Clinical MedicineCopenhagenDenmark
| | - Mikkel Østergaard
- Centre of Head and Orthopaedics, RigshospitaletCopenhagen Center for Arthritis Research, Department of Rheumatology and Spine DiseasesGlostrupDenmark
| | | | - Anne G Semb
- Diakonhjemmet HospitalPreventive Cardio‐Rheuma ClinicOsloNorway
| | - Robin Christensen
- Bispebjerg and Frederiksberg HospitalMusculoskeletal Statistics Unit, The Parker InstituteCopenhagenDenmark
- Odense University HospitalDepartment of RheumatologyOdenseDenmark
| | - Thordis Thomsen
- Copenhagen University Hospital Herlev‐GentofteHerlev Anaesthesia Critical and Emergency Care Science Unit (ACES), Department of AnesthesiologyCopenhagenDenmark
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5
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Affiliation(s)
| | - Chun-Wei Lu
- Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Abstract
A 53-year-old Japanese man experienced fever/neck pain, and neck magnetic resonance imaging revealed a spinal epidural abscess. The following day, he developed a palpable mass with evident inflammatory signs in the right sternoclavicular joint (SCJ) with severe pain. Ultrasound revealed synovitis with remarkable power Doppler signals in the right SCJ. Blood cultures yielded Streptococcus agalactiae growth. After 12 days, ultrasound showed right distal clavicle bone erosion. His symptoms improved with long-term parenteral antibiotic treatment, but the right SCJ joint destruction progressed for several months. We diagnosed him with sternoclavicular septic arthritis complicated with a spinal epidural abscess and bacteremia.
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Affiliation(s)
- Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yushiro Edo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Kuyucu E, Çabuk H, Güler Y, Çabuk F, Kiliç E, Bülbül M. Is Intraarticular Antibiotic Administration Effective in the Treatment of Methicillin-Resistant Staphylococcus aureus? Acta Chir Orthop Traumatol Cech 2019; 86:276-280. [PMID: 31524589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF THE STUDY Septic arthritis is an infection of joints caused by a pathogenic microorganism. Septic arthritis has a mortality rate of 11-40% when it's not treated properly. The mortality rate with methicillin-sensitive Staphylococcus aureus (MSSA)is 5-7%, while the rate with methicillin-resistant Staphylococcus aureus (MRSA)is 13-20%. The aim of this study is to evaluate the effects of intraarticular vancomycin and teicoplanin on joint cartilage in in vivo settings and its utility in routine MRSA treatment. MATERIALS AND METHODS In our study, 35 male Sprague-Dawley rats aged 28 days were used. Rats were obtained from the Regenerative and Restorative Medicine Research Center (REMER) of Istanbul Medipol University. Rats were randomly divided into 5 groups each containing 7 rats. Joint injections were administered with isoflurane analgesia every day at 6 am. Three rats (15 rats) from each group were sacrified in seventh day and evaluated immunohistologically to evaluate acute healing in articular cartilage. All remaining rats were sacrificed on day 28 and their knees were evaluated by immunohistochemical examination. RESULTS In our study, there were no complications in any rat during injection and the study period. Hematoxylin eosin (H & E) histological staining for evaluating cartilage healing and healing levels did not show statistically significant differences between the groups at first week (p > 0.05). Matrix metalloproteinase-13 (MMP-13) staining did not show any statistically significant difference between the groups. (p > 0.05). DISCUSSION MRSAseptic arthritis, diagnosed for the first time in 1960, has recently been responsible for 6-22% of all septic arthritis and is increasing day by day. The use of systemic vancomycin or teicoplanin is the first-line treatment method in MRSA septic arthritis. Serum levels reach the desired level, especially with intravenous infusion dose. On the other hand, it has been shown that intraarticular concentration does not reach a sufficient level in studies conducted. The use of intraarticular antibiotics during treatment can lead to more effective and early disease control by turning this negative situation into favor of the patient. As a result, intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSAseptic arthritis. CONCLUSIONS Intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSA septic arthritis. Key words:arthritis, infectious; methicillin-resistant Staphylococcus aureus; mortality.
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Affiliation(s)
- E Kuyucu
- Istanbul Medipol University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Daivajna S, Jones A, O'Malley M, Mehdian H. Unilateral Septic Arthritis of a Lumbar Facet Joint Secondary to Acupuncture Treatment - a Case Report. Acupunct Med 2018; 22:152-5. [PMID: 15551942 DOI: 10.1136/aim.22.3.152] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This report describes a case of septic arthritis of the lumbar facet joint probably as a result of acupuncture treatment. A 48 year old man with a long history of back pain presented with a two week history of increasing pain following a third session of acupuncture. Examination revealed tenderness in the right lumbosacral area and laboratory investigations revealed raised inflammatory markers with negative blood cultures. A bone scan and MRI scan showed evidence of septic arthritis of the right L5/S1 facet joint. An x ray computed tomography guided biopsy was carried out which isolated staphylococcus aureus. The patient was initially treated with intravenous antibiotics. A repeat MRI scan demonstrated persistent septic arthritis with adjacent early abscess formation. Surgical debridement of the facet joint was therefore performed. The patient had resolution of his symptoms and the inflammatory markers returned to normal. He regained a full range of movement of the lumbar spine. Very few cases have been reported of lumbar facet joint septic arthritis and this condition is rare in association with acupuncture treatment. A high index of suspicion needs to be maintained and if conservative management fails then debridement can result in an acceptable outcome.
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Affiliation(s)
- Sachin Daivajna
- Centre for Spinal Studies and Surgery, University Hospital, Nottingham,UK
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Bémer P, Léger J, Milin S, Plouzeau C, Valentin AS, Stock N, Jolivet-Gougeon A, Moreau A, Corvec S, Quintin-Roue I, Tandé D, Héry-Arnaud G, Rousselet MC, Lemarié C, Kempf M, Michenet P, Bret L, de Pinieux G, Burucoa C. Histopathological Diagnosis of Prosthetic Joint Infection: Does a Threshold of 23 Neutrophils Do Better than Classification of the Periprosthetic Membrane in a Prospective Multicenter Study? J Clin Microbiol 2018; 56:e00536-18. [PMID: 29976593 PMCID: PMC6113493 DOI: 10.1128/jcm.00536-18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 01/07/2023] Open
Abstract
No gold standard exists for histopathological diagnosis of a prosthetic joint infection (PJI). The historical criterion considers the presence of neutrophil infiltration upon examination of periprosthetic tissue. Morawietz et al. proposed a classification of periprosthetic membranes (Morawietz et al., Clin Pathol 59:591-597, 2006, https://doi.org/10.1136/jcp.2005.027458) and a more recently described classification with a new cutoff value of 23 neutrophils in 10 high-power fields (Morawietz et al., Histopathology 54:847-853, 2009. https://doi.org/10.1111/j.1365-2559.2009.03313.x). We performed a multicenter prospective study, which compared both methods for the diagnosis of PJI. All suspicions of PJI (n = 264) between December 2010 and March 2012 in seven centers were prospectively included. Five perioperative specimens were collected per patient for cultures, and one was collected for histology. Diagnosis of PJI was made according to the Infectious Diseases Society of America (IDSA) guidelines. Histopathological analysis classified the patients according to the threshold of 23 neutrophils and according to the classification of Morawietz. Performances of both methods were compared by using clinical and/or bacteriological criteria as the gold standard. Among 264 patients with suspected PJI, a diagnosis of infection was confirmed in 215 and unconfirmed in 49 patients. Histopathological analysis was available for 150 confirmed PJI and 40 unconfirmed PJI cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.7%, 90.0%, 96.7%, 52.9%, and 81.1%, respectively, for the Morawietz classification, and 82.0%, 90.0%, 96.9%, 57.1%, and 83.7%, respectively, for the 23-neutrophil threshold. The new algorithm using a threshold of 23 neutrophils can be proposed as a new gold standard for the histopathological diagnosis of PJI.
