RESUMEN
BACKGROUND: Shewanella putrefaciens is a gram-negative, nonfermenting, oxidase-positive, hydrogen sulfide-producing bacillus and a halophilic bacterium, known for causing unusual infections in humans and often regarded as an opportunistic pathogen. Its diverse symptoms have a significant impact on human health, with 260 documented disorders reported in the literature over the last 40 years, highlighting its potential danger. CASE PRESENTATION: We present the case of a previously healthy 15-year-old male patient who sustained a self-inflicted sharp-object injury while working in the field, resulting in secondary septic monoarthritis due to Shewanella putrefaciens. CONCLUSIONS: This case highlights the bacteriological and clinical characteristics, as well as the antibiogram, of Shewanella spp. Given the recent increase in notifications of Shewanella infections, predominantly by S. algae and S. putrefaciens, it is essential to consider these pathogens in patients with a history of contact with bodies of water. Special attention must be paid to their resistance patterns in patient management to prevent the development of intrinsic antimicrobial resistance.
Asunto(s)
Antibacterianos , Artritis Infecciosa , Infecciones por Bacterias Gramnegativas , Shewanella putrefaciens , Humanos , Shewanella putrefaciens/aislamiento & purificación , Masculino , Adolescente , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Infecciosa/tratamiento farmacológico , Antibacterianos/uso terapéutico , Pruebas de Sensibilidad Microbiana , Articulación de la Rodilla/microbiologíaRESUMEN
OBJECTIVE: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. METHODS: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. RESULTS: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. CONCLUSION: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.
Asunto(s)
Artritis Infecciosa , Staphylococcus aureus Resistente a Meticilina , Osteomielitis , Sepsis , Infecciones Estafilocócicas , Lactante , Recién Nacido , Humanos , Masculino , Femenino , Estudios Retrospectivos , Artritis Infecciosa/complicaciones , Artritis Infecciosa/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus , Osteomielitis/complicaciones , Osteomielitis/tratamiento farmacológico , Sepsis/complicaciones , Antibacterianos/uso terapéuticoRESUMEN
We investigated the microbiology, management, and orthopedic outcomes of osteoarticular infections in infants age ≤1 year at our institution. Among 87 patients, Staphylococcus aureus was the most common pathogen (44.8%), followed by group B Streptococcus. Twenty-nine patients (33%), with a median age of 9.2 months, were transitioned to oral antibiotic therapy after ≤14 days of parenteral therapy; orthopedic outcomes were similar to those with prolonged parenteral therapy.
Asunto(s)
Antibacterianos/administración & dosificación , Artritis Infecciosa/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/tratamiento farmacológico , Administración Intravenosa , Administración Oral , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/aislamiento & purificación , Resultado del TratamientoRESUMEN
Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)
Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)
Asunto(s)
Humanos , Masculino , Adulto , Artritis Infecciosa/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Artrocentesis , Artritis Infecciosa/complicaciones , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/microbiología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagenRESUMEN
BACKGROUND: Primary meningococcal arthritis (PMA) is defined as the presence of acute septic arthritis with the identification of Neisseria meningitidis in synovial fluid or blood cultures but no clinical evidence of sepsis or meningitis. This report aimed to describe a clinical case of PMA caused by serogroup W, an uncommon etiology of this disease in Uruguay, and review the available literature. CASE REPORT: We report the case of a 5-year-old female, with no past medical history, admitted to the emergency department with a 12-hour history of fever of 39 °C and a limp. The patient was hemodynamically stable and had no clinical evidence of meningitis. Hip ultrasound showed an increase in synovial fluid. Arthrocentesis showed purulent exudate and synovial fluid culture showed no growth after five days. The blood culture showed isolates of N. meningitidis, serogroup W. The patient received treatment with ceftriaxone, and drainage of the affected joint was performed with excellent clinical response. CONCLUSIONS: Primary meningococcal arthritis is a rare presentation of meningococcal disease. Systematic arthrocentesis and the adequacy of antibiotic therapy when septic arthritis is clinically suspected are essential for confirming the diagnosis and decompressive drainage of the involved joint. This report is the first of PMA caused by serogroup W in Uruguay. Although the most common serogroup involved in meningococcal arthritis is serogroup B in Uruguay, an increase in serogroup W-related diseases has been reported in Chile and Argentina, emphasizing the need for epidemiological surveillance.
