Acute septic arthritis in children is an orthopaedic emergency.A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence.The clinical pres...Acute septic arthritis in children is an orthopaedic emergency.A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence.The clinical presentation can be a diagnostic challenge,especially in young children.A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis.Ultrasound is helpful in detecting the presence of a joint effusion.Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis.The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint,in case of a positive culture or a positive gram stain of the joint fluid,or if there is a white blood-cell count in the joint fluid of more than 50000/mm3.Staphylococcus aureus is the most commonly cultured organism.Recent systematic reviews have identified the most effective drainage techniques,including needle aspiration,arthroscopy and arthrotomy,depending on the affected joint.After the drainage procedure it is important to monitor the clinical and laboratory outcomes.Additional drainage procedures may be necessary in select cases.展开更多
BACKGROUND Septic arthritis of the hand,which is the second most common after damage of the knee joint,remains one of the leading causes of temporary disability.An inflammation can cause dysfunction of the joint,and i...BACKGROUND Septic arthritis of the hand,which is the second most common after damage of the knee joint,remains one of the leading causes of temporary disability.An inflammation can cause dysfunction of the joint,and in the most severe cases,the need for amputation of the finger may arise.The results of their treatment today,especially from a functional point of view,cannot be considered satisfactory.Urgent surgical treatment is extremely important in septic arthritis of the hand,as it helps to prevent cartilage destruction and the development of osteomyelitis.AIM To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results,depending on the nature of the damage to the articular structures.METHODS The results of the treatment of 170 patients with septic arthritis of the hand,which were treated in the period of 2020-2021,were analyzed.Inflammation of the interphalangeal and metacarpophalangeal joints(MCP)of fingers 1,2,and 3 was more often noted in 147(81.6%)joints.The most common cause of arthritis was a penetrating injury as a result of household trauma(101,59.4%),animal bite(30,17.6%),and clenched fist injury(15,8.8%).Septic arthritis with contiguous osteomyelitis was observed in 98(54.4%)cases.Surgical treatment was completed with drainage and irrigation of the joint.Early mobilization was used to restore function.In patients with osteomyelitis,it was aimed at the formation of neoarthrosis.Arthrodesis was not applied.Long-term results of treatment were assessed in 142(83.5%)patients within 1 mo to 12 mo after discharge from the hospital[the median was 7 mo(IQR:4-9)].RESULTS The most commonly isolated organism was Staphylococcus aureus(35.3%).The median treatment delay in patients without osteomyelitis was 5 d(IQR:4-7);for septic arthritis with contiguous osteomyelitis,it was 14 d(IQR:5-21).Radiography for osteomyelitis within 2 wk was uninformative:41.2%of diagnoses.A single surgical treatment was required in 138(81.2%)patients,two treatments in 22(12.9%),and three or more in 10(5.9%).Total elimination of the infection was achieved in 163(95.9%)patients.The best functional results of treatment were noted in patients without osteomyelitis.After septic arthritis,Total Active Motion(TAM)for the MCP was 96.2%(IQR:85.1-98.0),for the proximal interphalangeal joint(PIP)82.4%(IQR:54.5-98.5),and for the distal interphalangeal joint(DIP)69.4%(IQR:65.4-74.1).In cases with osteomyelitis,it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2%(IQR:45.3-90.1),for PIP-62.5%(IQR:41.8-68.9),and for DIP-59.4%(IQR:50-62.1).Additionally,the severity of pain during movements did not exceed 1 point.CONCLUSION The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis,especially in the presence of diabetes mellitus.Urgent surgical treatment,along with continued irrigation of the joint and antibiotic therapy,made it possible to eliminate the infection,and early rehabilitation restored the range of motion.The best results were noted in patients without osteomyelitis.With the development of osteomyelitis,a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis,without resorting to arthrodesis.展开更多
Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger.They rank second in the frequency of occurrence after lesions of th...Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger.They rank second in the frequency of occurrence after lesions of the knee joint.Many points concerning the etiology,the timing of the development of cartilage destruction and the development of osteomyelitis,approaches to surgical treatment,the duration of antibiotic therapy,and the start of rehabilitation measures remain the subject of numerous discussions.Based on a search in the PubMed,Web of Science and Google Scholar databases down to 1990-2021,publications on septic arthritis of the hand were found and analyzed.The following inclusion criteria were used in our review:(1) Septic arthritis of the hand;(2) Published in a peer review journal;(3) Written in English;and(4) Full text version available.Studies were excluded if they met any of the following criteria:(1) Letters;(2) Articles published in abstract form only;and(3) Cadaveric studies.Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers(> 50% of cases).Up to 90% of cases,the infection enters the joint as a result of penetrating trauma,animal bites,etc.Staphylococcus aureus became the most frequently isolated microorganism(30%-55%),and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found,according to various sources,from 0% to 73% among all isolated Staphylococcus aureus.In arthritis,Pasteurella multocida(6%-11%) is often isolated as a result of animal bites.Articular cartilage destruction in the experiment developed within 24-48 h after infection.In clinical studies,the development of osteomyelitis was noted when treatment was delayed by more than 10 d.X-ray data during the first two weeks were uninformative.Priority of surgical treatment of septic arthritis.Drainage and surgical treatment,and with the development of osteomyelitis,the implementation of arthrodesis.Antibacterial therapy for 2-4 wk and early start of rehabilitation measures.Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.展开更多
The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This...The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This includes the destruction of articular cartilage and bone tissue with the development of osteomyelitis, the involvement of paraarticular soft tissues in the purulent process, and the destruction of the flexor/extensor tendons of the fingers. The currently missing specialized classification of septic arthritis could help in systematizing the diseases, determining treatment tactics, and predicting the results of treatment.The classification of septic arthritis of the hand proposed for discussion is based on the following principle: Joint-Wound-Tendon(Jx Wx Tx);Jx characterizes damage to the osteochondral structures of the joint, Wx is the presence of paraarticular purulent wounds or fistulas, and Tx is destruction of the flexor/extensor tendons of the finger. The classification of the diagnosis makes it possible to assess the nature and severity of damage to the structures of the joint and may also be useful when comparing the results of treatment of septic arthritis of the hand.展开更多
BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of com...BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.展开更多
BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical characteristic.Conventional ultrasound,plain radiographs,and computed tomography are not able to conf...BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical characteristic.Conventional ultrasound,plain radiographs,and computed tomography are not able to confirm or even suspect arthritis early.Superb microvascular imaging is a new advanced Doppler technique in evaluating low-flow microvascular patterns.The higher sensitivity for increased perisynovial vascularity helps to suspect septic arthritis and forms a methodical approach to using magnetic resonance imaging(MRI).CASE SUMMARY A 34-year-old immunocompetent woman presented with a fever and a dull ache in the chest radiating to the right arm.Traumatic injury and the most common respiratory and cardiac disorders were ruled out.Blood cultures came back positive for Staphylococcus aureus,and sepsis was confirmed.A small lump was noted on the chest during the first week of hospitalization.Superb microvascular imaging was performed and septic arthritis of the manubriosternal joint was detected.MRI confirmed the diagnosis and showed septic arthritis of the manubriosternal joint with several localized abscesses behind the sternum.The patient was treated for three weeks with intravenous antibiotics and the outcome was favorable:Inflammatory markers became normal,and the lump disappeared.Three months later,the patient was examined for a new episode of mild pain in the sternum and was diagnosed with persistent perichondritis by ultrasound in comparison with MRI.CONCLUSION Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.展开更多
BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and ...BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and factors associated with return to surgery(RTS)and readmission after index surgical debridement for septic arthritis of the knee in children.METHODS This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project(HCUP).We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017.Demographic data included age,gender,race,hospital type and insurance type.Clinical data including index admission length of stay(LOS)and Charlson Comorbidity Index(CCI)were available from the HCUP database.Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.RESULTS Nine-hundred thirty-two cases of pediatric septic knee were included.This cohort was 62.3%male,with mean age of 9.0(±6.1)years.Approximately 46%of patients were white and approximately half had Medicaid insurance.Thirty-six patients(3.6%)required RTS at a minimum of 2 year after index surgery,and 172 patients(18.5%)were readmitted at any point.The mean readmission LOS was 11.6(±11.3)d.Higher CCI was associated with RTS(P=0.041).There were no significant associations in age,gender,race,insurance type,or type of hospital to which patients presented.Multivariate analysis showed that both increased CCI(P=0.008)and shorter LOS(P=0.019)were predictive of RTS.CONCLUSION Septic arthritis of the knee is an important condition in children.The CCI was associated with RTS at a minimum of 2 years after index procedure.No association was found with age,gender,race,insurance type,or hospital type.Shorter LOS and CCI were associated with RTS in multivariate analysis.Overall,risk of subsequent surgery and readmission after pediatric septic knee arthritis is low,and CCI and shorter LOS are predictive of RTS.展开更多
<span style="font-family:Verdana;"><strong>Objectives: </strong>To determine the epidemiological, clinical, and bacteriological characteristics of septic arthritis of the hip (SAH) among pa...<span style="font-family:Verdana;"><strong>Objectives: </strong>To determine the epidemiological, clinical, and bacteriological characteristics of septic arthritis of the hip (SAH) among patients hospitalized in the departments of Rheumatology in Lomé. <strong>Patients and Methods:</strong> This was a multicentre, descriptive study, conducted over a 16-year period, from January 2004 to December 2020 on patients’ records at the three departments of Rheumatology in Lomé. We included in this study only patients with complete laboratory and radiological data. Patients who underwent hip replacement surgery and those with arthritis of the hip due to all inflammatory arthropathies were excluded. The diagnosis of SAH was based on clinical, radiological and bacteriological features. In the absence of bacteriological confirmation, the presumptive etiological diagnosis was based on epidemiological data, contacting with a person with tuberculosis, the presence of high-grade fever, the mode of presentation of the symptoms, the patient’s general appearance, and the result of the tuberculin skin test. The data was collected using Epi info 7.0 and statistical analysis was performed using STATA/IC 11.0. <strong>Results:</strong> Out of 3776 patients hospitalized in the three departments over the study period, 705 (18.67%) were diagnosed with septic arthritis of which 70 (9.92%) patients with SAH. The 70 patients with SAH were 44 (62.86%) females, and 26 (37.14%) males, with a sex ratio of 1.7 F/M. The mean age of the patients was 42.43 ± 19.37 years (range: 5 years and 80 years) and the mean duration of symptoms was 6.57 ± 8.85 months (range: 2 days and 48 months). The pain was inflammatory in nature in 46 (65.71%) and mechanical in nature in 24 (34.29%) patients. The onset of the disease was progressive in 50 (71.43%) patients and sudden in 20 (28.57%) patients. The locations of the pain were: groin only 25 (35.71%), greater trochanter only 15 (21.43%), groin and lower back 14 (20%), and groin and greater trochanter 9 (12.86%). Sixty-four patients (91.43%) were limping and only six (08.57%) were crippled. Weight loss was noted in 38 (54.29%) patients. A risk factor was identified in 63 (90.00%) patients;they were chronic alcohol abuse 24 (34.29%), poor hygiene 17 (24.29%), sickle cell disease 13 (18.57%), HIV infection five (7.14%), and diabetes four (05.71%). Radiologic features suggestive of SAH were seen on plain radiograph and computed tomography in 55 (78.57%) and 15 (21.43%) patients, respectively. The SAH was unilateral (48 right hip and 20 left hip) in 68 (97.14%) patients and bilateral in two (02.86%) patients. The diagnosis of SAH was probable tuberculosis in 46 (65.71%) patients and probable pyogenic bacteria in 24 (34.29%) patients. The outcome was favourable in 68 (97.14%) patients and two (02.86%) patients died. <strong>Conclusion:</strong> The hip remains a relatively rare localization of infectious pathologies. Most cases of SAH are due to tuberculosis.</span>展开更多
We’re reporting the case of an arthritis to banal germ occurred in concomitance with an advanced polyarticular of gout. It was about a patient of 59 years with alcoholic and gouty chronicle more than 10 years, but wi...We’re reporting the case of an arthritis to banal germ occurred in concomitance with an advanced polyarticular of gout. It was about a patient of 59 years with alcoholic and gouty chronicle more than 10 years, but without specialized medical follow-up. He has been admitted in hospitalization for a big inflammatory and stiff right knee, letting rising the pus through two cutaneous fistulas in a context of non-febrile change of his peripheral polyarthritis of the big and small articulations. Gout was at distal predominance, bilateral, distorting, tophaceous and active. Inflammatory syndrome was important (ESR = 50 mm in the 1st hour and CRP = 28 mg/l) and uricemia was high, at 84 mg/l. The glycaemia, the hepatic, the viral, renal and serological evaluation (HIV and B, C hepatitis) were normal. The bacteriological analysis of the pus collected after puncture of the knee and cleaning identified a negative gram bacillus, Morganella morganii, multi-resistant, but sensitive to the Imipeneme and to the aminosides. The evolution was lethal in a picture of multivisceral failing in spite of a bi-antibiotherapy and under hypo-uricemia treatment prescription.展开更多