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Affiliation(s)
- Pascale Bémer
- Department of Bacteriology, Nantes University Hospital, Nantes, France
| | - Julie Léger
- Inserm, CIC 1415, Tours, France
- Tours University Hospital, Tours, France
| | - Serge Milin
- Department of Anatomopathology, Poitiers University Hospital, Poitiers, France
| | - Chloé Plouzeau
- Department of Bacteriology, Poitiers University Hospital, Poitiers, France
| | | | - Nathalie Stock
- Department of Anatomopathology, Rennes University Hospital, Rennes, France
| | | | - Anne Moreau
- Department of Anatomopathology, Nantes University Hospital, Nantes, France
| | - Stéphane Corvec
- Department of Bacteriology, Nantes University Hospital, Nantes, France
| | | | - Didier Tandé
- Department of Bacteriology, Brest University Hospital, Brest, France
| | | | | | - Carole Lemarié
- Department of Bacteriology, Angers University Hospital, Angers, France
| | - Marie Kempf
- Department of Bacteriology, Angers University Hospital, Angers, France
| | - Patrick Michenet
- Department of Anatomopathology, Orléans Hospital, Orléans, France
| | - Laurent Bret
- Department of Bacteriology, Orléans Hospital, Orléans, France
| | | | - Christophe Burucoa
- Department of Bacteriology, Poitiers University Hospital, Poitiers, France
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Zaid A, Gérardin P, Taylor A, Mostafavi H, Malvy D, Mahalingam S. Chikungunya Arthritis: Implications of Acute and Chronic Inflammation Mechanisms on Disease Management. Arthritis Rheumatol 2018; 70:484-495. [PMID: 29287308 DOI: 10.1002/art.40403] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022]
Abstract
In the past decade, arboviruses-arthropod-borne viruses-have been the focus of public health institutions worldwide following a spate of devastating outbreaks. Chikungunya virus, an arbovirus that belongs to the alphavirus genus, is a reemerging arthritogenic virus that has caused explosive outbreaks since 2006, notably on Réunion Island, and more recently in the Caribbean, South America, India, and Southeast Asia. The severity of arthritic disease caused by chikungunya virus has prompted public health authorities in affected countries to develop specific guidelines to tackle this pathogen. Chikungunya virus disease manifests first as an acute stage of severe joint inflammation and febrile illness, which later progresses to a chronic stage, during which patients may experience debilitating and persisting articular pain for extended periods. This review aims to provide a broad perspective on current knowledge of chikungunya virus pathogenesis by identifying key clinical and experimental studies that have contributed to our understanding of chikungunya virus to date. In addition, the review explores the practical aspects of treatment and management of both acute and chronic chikungunya virus based on clinical experience during chikungunya virus outbreaks. Finally, recent findings on potential therapeutic solutions-from antiviral agents to immunomodulators-are reviewed to provide both viral immunologists and clinical rheumatologists with a balanced perspective on the nature of a reemerging arboviral disease of significant public health concern, and insight into future therapeutic approaches to better address the treatment and management of chikungunya virus.
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Affiliation(s)
- Ali Zaid
- Griffith University, Gold Coast, Queensland, Australia
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion, France, and CNRS 9192, INSERM U1187, Université de la Réunion, Sainte Clotilde, Réunion, France
| | - Adam Taylor
- Griffith University, Gold Coast, Queensland, Australia
| | | | - Denis Malvy
- Department of Tropical Medicine and Clinical International Health, University Hospital Center and INSERM 1219, University of Bordeaux, Bordeaux, France
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11
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Affiliation(s)
- N J Goddard
- Department of Orthopaedics, Princess Alexandra Hospital, Harlow, Essex
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12
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Marzano AV, Damiani G, Genovese G, Gattorno M. A dermatologic perspective on autoinflammatory diseases. Clin Exp Rheumatol 2018; 36 Suppl 110:32-38. [PMID: 29742056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 06/08/2023]
Abstract
Autoinflammatory diseases (AIDs) encompass a heterogeneous group of disorders pathogenetically related to an abnormal activation of the innate immunity and clinically characterised by aseptic inflammation in the affected organs in the absence of high titer of circulating autoantibodies or autoreactive T cells. In classic monogenic AIDs, the skin is frequently involved with a wide range of cutaneous lesions. Monogenic AIDs result from different mutations in a single gene, which regulates the innate immunity. These mutations cause an uncontrolled activation of the inflammasome, leading to an overexpression of interleukin (IL)- 1β. IL-1β is the pivotal cytokine which is responsible for the exaggerated production of cytokines and chemokines that induce the recruitment of neutrophils, key cells in autoinflammation. Paradigmatic autoinflammatory forms are the cryopyrin-associated periodic syndromes (CAPS), whose skin involvement consists of urticarial lesions. Similar IL-1β-mediated autoinflammatory pathomechanisms also occur in deficiency of IL-1 receptor antagonist (DIRA) and deficiency of IL-36 receptor antagonist (DITRA), whose cutaneous appearance is characterised by pustular lesions, as well as in pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome. Pyoderma gangrenosum, which is the cutaneous hallmark of the PAPA syndrome, is a prototypic neutrophil-mediated skin disease, manifesting as single or multiple ulcers with undermined, raised erythematous to violaceous borders. This review is focused on the CAPS, DIRA/DITRA and PAPA syndromes with emphasis on their cutaneous manifestations, as well as their histology and pathophysiology.
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Affiliation(s)
- Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Giovanni Genovese
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
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d'Aleo F, Bonanno R, Midiri A, Mancuso G, Cordaro S, Warm A, Verduci E, Beninati C, Biondo C. A case of Candida septic arthritis with rice body formation in a 2-month-old infant. Infez Med 2017; 25:374-376. [PMID: 29286020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a case of rice body formation in the left knee joint of a 2-month-old infant affected by Candida albicans septic arthritis which has never been reported before. Rice body formation has been described in association with rheumatoid or tuberculous arthritis and is very rare in Candida arthritis. After three weeks of therapy with amphotericin B administered intravenously, the infant recovered fully from infection. Septic arthritis is a serious cause of morbidity and for proper evaluation and treatment fungal septic arthritis should be included in the differential diagnosis.
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Affiliation(s)
- Francesco d'Aleo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Angelina Midiri
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Giuseppe Mancuso
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Stefania Cordaro
- D.A.I. Materno-Infantile A.O.U. "G. Martino", Messina, Italy, Italy
| | - Amiel Warm
- D.A.I. Materno-Infantile A.O.U. "G. Martino", Messina, Italy, Italy
| | - Elisa Verduci
- D.A.I. Medicine Specialistiche, A.O.U. "G. Martino", Messina, Italy
| | - Concetta Beninati
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Carmelo Biondo
- Department of Human Pathology, University of Messina, Messina, Italy
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Prow NA, Tang B, Gardner J, Le TT, Taylor A, Poo YS, Nakayama E, Hirata TDC, Nakaya HI, Slonchak A, Mukhopadhyay P, Mahalingam S, Schroder WA, Klimstra W, Suhrbier A. Lower temperatures reduce type I interferon activity and promote alphaviral arthritis. PLoS Pathog 2017; 13:e1006788. [PMID: 29281739 PMCID: PMC5770078 DOI: 10.1371/journal.ppat.1006788] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/16/2018] [Accepted: 12/04/2017] [Indexed: 12/28/2022] Open
Abstract
Chikungunya virus (CHIKV) belongs to a group of mosquito-borne alphaviruses associated with acute and chronic arthropathy, with peripheral and limb joints most commonly affected. Using a mouse model of CHIKV infection and arthritic disease, we show that CHIKV replication and the ensuing foot arthropathy were dramatically reduced when mice were housed at 30°C, rather than the conventional 22°C. The effect was not associated with a detectable fever, but was dependent on type I interferon responses. Bioinformatics analyses of RNA-Seq data after injection of poly(I:C)/jetPEI suggested the unfolded protein response and certain type I interferon responses are promoted when feet are slightly warmer. The ambient temperature thus appears able profoundly to effect anti-viral activity in the periphery, with clear consequences for alphaviral replication and the ensuing arthropathy. These observations may provide an explanation for why alphaviral arthropathies are largely restricted to joints of the limbs and the extremities.