Asunto(s)
Artritis Infecciosa , Infecciones Meningocócicas , Neisseria meningitidis , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Ceftriaxona , Niño , Preescolar , Femenino , Humanos , Infecciones Meningocócicas/diagnóstico , Infecciones Meningocócicas/tratamiento farmacológico , SerogrupoRESUMEN
Most studies on chronic chikungunya virus (CHIKV) arthritis include patients treated with disease-modifying antirheumatic drugs (DMARDs), likely altering the expression of clinical manifestations and outcome. Therefore, we sought to evaluate the clinical features and correlates in DMARD-naive patients with chronic CHIKV arthritis. We conducted a case-control study in adult patients with serologically confirmed CHIKV infection in Puerto Rico. Demographic features, clinical manifestations, comorbidities, disease activity (per Clinical Disease Activity Index [CDAI]), functional status (per Health Assessment Questionnaire Disability Index [HAQ-DI]), and pharmacologic treatment were ascertained. Patients with and without chronic CHIKV arthritis were compared. Furthermore, a sub-analysis was performed among patients with chronic CHIKV who presented with mild disease activity versus moderate-to-high disease activity at study visit. In total, 61 patients were studied; 33 patients had chronic arthritis and 28 had resolved arthritis. Patients with chronic arthritis had significantly more diabetes mellitus, chronic back pain, and fever, tiredness, and myalgias on the acute phase. The mean (SD) HAQ score was 0.95 (0.56), and 57.6% had moderate-to-high disease activity. Patients with moderate-to-high disease activity had higher scores in overall HAQ-DI and HAQ-DI categories (dressing and grooming, arising, hygiene, reaching, and activities) than in those with mild activity. In conclusion, in this group of DMARD-naive patients with chronic CHIKV arthritis, nearly 58% had moderate-to-high disease activity and had substantial functional disability. Diabetes mellitus, chronic back pain, and some manifestations on acute infection were associated with chronic CHIKV arthritis.
Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Dolor de Espalda/tratamiento farmacológico , Fiebre Chikungunya/tratamiento farmacológico , Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Actividades Cotidianas , Adulto , Artritis Infecciosa/complicaciones , Artritis Infecciosa/fisiopatología , Artritis Infecciosa/virología , Dolor de Espalda/complicaciones , Dolor de Espalda/fisiopatología , Dolor de Espalda/virología , Estudios de Casos y Controles , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/fisiopatología , Fiebre Chikungunya/virología , Virus Chikungunya , Enfermedad Crónica , Complicaciones de la Diabetes/fisiopatología , Complicaciones de la Diabetes/virología , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/virología , Fatiga/complicaciones , Fatiga/tratamiento farmacológico , Fatiga/fisiopatología , Fatiga/virología , Femenino , Fiebre/complicaciones , Fiebre/tratamiento farmacológico , Fiebre/fisiopatología , Fiebre/virología , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Resumen Introducción: Las infecciones osteoarticulares (IOA) son consideradas una urgencia infectológica en niños. Los principales microorganismos causales son Staphylococcus aureus y Streptococcus pyogenes. Objetivo: Describir las características bio-demográficas y clínicas de pacientes de 2 meses a 15 años hospitalizados entre 2012 y 2017 con diagnóstico de IOA. Pacientes y Métodos: Estudio retrospectivo en un hospital pediátrico. Se revisaron fichas clínicas de pacientes internados con diagnóstico de IOA. Resultados: Se incluyó a 146 pacientes. Un 60,3% fueron de sexo masculino, mediana de edad 3 años 11 meses. El síntoma más frecuente al ingreso fue dolor articular (90%) y la mediana de PCR fue de 43 mg/L. Se obtuvo identificación microbiológica en 48%; de ellos, 67,8 % S. aureus (10,2% resistentes a meticilina). El 94,5% de los pacientes recibió de forma empírica β-lactámico anti-estafilocócico. Un 70,5% de los niños requirió procedimiento quirúrgico. A las 72 h se observó respuesta clínica y a los 4,7 días descenso de parámetros inflamatorios de laboratorio. El 88% de los pacientes cursó sin complicaciones. Conclusiones: Las IOA son más frecuentes en varones, el agente infeccioso más frecuentemente identificado fue S. aureus, por lo cual se sugiere inicio del esquema antimicrobiano con un β-lactámico anti-estafilocócico, ampliando cobertura en pacientes bajo 5 años de edad. A los 5 días del tratamiento antimicrobiano ya hay respuesta clínica y descenso de parámetros inflamatorios.
Abstract Background: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. Aim: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. Methods: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. Results: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. Conclusions: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.