Septic arthritis is a rheumatological emergency due to its potential for rapid articular destruction and permanent functional loss. Its incidence ranges between 4 and 29 cases per 100,000 person-years, and depends on ...Septic arthritis is a rheumatological emergency due to its potential for rapid articular destruction and permanent functional loss. Its incidence ranges between 4 and 29 cases per 100,000 person-years, and depends on population variables and preexisting structural joint abnormalities. Clinical manifestations, severity, treatment and prognosis depend on the aetiologic agent, patient basal status and articulation involved. The sternoclavicular and condrosternal articulations are rarely affected. A 24 years old man presented with fever and right shoulder pain. Physical examination revealed swelling, redness, increased local heat, intense pain and functional impairment of the patient’s right shoulder. Laboratory inflammatory markers were elevated. Right sternoclavicular articulation ultrasound, right sternoclavicular articulation X-ray, and galium bone scan have shown sternoclavicular arthritis and medial clavicular osteomyelitis. Blood cultures identified Staphylococcus aureus methicillin sensitive. The patient completed a six week antibiotic regimen and physical rehabilitation program. Herein, the authors report a case of sternoclavicular septic arthritis complicated with osteomyelitis and review aetiology, diagnosis, treatment and prognosis of this rare medical condition.展开更多
Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the dela...Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the delay in diagnosing the primary site infection.We present a case of septic arthritis with primary lung melioidosis,whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis.This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients,even in non-endemic areas.It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.展开更多
Septic arthritis of acromioclavicular （AC） joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients, We r...Septic arthritis of acromioclavicular （AC） joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients, We report a case of septic arthritis of AC joint in an immunocompetent child. A 9 years old girl presented with history of pain in left shoulder for 4 days associated with fever, No history suggestive of any immunocompromised state was complained. On local examination, a swelling of around 3 cm in diameter was found over left AC joint region with raised local temperature, tenderness on palpation and positive response in fluctuation test. Total leukocyte count was 18.7 - 109/L with 80% of neutrophils. Erythrocyte sedimentation rate （ESR） was 28 mm/1 h. C-reactive protein （CRP） was 12 mg/L. X-ray showed enlarged left AC joint space. Ultrasound revealed hypoechoic collection in the AC joint and the surrounding area. The aspirate was thick and purulent in nature, revealing Gram positive cocci at staining. Arthrotomy and thorough lavage of AC joint was done. Culture of the aspirate showed Methicillin Resistant Staphylococcus Aureus （MRSA） after 48 hours that was sensitive to amikacin, gentamicin, erythromycin and teicoplanin. Patient was symptom-free at 2 months of follow-up with no signs of osteomyelitis on the radiographs. Thus this is the first case of AC joint septic arthritis in healthy individual. Being proximal to the shoulder joint, AC joint septic arthritis can be confused with the shoulder joint septic arthritis. Thus, high index of suspicion is required for accurate diagnosis.展开更多
Microbiological diagnosis of chronic osteoarticular infections remains a major challenge,particularly when the clinical presentation is atypical and the pathogen is uncommon.In this unique case,Capnocytophaga canimors...Microbiological diagnosis of chronic osteoarticular infections remains a major challenge,particularly when the clinical presentation is atypical and the pathogen is uncommon.In this unique case,Capnocytophaga canimorsus,a microorganism belonging to the oral microbiota of some domestic animals,caused septic arthritis and multifocal osteomyelitis in the long bone of a 43-year-old immunocompetent man.The patient was treated with two-stage surgery and local and systemic antibiotic therapy,and had a successful recovery.C.canimorsus should be considered as a possible etiological agent in patients with osteoarticular pathology and a history of exposure to domestic animals.展开更多
The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising...The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections.We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis.On hospital day 1,joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri,a pathogen not commonly associated with septic arthritis,and ceftriaxone was administered to target it.On hospital day 7,antibiotic was transitioned to levofloxacin,every other day for 4 weeks.The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay.This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling,especially in a postoperative setting.展开更多
BACKGROUND Pancreatitis,panniculitis,and polyarthritis(PPP)syndrome is a rare form of pancreatic disease.It is characterized by bullous erythematous skin lesions and arthritis,and both are triggered by pancreatic malf...BACKGROUND Pancreatitis,panniculitis,and polyarthritis(PPP)syndrome is a rare form of pancreatic disease.It is characterized by bullous erythematous skin lesions and arthritis,and both are triggered by pancreatic malfunction.Few cases have been described in the literature thus far.Due to the inconsistency in its clinical presentation,its diagnosis can be a challenge.Early therapy initiation is essential to reduce mortality;however,there is currently no gold standard for treatment.CASE SUMMARY A 66-year-old polymorbid male patient presented with several superficial abscesses on both lower legs and painful swelling in the knee.Treatment for septic arthritis and septic skin infection over several weeks failed.His general condition deteriorated gradually and worsened with sudden onset of abdominal pain.A diagnosis of necrotizing pancreatitis was made.He subsequently underwent a laparotomy and drainage of the pancreas.Eventually,our patient improved,and his abdominal complaints,knee pain,and dermal lesions resolved.CONCLUSION PPP syndrome is rare and easily misdiagnosed,as abdominal symptoms may be delayed or absent.Clinicians should consider PPP syndrome if they encounter refractory panniculitis in combination with joint infection.展开更多
Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients adm...Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients admitted for arthritis between 2000 and 2014, in Rheumatology department of Brazzaville university teaching hospital have been included. Among 416 patients listed as cases of arthritis, 201 answered to the inclusion criterias have been kept for analysis. The etiological diagnoses were based on criterias of classification and/or diagnosis used in Rheumatology. Results: 201 patients, 110 men (54.72%) and 91 women (45.28%) were included. The sex-ratio was 1.2, and average age was 45.5 years old (extremes: 8-86 years). Among them, 72 patients had microcrystal arthritis. Septic arthritis and those associated with HIV constituted the second etiological group of 60 patients and respectively, 32 were bacterial and 28 HIV associated arthritis. 58 remaining patients had a chronic inflammatory arthritis. Etiology distribution showed that gout was the most frequent (33.83%), followed by septic arthritis (15.92%), HIV associated arthritis (13.93%) and rheumatoid arthritis (11.94%). In 11 patients (5.5%), etiology was unknown. Conclusion: Three decades after the first publications in Brazzaville, the etiologies of arthritis remain dominated in order of frequency by gout, septic arthritis and HIV associated arthritis and rheumatoid arthritis. The frequency of indeterminate arthritis decreased significantly. Spondy-loarthropathy and autoimmune diseases are more common diagnosis.展开更多
