RESUMEN
RATIONALE: Infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa are strongly associated with poor outcomes, including prolonged hospitalization and an increased risk of mortality. Antimicrobial options for the treatment of severe infections due to MDR P aeruginosa are quite limited, and treatment remains challenging. PATIENT CONCERNS: A 65-year-old woman presented to our orthopedic clinic with a 3-month history of progressive pain and stiffness in her left knee. Her primary care provider administered a hyaluronic acid injection, which unfortunately resulted in worsening symptoms. Subsequent treatment included a 1-month course of intravenous gentamicin and ceftriaxone, which failed to alleviate her symptoms. DIAGNOSIS: MDR P aeruginosa septic arthritis of the knee. The culture isolate was tested for susceptibility to multiple antibiotics. Magnetic resonance imaging evaluations were conducted, showing notable erosive and osteolytic changes around the joint surfaces that had progressed significantly. INTERVENTIONS: The patient underwent arthroscopic irrigation and synovectomy. The treatment regimen included a combination of intravenous colistin and piperacillin/tazobactam administered over a 6-week period. Total knee arthroplasty was performed 6 months later without additional antibiotic treatment. OUTCOMES: Patient's knee condition remained continuously stable without abnormal findings of inflammation. The patient's knee range of motion increased 0 to 125 degrees, her pain almost disappeared, and she was able to maintain activities of daily life. LESSONS: This case underscores the challenges of managing infections with MDR organisms in complex clinical scenarios, emphasizing the need for timely intervention and appropriate antibiotic therapy.
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Antibacterianos , Artritis Infecciosa , Farmacorresistencia Bacteriana Múltiple , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Humanos , Femenino , Anciano , Artritis Infecciosa/microbiología , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/diagnóstico , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/aislamiento & purificación , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Articulación de la Rodilla/microbiologíaRESUMEN
Radiography is considered the first-line screening exam for clinically suspected osteomyelitis. However, additional evaluation is generally needed. MRI is the definitive diagnostic exam with high sensitivity and specificity combined with excellent anatomic definition. Gadolinium contrast can be useful to detect areas of devitalization before surgery. Bone marrow edema on fluid-sensitive images and low signal intensity on T1-weighted images in the presence of secondary MRI findings, including ulcer, sinus tract, and cellulitis with or without abscess are typical findings of osteomyelitis. If MRI is contraindicated, three phase bone scan can be used. Early diagnosis and treatment is essential.
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Artritis Infecciosa , Imagen por Resonancia Magnética , Osteomielitis , Humanos , Osteomielitis/diagnóstico por imagen , Osteomielitis/diagnóstico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/terapia , Articulación del Tobillo/diagnóstico por imagenRESUMEN
Objective: To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) in detecting pathogens from joint infection (JI) synovial fluid (SF) samples with previous antibiotic exposure. Methods: From January 2019 to January 2022, 59 cases with suspected JI were enrolled. All cases had antibiotic exposure within 2 weeks before sample collection. mNGS and conventional culture were performed on SF samples. JI was diagnosed based on history and clinical symptoms in conjunction with MSIS criteria. The diagnostic values, including sensitivity, specificity, positive/negative predictive values (PPV/NPV), and accuracy, were in comparison with mNGS and culture. Results: There were 47 of the 59 cases diagnosed with JI, while the remaining 12 were diagnosed with non-infectious diseases. The sensitivity of mNGS was 68.1%, which was significantly higher than that of culture (25.5%, p<0.01). The accuracy of mNGS was significantly higher at 71.2% compared to the culture at 39.0% (p <0.01). Eleven pathogenic strains were detected by mNGS but not by microbiological culture, which included Staphylococcus lugdunensis, Staphylococcus cohnii, Finegoldia magna, Enterococcus faecalis, Staphylococcus saprophytics, Escherichia coli, Salmonella enterica, Pseudomonas aeruginosa, Acinetobacter pittii, Brucella ovis, andCoxiella burnetii. Antibiotic therapy was adjusted based on the mNGS results in 32 (68.1%) patients, including 12 (25.5%) and 20 (42.6%) patients, in whom treatment was upgraded and changed, respectively. All JI patients underwent surgery and received subsequent antibiotic therapy. They were followed up for an average of 23 months (20-27 months), and the success rate of treatment was 89.4%. Out of the 33 patients who had positive results for pathogens, reoperation was performed in 1 case (3.03%), while out of the 14 cases with negative results for both mNGS and cultures, reoperation was performed in 4 cases (28.6%). Conclusions: mNGS has advantages over conventional culture in detecting pathogens in SF samples from JI patients previously treated with antibiotics, potentially improving clinical outcomes.