Asunto(s)
Niño , Preescolar , Femenino , Humanos , Masculino , Osteomielitis , Infecciones Estafilocócicas , Artritis Infecciosa , Osteomielitis/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Estudios Retrospectivos , Antibacterianos/uso terapéuticoRESUMEN
Septic arthritis is not a very frequent disease, but with a high morbidity due to the important sequelae that it can cause. The etiology is age-specific, with Staphylococcus aureus being the most frequent microorganism in all ages. Streptococcus agalactiae or group B Streptococcus is an uncommon cause of infection outside the neonatal period. Beyond 3 months of age, infections by this pathogen are associated with serious infections in immunocompromised patients. The treatment of choice is penicillin G or ampicillin. A 4.5-month-old child who developed a group B Streptococcus septic arthritis is reported. The onset was insidious, and the etiological diagnosis prompted us to rule out meningitis and associated immunodeficiency. The extremely low frequency of group B Streptococcus septic arthritis at this age and the importance of ruling out a disseminated disease are crucial learning points in this case.
La artritis séptica es una patología poco frecuente, pero con una alta morbilidad, debido a las importantes secuelas que puede originar. La etiología varía según la edad, y Staphylococcus aureus es el microorganismo más frecuente en todas ellas. Streptococcus agalactiae o del grupo B es una causa infrecuente de infección fuera del período neonatal; se asocia, a partir de los 3 meses de edad, con infecciones graves en pacientes inmunocomprometidos. El tratamiento de elección es penicilina G o ampicilina. Aquí se describe el caso de un niño de cuatro meses y medio de edad que desarrolló una artritis séptica por Streptococcus agalactiae o del grupo B, con inicio insidioso de la clínica. El diagnóstico etiológico obligó a descartar meningitis y una inmunodeficiencia asociada. La frecuencia extremadamente baja de dicha artritis a esta edad y la importancia de descartar una enfermedad diseminada son importantes puntos de aprendizaje en este caso.
Asunto(s)
Artritis Infecciosa/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae/aislamiento & purificación , Antibacterianos/administración & dosificación , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Humanos , Lactante , Masculino , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiologíaRESUMEN
BACKGROUND Iliacus muscle abscess is a rare condition that frequently presents with nonspecific clinical symptoms. Abscesses in the iliacus muscle can arise from contiguous spread from adjacent structures or from distant sites via hematogenous or lymphatic routes. CASE REPORT We report a case of iliacus muscle abscess in a 22-year-old female microbiologist who presented to the emergency department with severe back pain and lower-extremity weakness after returning from a trip to Mexico. She was found to have urinary tract infection due to Salmonella. The patient was found to have left iliacus muscle abscess and septic arthritis of the sacroiliac joint. She was initially treated with piperacillin-tazobactam, vancomycin, and metronidazole, which were later switched to intravenous ceftriaxone and oral levofloxacin. She was successfully treated with antibiotics, with a complete resolution of the multiple tiny abscesses. CONCLUSIONS Iliacus muscle abscess presents with nonspecific symptoms that can mimic neurologic diseases such as spinal cord compression. A high index of suspicion is required to make an early diagnosis and initiate prompt treatment with antibiotics and abscess drainage, if accessible. A detailed history is essential to assess risk factors and establish likely causative organisms. Delay in treatment can lead to an increase in morbidity and mortality. Long-term follow-up is crucial, as the incidence of relapse is high.
Asunto(s)
Artritis Infecciosa/diagnóstico , Absceso del Psoas/diagnóstico , Absceso/tratamiento farmacológico , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Quimioterapia Combinada , Diagnóstico Precoz , Femenino , Humanos , México , Absceso del Psoas/tratamiento farmacológico , Absceso del Psoas/microbiología , Infecciones por Salmonella/tratamiento farmacológico , Viaje , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Adulto JovenRESUMEN
Abstract Objective To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment. Source of data A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database. Synthesis of data Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development. Conclusion A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.