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Affiliation(s)
- Natalie A. Prow
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Disease Research Centre, Brisbane, Queensland, Australia
| | - Bing Tang
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Joy Gardner
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thuy T. Le
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adam Taylor
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Yee S. Poo
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Eri Nakayama
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Thiago D. C. Hirata
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Helder I. Nakaya
- School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrii Slonchak
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
| | | | - Suresh Mahalingam
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Wayne A. Schroder
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - William Klimstra
- Department of Microbiology and Molecular Genetics Center for Vaccine Research University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Andreas Suhrbier
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Disease Research Centre, Brisbane, Queensland, Australia
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15
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Saleem MA, Ul Abideen Z, Kiani IS, Yousaf A, Rasheed A, Shabbir RW. Sporadic actinomycosis of the hip complicated by Central Nervous System infection. J PAK MED ASSOC 2017; 67:637-640. [PMID: 28420932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Actinomycosis is caused by the Gram positive filamentous Actinomyces bacterial species that are normal commensals of the oral cavity. Due to their low virulence, disease is rare in the immune competent patient. Although it may afflict any system in the body, involvement of the musculoskeletal system is uncommon. Here in, we describe the case of a 60 year old lady presenting with low grade fever, left hip pain and drowsiness. She was diagnosed as left hip actinomycosis on Computed tomogram (CT) guided biopsy and histopathological analysis of infiltrative lesions identified on Magnetic Resonance Imaging (MRI). She also had meningitis diagnosed on cerebrospinal fluid analysis which improved with treatment of actinomycosis. Actinomycosis of the hip is rare, and occurs in the presence of described predisposing factors. To the best of our knowledge, this is the first case of sporadic actinomycosis of the hip complicated by meningitis in an immune competent individual.
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Affiliation(s)
| | - Zain Ul Abideen
- Department of Nephrology and Renal Transplant, Shifa International Hospital, Islamabad, Pakistan
| | - Iram Shakir Kiani
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Anum Yousaf
- Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Amna Rasheed
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Raja Wajid Shabbir
- Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan
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16
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Fatima F, Fei Y, Ali A, Mohammad M, Erlandsson MC, Bokarewa MI, Nawaz M, Valadi H, Na M, Jin T. Radiological features of experimental staphylococcal septic arthritis by micro computed tomography scan. PLoS One 2017; 12:e0171222. [PMID: 28152087 PMCID: PMC5289588 DOI: 10.1371/journal.pone.0171222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Permanent joint dysfunction due to bone destruction occurs in up to 50% of patients with septic arthritis. Recently, imaging technologies such as micro computed tomography (μCT) scan have been widely used for preclinical models of autoimmune joint disorders. However, the radiological features of septic arthritis in mice are still largely unknown. METHODS NMRI mice were intravenously or intra-articularly inoculated with S. aureus Newman or LS-1 strain. The radiological and clinical signs of septic arthritis were followed for 10 days using μCT. We assessed the correlations between joint radiological changes and clinical signs, histological changes, and serum levels of cytokines. RESULTS On days 5-7 after intravenous infection, bone destruction verified by μCT became evident in most of the infected joints. Radiological signs of bone destruction were dependent on the bacterial dose. The site most commonly affected by septic arthritis was the distal femur in knees. The bone destruction detected by μCT was positively correlated with histological changes in both local and hematogenous septic arthritis. The serum levels of IL-6 were significantly correlated with the severity of joint destruction. CONCLUSION μCT is a sensitive method for monitoring disease progression and determining the severity of bone destruction in a mouse model of septic arthritis. IL-6 may be used as a biomarker for bone destruction in septic arthritis.
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Affiliation(s)
- Farah Fatima
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Pathology and Forensic Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ying Fei
- Department of Microbiology and Immunology, Affiliated Hospital of GuiZhou Medical University, Guiyang, P.R. China
| | - Abukar Ali
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Majd Mohammad
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Malin C. Erlandsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Maria I. Bokarewa
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Muhammad Nawaz
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Pathology and Forensic Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Hadi Valadi
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Manli Na
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Tao Jin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden
- * E-mail:
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17
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Affiliation(s)
- P Sudeck
- Surgical Department, New General Hospital, Hamburg-Eppendorf
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18
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Dotsenko TG, Shlikova GI, Teplyakova OV. [The analysis of synovial fluid: clinical significance of derived results]. Klin Lab Diagn 2016; 61:478-484. [PMID: 30601639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The review presents modern data concerning characteristics of drawing of synovial fluid and also informativeness of its particular indices for resolving main clinical differential diagnostic task namely - selection group of septic and micro-crystal arthritis. It is demonstrated that minimal generally available span of analysis of synovial fluid is to include: finding number of leukocytes (threshold level for diagnostic of septic arthritis is 50 000 - 100 000 kl/mkl) and percentage of ploymorpho-nuclear cells (threshold level is 90%); analysis of content of crystals, Gram's stain and culture analysis of synovial fluid using light microscopy; and all this with mandatory registration of clinical data. The common evaluation of content of glucose and protein in synovialfluid is not enough informative. The detection of concentration of procalcitonin and lactate in synovial fluid is perspective for establishing septic genesis of arthritis. The sensitivity and specificity of light microscopy are quite high. Because of it absence of polarized microscope is no obstacle for implementation of crystallographic analysis of synovial fluid.
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19
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Fernandes S, Vieira-Sousa E, Furtado C, Costa A, Barros R, Fonseca JE. A diagnosis of disseminated tuberculosis based on knee arthroscopic guided synovial biopsy in the context of monoarthritis. Acta Reumatol Port 2016; 41:256-259. [PMID: 27155318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Accounting for 2.2-4.7% of all tuberculosis cases in Europe and USA and around 10-15% of extra-pulmonary tuberculosis cases, osteoarticular tuberculosis tends to be chronic, slowly progressive and destructive. We report the case of an 81-year-old male with 3 weeks of progressively worsening pain, swelling and limited range of motion of the left knee. A knee arthroscopy was performed for synovial biopsy at our department revealing diffuse synovitis with scarce villi formation. The positive polymerase chain reaction assay for Mycobacterium tuberculosis in the synovial tissue allowed the establishment of the diagnosis and synovium histology showed caseating granulomas. A lengthy delay between first symptoms of osteoarticular tuberculosis and the beginning of treatment has been reported. A high index of suspicion, synovial membrane biopsy and appropriate microbiologic testing are fundamental to avoid a delay in diagnosis.
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20
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Gagea MI, Bateman KG, Shanahan RA, van Dreumel T, McEwen BJ, Carman S, Archambault M, Caswell JL. Naturally Occurring Mycoplasma Bovis—Associated Pneumonia and Polyarthritis in Feedlot Beef Calves. J Vet Diagn Invest 2016; 18:29-40. [PMID: 16566255 DOI: 10.1177/104063870601800105] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mycoplasma bovis is perceived as an emerging cause of mortality in feedlot beef cattle. This study examined the lesions and infectious agents in naturally occurring M. bovis–associated bronchopneumonia and arthritis and the relationship of this condition with bovine viral diarrhea virus (BVDV) infection. Standardized pathologic, immunohistochemical, and microbiologic investigations were conducted on 99 calves that died or were euthanized within 60 days after arrival in 72 feedlots. Cranioventral bronchopneumonia with multiple foci of caseous necrosis was identified in 54 of 99 calves, including 30 with concurrent fibrinosuppurative bronchopneumonia typical of pneumonic pasteurellosis. Mycoplasma bovis was consistently identified in these lesions by culture and immunohistochemistry, but also commonly in healthy lungs and those with pneumonia of other causes. Focal lesions of coagulation necrosis, typical of pneumonic pasteurellosis, were often infected with both Mannheimia haemolytica and M. bovis. Arthritis was present in 25 of 54 (46%) calves with M. bovis pneumonia, and all calves with arthritis had pneumonia. BVDV infection was more common in calves with lesions of bacterial pneumonia than in those dying of other causes, but BVDV infection was not more common in calves with caseonecrotic bronchopneumonia than those with fibrinosuppurative bronchopneumonia. Retrospective analysis identified cases of M. bovis pneumonia in the early 1980s that had milder lesions than the current cases. The findings suggest that, in at least some calves, M. bovis induces caseonecrotic bronchopneumonia within the lesions of pneumonic pasteurellosis.