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Antibacterianos , Bacterias , Secuenciación de Nucleótidos de Alto Rendimiento , Metagenómica , Líquido Sinovial , Humanos , Metagenómica/métodos , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Líquido Sinovial/microbiología , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/clasificación , Bacterias/efectos de los fármacos , Sensibilidad y Especificidad , Adulto , Artritis Infecciosa/microbiología , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológicoRESUMEN
BACKGROUND: Sternoclavicular joint arthritis is a rare condition that poses considerable diagnostic and therapeutic challenges, leading to severe complications and a high mortality rate. Although surgical interventions are often considered necessary for advanced cases, some reports have suggested that conservative management with antibiotic therapy can be effective in certain cases. However, to our knowledge, there are no reports of successful conservative treatment in cases exhibiting aggressive spread. This report highlights a case of advanced sternoclavicular joint arthritis with bone destruction and pulmonary infiltration, successfully treated conservatively with outpatient antibiotic therapy. CASE PRESENTATION: A 58-year-old Japanese male presented with a 1-month history of left-sided shoulder pain. Contrast-enhanced computed tomography showed abscess formation and clavicular bone destruction, with infiltrative shadows suggesting lung involvement. The diagnosis of sternoclavicular joint arthritis was made, and outpatient oral antibiotic therapy was initiated. The patient exhibited a marked reduction in inflammatory marker levels and symptoms, and antibiotic therapy was discontinued after 3 weeks, with no recurrence observed at a 4-month follow-up. CONCLUSIONS: This case highlights that conservative management with antibiotics can be effective for treating advanced sternoclavicular joint arthritis, emphasizing the need for individualized management and further research into non-surgical treatment options.
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Antibacterianos , Artritis Infecciosa , Tratamiento Conservador , Osteomielitis , Articulación Esternoclavicular , Humanos , Masculino , Articulación Esternoclavicular/diagnóstico por imagen , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Osteomielitis/tratamiento farmacológico , Osteomielitis/diagnóstico , Osteomielitis/terapia , Osteomielitis/diagnóstico por imagen , Artritis Infecciosa/terapia , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/diagnóstico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/complicacionesRESUMEN
INTRODUCTION: The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease. PATIENT CONCERNS: A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand. DIAGNOSES: Left-sided infected wrist arthritis complicating ACTS. INTERVENTIONS: The child received emergency surgery and anti-infective treatment combined with regular rehabilitation. OUTCOMES: During the treatment period, the child's wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited. CONCLUSION: In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.
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Artritis Infecciosa , Síndrome del Túnel Carpiano , Articulación de la Muñeca , Humanos , Masculino , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Niño , Artritis Infecciosa/complicaciones , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Artritis Infecciosa/diagnóstico , Antibacterianos/uso terapéutico , Enfermedad AgudaRESUMEN
BACKGROUND: This study aimed to analyze the distribution of pathogens and antimicrobial resistance in bone and joint infections (BJIs) among children under four years old. METHODS: A retrospective analysis was conducted on the clinical data of children under four years old who received inpatient treatment for BJIs at the Children's Hospital of Soochow University between January 2016 and December 2022. Results of bacterial culture and antimicrobial resistance were analyzed. RESULTS: Among the 131 patients, 52 (39.7%) showed positive bacterial culture results. There were Gram-positive (G+) bacteria detected in 38 strains (73.07%), Gram-negative (G-) bacteria in 12 strains (23.08%), and fungi in 2 strains (3.85%). Thirty-one strains of Staphylococcus aureus (S. aureus) were detected (59.62%), including 7 MRSA strains (22.58%). The resistance rate of G+ bacteria to penicillin was 72.97%, while resistance to erythromycin and clindamycin was approximately 50%. No resistance was found against linezolid, vancomycin, and teicoplanin. G- bacteria showed a sensitivity of 100% to carbapenems, including meropenem, ertapenem, and imipenem, a resistance rate of 91.67% to ampicillin-sulbactam, and relatively high resistance rates to compound sulfamethoxazole, ampicillin/sulbactam, and piperacillin. CONCLUSIONS: Regional variations existed in the distribution of pathogens and antimicrobial resistance in children under four years old with BJIs. In our hospital, the most common pathogen is S. aureus, with MRSA accounting for approximately one-fourth of all S. aureus patients. Additionally, extended-spectrum ß-lactamase (ESBL)-producing G- bacteria have been identified, underscoring the importance of careful consideration during empirical antibiotic therapy.
