Borrelia burgdorferi migrates into joint capsules and causes an up-regulation of interleukin-8 in synovial membranes of dogs experimentally infected with ticks

Twenty 6-week-old specific-pathogen-free beagles were infected with Borrelia burgdorferi by tick challenge, and five uninfected dogs served as controls. During the study, all dogs were monitored for infection, clinical signs, and antibody response against B. burgdorferi. During episodes of lameness or postmortem, synovial fluids from each dog were examined for volume, cell number, polymorphonuclear leukocyte (PMN) content, cell viability, and chemotactic activity. Twenty-five tissues collected postmortem from each dog were tested for interleukin-8 (IL-8) mRNA, tumor necrosis factor alpha (TNF-alpha) mRNA, presence of live spirochetes, and histopathological changes. Thirteen infected dogs (group A), which seroconverted rapidly (maximum titers within 50 to 90 days), developed acute and severe mono- or oligoarthritis almost exclusively in the limb closest to the tick bite (median incubation period, 66 days). Synovial fluids of the arthritic joints collected during episodes of lameness had significantly elevated volume, cell count, PMN proportion, cell viability, and chemotactic activity for PMNs. The remaining joints of the same animals contained synovial fluids with elevated chemotactic activity and cell viability. Twelve dogs tested positive for IL-8 mRNA in multiple tissues (synovia, pericardium, and peritoneum), and 10 dogs expressed TNF-alpha mRNA, but only in the tributary lymph nodes of the inflamed joints. Histological examinations revealed severe poly- or oligoarthritis and moderate to severe cortical hyperplasia in draining lymph nodes of the inflamed joints in all 13 dogs. Seven infected dogs with mild or no clinical signs (group B) seroconverted slowly (peak titers after 90 days), and only some joint fluids showed chemotactic activity, which on average was lower than that in inflamed and noninflamed joints from dogs in group A. Four dogs expressed IL-8 mRNA (in the synovia and pericardium), and three dogs had TNF-alpha mRNA in tributary lymph nodes. Histologically, nonsuppurative arthritis was found in multiple joints, and mild to moderate cortical hyperplasia was found in draining lymph nodes. Five uninfected dogs without lameness (group C) had normal synovial fluids and tissues. In all infected dogs, live spirochetes were demonstrated more frequently in tissues of the somatic quadrant closest to the tick bite than in tissues further from the site of infection, suggesting that dissemination of B. burgdorferi occurs more by migration than by blood-borne spread. From these studies employing a canine model of B. burgdorferi infection, we conclude that IL-8 is involved in the pathogenesis of acute Lyme arthritis.

Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period

Data from 1158 cases of septic arthritis reported to the Public Health Laboratory Service (PHLS) Communicable Disease Control Centre (CDSC) from England and Wales over a 4 yr period (January 1990 December 1993) are presented. Reports where a bacterial organism was isolated from synovial fluid, or where an organism was isolated from blood cultures where a diagnosis of septic arthritis was reported, were examined. Reports of infection were more common in children (12.7% of infections were in the under 10 age group) and the elderly (54.7% aged 60 or over), and were higher in males in all age groups except in the elderly. The most common causative organisms remain staphylococcal and streptococcal species, comprising 40.6% (470) and 28% (324) of cases, respectively. The most common streptococci seen were Streptococcus pneumoniae and Lancefield group A beta-haemolytic Streptococcus organisms, 60.8% (197/324), although group B, C and G organisms accounted for 33.6% of streptococcal isolates (109/324). Haemophilus influenzae septic arthritis is not exclusive to children as 23.2% (16-69) of cases occurred over the age of 15. A total of 48% (635) of isolates were identified from both synovial fluid and blood cultures, 32.6% (378) from joint fluid alone and 12.5% (146) from blood cultures. Although this study excludes cases of septic arthritis where no organism was isolated, it presents important bacteriological information from a large number of isolates from England and Wales over a 4 yr period. Risk factors identified include a joint prosthesis, joint disease/connective tissue disorder. immunosuppression and diabetes.