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MESH Headings
- Animals
- Antigens, Bacterial/analysis
- Arthritis, Infectious/mortality
- Arthritis, Infectious/pathology
- Arthritis, Infectious/veterinary
- Bovine Virus Diarrhea-Mucosal Disease/complications
- Bovine Virus Diarrhea-Mucosal Disease/mortality
- Bovine Virus Diarrhea-Mucosal Disease/pathology
- Bronchopneumonia/microbiology
- Bronchopneumonia/pathology
- Bronchopneumonia/veterinary
- Cattle
- Cattle Diseases/microbiology
- Cattle Diseases/mortality
- Cattle Diseases/pathology
- Communicable Diseases, Emerging/microbiology
- Communicable Diseases, Emerging/mortality
- Communicable Diseases, Emerging/veterinary
- Immunohistochemistry/veterinary
- Mannheimia haemolytica/isolation & purification
- Mycoplasma bovis/immunology
- Mycoplasma bovis/isolation & purification
- Mycoplasma bovis/pathogenicity
- Pasteurellosis, Pneumonic/microbiology
- Pasteurellosis, Pneumonic/mortality
- Pneumonia, Mycoplasma/mortality
- Pneumonia, Mycoplasma/pathology
- Pneumonia, Mycoplasma/veterinary
- Retrospective Studies
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Affiliation(s)
- Mihai I Gagea
- Departments of Pathobiology, Ontario Veterinary College, Canada
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Abstract
This case report describes chronic sepsis of the right temporomandibular joint in a juvenile horse. Diagnostic work-up included physical examination, radiography, and computed tomography. Humane euthanasia was indicated due to the chronicity of the condition, prognosis, and financial constraints.
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Affiliation(s)
- Dustin V Devine
- Equine Section, Oklahoma State University, College of Veterinary Medicine, Stillwater 74078, USA.
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22
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Büchsel M, Pletschen L, Fleiner M, Häcker G, Serr A. A case of septic arthritis caused by a Mycoplasma salivarium strain resistant towards Ciprofloxacin and Clarithromycin in a patient with chronic lymphatic leukemia. Diagn Microbiol Infect Dis 2016; 86:115-7. [PMID: 27342785 DOI: 10.1016/j.diagmicrobio.2016.05.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 11/18/2022]
Abstract
Mycoplasma salivarium is a rare agent of septic arthritis in immunocompromised patients. We report a case of septic arthritis due to Mycoplasma salivarium in a patient with B-cell chronic lymphocytic leukemia who underwent chemotherapy with rituximab and bendamustin. Therapy of arthritis due to Mycoplasma salivarium is difficult because there are almost no susceptibility data available. The present case illustrates that antimicrobial susceptibility of Mycoplasma strains is not necessarily predictable and that antibiotic therapy should therefore be guided by in vitro susceptibility testing.
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MESH Headings
- Aged
- Anti-Bacterial Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/microbiology
- Arthritis, Infectious/pathology
- Bendamustine Hydrochloride/therapeutic use
- Ciprofloxacin/pharmacology
- Clarithromycin/pharmacology
- Drug Resistance, Bacterial
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Mycoplasma Infections/diagnosis
- Mycoplasma Infections/microbiology
- Mycoplasma Infections/pathology
- Mycoplasma salivarium/drug effects
- Mycoplasma salivarium/isolation & purification
- Rituximab/therapeutic use
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Affiliation(s)
- Martin Büchsel
- Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany.
| | - Lars Pletschen
- Department of Medical Oncology, Tumor Biology Center, Breisacher Straße 117, 79106 Freiburg, Germany
| | - Michael Fleiner
- Department of Medical Oncology, Tumor Biology Center, Breisacher Straße 117, 79106 Freiburg, Germany
| | - Georg Häcker
- Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany
| | - Annerose Serr
- Institute of Medical Microbiology and Hygiene, University Medical Centre Freiburg, Hermann-Herder-Straße 11, 79104 Freiburg, Germany
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Burgstaller J, Kofler J. Complete ostectomy of middle phalanx and partial ostectomy of proximal phalanx in a Brown Swiss calf for treatment of purulent arthritis of the proximal interphalangeal joint and adjacent severe osteomyelitis. Berl Munch Tierarztl Wochenschr 2016; 129:138-143. [PMID: 27169151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A five month old Brown Swiss heifer calf (212 kg body mass) with severe left hind limb lameness, caused by a wound of the lateral digit was referred to the veterinary teaching hospital. The calf showed a score 4 of 5 lameness on the left hind limb. A scarified skin lesion with a fistula formation and purulent exudate was observed at the level of the proximal interphalangeal joint (PIJ) of the lateral digit of the left hind. The PIJ region and the lateral digit were severely swollen and painful. Ultrasonography showed a moderate anechoic effusion of the lateral digital flexor tendon sheet (DFTS) and a severe heterogeneous hypoechoic effusion with some small hyperechoic areas of the plantar and dorsal pouch of the PIJ. In addition, a highly irregular contour of the dorsal and abaxial surface of the phalanx media (P2) and the distal aspect of the proximal phalanx (P1) were imaged. Based on physical examination and ultrasonographic findings, the diagnosis was chronic purulent arthritis of the PIJ, osteitis of P2 and the distal end of P1 with suspected adjacent osteomyelitis. Complete ostectomy of P2 and ostectomy of the distal part of the P1 of the lateral digit was performed with an oscillating saw through the extended debrided wound. The lameness improved subsequently and 21 days post-surgery the calf was discharged from the clinic without lameness, and with a wooden block attached to the healthy claw. A year later the heifer was pregnant and still in the herd, during this period it did not exhibit lameness. The described surgical technique resulted in an excellent long-term outcome and may be considered in cases of severe purulent joint infection of the PIJ with osteolytic processes in adjacent bones, as a digit salvage procedure especially for young cattle.
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Spira D, Germann T, Lehner B, Hemmer S, Akbar M, Jesser J, Weber MA, Rehnitz C. CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection. PLoS One 2016; 11:e0146399. [PMID: 26727377 PMCID: PMC4699662 DOI: 10.1371/journal.pone.0146399] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives To search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis. Methods 34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients. Results Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002). Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%. Conclusions Inflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.
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Affiliation(s)
- Daniel Spira
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
- * E-mail:
| | - Thomas Germann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Burkhard Lehner
- Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Stefan Hemmer
- Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christoph Rehnitz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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25
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Maier K, Fischer D, Hartmann A, Kershaw O, Prenger-Berninghoff E, Pendl H, Schmidt MJ, Lierz M. Vertebral Osteomyelitis and Septic Arthritis Associated With Staphylococcus hyicus in a Juvenile Peregrine Falcon ( Falco peregrinus ). J Avian Med Surg 2015; 29:216-23. [PMID: 26378668 DOI: 10.1647/2014-036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 6-week-old, parent-reared peregrine falcon ( Falco peregrinus ) was presented with spastic hypertonus of its hind limbs of unknown origin and duration. Radiologic examination revealed smooth periosteal reactions ventrally at thoracic vertebrae 5 to 7. Contrast-enhanced computed tomography identified the swelling as inflammation; antibiotic, antimycotic, anti-inflammatory, and analgesic treatments were initiated, and vitamins and minerals were supplemented. Because the bird's condition did not improve after 10 days, it was euthanatized and submitted for postmortem examination. On histopathologic examination, chronic, active osteomyelitis was diagnosed in thoracic vertebrae 5 to 7, and chronic, active arthritis was present in both the right shoulder and left elbow joints. Staphylococcus hyicus was isolated from these 3 locations, as well as from lungs and liver, indicating a chronic septic staphylococcosis. Although infections with Staphylococcus species are occasional causes of vertebral osteomyelitis in juvenile poultry with active growth plates, it is only sporadically reported in raptors and companion birds. This case report is the first description of the clinical features and diagnostic and pathologic findings in a juvenile peregrine falcon with hematogenous osteomyelitis and arthritis associated with septicemia caused by S hyicus.