Kohler’s disease is an osteochondrosis of the tarsal navicular bone. The exact causes of osteochondrosis remain unknown. We report a 4-year-old girl with a haematogenous tarsal arthritis who developed a K?hler’s dis...Kohler’s disease is an osteochondrosis of the tarsal navicular bone. The exact causes of osteochondrosis remain unknown. We report a 4-year-old girl with a haematogenous tarsal arthritis who developed a K?hler’s disease immediately after the infection. It is hypothesised that avascular necrosis of the navicular bone was developed secondary to pyogenic arthritis.展开更多
BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy.Multiple reports have focused on th...BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy.Multiple reports have focused on the diagnostic accuracy of different inflammatory markers,however,mainly in the diabetic population.AIM To evaluate the diagnostic accuracy of white cell count(WCC)and C-reactive protein(CRP)as diagnostic tools for this distinction in the non-diabetic cohort.METHODS Data was reviewed from a prospectively maintained Infectious Diseases Unit database of 216 patients admitted at Leicester University Hospitals–United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020(68 mo).All patients with confirmed diagnosis of diabetes were excluded while only those with confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study.For the included patients,we retrospectively retrieved the inflammatory markers(WCCs and CRP)at the time of presentation.Values of CRP 0-10 mg/L and WCC 4.0-11.0×109/L were considered normal.RESULTS After exclusion of patients with confirmed diabetes,25 patients with confirmed foot or ankle infections were included.All infections were confirmed microbiolo-gically with positive intra-operative culture results.7(28%)patients with osteomyelitis(OM)of the foot,11(44%)with OM of the ankle,5(20%)with ankle septic arthritis and 2(8%)patients with post-surgical wound infection were identified.Previous bony surgery was identified in 13(52%)patients,either a corrective osteotomy or an open reduction and internal fixation for a foot or ankle fracture with the infection developing on top of the existing metalwork.21(84%)patients did have raised inflammatory markers while 4(16%)patients failed to mount an inflammatory response even with subsequent debridement and removal of metal work.CRP sensitivity was 84%,while WCC sensitivity was only 28%.CONCLUSION CRP has a relatively good sensitivity in the diagnosis of foot and ankle infections in non-diabetic patients,whereas WCC is a poor inflammatory marker in the detection of such cases.In presence of clinically high level of suspicion of foot or ankle infection,a normal CRP should not rule out the diagnosis of OM.展开更多
Septic arthritis of the sternoclavicular joint is a rare and serious infection. A delay in the diagnosis may lead to serious complications. The appropriate medical and surgical treatment is crucial to the outcome. Thi...Septic arthritis of the sternoclavicular joint is a rare and serious infection. A delay in the diagnosis may lead to serious complications. The appropriate medical and surgical treatment is crucial to the outcome. This article aims to report our experience in the successful management of sternoclavicular joint infection complicated with a lung infection. The authors present an unusual case of sternoclavicular joint infection extending into lung parenchyma with lung abscess formation in a diabetic patient, with uncontrolled diabetes that was successfully treated. At revaluation, he was asymptomatic with no evidence of relapse. Although sternoclavicular joint infection is a rare condition we highlight the importance of clinician’s awareness for an early diagnosis and treatment with broad-spectrum antibiotics and surgery.展开更多
<b><span style="font-family:Verdana;">Introduction</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: With ...<b><span style="font-family:Verdana;">Introduction</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: With a considerable morbidity, mortality and a high financial impact, PJI has been considered as one of the most serious complications after arthroplasty. Special awareness must be given to these patients due to a life threatening systemic PJI related complication, sepsis. A prompt detection and adequate medical management of this situation is crucial for avoiding unfavorable outcomes. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Between January 2011 and December 2012</span></span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> we retrospectively examined adult patients who met PJI-SIRS criteria. Medi</span><span style="font-family:Verdana;">cal history search for patients’ anamnesis, surgical times, laborato</span><span style="font-family:Verdana;">ry-microbiological findings and success rates was performed. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Twenty patients were enrolled in this study with a mean age of 71.35 years. Men population was more commonly affected with 55% of the cases. The knee was mainly the affected joint with 52%. A severe systemic disease was present in 80% of the </span><span style="font-family:Verdana;">cases. A sickness sensation and pain were the most common prodromal</span><span> </span><span style="font-family:Verdana;">symp</span><span style="font-family:Verdana;">toms found 4.9 days before the admission to the hospital. In 85.7% of the</span><span style="font-family:Verdana;"> cases the etiological agent was identified, with </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> as the most common. Two</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">stage surgery treatment was performed with a time interval between admission and the first operation of 5.45</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">h. The mean time during the first and second operation was of 23 minutes and 117 minutes respectively. A reduction on microbiological positive cultures was found after </span><span><span style="font-family:Verdana;">the first rapid operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0038). Serum CRP levels and fever </span></span><span style="font-family:Verdana;">disappearance were the first parameters which indicated a favorable disease evolution </span><span><span style="font-family:Verdana;">after the first operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0137) and (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0181) respectively. A</span></span><span style="font-family:Verdana;"> successful </span><span><span style="font-family:Verdana;">management was possible in 90% of the cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Sepsis in patients with PJI announces itself early through the leading symptoms of feel</span></span><span style="font-family:Verdana;">ing sick and pain in the affected joint. This time interval should be used</span><span style="font-family:Verdana;"> therapeutically</span><span style="font-family:Verdana;"> and diagnostically to prevent the complication of a life-threatening</span><span style="font-family:Verdana;"> sepsis at best.</span></span>展开更多
文摘Acute septic arthritis in children is an orthopaedic emergency.A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence.The clinical presentation can be a diagnostic challenge,especially in young children.A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis.Ultrasound is helpful in detecting the presence of a joint effusion.Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis.The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint,in case of a positive culture or a positive gram stain of the joint fluid,or if there is a white blood-cell count in the joint fluid of more than 50000/mm3.Staphylococcus aureus is the most commonly cultured organism.Recent systematic reviews have identified the most effective drainage techniques,including needle aspiration,arthroscopy and arthrotomy,depending on the affected joint.After the drainage procedure it is important to monitor the clinical and laboratory outcomes.Additional drainage procedures may be necessary in select cases.