Role of the staphylococcal accessory gene regulator (sar) in septic arthritis

Staphylococcus aureus arthritis is a highly erosive disease in which both host and bacterial factors are of importance for its induction and progression. At the transcriptional level, three known loci act in regulating production of exoproteins and expression of cell wall structures. The aim of our study was to assess the role of the sar locus as a virulence determinant in the pathogenesis of septic arthritis. A recently established murine model of hematogenously spread S. aureus arthritis was employed. S. aureus strains, isogenic for the sar locus, were inoculated intravenously into NMRI mice, and the clinical, bacteriological, serological, and histopathological progression of the disease was studied. Within 1 week after inoculation of bacteria, the frequency of arthritis was 79% in the group of mice inoculated with the sar+ strain, whereas the corresponding frequency in sar mutants was 21% (P < 0.01). Mice inoculated with the sar+ staphylococcal strain exhibited a more pronounced T- and B-lymphocyte activation than those inoculated with the sar mutant, evidenced by splenomegaly, polyclonal B-cell activation, and high serum levels of interleukin 6 and gamma interferon. Also, infection with sar+ staphylococci induced a pronounced weight loss. To assess the relationship between clinical signs and spread of bacteria, we analyzed the homing pattern and persistence of S. aureus in host tissues. Kidneys and joints from sar+-inoculated subjects displayed a higher degree of bacterial persistence than other organs. Our results suggest that molecules controlled by the sar locus are important virulence determinants in the induction and progression of septic arthritis.

Importance of Staphylococcus hyicus ssp hyicus as a cause of arthritis in pigs up to 12 weeks of age

Lame pigs, up to 12 weeks of age, were necropsied to establish a diagnosis. Of 175 pigs examined, 165 were confirmed to have arthritis by histopathological examination of joint tissues. Lesions were most common in the elbow and tarsal joints and least common in the joints of the feet. Typically, there was severe fibrinopurulent inflammation of synovial membranes regardless of the bacteria isolated. A bacterial aetiology was found in 114 (69%) of the 165 pigs. In arthritic pigs in which an aetiology was established the causative agents were Staphylococcus hyicus ssp hyicus (24.6%), Streptococcus equisimilis (26.3%), Actinomyces pyogenes (13.2%), Staphylococcus aureus (7.9%) and Haemophilus parasuis (7.9%). While gender did not affect the prevalence of arthritis, there was an age influence, most of the pigs culled for arthritis being under 6 weeks of age.

Effects of potentiated chlorhexidine on bacteria and tarsocrural joints in ponies

OBJECTIVES

To evaluate the bactericidal properties of chlorhexidine diacetate (CHD) after potentiation with EDTA and Tris buffer (EDTA-Tris), and to find a potentiated CHD concentration that would achieve 90 to 100% killing for all bacteria tested.

ANIMALS

6 adult ponies.

PROCEDURES

Serial dilutions of CHD, CHD in EDTA-Tris and EDTA-Tris alone were evaluated for bactericidal activity against Staphylococcus aureus, Escherichia coli, and Streptococcus zooepidemicus. The tarsocrural joints of 6 ponies were lavaged with either 1 L phosphate-buffered saline solution (control) or 1 L of 0.0005% CHD in EDTA-Tris. Synovial fluid was collected before lavage and on days 1,4, and 8. Synovia, cartilage, and bone with cartilage were collected on day 8 when the ponies were euthanatized.

RESULTS

In vitro results indicated that 0.0005% CHD in EDTA-Tris was 90% lethal to all bacteria tested. Results of synovial fluid analysis, glycosaminoglycan analysis, and histologic examination of the synovial membrane and articular cartilage indicated that joint lavage with 0.0005% CHD in EDTA-Tris was not detrimental to the synovium or the articular cartilage of pony tarsocrural joints. Changes observed were a result of the actual lavage process, the phosphate-buffered saline solution, and hemarthrosis.

CONCLUSIONS

A concentration of 0.0005% CHD in EDTA-Tris was 90% lethal to all bacteria tested. Pony tarsocrural joint lavage with 0.0005% CHD in EDTA-Tris was not detrimental to the synovium or the articular cartilage. The efficacy of 0.0005% CHD potentiated with EDTA-Tris as a potential joint lavage fluid for treatment of infectious arthritis needs to be evaluated in clinical patients.