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26
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Farah Z, Reddy V, Matthews W, Giles I. Poor adherence to guidelines on early management of acute hot swollen joint(s): an evaluation of clinical practice and implications for training. Int J Clin Pract 2015; 69:618-22. [PMID: 25650874 DOI: 10.1111/ijcp.12580] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/23/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Synovial fluid analysis is an indispensable investigation to attain a diagnosis in a patient with acute hot swollen joint(s), septic arthritis in particular. A delay in appropriate early management results in serious undesired consequences. METHODS We evaluated clinical practice at two teaching hospitals including 81 patients. We analysed medical records, laboratory pathology results and discharge summaries with regard to documentation of joint aspiration, blood cultures, antibiotic treatment and specialist referral. We then conducted a survey of 140 medical trainees to evaluate their self-reported competence at managing the acute hot swollen joint. RESULTS We found that synovial aspiration and blood cultures were performed in only 42(52%) and 30(37%) patients, respectively, not in accord with current guidelines. Given trainee doctors are responsible for the early management of acute hot swollen joint(s), our survey reveal low self-reported levels of competence and confidence at managing acute hot swollen joint(s) in 72(52%) and 37(27%) respondents, respectively. Furthermore, 101(75%) trainees indicated a need for more training in joint aspiration. We also report that 13 of 15 hospitals surveyed in London and South East UK do not provide specific training on the management of the hot swollen joint and joint aspiration as part of their induction programme. CONCLUSIONS Early management of patients with hot swollen joint(s) to perform synovial fluid aspiration and blood cultures are not being done in accordance with guidelines. We suggest that the medical trainee curricula should incorporate joint aspiration skills as an 'essential procedure', to improve the trainee doctor's confidence and competence at managing acute hot swollen joint(s) to improve adherence to guidelines, and consequently, patient outcomes.
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Affiliation(s)
- Z Farah
- Department of Medicine, Northwick Park Hospital, London, UK
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Oliveira AS, Abbasi F, Radha SS. A hot, swollen joint without trauma: septic arthritis until proven otherwise. BMJ Case Rep 2015; 2015:bcr-2014-209190. [PMID: 25858944 DOI: 10.1136/bcr-2014-209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Faisal Abbasi
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Sarkhell Saadi Radha
- Department of Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Stevenage, UK
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28
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Valerio-Moraes IA, Espinosa-Morales R, Sánchez-González A, Cedeño-Garcidueñas AL, Pichardo-Bahena R, Lezama-Peniche M. [Pseudoseptic arthritis with foreign body synovitis in a patient with gout]. Acta Ortop Mex 2015; 29:123-126. [PMID: 27012087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Monoarthritis is a diagnostic challenge for the clinician, as the list of associated conditions is quite long. It is accepted that in patients with a diagnosis of inflammatory joint disease monoarthritis represents exacerbation of the underlying disease. However, ignoring the systematized approach to monoarthritides may lead to omissions and mistaken diagnostic implications. This report describes the approach to a case of pseudoseptic arthritis that mimicked an acute episode of recurrent arthritis due to monosodium urate in a patient with retention of an intraarticular foreign body.
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29
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Isidro A, Díez-Santacoloma I, Méndez-López J. Approach to the diagnosis of unusual carpal ankylosis from ancient Egypt. Clin Exp Rheumatol 2015; 33:50-55. [PMID: 25437122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/29/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Carpal fusion is not an uncommon finding in archaeological bones. The majority of cases are due to inflammatory or infectious diseases and those are usually associated with other major alterations in the skeleton. METHODS Two distinct individual cases, both adult females recovered from the Necropolis of Sharuna in the Middle Egypt from the Ptolemaic Period (IV to I BC) are presented in this study. Specimen 4323/1 shows a fusion of the scaphoid, lunate and triquetral bones in the right wrist. Specimen 4323/2 is a very rare fusion of a dysplastic lunate bone with the radius in the left wrist. In the proximal end of that left wrist, two possible remains of the flattened scaphoid and triquetral bones are also present. RESULTS A differential diagnosis of both abnormalities as well as broad research into similar paleopathological cases were carried out: the most probable diagnosis for the specimen 4323/1 is an uncommon carpal coalition of three bones from the same row; the diagnosis of the specimen 4323/2 is more dubious with both rheumatoid arthritis and septic arthritis being strong candidates. CONCLUSIONS In archaeological remains, carpal fusion should be thoroughly studied in order to ensure an accurate differential diagnosis.
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Affiliation(s)
- Albert Isidro
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Museu Egipci de Barcelona, Spain
| | - Ivan Díez-Santacoloma
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Jose Méndez-López
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Sagrat Cor, Barcelona; and Hand Unit, M.C. Mutual, Barcelona, Spain
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30
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Ali A, Zhu X, Kwiecinski J, Gjertsson I, Lindholm C, Iwakura Y, Wang X, Lycke N, Josefsson E, Pullerits R, Jin T. Antibiotic-killed Staphylococcus aureus induces destructive arthritis in mice. Arthritis Rheumatol 2015; 67:107-116. [PMID: 25302691 DOI: 10.1002/art.38902] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/30/2014] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Permanent reduction in joint function is a severe postinfectious complication in patients with Staphylococcus aureus septic arthritis. We undertook this study to determine whether this reduction in joint function might be caused by persistent joint inflammation after the adequate eradication of bacteria by antibiotics. METHODS After intraarticular injection of cloxacillin-killed S aureus into mouse knee joints, we investigated whether antibiotic-killed S aureus induced joint inflammation and elucidated the molecular and cellular mechanisms of this type of arthritis. RESULTS Intraarticular injection of antibiotic-killed S aureus induced mild-to-moderate synovitis and bone erosions that lasted for a minimum of 14 days. Compared with wild-type animals, mice deficient in tumor necrosis factor receptor type I (TNFRI), receptor for advanced glycation end products (RAGE), or Toll-like receptor 2 (TLR-2) had a significantly reduced frequency and severity of synovitis. Combined depletion of monocytes and neutrophils also resulted in a significantly lower frequency of synovitis. Among bacterial factors, insoluble cell debris played a more important role than bacterial DNA or soluble components in inducing joint inflammation. Importantly, anti-TNF therapy abrogated joint inflammation induced by antibiotic-killed S aureus. CONCLUSION Antibiotic-killed S aureus induced and maintained joint inflammation mediated through TLR-2, TNFRI, and RAGE. The cross-talk between neutrophils and monocytes is responsible for this type of arthritis. Anti-TNF therapy might be used as a novel strategy, in combination with antibiotics, to treat staphylococcal septic arthritis.