基金The study was reviewed and approved by the I.M.Sechenov First Moscow State Medical University Institutional Review Board(Approval No.03-22).
文摘BACKGROUND Septic arthritis of the hand,which is the second most common after damage of the knee joint,remains one of the leading causes of temporary disability.An inflammation can cause dysfunction of the joint,and in the most severe cases,the need for amputation of the finger may arise.The results of their treatment today,especially from a functional point of view,cannot be considered satisfactory.Urgent surgical treatment is extremely important in septic arthritis of the hand,as it helps to prevent cartilage destruction and the development of osteomyelitis.AIM To explore the features of the course of septic arthritis of the hand as well as approaches to surgical treatment and its results,depending on the nature of the damage to the articular structures.METHODS The results of the treatment of 170 patients with septic arthritis of the hand,which were treated in the period of 2020-2021,were analyzed.Inflammation of the interphalangeal and metacarpophalangeal joints(MCP)of fingers 1,2,and 3 was more often noted in 147(81.6%)joints.The most common cause of arthritis was a penetrating injury as a result of household trauma(101,59.4%),animal bite(30,17.6%),and clenched fist injury(15,8.8%).Septic arthritis with contiguous osteomyelitis was observed in 98(54.4%)cases.Surgical treatment was completed with drainage and irrigation of the joint.Early mobilization was used to restore function.In patients with osteomyelitis,it was aimed at the formation of neoarthrosis.Arthrodesis was not applied.Long-term results of treatment were assessed in 142(83.5%)patients within 1 mo to 12 mo after discharge from the hospital[the median was 7 mo(IQR:4-9)].RESULTS The most commonly isolated organism was Staphylococcus aureus(35.3%).The median treatment delay in patients without osteomyelitis was 5 d(IQR:4-7);for septic arthritis with contiguous osteomyelitis,it was 14 d(IQR:5-21).Radiography for osteomyelitis within 2 wk was uninformative:41.2%of diagnoses.A single surgical treatment was required in 138(81.2%)patients,two treatments in 22(12.9%),and three or more in 10(5.9%).Total elimination of the infection was achieved in 163(95.9%)patients.The best functional results of treatment were noted in patients without osteomyelitis.After septic arthritis,Total Active Motion(TAM)for the MCP was 96.2%(IQR:85.1-98.0),for the proximal interphalangeal joint(PIP)82.4%(IQR:54.5-98.5),and for the distal interphalangeal joint(DIP)69.4%(IQR:65.4-74.1).In cases with osteomyelitis,it was possible to achieve the formation of neoarthrosis with TAM for MCP-64.2%(IQR:45.3-90.1),for PIP-62.5%(IQR:41.8-68.9),and for DIP-59.4%(IQR:50-62.1).Additionally,the severity of pain during movements did not exceed 1 point.CONCLUSION The delay in treatment of patients with septic arthritis of the hand was accompanied by a high incidence of osteomyelitis,especially in the presence of diabetes mellitus.Urgent surgical treatment,along with continued irrigation of the joint and antibiotic therapy,made it possible to eliminate the infection,and early rehabilitation restored the range of motion.The best results were noted in patients without osteomyelitis.With the development of osteomyelitis,a complex of early rehabilitation measures also made it possible to partially restore the range of motion due to the formation of neoarthrosis,without resorting to arthrodesis.
文摘Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger.They rank second in the frequency of occurrence after lesions of the knee joint.Many points concerning the etiology,the timing of the development of cartilage destruction and the development of osteomyelitis,approaches to surgical treatment,the duration of antibiotic therapy,and the start of rehabilitation measures remain the subject of numerous discussions.Based on a search in the PubMed,Web of Science and Google Scholar databases down to 1990-2021,publications on septic arthritis of the hand were found and analyzed.The following inclusion criteria were used in our review:(1) Septic arthritis of the hand;(2) Published in a peer review journal;(3) Written in English;and(4) Full text version available.Studies were excluded if they met any of the following criteria:(1) Letters;(2) Articles published in abstract form only;and(3) Cadaveric studies.Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers(> 50% of cases).Up to 90% of cases,the infection enters the joint as a result of penetrating trauma,animal bites,etc.Staphylococcus aureus became the most frequently isolated microorganism(30%-55%),and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found,according to various sources,from 0% to 73% among all isolated Staphylococcus aureus.In arthritis,Pasteurella multocida(6%-11%) is often isolated as a result of animal bites.Articular cartilage destruction in the experiment developed within 24-48 h after infection.In clinical studies,the development of osteomyelitis was noted when treatment was delayed by more than 10 d.X-ray data during the first two weeks were uninformative.Priority of surgical treatment of septic arthritis.Drainage and surgical treatment,and with the development of osteomyelitis,the implementation of arthrodesis.Antibacterial therapy for 2-4 wk and early start of rehabilitation measures.Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.