Synovitis, osteomyelitis, and green liver in turkeys associated with Escherichia coli

Birds in seven commercial meat turkey flocks ranging in age from 8 to 11 weeks experienced lameness with swollen joints. In addition to synovitis, the most frequent lesions were swollen liver, green liver, and osteomyelitis. Different serotypes of Escherichia coli were isolated from lesions. Histopathology revealed the absence of respiratory lesions in five flocks and the presence of enteritis in at least five flocks. Hemorrhagic enteritis virus infection was implicated in six flocks by positive serology, diagnostic histopathology, and/or clinical history. Three E. coli serotypes, isolated from different types of lesions in turkeys, were inoculated intravenously into 7-wk-old poults and produced synovitis and swollen livers 3 days postinoculation. These findings suggest that the synovitis, osteomyelitis, and green liver complex is a distinct form of disease associated with E. coli, which may result from hematogenous spread of the bacteria following hemorrhagic enteritis virus infection.

Outbreaks of fowl cholera in Muscovy ducks (Cairina moschata) on a farm in Aomori Prefecture

Outbreaks of a subacute disease characterized by lameness, corneal turbidity, dysstasia and depression occurred in Muscovy ducks (Cairina moschata) on a farm in Aomori Prefecture in February and May 1991. Nine strains of Pasteurella multocida were isolated from 5 to 6 dead ducks, and 4 of 8 ducks with clinical signs. Serotypes of the isolates were identified as Heddleston's serotype 1, 10 or 12 and Namioka's serotypes 5:A, 8:A, 9:A or 9:UT. These isolates were highly susceptible to 12 antibiotics, although, some of them were considerably resistant to chloramphenicol. Mouse LD50 values of the 9 isolates ranged from 10(1.0) to 10(5.3). The most virulent strain for the mouse killed 2 to 4 ducks when inoculated intramuscularly at a concentration of 10(3.3). This is the first report of outbreaks of fowl cholera in Muscovy ducks infected with various serotypes strains of P. multocida in Japan.

A canine case of profound granulomatosis due to Paecillomyces fungus

A 5-year-old dog showed remarkable edematous swelling of the left hock with lameness and local cellulitis, and paecillomyces fungus was isolated from ulcerative lesion of the hock joint and mediastinum. At autopsy severe effusive pleuritis was shown and numerous necrotizing and granulomatous lesions with fungal elements were seen in the liver, pancreas, kidney and mediastinal lymph nodes.

Non-purulent arthritis in Danish slaughter pigs. I. A study of field cases

The pathology and microbiology of non-purulent arthritis in Danish slaughter pigs were studied in order to draw up an updated picture of the disease. Samples of one or more joints, their regional lymph nodes and the heart were collected from 101 arthritic pigs, totalling 137 joints, 86 lymph nodes and 96 hearts (group I). For another selected group including 25 pigs (group II), the preliminary diagnosis of mycoplasmic arthritis, based on the appearance of the corresponding regional lymph node, was assessed versus the appearance of the joint fluid. A total of 44 samples were examined. More than 70% of all joint samples in both groups were sterile. Erysipelothrix rhusiopathiae was isolated from 7% of the joints and Mycoplasma hyosynoviae from 9%. A contamination flora was isolated in 17% of the samples. Very few of the lymph nodes (5%) were infected, and none of the hearts were. In group-II M. hyosynoviae was isolated from 8% of the joints. From the remainder the isolates were contamination flora or low numbers of non-specific bacteria. The gross pathological changes of the lymph nodes and joints of the E. rhusiopathiae cases differed notably from those of the M. hyosynoviae cases. The pathological features of the lymph nodes, in particular, were type specific. This suggests that these features may be used to differentiate between the two types of arthritis. Considering the high number of sterile samples, it is necessary to test this hypothesis in greater detail. A programme is outlined to elucidate the zoonotic and hygienic consequences of a proposed alternative handling and removal procedures for the two types of arthritis at slaughter.