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Antibacterianos , Farmacorresistencia Bacteriana , Pruebas de Sensibilidad Microbiana , Humanos , Preescolar , Estudios Retrospectivos , Lactante , Masculino , Femenino , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Recién Nacido , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Artritis Infecciosa/microbiología , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/epidemiología , Osteomielitis/microbiología , Osteomielitis/tratamiento farmacológicoRESUMEN
BACKGROUNDS: Septic arthritis is a dangerous disease that occurs when microorganisms enter synovial fluid. It needs fast and accurate management; otherwise, it can harm the patient's life. Currently, the tests measure WBC and PMN in SF, so we hypothesized to use a proxy that is easier and faster to measure. Leukocyte esterase is an enzyme secreted by neutrophils that can be found in the synovial fluid of SA patients. In this study, we tried to investigate the sensitivity and specificity of leukocyte esterase in diagnosing septic arthritis. METHODS: We obtained synovial fluid samples from forty-six patients suspected of having septic arthritis and fifty-eight healthy individuals and measured the WBCs, ESR, CRP, PMN, glucose, and protein of SF in 2021. We also used the leukocyte esterase dipstick test to investigate the level of LE in synovial fluid for one minute. RESULTS: Based on clinical and paraclinical criteria, sixteen out of the forty-six patients were diagnosed with SA. When (++) was considered positive, the sensitivity and specificity of the LE dipstick test for the diagnosis of SA were 93.7% (95% CI: 81.8-100%) and 60% (95% CI: 42.4-77.5%, P = 0.000), respectively. When both (+) and (++) were considered positive, they were 100% and 43.3% (95% CI: 25.6-61.0% P = 0.000), respectively. All the patients in the control group had negative cultures and LE test readings (specificity = 100%). CONCLUSION: The LE dipstick test can be a valuable diagnostic tool in the initial diagnosis of SA since it is affordable, fast, and reliable.
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Artritis Infecciosa , Hidrolasas de Éster Carboxílico , Tiras Reactivas , Sensibilidad y Especificidad , Líquido Sinovial , Humanos , Artritis Infecciosa/diagnóstico , Hidrolasas de Éster Carboxílico/análisis , Líquido Sinovial/química , Masculino , Femenino , Persona de Mediana Edad , Adulto , Estudios de Casos y Controles , Proteína C-Reactiva/análisis , Anciano , Sedimentación Sanguínea , Recuento de Leucocitos , Glucosa/análisisRESUMEN
Brucellosis, a zoonotic ailment induced by the Brucella and some patients may present with joint involvement. This report describes a pediatric patient diagnosed with Brucella arthritis, presenting with swelling and pain in the right knee. The patient had a reoccurrence of fever due to sulfamethoxazole-trimethoprim allergy during treatment. Symptoms improved after adjusting the antimicrobial regimen to ceftriaxone and rifampicin. This case emphasizes the importance of the need for brucellosis as a differential diagnosis for arthralgia and fever in brucellosis- endemic areas. Furthermore, it emphasizes the importance of timely recognition that recurrent fever after effective anti-infective therapy must be considered as a possibility of drug fever.
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Antibacterianos , Artritis Infecciosa , Brucelosis , Rifampin , Humanos , Brucelosis/tratamiento farmacológico , Brucelosis/diagnóstico , Brucelosis/microbiología , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/diagnóstico , Antibacterianos/uso terapéutico , Rifampin/uso terapéutico , Niño , Masculino , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Fiebre/tratamiento farmacológico , Fiebre/microbiología , Ceftriaxona/uso terapéutico , Fiebre por MedicamentoRESUMEN
Blau syndrome is an autosomal dominant chronic inflammatory disease, which may begin with skin manifestations in the first months of life, alerting physicians to the diagnosis. This case reports a patient diagnosed jointly by pediatric dermatology and rheumatology consultants at two years of age.