文摘The severity of septic arthritis of the hand and the prospects for restoration of joint function are determined by a complex of factors. Among them, the leading role belongs to local changes in tissue structures. This includes the destruction of articular cartilage and bone tissue with the development of osteomyelitis, the involvement of paraarticular soft tissues in the purulent process, and the destruction of the flexor/extensor tendons of the fingers. The currently missing specialized classification of septic arthritis could help in systematizing the diseases, determining treatment tactics, and predicting the results of treatment.The classification of septic arthritis of the hand proposed for discussion is based on the following principle: Joint-Wound-Tendon(Jx Wx Tx);Jx characterizes damage to the osteochondral structures of the joint, Wx is the presence of paraarticular purulent wounds or fistulas, and Tx is destruction of the flexor/extensor tendons of the finger. The classification of the diagnosis makes it possible to assess the nature and severity of damage to the structures of the joint and may also be useful when comparing the results of treatment of septic arthritis of the hand.
文摘BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.
文摘BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical characteristic.Conventional ultrasound,plain radiographs,and computed tomography are not able to confirm or even suspect arthritis early.Superb microvascular imaging is a new advanced Doppler technique in evaluating low-flow microvascular patterns.The higher sensitivity for increased perisynovial vascularity helps to suspect septic arthritis and forms a methodical approach to using magnetic resonance imaging(MRI).CASE SUMMARY A 34-year-old immunocompetent woman presented with a fever and a dull ache in the chest radiating to the right arm.Traumatic injury and the most common respiratory and cardiac disorders were ruled out.Blood cultures came back positive for Staphylococcus aureus,and sepsis was confirmed.A small lump was noted on the chest during the first week of hospitalization.Superb microvascular imaging was performed and septic arthritis of the manubriosternal joint was detected.MRI confirmed the diagnosis and showed septic arthritis of the manubriosternal joint with several localized abscesses behind the sternum.The patient was treated for three weeks with intravenous antibiotics and the outcome was favorable:Inflammatory markers became normal,and the lump disappeared.Three months later,the patient was examined for a new episode of mild pain in the sternum and was diagnosed with persistent perichondritis by ultrasound in comparison with MRI.CONCLUSION Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.
文摘BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and factors associated with return to surgery(RTS)and readmission after index surgical debridement for septic arthritis of the knee in children.METHODS This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project(HCUP).We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017.Demographic data included age,gender,race,hospital type and insurance type.Clinical data including index admission length of stay(LOS)and Charlson Comorbidity Index(CCI)were available from the HCUP database.Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.RESULTS Nine-hundred thirty-two cases of pediatric septic knee were included.This cohort was 62.3%male,with mean age of 9.0(±6.1)years.Approximately 46%of patients were white and approximately half had Medicaid insurance.Thirty-six patients(3.6%)required RTS at a minimum of 2 year after index surgery,and 172 patients(18.5%)were readmitted at any point.The mean readmission LOS was 11.6(±11.3)d.Higher CCI was associated with RTS(P=0.041).There were no significant associations in age,gender,race,insurance type,or type of hospital to which patients presented.Multivariate analysis showed that both increased CCI(P=0.008)and shorter LOS(P=0.019)were predictive of RTS.CONCLUSION Septic arthritis of the knee is an important condition in children.The CCI was associated with RTS at a minimum of 2 years after index procedure.No association was found with age,gender,race,insurance type,or hospital type.Shorter LOS and CCI were associated with RTS in multivariate analysis.Overall,risk of subsequent surgery and readmission after pediatric septic knee arthritis is low,and CCI and shorter LOS are predictive of RTS.
文摘<span style="font-family:Verdana;"><strong>Objectives: </strong>To determine the epidemiological, clinical, and bacteriological characteristics of septic arthritis of the hip (SAH) among patients hospitalized in the departments of Rheumatology in Lomé. <strong>Patients and Methods:</strong> This was a multicentre, descriptive study, conducted over a 16-year period, from January 2004 to December 2020 on patients’ records at the three departments of Rheumatology in Lomé. We included in this study only patients with complete laboratory and radiological data. Patients who underwent hip replacement surgery and those with arthritis of the hip due to all inflammatory arthropathies were excluded. The diagnosis of SAH was based on clinical, radiological and bacteriological features. In the absence of bacteriological confirmation, the presumptive etiological diagnosis was based on epidemiological data, contacting with a person with tuberculosis, the presence of high-grade fever, the mode of presentation of the symptoms, the patient’s general appearance, and the result of the tuberculin skin test. The data was collected using Epi info 7.0 and statistical analysis was performed using STATA/IC 11.0. <strong>Results:</strong> Out of 3776 patients hospitalized in the three departments over the study period, 705 (18.67%) were diagnosed with septic arthritis of which 70 (9.92%) patients with SAH. The 70 patients with SAH were 44 (62.86%) females, and 26 (37.14%) males, with a sex ratio of 1.7 F/M. The mean age of the patients was 42.43 ± 19.37 years (range: 5 years and 80 years) and the mean duration of symptoms was 6.57 ± 8.85 months (range: 2 days and 48 months). The pain was inflammatory in nature in 46 (65.71%) and mechanical in nature in 24 (34.29%) patients. The onset of the disease was progressive in 50 (71.43%) patients and sudden in 20 (28.57%) patients. The locations of the pain were: groin only 25 (35.71%), greater trochanter only 15 (21.43%), groin and lower back 14 (20%), and groin and greater trochanter 9 (12.86%). Sixty-four patients (91.43%) were limping and only six (08.57%) were crippled. Weight loss was noted in 38 (54.29%) patients. A risk factor was identified in 63 (90.00%) patients;they were chronic alcohol abuse 24 (34.29%), poor hygiene 17 (24.29%), sickle cell disease 13 (18.57%), HIV infection five (7.14%), and diabetes four (05.71%). Radiologic features suggestive of SAH were seen on plain radiograph and computed tomography in 55 (78.57%) and 15 (21.43%) patients, respectively. The SAH was unilateral (48 right hip and 20 left hip) in 68 (97.14%) patients and bilateral in two (02.86%) patients. The diagnosis of SAH was probable tuberculosis in 46 (65.71%) patients and probable pyogenic bacteria in 24 (34.29%) patients. The outcome was favourable in 68 (97.14%) patients and two (02.86%) patients died. <strong>Conclusion:</strong> The hip remains a relatively rare localization of infectious pathologies. Most cases of SAH are due to tuberculosis.</span>
文摘We’re reporting the case of an arthritis to banal germ occurred in concomitance with an advanced polyarticular of gout. It was about a patient of 59 years with alcoholic and gouty chronicle more than 10 years, but without specialized medical follow-up. He has been admitted in hospitalization for a big inflammatory and stiff right knee, letting rising the pus through two cutaneous fistulas in a context of non-febrile change of his peripheral polyarthritis of the big and small articulations. Gout was at distal predominance, bilateral, distorting, tophaceous and active. Inflammatory syndrome was important (ESR = 50 mm in the 1st hour and CRP = 28 mg/l) and uricemia was high, at 84 mg/l. The glycaemia, the hepatic, the viral, renal and serological evaluation (HIV and B, C hepatitis) were normal. The bacteriological analysis of the pus collected after puncture of the knee and cleaning identified a negative gram bacillus, Morganella morganii, multi-resistant, but sensitive to the Imipeneme and to the aminosides. The evolution was lethal in a picture of multivisceral failing in spite of a bi-antibiotherapy and under hypo-uricemia treatment prescription.