Localization of viable bacteria and bacterial antigens in arthritic joints of Erysipelothrix rhusiopathiae-infected pigs

Chronic polyarthritis was induced in pigs by infection with Erysipelothrix rhusiopathiae (serovar 2, strain T28). Viable bacteria could be reisolated as long as 5 months post-infection from synovial fluid, synovial tissue and from isolated chondrocytes. The number of viable bacteria could be increased by hypotonic shock of the chondrocytes indicating a substantial intracellular amount of bacteria. Bacterial antigens were shown by immunohistochemistry to be present on the surface of both chondrocytes and synovial cells in arthritic joints. Neither viable bacteria nor bacterial antigen were detected in unaffected joints.

In vivo efficacy of azithromycin in treatment of systemic infection and septic arthritis induced by type IV group B Streptococcus strains in mice: comparative study with erythromycin and penicillin G

We compared the activities of azithromycin, erythromycin, and penicillin G in a mouse model of systemic infection and septic arthritis induced by type IV group B streptococci (GBS). The in vitro and in vivo efficacy data for these drugs were analyzed relative to the pharmacokinetics of the drugs in sera, joints, and kidneys. Adult CD-1 mice were infected intravenously with 10(7) CFU of type IV GBS. Intraperitoneal drug administration was initiated with different dose regimens at different times after infection. A single dose of azithromycin (100 mg/kg) strongly reduced the incidence of articular lesions with respect to that with erythromycin or penicillin G. Treatment with azithromycin (three intraperitoneal administrations of 50 mg/kg at 12-h intervals) resulted in the complete prevention of arthritis. In contrast, erythromycin was poorly effective and penicillin G was effective only if inoculated 30 min after infection and at high doses (400,000 or 600,000 IU/kg). Furthermore, azithromycin was able to cure about 70% of the mice when administered 7, 8, and 9 days after GBS infection. Azithromycin was much more active than erythromycin and penicillin G with respect to bacterial killing in the joints and kidneys. In fact, cultures from these tissues were always negative no matter what treatment schedule was employed. The pharmacokinetics of azithromycin account for its superior in vivo efficacy against type IV GBS. A longer half-life and higher levels of this drug in serum and tissues with respect to those for erythromycin or penicillin G were achieved. The high affinity of azithromycin for the joints strongly supports its potential value for therapy of septic arthritis, which is a severe and frequent clinical manifestation of GBS infection.

Reiter's syndrome and reactive arthritis: a current view

This paper reviews advances in the understanding of the pathogenesis of reactive arthritis that have occurred over the last decade. Inflammatory aseptic joint disease has been linked with prior infection initiated by many different species of microorganisms. The presence of intra-articular bacterial antigens has now been firmly established with the demonstration of bacteria, bacterial fragments, DNA, RNA, and bacterial lipopolysaccharide in joints of patients with reactive arthritis. Chlamydia trachomatis, Salmonella enteritidis, and Shigella flexneri have all been detected in the joint by immunological techniques, although there is still some doubt as to the form in which they reach the joint and whether or not they persist. A number of phlogistic bacterial components could be acting as arthritogens. Negative joint culture results from patients with reactive arthritis make it unlikely that bacteria in the joint are viable, although chlamydial DNA has been shown in the joints of patients with sexually acquired reactive arthritis using the polymerase chain reaction. The use of antimicrobial therapy in the treatment of reactive arthritis is under review; data suggests that long-term antibiotic treatment warrants further study. The role of HLA-B27 in disease pathogenesis is discussed as are possible mechanisms of interplay between germ and gene. HLA-B27 might confer disease susceptibility by affecting immune mechanisms other than classical antigen presentation. The immunopathogenesis of joint inflammation in reactive arthritis is explored with reference to studies of humoral and cellular immune responses. Serological evidence to support the concept of molecular mimicry is far from conclusive; the results of relevant studies are summarized. Lymphocyte proliferation experiments suggest that antigen presenting cells play an important role. Finally, our views on reactive arthritis in the 1990s, and areas of new and potentially fruitful future research are presented.