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MESH Headings
- Animals
- Anti-Bacterial Agents/pharmacology
- Arthritis, Experimental/metabolism
- Arthritis, Experimental/microbiology
- Arthritis, Experimental/pathology
- Arthritis, Infectious/metabolism
- Arthritis, Infectious/microbiology
- Arthritis, Infectious/pathology
- Cell Communication/physiology
- Cloxacillin/pharmacology
- Disease Models, Animal
- Female
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Knockout
- Monocytes/pathology
- Neutrophils/pathology
- Receptor for Advanced Glycation End Products
- Receptors, Immunologic/deficiency
- Receptors, Immunologic/genetics
- Receptors, Immunologic/metabolism
- Receptors, Tumor Necrosis Factor, Type I/deficiency
- Receptors, Tumor Necrosis Factor, Type I/genetics
- Receptors, Tumor Necrosis Factor, Type I/metabolism
- Severity of Illness Index
- Staphylococcus aureus/drug effects
- Toll-Like Receptor 2/deficiency
- Toll-Like Receptor 2/genetics
- Toll-Like Receptor 2/metabolism
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Affiliation(s)
- Abukar Ali
- Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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31
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Affiliation(s)
- J K Loh
- From the Departments of Genitourinary Medicine & Infectious Diseases and Clinical Microbiology, St James Hospital, Dublin, Ireland
| | - D O'Shea
- From the Departments of Genitourinary Medicine & Infectious Diseases and Clinical Microbiology, St James Hospital, Dublin, Ireland
| | - K O'Connell
- From the Departments of Genitourinary Medicine & Infectious Diseases and Clinical Microbiology, St James Hospital, Dublin, Ireland
| | - B Crowley
- From the Departments of Genitourinary Medicine & Infectious Diseases and Clinical Microbiology, St James Hospital, Dublin, Ireland
| | - C J Bergin
- From the Departments of Genitourinary Medicine & Infectious Diseases and Clinical Microbiology, St James Hospital, Dublin, Ireland
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32
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Pocock JM, Khun PA, Moore CE, Vuthy S, Stoesser N, Parry CM. Septic arthritis of the hip in a Cambodian child caused by multidrug-resistant Salmonella enterica serovar Typhi with intermediate susceptibility to ciprofloxacin treated with ceftriaxone and azithromycin. Paediatr Int Child Health 2014; 34:227-9. [PMID: 24749773 DOI: 10.1179/2046905514y.0000000123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Septic arthritis is a rare complication of typhoid fever. A 12-year-old boy without pre-existing disease attended a paediatric hospital in Cambodia with fever and left hip pain. A hip synovial fluid aspirate grew multidrug-resistant Salmonella enterica ser. Typhi with intermediate susceptibility to ciprofloxacin. Arthrotomy, 2 weeks of intravenous ceftriaxone and 4 weeks of oral azithromycin led to resolution of symptoms. The optimum management of septic arthritis in drug-resistant typhoid is undefined.
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33
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Al-Zaiem MM, Bajuifer SJ, Fattani MO, Al-Zaiem FM. Bilateral iliopsoas abscess associated with right hip septic arthritis in a neonate. Saudi Med J 2014; 35:743-746. [PMID: 25028234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Iliopsoas abscess is a very rare pathology in the neonatal period. There is a lack of reports in the literature on bilateral psoas abscess with hip joint arthritis. We report a case of bilateral iliopsoas abscess with concomitant right hip septic arthritis, caused by methicillin-resistant Staphylococcus aureus in a 28-day-old male infant. The baby presented with bilateral diffuse swelling of the groins and upper thighs. He was treated successfully by ultrasound-guided percutaneous drainage along with systemic antibiotic therapy. Clinical improvement was observed within 24-48 hours of drainage.
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Affiliation(s)
- Maher M Al-Zaiem
- Department of Pediatric Surgery, Maternity and Children Hospital, Makkah, Kingdom of Saudi Arabia. E-mail:
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34
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Black AC, Soni R. Intra-articular metastatic pancreatic carcinoma of the right knee mimicking septic arthritis. Clin Colorectal Cancer 2014; 13:131-3. [PMID: 24674652 DOI: 10.1016/j.clcc.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/28/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander C Black
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
| | - Rashida Soni
- Cedar Sinai Medical Center, West Hollywood, CA; Department of Oncology and Pathology, Henry Mayo Newhall Memorial Hospital, Valencia, CA
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35
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Roberts J, Schaefer E, Gallo RA. Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses. Orthopedics 2014; 37:e98-e102. [PMID: 24679214 DOI: 10.3928/01477447-20140124-09] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/20/2013] [Indexed: 02/03/2023]
Abstract
Differentiating septic arthritis from culture-negative, acute atraumatic joint effusion is difficult. Studies have attempted to elucidate factors that herald infection, but, due to overlap, most conclude that the diagnosis ultimately relies on clinical judgment. Furthermore, studies are limited by broad inclusion criteria. The current retrospective case study sought to examine (1) which markers differentiate a culture-positive septic joint from culture-negative effusion in patients suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint and (2) whether threshold values of these markers exist that predict septic arthritis. The study was performed by reviewing records of those who underwent operative irrigation and debridement involving the shoulder, elbow, wrist, hip, knee, and ankle. Patients were included if they were older than 18 years and had an acutely swollen/painful joint and no organisms on initial Gram stain. Exclusion criteria were lack of serum markers or synovial fluid aspirate, antibiotics within 1 week, adjacent wound or skin infection, recent trauma to the joint, and previous joint infection or surgery to the joint. Several clinical, serological, and synovial parameters were collected and analyzed using paired t test with Bonferonni correction. Serum C-reactive protein was the only significantly different variable between groups. Serum C-reactive protein greater than 10.5 mg/dL was predictive of infection. In those suspicious for infection despite no growth on Gram stain and without previous surgery in the affected joint, C-reactive protein greater than 10.5 mg/dL is suspicious for joint sepsis and should warrant consideration for urgent irrigation and debridement.
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36
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Ponka D, Baddar F. Joint aspiration. Can Fam Physician 2013; 59:747. [PMID: 23851540 PMCID: PMC3710040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- David Ponka
- Department of Family Medicine, University of Ottawa, Ontario
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37
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Hedegaard SS, Zaccarin M, Lindberg J. [Septic arthritis caused by Streptococcus suis]. Ugeskr Laeger 2013; 175:1574-1575. [PMID: 23721843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Streptococcus suis is a global endemic swine pathogen. S. suis can cause meningitis, endocarditis and severe sepsis in humans, who are exposed to swine. Human infection with S. suis was first reported in 1968, since then, human infections have been sporadic although an outbreak in China counted 215 cases. In a rare case of disseminated arthritis we found that correct clinical diagnosis was difficult due to unspecific symptomatology and slow growing bacterial culture. However, conducting thorough examinations is crucial, and if treated correctly the outcome is favourable.
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38
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Galvan N, Middleton JR, Cook C, Britt LG, Kuroki K. Otitis interna, media, and externa with destruction of the left tympanic bulla and subluxation and septic arthritis of the left temporomandibular joint in an alpaca (Vicugna pacos). Can Vet J 2013; 54:283-285. [PMID: 23997267 PMCID: PMC3573636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 1.5-year-old, 37.7 kg, female alpaca was evaluated for a 2-week history of weight loss, left ear droop, and deviation of the rostral mandible to the right. Antemortem radiography and postmortem examination revealed otitis interna, media, and externa, destruction of the left tympanic bulla, and subluxation and septic arthritis of the left temporomandibular joint.
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39
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Woods KS, Barry M, Richardson D. Carpal intra-articular blastomycosis in a Labrador retriever. Can Vet J 2013; 54:167-170. [PMID: 23904641 PMCID: PMC3552596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 6-month-old male castrated Labrador retriever was presented for coughing and forelimb lameness. Blastomyces dermatitidis was identified in cytology of sputum and synovial fluid. Repeat arthrocentesis 7 months later revealed resolution of septic arthritis. Fungal septic arthritis should be considered for cases of monoarthritis and may respond to oral itraconazole treatment.
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Affiliation(s)
- Katharine S Woods
- Department of Clinical Studies (Woods, Richardson, Barry), Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1.
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40
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Doyle A, López A, Pack L, Muckle A. Candida osteomyelitis in a gelding. Can Vet J 2013; 54:176-178. [PMID: 23904643 PMCID: PMC3552598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 2-year-old gelding was referred for evaluation of severe right forelimb lameness. The horse was grade 4/5 lame on the right forelimb. Clinical, laboratory, and radiographic findings were consistent with septic arthritis and osteomyelitis. Due to poor prognosis the owner elected euthanasia. Histopathology confirmed chronic arthritis and osteomyelitis with intralesional yeast (Candida species).