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Artritis , Sarcoidosis , Sinovitis , Uveítis , Humanos , Sinovitis/genética , Sinovitis/diagnóstico , Uveítis/diagnóstico , Sarcoidosis/diagnóstico , Sarcoidosis/patología , Artritis/diagnóstico , Preescolar , Masculino , Femenino , Artritis Infecciosa/diagnóstico , Enfermedades Autoinflamatorias HereditariasRESUMEN
Streptococcal toxic shock syndrome (STSS) is an uncommon disorder characterised by hypotension and multiorgan failure in the setting of streptococcal infection. Recurrent STSS is rare and has been due to recurrence of the same streptococcal species. Here, we present a case of a patient who developed recurrent STSS from a Streptococcus dysgalactiae right native joint septic arthritis and subsequently from a Streptococcus agalactiae left native joint septic arthritis.
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Artritis Infecciosa , Recurrencia , Choque Séptico , Infecciones Estreptocócicas , Streptococcus agalactiae , Humanos , Choque Séptico/microbiología , Artritis Infecciosa/microbiología , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus agalactiae/aislamiento & purificación , Streptococcus/aislamiento & purificación , Masculino , Antibacterianos/uso terapéutico , Femenino , Persona de Mediana EdadRESUMEN
The diagnosis of septic arthritis requires a reliance on ancillary tests, including synovial fluid white blood cell count (jWBC), percentage of polymorphonuclear leukocytes (%PMN), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). This study evaluated these tests to determine their diagnostic utility in suspected septic arthritis. A retrospective chart review was performed on patients admitted to an urban hospital who underwent arthrocentesis. The authors evaluated the jWBC, %PMN, ESR, and CRP with receiver operating characteristic (ROC) curve analyses. Two hundred sixty-five patients met inclusion criteria. Sixty-three had a culture-positive aspirate. ROC curve analysis resulted in an area under the curve (AUC) of 0.80 for jWBC with cutoff point of 22,563 cells/mm3 and an AUC of 0.71 for %PMN with cutoff point of 90.5%. CRP and ESR had AUC values of 0.62 and 0.61, respectively. The culture-positive cohort had higher elevations in all assessed diagnostic tests. However, AUC data for ESR and CRP showed little diagnostic utility. Additionally, sensitivities and specificities of jWBC and %PMN were too low. Associated cutoff points would result in excessive unnecessary operative intervention. Further studies should incorporate synovial fluid biomarkers into the workup of a suspected septic joint. (Journal of Surgical Orthopaedic Advances 33(2):108-111, 2024).
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Artritis Infecciosa , Sedimentación Sanguínea , Proteína C-Reactiva , Líquido Sinovial , Humanos , Artritis Infecciosa/diagnóstico , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Proteína C-Reactiva/análisis , Recuento de Leucocitos , Anciano , Curva ROC , Adulto , Artrocentesis , Neutrófilos , Sensibilidad y Especificidad , Biomarcadores/análisis , Anciano de 80 o más AñosRESUMEN
Aspergillus species are common hyphal fungi. In addition to allergies and mycotoxicosis, Aspergillus species can cause various infections known as aspergillosis. Aspergillosis of the respiratory tract, central nervous system, skin and soft tissues is well described. However, musculoskeletal infections due to invasive aspergillosis are not well described. Fungal joint infection due to invasive aspergillosis is a rare form of septic arthritis. In this case report, a patient who admitted to our hospital for liver transplantation and developed knee joint arthritis caused by Aspergillus flavus/Aspergillus oryzae during this process was presented. A 28-year-old male patient with autoimmune hepatitis was admitted to hospital with decompensated liver cirrhosis and encephalopathy. The patient, who was awaiting an emergency liver transplant, developed pain, swelling and limitation of movement in his right knee and appropriate consultations and tests were requested. Three joint fluid cultures taken one day apart and nine days later were positive for fungal growth. Macroscopic examination of the mould growth and microscopic examination with lactophenol cotton blue suggested a species belonging to the A.flavus complex and the isolate was identified as A.flavus/A.oryzae by matrix-assisted laser desorption/ionisation mass spectrometry (MALDI-TOF MS) (EXS 2600, Zybio, China). As a result of ITS gene sequencing, the species was determined to be A.oryzae. As cases have been reported where A.flavus and A.oryzae species could not be distinguished by ITS gene sequencing, the pathogen was defined as A.flavus/oryzae. The patient died of liver disease during treatment with amphotericin B. There are few cases of arthritis caused by Aspergillus species in the literature. Aspergillus species found in joint infections are, Aspergillus fumigatus, A.flavus, Aspergillus niger and Aspergillus terreus species complexes, in