Role of YadA in arthritogenicity of Yersinia enterocolitica serotype O:8: experimental studies with rats

Outer membrane protein YadA, the Yersinia adhesin, is one of the plasmid-encoded virulence factors of yersiniae. To evaluate the role of YadA in the pathogenesis of reactive arthritis experimentally, we used YadA- strain YeO8-116, a kanamycin GenBlock insertion mutant derived from Yersinia enterocolitica O:8 wild-type strain 8081. As control strains, a plasmid-cured derivative (8081-c) of 8081 and a YopH- mutant (8081-yoph) were used. In addition, YeO8-116, with the yadA mutation transcomplemented with plasmid pMW10, was used. YeO8-116 induced arthritis to a considerably lesser extent than did wild-type strain 8081 when inoculated intravenously into Lewis rats. In rats surviving for over 14 days after the bacterial inoculation, the arthritis incidences were 6% (4 of 72) among those inoculated with the yadA mutant and 51% (33 of 65) among those inoculated with wild-type strain 8081. When the yadA gene was transcomplemented back to YeO8-116, YeO8-116/pMW10 induced arthritis in 47% (9 of 19) of the inoculated rats. Plasmid-cured strain 8081-c did not induce arthritis in any of the 24 inoculated rats, whereas YopH- mutant 8081-yoph induced arthritis in 20% (5 of 25) of the rats inoculated. Although the 50% lethal dose of YeO8-116 was about sixfold higher than that of 8081, the kinetics of bacterial elimination from the spleen and mesenteric lymph nodes were about the same with both strains. Antibody responses in rats infected with the two strains were also indistinguishable. Our results indicate that YadA contributes to the arthritogenicity of Y. enterocolitica in the rat model.

Mycoplasmas and ureaplasmas in patients with hypogammaglobulinaemia and their role in arthritis: microbiological observations over twenty years

OBJECTIVES

To study the occurrence of mycoplasmas and ureaplasmas in patients with hypogammaglobulinaemia and the relationship of these micro-organisms to septic arthritis.

METHODS

Over a period of about 20 years, 53 men and 38 women with hypogammaglobulinaemia, most of whom were less than 50 years old, were examined clinically and microbiologically. Mycoplasmas and ureaplasmas were sought in the throat, urogenital tract and joints by standard cultural methods, although not consistently in the three sites of all patients.

RESULTS

Arginine-hydrolysing mycoplasmas and ureaplasmas occurred with similar frequency in the sputum/throat of the hypogammaglobulinaemic patients, but no more often than might be expected in immunocompetent patients. Ureaplasmas, however, dominated in the urogenital tracts of both men and women, being found in 75% of vaginal specimens. Arginine-hydrolysing mycoplasmas occurred two to six times more frequently and ureaplasmas two to three times more frequently in urine specimens from hypogammaglobulinaemic patients than they did in such specimens from sex- and age-matched non-venereal disease, hospital patients or healthy subjects; these differences were statistically significant (p < 0.05). Enhanced mucosal colonisation probably increases the chance of spread to distant sites, such as the joints. Of the 91 patients, 21 (23%) had septic arthritis involving one or more joints. Mycoplasmas and/or ureaplasmas, but not bacteria, were isolated from the joints of eight (38%) of these patients. However, dissemination to joints apparently had not occurred in some despite the opportunity by virtue of mycoplasmal or ureaplasmal colonisation at a mucosal site. Sometimes antibiotic therapy failed clinically, and microbiologically and recommendations for management are outlined.

CONCLUSIONS

Hypogammaglobulinaemic patients appear to be more susceptible to colonisation of mucous membranes, especially of the urogenital tract, with mycoplasmas and ureaplasmas than are immunocompetent individuals. These micro-organisms are responsible for about two fifths of the septic arthritides occurring in these patients.

Chymotrypsin and trypsin sensitivities of avian reoviruses

Experiments were undertaken to examine the chymotrypsin sensitivity and trypsin sensitivity of 13 avian reoviruses, and to determine if there was any correlation with pathogenicity of some chicken reoviruses. A wide variation in the degree of sensitivity of avian reoviruses to chymotrypsin and trypsin was observed. Overall, the infectivity of the 13 avian reoviruses for Vero cells was markedly reduced by treatment with 0.01% chymotrypsin (the lowest concentration tested) while 0.5% trypsin significantly reduced the infectivity of 9 of 13 strains. Comparison of four avian reoviruses, three resistant and one sensitive to trypsin, for pathogenicity in day old chicks following oral inoculation showed the strains that were resistant to trypsin to be more pathogenic. Tenosynovitis and virus persistence in intestines, liver, heart and hock joint tissues occurred only in chickens inoculated with the trypsin resistant strains. It is concluded that the degree of sensitivity to chymotrypsin and trypsin among avian reoviruses is heterogenous. Sensitivity to trypsin influenced the development of tenosynovitis based on microscopic lesions and virus persistence in tissues.