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Affiliation(s)
| | - Alfonso López
- Address all correspondence to Dr. Alfonso López; e-mail:
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41
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Tahasildar N, Sudesh P, Tripathy SK, Shashidhar BK. Bilateral pathological dislocation of the hip secondary to tuberculous arthritis following disseminated tuberculosis: a case report and review of the literature. J Pediatr Orthop B 2012; 21:567-73. [PMID: 22668573 DOI: 10.1097/bpb.0b013e328354da73] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pathological dislocation of the hip has been reported as a complication in various hip disorders. Several pathomechanisms including capsular laxity, synovial hypertrophy, and acetabular and proximal femur destruction have been described. We report a case of bilateral pathological dislocation of the hip in a 6-year-old girl secondary to tuberculous arthritis following disseminated tuberculosis, which we managed operatively. At the 18-month follow-up, the child had a clinically stable left hip despite radiological subluxation. Bilateral pathological dislocation of the hip associated with tuberculous arthritis is a rare condition and has never been reported in the literature.
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Affiliation(s)
- Naveen Tahasildar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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42
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Seyman D, Ozen NS, Inan D, Ongut G, Ogunc D. Pseudomonas aeruginosa septic arthritis of knee after intra-articular ozone injection. New Microbiol 2012; 35:345-348. [PMID: 22842605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 03/09/2012] [Indexed: 06/01/2023]
Abstract
We describe a case of septic arthritis caused by Pseudomonas aeruginosa in an immunocompetent patient following intra-articular ozone injection into the knee. To the best of our knowledge, and after considering the current literature,we believe this case is unique as no other reports of septic arthritis caused by P. aeruginosa following intra-articular ozone injection has been made.
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Affiliation(s)
- Derya Seyman
- Antalya Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Antalya, Turkey
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43
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Gjertsson I, Lagerquist MK, Kristiansson E, Carlsten H, Lindholm C. Estradiol ameliorates arthritis and protects against systemic bone loss in Staphylococcus aureus infection in mice. Arthritis Res Ther 2012; 14:R76. [PMID: 22507741 PMCID: PMC3446450 DOI: 10.1186/ar3799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 02/01/2012] [Accepted: 04/16/2012] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus is a common cause of bacterial arthritis, which is associated with progressive bone loss in affected joints. We recently showed that S. aureus infection also induces a significant systemic bone loss in mice. This study was performed to assess the effect of estradiol treatment on the clinical course and outcome of S. aureus arthritis and on infection-induced bone loss in experimental S. aureus infection. METHODS Mice were ovariectomized, treated with estradiol or placebo, and S. aureus infection was established by intravenous inoculation of bacteria. RESULTS Estradiol treatment was found to decrease significantly the frequency and clinical severity of S. aureus arthritis, a finding that was accompanied with significantly higher serum levels of interleukin-10 in estradiol-treated mice. Estradiol was also highly protective against S. aureus-induced systemic trabecular, and cortical bone loss. Lack of endogenous estrogens and S. aureus infection had additive effects on trabecular bone loss. The S. aureus-infected, ovariectomized mice lost as much as 76% of their trabecular bone mass. CONCLUSIONS Treatment with estradiol ameliorates S. aureus arthritis and is protective against infection-induced systemic bone loss in experimental S. aureus infection.
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Affiliation(s)
- Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
| | - Marie K Lagerquist
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
- CBAR, Centre for Bone and Arthritis Research, Sahlgrenska Academy at University of Gothenburg, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
| | - Erik Kristiansson
- Department of Mathematical Statistics, Chalmers University of Technology, Chalmers tvärgata 3, Gothenburg, S-412 96, Sweden
| | - Hans Carlsten
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
- CBAR, Centre for Bone and Arthritis Research, Sahlgrenska Academy at University of Gothenburg, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
| | - Catharina Lindholm
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
- CBAR, Centre for Bone and Arthritis Research, Sahlgrenska Academy at University of Gothenburg, Guldhedsgatan 10A, Gothenburg, S-413 46, Sweden
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44
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Andrews JA, Rizzato Lede D, Senderovsky M, Finn BC, Emery N, Bottaro F, Bruetman JE, Young P. [Septic arthritis of the pubic symphysis in two athletes]. Medicina (B Aires) 2012; 72:247-250. [PMID: 22763164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Septic arthritis of the pubic symphysis, so called osteomyelitis pubis is the infection which involves pubic symphysis and its joint. It is a rare condition, representing less than one percent of all cases of osteomyelitis. It affects most frequently young athletes and women undergoing gynecologic or urologic surgery. It presents itself with fever and pubic pain which irradiates to the genitals and increases when hip is mobilized, and this fact produces gait claudication. Differential diagnosis should be made with pubic osteitis, which is a sterile inflammatory condition. Diagnosis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase. Image guided puncture is often necessary for the differential diagnosis with pubic osteitis. The etiologic agents most commonly found are Staphylococcus aureus, followed by gram-negative bacilli, and polymicrobial infection in recent pelvis surgery. The antibiotic treatment is adjusted depending on the microbiological diagnosis, adding NSAIDs, and bed rest. Surgical debridement is required up to 55% of the cases. Two cases of osteomyelitis of the pubis by S. aureus, with good outcome to treatment with antibiotics, NSAIDs and rest are here described. Both patients were healthy relevant athletes.
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Affiliation(s)
- José A Andrews
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires
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45
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Kim HK, Zbojniewicz AM, Merrow AC, Cheon JE, Kim IO, Emery KH. MR findings of synovial disease in children and young adults: Part 2. Pediatr Radiol 2011; 41:512-24. [PMID: 21336643 DOI: 10.1007/s00247-011-2007-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/25/2022]
Abstract
Synovium is the thin membranous lining of a joint. It produces synovial fluid, which lubricates and nourishes the cartilage and bone in the joint capsule. Synovial diseases in children can be classified as normal structures as potential sources of pathology (synovial folds: plicae, infrapatellar fat pad clefts), noninfectious synovial proliferation (juvenile idiopathic arthritis, hemophilic arthropathy, lipoma arborescens, synovial osteochondromatosis, pigmented villonodular synovitis, reactive synovitis), infectious synovial proliferation (pyogenic arthritis, tuberculous arthritis), deposition disease (gouty arthropathy), vascular malformation, malignancy (metastasis) and intra-/periarticular cysts and cyst-like structures. Other intra-articular neoplasms, such as intra-articular synovial sarcoma, can mimic synovial disease in children.
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Affiliation(s)
- Hee K Kim
- Department of Radiology, Cincinnati Children's Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
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46
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Chen SH, Wang T, Lee CH. Tuberculous ankle versus pyogenic septic ankle arthritis: a retrospective comparison. Jpn J Infect Dis 2011; 64:139-142. [PMID: 21519128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Ankle tuberculosis (TB) manifests with varying symptoms and is easily confused with pyogenic septic ankle arthritis. In this study, all patients with either ankle TB or pyogenic septic ankle arthritis who were admitted to a medical center in southern Taiwan between May 1986 and October 2006 were reviewed retrospectively to identify risk factors for ankle TB. Compared with the 42 patients with culture-confirmed pyogenic septic ankle arthritis, the 26 patients with ankle TB (12 definitive, 5 probable, and 9 possible) were significantly more likely to have evidence of TB on chest radiographs (50 versus 10%; P<0.01), a history of trauma (58 versus 17%; P<0.01), presentation with sinus discharge (50 versus 12%; P<0.01), duration of symptoms of more than 3 months (69 versus 12%; P<0.01), a leukocyte count of <10,000/μL (58 versus 29%; P=0.03), and C-reactive protein of <5 mg/dL (42 versus 17%; P=0.03). Evidence of TB on chest radiographs was identified as an independent risk factor for ankle TB (odds ratio=35.1; 95% confidence interval=1.6‒779.8; P=0.02) by multiple logistic regression analysis. Awareness of these factors is essential for the accurate and timely diagnosis of ankle TB.