order of frequency. A.flavus and A.oryzae are closely related. They are difficult to distinguish by conventional methods, MALDI-TOF MS or ITS region sequencing, which is commonly used for genus/species identification in fungi. The number of Aspergillus arthritis cases is low and the identification methods applied to the species reported as causative agents in most studies can identify at the species complex level. In addition, it can be assumed that species not previously reported as causative agents may be encountered as a result of developments in identification methods. In the few publications in the literature where A.flavus complex was reported as the causative agent of joint infections, it seems possible that some of the agents may be A.flavus and some may be A.oryzae, since the agents were identified at the complex level. There are a limited number of cases in the literature where A.oryzae is the causative agent, particularly in the respiratory tract. A PubMed search using the keywords "A.oryzae infections, arthritis, osteomyelitis" did not reveal any literature on joint infections caused by A.oryzae.
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Artritis Infecciosa , Aspergilosis , Aspergillus flavus , Aspergillus oryzae , Articulación de la Rodilla , Humanos , Masculino , Adulto , Aspergillus flavus/aislamiento & purificación , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Aspergilosis/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Articulación de la Rodilla/microbiología , Aspergillus oryzae/aislamiento & purificación , Turquía , Hepatitis Autoinmune/microbiología , Hepatitis Autoinmune/tratamiento farmacológico , Trasplante de Hígado , Antifúngicos/uso terapéuticoRESUMEN
Joint infections cause significant morbidity and mortality. Rapid diagnosis enables prompt initiation of appropriate antimicrobial therapy and surgical treatment. We conducted a systematic review and meta-analysis to evaluate the accuracy of genus- or species-specific polymerase chain reaction (PCR) in diagnosing joint infections. The literature databases were searched for articles from January 2010 to December 2022. The meta-analysis using the split component synthesis (SCS) method, included 20 studies with 2,457 adult participants. The pooled sensitivity, specificity, diagnostic odds ratio, and AUC of PCR were 49 % (95 % CI [37.9-60.2]), 95.7 % (95 % CI [91.6-97.8]), 21.32, and 0.82 respectively. Sensitivity was highest for sonicate fluid and lowest for periprosthetic tissue. The mean turnaround time to results was 4.7 hours (SD 1.1). PCR is a favourable option for diagnosing joint infections due to its rapid results, but it has low sensitivity. To enhance diagnostic yield, the test should be used in conjunction with other methods.
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Reacción en Cadena de la Polimerasa , Sensibilidad y Especificidad , Humanos , Reacción en Cadena de la Polimerasa/métodos , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/clasificación , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Técnicas de Diagnóstico Molecular/métodosRESUMEN
BACKGROUND Facet joint septic arthritis (SAFJ) is a rare clinical entity that is extremely challenging to diagnose, often presenting unilaterally and with nonspecific clinical symptoms. However, SAFJ has significant morbidity and mortality, especially with delayed diagnosis. It becomes all the more important for the clinician to recognize that SAFJ can present bilaterally and be associated with direct inoculation, such as in acupuncture. CASE REPORT A 53-year-old woman with chronic alcoholism and well-controlled type 2 diabetes mellitus was initially admitted for progressively worsening atraumatic lower back pain. Initial non-contrast magnetic resonance imaging (MRI) of the lumbar spine revealed bilateral L4-L5 and L5-S1 nonspecific facet joint effusions. Clinical examination was unremarkable. Biochemically, the patient had mildly elevated inflammatory markers. She was treated conservatively with close outpatient follow-up. However, her back pain progressively worsened, with new-onset lower limb weakness and numbness. Repeat MRI showed L4-L5 bilateral facet joint fluid collection with adjacent bony destruction, as well as posterior paraspinal and epidural fluid collections compatible with L4-L5 bilateral SAFJ with paraspinal and epidural abscesses. Urgent surgical drainage and bilateral lateral facet decompression was performed. Intraoperative cultures revealed methicillin-sensitive Staphylococcus aureus as the causative organism. Postoperatively, 6 weeks of intravenous and oral antibiotics were given with good recovery. CONCLUSIONS We describe a case of bilateral SAFJ following acupuncture that was initially missed. With the increasing prevalence of acupuncture treatment for lower back pain, bilateral SAFJ should be a diagnostic consideration. Detailed clinical history is key; this, as well as a high index of suspicion, early evaluation and treatment, are essential to obtain a favorable outcome.