Resumo Objetivo Compilar as informações mais atuais referentes às infecções ostoarticulares em pediatria, inclusive perfil epidemiológico e microbiológico, diagnóstico e tratamento. Fonte dos dados Feita revisão não sistemática nos mecanismos de busca Pubmed, Scielo, Lilacs e Google Scholar, com as palavras-chave bone and joint infection, children, pediatric, osteomyelitis, septic arthritis e espondylodiscitis nos últimos 10 anos. Os artigos mais relevantes foram selecionados pelos autores para compor a base de dados. Síntese dos dados As infecções osteoarticulares ainda são causa importante de morbidade na pediatria. A sua principal etiologia é o Staphylococcus aureus, porém há um aumento na detecção de Kingella kingae, especialmente através de métodos moleculares. A identificação microbiológica possibilita direcionamento de tratamento, enquanto que as provas de atividade inflamatória auxiliam no acompanhamento do tratamento. Exames de imagem são especialmente úteis no diagnóstico inicial das infecções. O tratamento empírico deve incluir cobertura para os principais microrganismos, de acordo com a faixa etária e as condições clínicas do paciente, considerando o perfil de resistência local. Procedimentos cirúrgicos podem ser indicados para diagnóstico, controle do foco e preservação da função. As complicações agudas incluem sepse, trombose venosa profunda e embolia pulmonar. Óbitos são raros. As complicações tardias são incomuns, mas podem levar a deformidades que comprometem o desenvolvimento motor. Conclusão O diagnóstico correto e precoce, com pronta instituição de terapia antimicrobiana adequada e controle do foco, quando indicado, é fundamental para um melhor prognóstico.
Asunto(s)
Humanos , Lactante , Niño , Osteomielitis/tratamiento farmacológico , Osteomielitis/terapia , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/terapia , Kingella kingae , Pediatría , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus , Antibacterianos/uso terapéuticoRESUMEN
OBJECTIVE: To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment. SOURCE OF DATA: A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database. SYNTHESIS OF DATA: Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development. CONCLUSION: A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.
Asunto(s)
Artritis Infecciosa , Kingella kingae , Osteomielitis , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/terapia , Niño , Humanos , Lactante , Osteomielitis/tratamiento farmacológico , Osteomielitis/terapia , Pediatría , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureusRESUMEN
Chikungunya virus is known to cause acute disease characterized by fever, rash, myalgias, conjunctivitis and arthritis, having potential to cause chronic musculoskeletal disease, namely persistent arthritis. The area of spread of the virus in the world has been increasing and the migratory flows make the occurrence of Chikungunya induced chronic arthritis more and more scattered. Data regarding the experience of Portuguese rheumatology centres in identifying and treating chronic ChikV induced arthritis are not available. The authors describe the diagnosis and treatment aspects of three cases of "imported" Chikungunya induced chronic arthritis, briefly discuss its approach in the light of current knowledge and alert to the possibility this situation may become more prevalent in the Portuguese rheumatology setting.
Asunto(s)
Artritis Infecciosa/etiología , Fiebre Chikungunya/complicaciones , Adulto , Antirreumáticos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Brasil/etnología , Virus Chikungunya , Femenino , Articulaciones de los Dedos , Humanos , Hidroxicloroquina/uso terapéutico , Articulación Metacarpofalángica , Persona de Mediana Edad , Portugal , Esteroides/administración & dosificaciónRESUMEN
BACKGROUND: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. AIM: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. METHODS: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. RESULTS: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. CONCLUSIONS: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.
Asunto(s)
Artritis Infecciosa , Osteomielitis , Infecciones Estafilocócicas , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Niño , Preescolar , Femenino , Humanos , Masculino , Osteomielitis/tratamiento farmacológico , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureusRESUMEN
BACKGROUND: There are limited data on the utility of a standard primary total knee arthroplasty (TKA) femoral component with an all polyethylene tibia as a functional prosthetic spacer in place of a conventional all cement spacer for the management of periprosthetic joint infection (PJI). The aim of this multicenter study was to retrospectively review (1) ultimate treatment success; (2) reimplantation rates; (3) reoperation rates; and (4) change in knee range of motion in patients managed with functional prosthetic spacers following TKA PJI. METHODS: A retrospective review was performed for patients at 2 tertiary care centers who underwent a functional prosthetic spacer implantation as part of a functional single-stage (n = 57) or all cement spacer conventional two-stage (n = 137) revision arthroplasty protocol over a 5-year period. Outcomes including reinfection, reimplantation, and reoperation rates, success rate as defined by the Delphi criteria, and final range of motion were compared between the 2 cohorts at a minimum of 2-year follow-up. RESULTS: There was no significant difference in reinfection (14.0 vs 24.1%), reoperation (19.3 vs 27.7%), or success rates (78.9 vs 70.8%; P > .05 for all) between the one-stage and two-stage revision TKA cohorts. Mean final total arc of motion was also similar between the 2 groups (105.8 vs 101.8 degrees, respectively). CONCLUSION: Functional prosthetic spacers offer the advantage of a single procedure with decreased overall hospitalization and improved cost-effectiveness with analogous success rates (78.9%) compared with two-stage exchange (70.8%) at mid-term follow-up. Although long-term data are required to determine its longevity and efficacy, the outcomes in this study are encouraging. LEVEL OF EVIDENCE: 3.