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Affiliation(s)
- Shih-Hao Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University, Kaohsiung, Taiwan
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47
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Tiwari N, Chabra S, Mehdi S, Sweet P, Krasieva TB, Pool R, Andrews B, Peavy GM. Imaging of normal and pathologic joint synovium using nonlinear optical microscopy as a potential diagnostic tool. J Biomed Opt 2010; 15:056001. [PMID: 21054095 PMCID: PMC2951994 DOI: 10.1117/1.3484262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
An estimated 1.3 million people in the United States suffer from rheumatoid arthritis (RA). RA causes profound changes in the synovial membrane of joints, and without early diagnosis and intervention, progresses to permanent alterations in joint structure and function. The purpose of this study is to determine if nonlinear optical microscopy (NLOM) can utilize the natural intrinsic fluorescence properties of tissue to generate images that would allow visualization of the structural and cellular composition of fresh, unfixed normal and pathologic synovial tissue. NLOM is performed on rabbit knee joint synovial samples using 730- and 800-nm excitation wavelengths. Less than 30 mW of excitation power delivered with a 40×, 0.8-NA water immersion objective is sufficient for the visualization of synovial structures to a maximum depth of 70 μm without tissue damage. NLOM imaging of normal and pathologic synovial tissue reveals the cellular structure, synoviocytes, adipocytes, collagen, vascular structures, and differential characteristics of inflammatory infiltrates without requiring tissue processing or staining. Further study to evaluate the ability of NLOM to assess the characteristics of pathologic synovial tissue and its potential role for the management of disease is warranted.
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MESH Headings
- Animals
- Arthritis, Experimental/pathology
- Arthritis, Infectious/pathology
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/pathology
- Disease Models, Animal
- Humans
- Male
- Microscopy/methods
- Microscopy/statistics & numerical data
- Microscopy, Confocal/methods
- Microscopy, Confocal/statistics & numerical data
- Microscopy, Fluorescence, Multiphoton/methods
- Microscopy, Fluorescence, Multiphoton/statistics & numerical data
- Nonlinear Dynamics
- Optical Phenomena
- Rabbits
- Synovial Membrane/anatomy & histology
- Synovial Membrane/pathology
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Affiliation(s)
- Nivedan Tiwari
- University of California, Irvine, Beckman Laser Institute, 1002 Health Sciences Road, Irvine, California 92612, USA.
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Shen S, Shin JJ, Strle K, McHugh G, Li X, Glickstein LJ, Drouin EE, Steere AC. Treg cell numbers and function in patients with antibiotic-refractory or antibiotic-responsive Lyme arthritis. ACTA ACUST UNITED AC 2010; 62:2127-37. [PMID: 20506317 DOI: 10.1002/art.27468] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In a murine model of antibiotic-refractory Lyme arthritis, the numbers of Treg cells are dramatically reduced. The aim of this study was to examine Treg cell numbers and function in patients with antibiotic-refractory Lyme arthritis. METHODS CD4+ T cell subsets were enumerated in the peripheral blood (PB) and synovial fluid (SF) of 12 patients with antibiotic-refractory arthritis and 6 patients with antibiotic-responsive arthritis. Treg cell function was examined using Borrelia-specific and nonspecific Treg cell proliferation assays. RESULTS In both patient groups, interferon-gamma-positive Th1 cells in SF were abundant and enriched (approximately 50% of CD4+ T cells). In patients with antibiotic-refractory arthritis, the median percentages of FoxP3-positive Treg cells were significantly higher in SF than in PB (12% versus 6%; P = 0.03) or in SF from patients with antibiotic-responsive arthritis (12% versus 5%; P = 0.04). Moreover, in the antibiotic-refractory group, a higher percentage of Treg cells in SF correlated with a shorter duration until resolution of arthritis (r = -0.74, P = 0.006). In contrast, patients with fewer Treg cells had suboptimal responses to disease-modifying antirheumatic drugs and a longer duration of arthritis after antibiotic treatment, and they often required synovectomies for arthritis resolution. In each group, Treg cells in SF dampened Borrelia burgdorferi-specific proliferative responses, and in 2 patients with antibiotic-refractory arthritis, Treg cells were functional in nonspecific suppression assays. CONCLUSION Treg cells were functional in patients with antibiotic-refractory arthritis, and in some patients, higher numbers of these cells in SF appeared to participate in arthritis resolution. However, as in the murine model, patients with antibiotic-refractory arthritis and lower numbers of Treg cells seemed unable to achieve resolution of synovial inflammation.
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Affiliation(s)
- Shiqian Shen
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Dedouit F, Piercecchi-Marti MD, Leonetti G, Rougé D, Telmon N. Cause of internal hemorrhage determined after exhumation: Report of one case. Forensic Sci Int 2010; 204:e20-3. [PMID: 20594783 DOI: 10.1016/j.forsciint.2010.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 05/22/2010] [Accepted: 05/29/2010] [Indexed: 11/18/2022]
Abstract
A 36-year-old woman consulted the medical emergency unit of a private health center for abdominal pain and gastroenteritis of 5 days duration. Acute right pyelonephritis was diagnosed. Five hours after admission she became unconscious in a state of clinical shock. She was transferred to an intensive care unit but resuscitation attempts were unsuccessful and she died 3h later. Three days after death, she was buried in the family vault. Five days after the burial, her husband lodged a complaint with the public prosecutor because he had not received a clear explanation from the physicians concerning the cause of his wife's death. After analysis of the medical records of the deceased by two forensic pathologists, a medicolegal autopsy was ordered by the public prosecutor. The corpse was exhumed and autopsy performed 9 days after death. Massive hemoperitoneum was diagnosed with a macroscopically ruptured subcapsular hematoma. Pathological study confirmed acute right pyelonephritis and demonstrated the precise cause of the hemorrhage: rupture of the hepatic artery at the hilar part, following infectious arteritis which was probably secondary to the acute pyelonephritis. To the best of our knowledge, this is the first published report of such a case.
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Affiliation(s)
- Fabrice Dedouit
- Service de Médecine Légale, CHU Toulouse-Rangueil, 1 Avenue Professeur Jean Poulhès, 31059 Toulouse Cedex 9, France.
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Mandac I, Prkacin I, Matovinović MS, Sustercić D. Septic arthritis due to Streptococcus sanguis. Coll Antropol 2010; 34:661-664. [PMID: 20698149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Septic arthritis may represent a direct invasion of joint space by various microorganisms, including bacteria, viruses and fungi. Although any infectious agent may cause bacterial arthritis, bacterial pathogens are the most significant because of their rapidly destructive nature. We present a case of septic arthritis in a 56-year old male patient due to Streptococcus viridans which is member of the viridans group streptococci. Patient was admitted to Our Hospital presented as fever of unknown origin, losing more than 30 kg of body weight during couple of months, and anemia of chronic disease as paraneoplastic process. He had long history of arterial hypertension and stroke. There was swelling and pain of the right sternoclavicular joint and precordial systolic murmur in physical status. A large diagnostic panel has been made, computerized tomography (CT) of right sternoclavicular joint showed widening of periarticular soft tissue and loss of clavicular corticalis. Cytologic analysis of synovial fluid showed more than 90% of polymorphonuclear leukocytes. There were no crystals on microscopic examination and Gram stain of fluid was negative. Blood cultures were positive for S. sanguis and there was a consideration about possible periodontal disease. Stomatologic examination verified periapical ostitis and extraction of potential cause of infection has been done. Therapy with benzilpenicilline was followed by the gradual improvement of clinical and laboratory parameters. Although viridans group streptococci and Streptococcus sanguis in particular are rare causes of septic arthritis in native joints, they should be considered in the differential diagnosis of periodontal disease.
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Affiliation(s)
- Inga Mandac
- "Merkur, University Hospital, Zagreb, Croatia.
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