文摘Septic arthritis is a rheumatological emergency due to its potential for rapid articular destruction and permanent functional loss. Its incidence ranges between 4 and 29 cases per 100,000 person-years, and depends on population variables and preexisting structural joint abnormalities. Clinical manifestations, severity, treatment and prognosis depend on the aetiologic agent, patient basal status and articulation involved. The sternoclavicular and condrosternal articulations are rarely affected. A 24 years old man presented with fever and right shoulder pain. Physical examination revealed swelling, redness, increased local heat, intense pain and functional impairment of the patient’s right shoulder. Laboratory inflammatory markers were elevated. Right sternoclavicular articulation ultrasound, right sternoclavicular articulation X-ray, and galium bone scan have shown sternoclavicular arthritis and medial clavicular osteomyelitis. Blood cultures identified Staphylococcus aureus methicillin sensitive. The patient completed a six week antibiotic regimen and physical rehabilitation program. Herein, the authors report a case of sternoclavicular septic arthritis complicated with osteomyelitis and review aetiology, diagnosis, treatment and prognosis of this rare medical condition.
文摘Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the delay in diagnosing the primary site infection.We present a case of septic arthritis with primary lung melioidosis,whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis.This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients,even in non-endemic areas.It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.
文摘Septic arthritis of acromioclavicular （AC） joint is a rare entity. It is generally seen in patients who are immunocompromised. Only 15 cases have been reported till now, with only one case series of 6 patients, We report a case of septic arthritis of AC joint in an immunocompetent child. A 9 years old girl presented with history of pain in left shoulder for 4 days associated with fever, No history suggestive of any immunocompromised state was complained. On local examination, a swelling of around 3 cm in diameter was found over left AC joint region with raised local temperature, tenderness on palpation and positive response in fluctuation test. Total leukocyte count was 18.7 - 109/L with 80% of neutrophils. Erythrocyte sedimentation rate （ESR） was 28 mm/1 h. C-reactive protein （CRP） was 12 mg/L. X-ray showed enlarged left AC joint space. Ultrasound revealed hypoechoic collection in the AC joint and the surrounding area. The aspirate was thick and purulent in nature, revealing Gram positive cocci at staining. Arthrotomy and thorough lavage of AC joint was done. Culture of the aspirate showed Methicillin Resistant Staphylococcus Aureus （MRSA） after 48 hours that was sensitive to amikacin, gentamicin, erythromycin and teicoplanin. Patient was symptom-free at 2 months of follow-up with no signs of osteomyelitis on the radiographs. Thus this is the first case of AC joint septic arthritis in healthy individual. Being proximal to the shoulder joint, AC joint septic arthritis can be confused with the shoulder joint septic arthritis. Thus, high index of suspicion is required for accurate diagnosis.
文摘Microbiological diagnosis of chronic osteoarticular infections remains a major challenge,particularly when the clinical presentation is atypical and the pathogen is uncommon.In this unique case,Capnocytophaga canimorsus,a microorganism belonging to the oral microbiota of some domestic animals,caused septic arthritis and multifocal osteomyelitis in the long bone of a 43-year-old immunocompetent man.The patient was treated with two-stage surgery and local and systemic antibiotic therapy,and had a successful recovery.C.canimorsus should be considered as a possible etiological agent in patients with osteoarticular pathology and a history of exposure to domestic animals.
文摘The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections.We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis.On hospital day 1,joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri,a pathogen not commonly associated with septic arthritis,and ceftriaxone was administered to target it.On hospital day 7,antibiotic was transitioned to levofloxacin,every other day for 4 weeks.The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay.This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling,especially in a postoperative setting.
文摘BACKGROUND Pancreatitis,panniculitis,and polyarthritis(PPP)syndrome is a rare form of pancreatic disease.It is characterized by bullous erythematous skin lesions and arthritis,and both are triggered by pancreatic malfunction.Few cases have been described in the literature thus far.Due to the inconsistency in its clinical presentation,its diagnosis can be a challenge.Early therapy initiation is essential to reduce mortality;however,there is currently no gold standard for treatment.CASE SUMMARY A 66-year-old polymorbid male patient presented with several superficial abscesses on both lower legs and painful swelling in the knee.Treatment for septic arthritis and septic skin infection over several weeks failed.His general condition deteriorated gradually and worsened with sudden onset of abdominal pain.A diagnosis of necrotizing pancreatitis was made.He subsequently underwent a laparotomy and drainage of the pancreas.Eventually,our patient improved,and his abdominal complaints,knee pain,and dermal lesions resolved.CONCLUSION PPP syndrome is rare and easily misdiagnosed,as abdominal symptoms may be delayed or absent.Clinicians should consider PPP syndrome if they encounter refractory panniculitis in combination with joint infection.