Asunto(s)
Artritis Infecciosa/cirugía , Artroplastia de Reemplazo de Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Reoperación/instrumentación , Anciano , Antibacterianos/administración & dosificación , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/etiología , Artroplastia de Reemplazo de Rodilla/instrumentación , Cementos para Huesos , Femenino , Fémur/cirugía , Humanos , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/etiología , Rango del Movimiento Articular , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUD: Daptomycin has been used in bone and joint infections (BJI) and prosthesis joint infections (PJI) considering spectrum of activity and biofilm penetration. However, the current experience is based on case reports, case series, cohorts, and international surveys. The aim of this systematic review was to evaluate studies about daptomycin treatment efficacy in BJI/PJI compared to other antibiotic regimens. METHODS: PubMed, LILACS, Scielo and Web of Science databases were searched for articles about daptomycin and treatment of BJI and PJI from inception to March 2018. Inclusion criteria were any published researches that included patients with BJI treated with daptomycin. Diagnosis of BJI was based on clinical, laboratory and radiological findings according to IDSA guidelines. RESULTS: From 5107 articles, 12 articles were included. Only three studies described the outcomes of patients with BJI treated with daptomycin with comparator regimen (vancomycin, teicoplanin and oxacillin). Studies presented large heterogeneity regarding device related infections, surgical procedures, and daptomycin regimens (varied from 4â¯mg/kg to 10â¯mg/kg). A total of 299 patients have been included in all studies (184 infections associated with orthopedic disposal and 115 osteomyelitis/septic arthritis). Two hundred and thirty-three patients were treated with daptomycin. The clinical cure rates on device related and non-device related infections (i.e. osteomyelitis) were 70% and 78%, respectively. Compared to all regimens evaluated, daptomycin group outcomes were non-inferior. CONCLUSION: Although a randomized clinical trial is needed, this systematic review tends to support daptomycin usage for bone and joint infections.
Asunto(s)
Antibacterianos/uso terapéutico , Enfermedades Óseas/tratamiento farmacológico , Daptomicina/uso terapéutico , Artropatías/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Artritis Infecciosa/tratamiento farmacológico , Humanos , Prótesis Articulares/efectos adversos , Osteomielitis/tratamiento farmacológicoRESUMEN
ABSTRACT Backgroud: Daptomycin has been used in bone and joint infections (BJI) and prosthesis joint infections (PJI) considering spectrum of activity and biofilm penetration. However, the current experience is based on case reports, case series, cohorts, and international surveys. The aim of this systematic review was to evaluate studies about daptomycin treatment efficacy in BJI/PJI compared to other antibiotic regimens. Methods: PubMed, LILACS, Scielo and Web of Science databases were searched for articles about daptomycin and treatment of BJI and PJI from inception to March 2018. Inclusion criteria were any published researches that included patients with BJI treated with daptomycin. Diagnosis of BJI was based on clinical, laboratory and radiological findings according to IDSA guidelines. Results: From 5107 articles, 12 articles were included. Only three studies described the outcomes of patients with BJI treated with daptomycin with comparator regimen (vancomycin, teicoplanin and oxacillin). Studies presented large heterogeneity regarding device related infections, surgical procedures, and daptomycin regimens (varied from 4 mg/kg to 10 mg/kg). A total of 299 patients have been included in all studies (184 infections associated with orthopedic disposal and 115 osteomyelitis/septic arthritis). Two hundred and thirty-three patients were treated with daptomycin. The clinical cure rates on device related and non-device related infections (i.e. osteomyelitis) were 70% and 78%, respectively. Compared to all regimens evaluated, daptomycin group outcomes were non-inferior. Conclusion: Although a randomized clinical trial is needed, this systematic review tends to support daptomycin usage for bone and joint infections.