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Terapia por Acupuntura , Artritis Infecciosa , Infecciones Estafilocócicas , Articulación Cigapofisaria , Humanos , Femenino , Persona de Mediana Edad , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/terapia , Terapia por Acupuntura/efectos adversos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Imagen por Resonancia Magnética , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia , Antibacterianos/uso terapéuticoRESUMEN
BACKGROUND: Melioidosis, a life-threatening infection caused by the gram negative bacterium Burkholderia pseudomallei, can involve almost any organ. Bone and joint infections (BJI) are a recognised, but incompletely defined, manifestation of melioidosis that are associated with significant morbidity and mortality in resource-limited settings. METHODOLOGY/PRINCIPAL FINDINGS: We identified all individuals with BJI due to B. pseudomallei managed at Cairns Hospital in tropical Australia between January 1998 and June 2023. The patients' demographics, their clinical findings and their treatment were correlated with their subsequent course. Of 477 culture-confirmed cases of melioidosis managed at the hospital during the study period, 39 (8%) had confirmed BJI; predisposing risk factors for melioidosis were present in 37/39 (95%). However, in multivariable analysis only diabetes mellitus was independently associated with the presence of BJI (odds ratio (95% confidence interval): 4.04 (1.81-9.00), p = 0.001). BJI was frequently only one component of multi-organ involvement: 29/39 (74%) had infection involving other organs and bacteraemia was present in 31/39 (79%). Of the 39 individuals with BJI, 14 (36%) had osteomyelitis, 8 (20%) had septic arthritis and 17 (44%) had both osteomyelitis and septic arthritis; in 32/39 (83%) the lower limb was involved. Surgery was performed in 30/39 (77%). Readmission after the initial hospitalisation was necessary in 11/39 (28%), 5/39 (13%) had disease recrudescence and 3/39 (8%) had relapse; 4/39 (10%) developed pathological fractures. ICU admission was necessary in 11/39 (28%) but all 11 of these patients survived. Only 1/39 (3%) died, 138 days after admission, due to his significant underlying comorbidity. CONCLUSIONS: The case-fatality rate from melioidosis BJI in Australia's well-resourced health system is very low. However, recrudescence, relapse and orthopaedic complications are relatively common and emphasise the importance of collaborative multidisciplinary care that includes early surgical review, aggressive source control, prolonged antibiotic therapy, and thorough, extended follow-up.
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Burkholderia pseudomallei , Melioidosis , Humanos , Melioidosis/diagnóstico , Melioidosis/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Burkholderia pseudomallei/aislamiento & purificación , Adulto , Anciano , Antibacterianos/uso terapéutico , Factores de Riesgo , Osteomielitis/microbiología , Osteomielitis/diagnóstico , Osteomielitis/terapia , Adulto Joven , Australia/epidemiología , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/mortalidad , Estudios Retrospectivos , Adolescente , Resultado del TratamientoRESUMEN
The BioFire Joint Infection Panel (JI panel) is a newly FDA-approved multiplex PCR assay for detection of common bone and joint pathogens with 39 targets which include select Gram-positive and Gram-negative bacteria, yeast, and antimicrobial resistance genes. We evaluated the performance of the JI panel in detecting joint infections in our patient population. Sixty-three frozen, residual joint fluid specimens were retrospectively tested using the JI panel. An additional 104 residual joint fluid specimens were de-identified and prospectively tested within 1 week of collection. Results from routine bacterial cultures were used as the reference standard, which included inoculation to agar plates and blood culture bottles. For the frozen specimens, the JI panel showed a positive percent agreement (PPA) of 92.8% and a negative percent agreement (NPA) of 97.1%. PPA was 71.4% and NPA was 94.8% for fresh specimens. A total of 12 discrepancies were observed among the 167 specimens tested. The JI panel demonstrated good overall agreement with routine culture for the detection of joint infections and may improve timely diagnosis when used in conjunction with bacterial culture. However, potential false-positive and false-negative results were observed in both retrospective and prospective testing of specimens.IMPORTANCEThe BioFire JI panel is a new commercially available multiplex PCR assay for detecting common pathogens causing bone and joint infections. The test is performed directly on joint fluids with a fast turnaround time of 1 hour. Our study shows that while the JI panel overall shows good agreement with routine culture, discrepancies were observed in 7% of cases and results should be interpreted with appropriate clinical context.