文摘Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients admitted for arthritis between 2000 and 2014, in Rheumatology department of Brazzaville university teaching hospital have been included. Among 416 patients listed as cases of arthritis, 201 answered to the inclusion criterias have been kept for analysis. The etiological diagnoses were based on criterias of classification and/or diagnosis used in Rheumatology. Results: 201 patients, 110 men (54.72%) and 91 women (45.28%) were included. The sex-ratio was 1.2, and average age was 45.5 years old (extremes: 8-86 years). Among them, 72 patients had microcrystal arthritis. Septic arthritis and those associated with HIV constituted the second etiological group of 60 patients and respectively, 32 were bacterial and 28 HIV associated arthritis. 58 remaining patients had a chronic inflammatory arthritis. Etiology distribution showed that gout was the most frequent (33.83%), followed by septic arthritis (15.92%), HIV associated arthritis (13.93%) and rheumatoid arthritis (11.94%). In 11 patients (5.5%), etiology was unknown. Conclusion: Three decades after the first publications in Brazzaville, the etiologies of arthritis remain dominated in order of frequency by gout, septic arthritis and HIV associated arthritis and rheumatoid arthritis. The frequency of indeterminate arthritis decreased significantly. Spondy-loarthropathy and autoimmune diseases are more common diagnosis.
文摘Kohler’s disease is an osteochondrosis of the tarsal navicular bone. The exact causes of osteochondrosis remain unknown. We report a 4-year-old girl with a haematogenous tarsal arthritis who developed a K?hler’s disease immediately after the infection. It is hypothesised that avascular necrosis of the navicular bone was developed secondary to pyogenic arthritis.
文摘BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy.Multiple reports have focused on the diagnostic accuracy of different inflammatory markers,however,mainly in the diabetic population.AIM To evaluate the diagnostic accuracy of white cell count(WCC)and C-reactive protein(CRP)as diagnostic tools for this distinction in the non-diabetic cohort.METHODS Data was reviewed from a prospectively maintained Infectious Diseases Unit database of 216 patients admitted at Leicester University Hospitals–United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020(68 mo).All patients with confirmed diagnosis of diabetes were excluded while only those with confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study.For the included patients,we retrospectively retrieved the inflammatory markers(WCCs and CRP)at the time of presentation.Values of CRP 0-10 mg/L and WCC 4.0-11.0×109/L were considered normal.RESULTS After exclusion of patients with confirmed diabetes,25 patients with confirmed foot or ankle infections were included.All infections were confirmed microbiolo-gically with positive intra-operative culture results.7(28%)patients with osteomyelitis(OM)of the foot,11(44%)with OM of the ankle,5(20%)with ankle septic arthritis and 2(8%)patients with post-surgical wound infection were identified.Previous bony surgery was identified in 13(52%)patients,either a corrective osteotomy or an open reduction and internal fixation for a foot or ankle fracture with the infection developing on top of the existing metalwork.21(84%)patients did have raised inflammatory markers while 4(16%)patients failed to mount an inflammatory response even with subsequent debridement and removal of metal work.CRP sensitivity was 84%,while WCC sensitivity was only 28%.CONCLUSION CRP has a relatively good sensitivity in the diagnosis of foot and ankle infections in non-diabetic patients,whereas WCC is a poor inflammatory marker in the detection of such cases.In presence of clinically high level of suspicion of foot or ankle infection,a normal CRP should not rule out the diagnosis of OM.
文摘Septic arthritis of the sternoclavicular joint is a rare and serious infection. A delay in the diagnosis may lead to serious complications. The appropriate medical and surgical treatment is crucial to the outcome. This article aims to report our experience in the successful management of sternoclavicular joint infection complicated with a lung infection. The authors present an unusual case of sternoclavicular joint infection extending into lung parenchyma with lung abscess formation in a diabetic patient, with uncontrolled diabetes that was successfully treated. At revaluation, he was asymptomatic with no evidence of relapse. Although sternoclavicular joint infection is a rare condition we highlight the importance of clinician’s awareness for an early diagnosis and treatment with broad-spectrum antibiotics and surgery.
文摘<b><span style="font-family:Verdana;">Introduction</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: With a considerable morbidity, mortality and a high financial impact, PJI has been considered as one of the most serious complications after arthroplasty. Special awareness must be given to these patients due to a life threatening systemic PJI related complication, sepsis. A prompt detection and adequate medical management of this situation is crucial for avoiding unfavorable outcomes. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Between January 2011 and December 2012</span></span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> we retrospectively examined adult patients who met PJI-SIRS criteria. Medi</span><span style="font-family:Verdana;">cal history search for patients’ anamnesis, surgical times, laborato</span><span style="font-family:Verdana;">ry-microbiological findings and success rates was performed. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Twenty patients were enrolled in this study with a mean age of 71.35 years. Men population was more commonly affected with 55% of the cases. The knee was mainly the affected joint with 52%. A severe systemic disease was present in 80% of the </span><span style="font-family:Verdana;">cases. A sickness sensation and pain were the most common prodromal</span><span> </span><span style="font-family:Verdana;">symp</span><span style="font-family:Verdana;">toms found 4.9 days before the admission to the hospital. In 85.7% of the</span><span style="font-family:Verdana;"> cases the etiological agent was identified, with </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> as the most common. Two</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">stage surgery treatment was performed with a time interval between admission and the first operation of 5.45</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">h. The mean time during the first and second operation was of 23 minutes and 117 minutes respectively. A reduction on microbiological positive cultures was found after </span><span><span style="font-family:Verdana;">the first rapid operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0038). Serum CRP levels and fever </span></span><span style="font-family:Verdana;">disappearance were the first parameters which indicated a favorable disease evolution </span><span><span style="font-family:Verdana;">after the first operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0137) and (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0181) respectively. A</span></span><span style="font-family:Verdana;"> successful </span><span><span style="font-family:Verdana;">management was possible in 90% of the cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Sepsis in patients with PJI announces itself early through the leading symptoms of feel</span></span><span style="font-family:Verdana;">ing sick and pain in the affected joint. This time interval should be used</span><span style="font-family:Verdana;"> therapeutically</span><span style="font-family:Verdana;"> and diagnostically to prevent the complication of a life-threatening</span><span style="font-family:Verdana;"> sepsis at best.</span></span>