Asunto(s)
Humanos , Enfermedades Óseas/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Daptomicina/uso terapéutico , Artropatías/tratamiento farmacológico , Antibacterianos/uso terapéutico , Osteomielitis/tratamiento farmacológico , Artritis Infecciosa/tratamiento farmacológico , Prótesis Articulares/efectos adversosRESUMEN
Introduction: Septic arthritis by Aggregatibacter aphrophilus is an uncommon entity, so it's important to diagnose it early, to avoid serious consequences. In adults, the knee is the most affected site. Methods: We present a case of a 17-year-old boy, with pain in the left knee since one month ago. It shows an increase in local temperature, erythema and movement inability. A nuclear magnetic resonance (NMR) was performed and empirical treatment was given with cephalothin and clindamycin. A knee arthrotomy was realized, and intramedullary secretion and bone tissue was sent to study. Results: the NMR images were suggestive of an infectious process. In the culture gram-negative coccobacilli were isolated, later identified like as Aggregatibacter aphrophilus. According to this diagnostic, the treatment was changed to ceftriaxone The main conclusions: the rapidity and certainty in the choice of antimicrobial therapy is the most important step for a well evolution of this infection, therefore is very important to emphasize the importance of a correct identification of these rare microorganisms
Introducción: Aunque la artritis séptica es una entidad poco común, es importante debido a las graves consecuencias de un diagnóstico tardío o un incorrecto tratamiento. En adultos, la rodilla es el sitio más afectado. El objetivo de este trabajo es presentar un caso clínico de artritis séptica por Aggregatibacter aphrophilus en rodilla en un paciente joven, inmunocompetente, sin antecedentes patológicos. Materiales y métodos: Se estudia el caso de un joven de 17 años, tabaquista, con un cuadro de 1 mes de evolución caracterizado por gonalgia izquierda, aumento de la temperatura local, eritema e impotencia funcional. Se realizan análisis de sangre, una ecografía,y resonancia magnética (RMN).Se solicitan hemocultivos y cultivos de líquido intrarticular de rodilla. En la RMN se observa una lesión expansiva en la región femoral, sugestiva de un proceso infeccioso. Se comienza tratamiento empírico con cefalotina y clindamicina. Se realiza una artrotomia de rodilla enviándose para su estudio secreción endomedular, tejido óseo y endomedular. Resultados: Los hemocultivos y el cultivo del líquido intraarticular fueron negativos, pero los materiales obtenidos por técnica quirúrgica fueron positivos para el cultivo, aislándose cocobacilos gram negativos, posteriormente identificados como Aggregatibacter aphrophilus Se realizó el diagnóstico de artritis séptica por Aggregatibacter aphrophilus y se roto el tratamiento antimicrobiano a ceftriaxona. Conclusión: La rapidez y la certeza en la elección de la terapia antimicrobiana son un paso decisivo para la evolución de la enfermedad, por lo tanto se remarca la importancia de una correcta identificación de estos microorganismos poco frecuentes.
Asunto(s)
Aggregatibacter aphrophilus/aislamiento & purificación , Artritis Infecciosa/microbiología , Articulación de la Rodilla/microbiología , Infecciones por Pasteurellaceae/microbiología , Adolescente , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/tratamiento farmacológico , Ceftriaxona/uso terapéutico , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Infecciones por Pasteurellaceae/diagnóstico por imagen , Infecciones por Pasteurellaceae/tratamiento farmacológicoRESUMEN
An eleven-year-old boy presented with fever and hip pain, with limited mobility of the right side of the hip. Computed tomography scan revealed an increased volume of the right coxo-femoral joint, requiring surgical drainage of purulent secretion, from which Salmonella enterica was isolated. After four weeks of treatment with third-generation cephalosporin, he was discharged with a favorable evolution. Invasive disease caused by Salmonella spp represents a small proportion of salmonellosis cases, although it is responsible for greater rates of hospitalization, morbidity and mortality. Children under 5 years, elders over 60 years and immunodeficient patients have greater risk for invasive salmonellosis.
Asunto(s)
Artritis Infecciosa/microbiología , Infecciones por Salmonella/microbiología , Salmonella enterica/aislamiento & purificación , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Niño , Humanos , Masculino , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/tratamiento farmacológicoRESUMEN
Abstract An eleven-year-old boy presented with fever and hip pain, with limited mobility of the right side of the hip. Computed tomography scan revealed an increased volume of the right coxo-femoral joint, requiring surgical drainage of purulent secretion, from which Salmonella enterica was isolated. After four weeks of treatment with third-generation cephalosporin, he was discharged with a favorable evolution. Invasive disease caused by Salmonella spp represents a small proportion of salmonellosis cases, although it is responsible for greater rates of hospitalization, morbidity and mortality. Children under 5 years, elders over 60 years and immunodeficient patients have greater risk for invasive salmonellosis.