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Técnicas de Diagnóstico Molecular , Reacción en Cadena de la Polimerasa Multiplex , Humanos , Reacción en Cadena de la Polimerasa Multiplex/métodos , Estudios Retrospectivos , Estudios Prospectivos , Técnicas de Diagnóstico Molecular/métodos , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/clasificación , Sensibilidad y Especificidad , Masculino , Femenino , Anciano , Persona de Mediana Edad , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , AdultoRESUMEN
BACKGROUND Clostridium cadaveris is a motile, anaerobic, gram-positive, spore-forming bacillus usually found in soil. However, rare cases of opportunistic infections have been documented in immunosuppressed individuals. This report details the case of an immunocompetent young patient who developed septic arthritis of the knee after a traumatic injury involving a rusty nail. The aim of this paper is to provide a comprehensive literature review, shed light on the potential occurrence of Clostridium cadaveris septic arthritis, and explore its management. CASE REPORT A young patient with no medical history presented a traumatic inoculation leading to septic arthritis on a native knee by Clostridium cadaveris. The patient underwent 2 surgical debridements after an initial bad evolution under probabilistic antibiotic therapy. Bacteriological long-growing cultures and antibiotic testing were employed to guide antibiotic therapy selection. The patient had a favorable clinical outcome with no residual knee complications, with laboratory results showed good evolution. A review of the literature showed that Clostridium cadaveris septic arthritis in immunocompetent patients is very rare. The management and subsequent results emphasize the potential impact of the initial emergency room treatment on patient outcomes, especially concerning seemingly benign traumas. CONCLUSIONS This case report highlights the necessity of rapid diagnosis of the cause of septic arthritis, particularly in children, to prevent joint and tissue damage, and the rare diagnosis of knee arthritis with Clostridium cadaveris. This report expands understanding of osteoarticular infections and enhances the need for rapid diagnosis and early treatment, when managing cases with atypical presentations.
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Artritis Infecciosa , Infecciones por Clostridium , Clostridium , Humanos , Artritis Infecciosa/microbiología , Artritis Infecciosa/diagnóstico , Clostridium/aislamiento & purificación , Masculino , Infecciones por Clostridium/diagnóstico , Inmunocompetencia , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/microbiología , Articulación de la Rodilla/microbiología , Antibacterianos/uso terapéuticoRESUMEN
AIM: To quantify and characterise patients with coexistent septic arthritis (SA) and crystal arthritis (CA) (SACA) in an emergency department (ED) setting. METHODS: A single-centre, retrospective, 10-year observational study was conducted at a major referral centre. Patients with a positive joint aspirate for CA or SA carried out in ED, were included. The Newman criteria were utilised to define SA. RESULTS: Of the 567 patients included in the final analysis, 427 had CA and 140 had a final diagnosis of SA. Twenty-three point six percent of patients diagnosed with SA had concomitant CA, while 7.2% of patients diagnosed with CA had concomitant SA. The greatest predisposing factors for SACA were previous history of gout, rheumatoid arthritis, being immunocompromised or having joint metalware. Synovial fluid (SF) white cell count (WCC) showed excellent predictive capability for joint infection with the area under the receiver operating characteristic curves (AUROCs) of 0.81 and 0.87 for SA and SACA respectively. The receiver operating characteristic curves (ROCs) reported a SF WCC cutoff of 32,000/mm3 allowed for 100% sensitivity and approximately 50% specificity. CONCLUSIONS: SACA remains a small but important sub-group of patients at risk of misdiagnosis of CA alone. SF WCC of 32,000/mm3 may be a better cutoff than the traditionally accepted 50,000/mm3, possibly warranting inpatient admission for investigation and management of presumed SA.