Inflammatory polyarthritis in mice transgenic for human T cell leukemia virus type I

OBJECTIVE

We have recently reported that arthropathy develops in high incidence among transgenic mice carrying the pX region of human T cell leukemia virus type I (HTLV-I). In the present study, the histopathologic features of the joints in these mice were examined in order to compare the animal disease with rheumatoid arthritis (RA) in humans.

METHODS

Paraffin sections of limbs (right and left fingers, wrists, elbows, shoulders, toes, knees, and ankles) were stained with hematoxylin and eosin, periodic acid-Schiff, azan-Mallory, or phosphotungstic acid hematoxylin, and examined by light microscopy.

RESULTS

Abnormalities of the limbs began to occur as early as 3 weeks of age, and the incidence gradually increased until the mice were 12 months old. The incidence of arthropathy was 22% (48 of 217) at 3 months of age and 28% (18 of 64) at 6 months. The severity of the histopathologic changes in the joints of the transgenic mice ranged from grade I to grade IV.

CONCLUSION

The major histopathologic features in the joints of HTLV-I transgenic mice are similar to those in humans with RA. Thus, these mice may represent a useful model for the study of the disease in humans.

Septic bone, joint and muscle lesions associated with human immunodeficiency virus infection

Ten episodes of musculoskeletal sepsis have been seen in nine patients with HIV infection. Seven patients had AIDS, circulating CD4-positive lymphocyte counts being less than 0.1 x 10(9)/l in six. Septic arthritis recurred in seven patients, osteomyelitis in three and pyomyositis and bursitis each occurred in one patient. Staphylococcus aureus was isolated from four patients, atypical micro-organisms being found in three. Presentation of musculoskeletal infection in this patient group may be atypical but rapid diagnosis is important as early antimicrobial therapy is often successful.

Yersinia enterocolitica serotype 0:3-induced arthritis in mice: microbiological and histopathological information

Gross anatomical and histopathological changes in arthritic joints resulting from oral challenge with Yersinia enterocolitica serotype 0:3, upon pretreatment with desferrioxamine, were always more severe than those induced by intravenous infection of immunized animals. In all the acute inflammation episodes studied, live Yersiniae were isolated from the arthritic region. Invariably, a heavy mixed infiltration of synovia, joint spaces and soft tissues was observed at this stage. Concurrent fibrous thickening and vascular proliferation, along with erosion of articular cartilages and anomalous bone regeneration, were also apparent. In spite of these significant facts, the bacterium could be histopathologically identified only in bone marrow where it developed microcolonies and caused significant necrosis as well. The live bacterium was also retrieved from two- and six-month-old arthritic ankles/paws examined, but it could not be seen in histological sections of joints. By this time, no cellular infiltration was evident, but there was extensive fibrosis. Bones were at times greatly enlarged, showing a spongeous-like structure. Additionally, articular cartilages could be completely lost and were substituted by an anomalous ossification filling the joint spaces. This situation led to bone fusion, resembling articular ankylosing traits. In summary, we present the first experimental evidence that Y. enterocolitica serotype 0:3 is a causal agent of osteoarthritis and osteomyelitis, and that it may survive for prolonged periods of time in osseous structures.

Chlamydial rRNA in the joints of patients with Chlamydia-induced arthritis and undifferentiated arthritis

Synovial fluid and synovial membrane specimens of 11 patients with Chlamydia-induced arthritis (CIA), 24 patients with undifferentiated arthritis (UndA), 4 patients with post-enteritic reactive arthritis, 3 patients with Lyme arthritis and 9 patients with rheumatoid arthritis were investigated for the presence of Chlamydia trachomatis (C. trachomatis). A single stranded DNA-probe was used for nucleic acid hybridization with ribosomal RNA (rRNA) from C. trachomatis. In 4 patients (CIA = 1, UndA = 3) chlamydial rRNA was found in the synovial fluid. In one additional patient (CIA) the specimen of a synovial membrane biopsy was positive for chlamydial rRNA. The detection of intra-articular chlamydial rRNA is discussed as an indicator for the presence of viable Chlamydiae in inflamed joints.