Asunto(s)
Artritis Infecciosa , Artropatías por Depósito de Cristales , Humanos , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/epidemiología , Estudios Retrospectivos , Masculino , Femenino , Nueva Zelanda/epidemiología , Anciano , Persona de Mediana Edad , Artropatías por Depósito de Cristales/diagnóstico , Artropatías por Depósito de Cristales/epidemiología , Líquido Sinovial/microbiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Anciano de 80 o más Años , Factores de Riesgo , Adulto , Recuento de Leucocitos , Gota/epidemiología , Gota/diagnóstico , Gota/complicacionesRESUMEN
Background: Septic arthritis is an orthopedic emergency. Diagnosis is difficult in patients with concomitant crystalline arthropathy (gout or pseudogout). The symptomatology of crystal arthritis mimics septic arthritis, clouding clinical diagnosis. Arthrocentesis and synovial fluid analysis are the standard diagnostic tests for both pathologies. Crystals on microscopy are diagnostic of crystal arthritis, however their presence does not rule out septic arthritis. Septic arthritis is diagnosed by positive microbiology culture. Though septic arthritis is associated with elevated synovial total nucleated count (TNC), TNC elevations can also occur with gout. The literature suggests that a TNC count of > 50,000 cells in a crystal-positive joint should raise suspicion for concurrent septic arthritis, however data is limited. Further diagnostic indicators are needed to help clinicians promptly identify crystal positive septic arthritis as the treatments and prognoses are different. Methods: Patients were retrospectively identified who had arthrocentesis of a native joint positive for monosodium urate (MSU) and/or (CPPD) crystals. Laboratory data was collected including synovial fluid cultures, total nucleated cell count (TNC), percent polymorphic neutrophils (%PMN), and crystal analysis; and serum CRP, ESR, and white blood cell count (WBC). Statistical analysis performed using Spearman correlation, Univariate-Fischer's exact and Wilcoxon tests, and multivariate analysis. Results: 442 joints identified with positive CPPD and/or MSU crystals, 31% female, 69% male. Of 442 aspirates, 58 had positive cultures. Patients were more likely to have positive cultures if synovial TNC > 50,000 (odds ratio 7.7), CRP > 10 mg/dL (OR 3.2), PMN > 90% (OR 2.17), and if the patient was female (OR 1.9), all were statistically significant with p < 0.05. There were 55 patients who underwent irrigation and debridement based on clinical suspicion or a positive gram stain, 37 of these ultimately had a positive culture (67%), the remaining 18 had negative cultures. Conclusion: Results are consistent with the literature, a TNC > 50,000 warrants a high suspicion for concurrent septic arthritis and should prompt providers to critically evaluate other patient laboratory data. Results further suggests that a patient with positive crystals, synovial TNC > 50,000 cells, PMN > 90%, and serum CRP > 10mg/dL is at high risk for having a concurrent septic arthritis and may warrant urgent irrigation and debridement and antibiotic therapy. This data serves as a supporting to develop an infection risk calculator for crystal positive septic arthritis. Level of Evidence: III.
Asunto(s)
Artritis Infecciosa , Artrocentesis , Artropatías por Depósito de Cristales , Líquido Sinovial , Humanos , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Femenino , Masculino , Estudios Retrospectivos , Líquido Sinovial/microbiología , Anciano , Persona de Mediana Edad , Artropatías por Depósito de Cristales/diagnóstico , Ácido Úrico/análisis , Adulto , Anciano de 80 o más AñosRESUMEN
Septic arthritis (SA) is a serious infection of the joint which can lead to irreversible destruction of the joint.We report a case of right hip SA with septic pulmonary embolism following a complicated dental extraction in a woman in her early 40s with sickle cell trait (SCT).The patient presented with severe right thigh pain and left jaw pain.Initial workup revealed raised C reactive protein and positive blood cultures. Right hip joint SA was confirmed following intraoperative joint aspiration. The patient had right hip debridement with long-term intravenous antibiotics.The incidence of SA in adults with sickle cell disease is low: 0.3% in a study in France and Brazil and 10.3% incidence of haematogenous osteoarticular infection in children with SCT in West Africa.