Differential ability of wild-type and vaccine strains of rubella virus to replicate and persist in human joint tissue

Natural rubella has been reported to be associated with a higher incidence of arthropathy than immunisation with rubella vaccine. In addition, the different vaccines (HPV77/DE5, RA27/3, Cendehill) have been shown to vary in their association with joint symptoms in clinical trials. To investigate possible reasons for these differences in arthritogenicity, the susceptibility of human joint tissue to five rubella virus strains (three vaccines and two wt+) has been examined. Human joint tissue in either organ or dispersed cell-culture was infected in vitro and the degree of replication and persistence of each rubella strain compared. The wt+ strains (M33 and Therien) replicated to high titre in both cell and organ cultures and persisted for over 2 months. The HPV77/DE5 strain (Meruvax I) showed a very similar pattern. In contrast, the replication of RA27/3 (Meruvax II) and Cendehill (Cendevax) was highly restricted in joint cells and both of these strains showed very limited ability to penetrate and persist in the organ cultures. These results concur with the differences in arthritogenicity observed between the strains in vivo, suggesting that local viral replication may play a role in the pathogenesis of rubella-associated arthritis.

Septic arthritis in heroin addicts

Over a 6-year period (1982 to 1988), 36 episodes of septic arthritis were diagnosed in 35 heroin addicts from Barcelona, Spain. Thirty (86%) were men and five (14%) were women, with a mean age of 24 years (range, 14 to 39). Twenty-nine episodes (80%) were monoarticular and seven (20%) were oligoarticular. The sacroiliac (16 cases), sternoclavicular (8), hip (5), and shoulder (4) joints were most frequently infected. Staphylococcus aureus and Pseudomonas aeruginosa were the etiological agents in 75% and 11% of episodes, respectively. Response to antibiotic treatment was good in 32 cases (90%), eight patients needed surgical drainage, and none died. We conclude that septic arthritis in heroin addicts localizes predominantly in axial joints. In our geographic area, infection with S aureus is more frequent than with gram-negative rods such as P aeruginosa or Serratia marcescens, which are most frequently found in reports from the United States.

Meningoencephalitis in commercial meat turkeys associated with Mycoplasma gallisepticum

Mycoplasma gallisepticum (MG) infection was diagnosed in three different flocks of 12-to-16-week-old commercial meat turkeys displaying torticollis and/or opisthotonos. MG was isolated from the brain, air sacs, trachea, and sinus of one bird with neurological signs. Histological examination of brains in all three cases revealed moderate-to-severe encephalitis with lymphoplasmacytic cuffing of vessels, fibrinoid vasculitis, focal parenchymal necrosis, and meningitis. Birds with neurological signs were seropositive for MG by the serum-plate agglutination and hemagglutination-inhibition tests. The encephalitic form of MG has been described previously but is rarely mentioned in the current literature.

Bacteriology of acute septic arthritis

In a study of septic arthritis infants formed the bulk of patients though, notably, neonates were not encountered. Gram-negative bacterial of the Salmonella species, especially Salmonella typhimurium and Klebsiella species were the most important cause of septic arthritis in infants. Staphylococcus aureus was also isolated. The combination of blood cultures and joint aspirate cultures resulted in very high rate (72 per cent) of bacteria isolation. It is strongly recommended that every effort should be made to obtain two bacteriological specimens for culture to improve bacteriological diagnosis of the disease.

Isolation of Mycoplasma synoviae from the brains of commercial meat turkeys with meningeal vasculitis

Mycoplasma synoviae (MS) was isolated from the brains of 22-week-old commercial meat turkeys displaying severe synovitis and infrequent central nervous system signs. Histological examination of the brains revealed mild-to-severe meningeal vasculitis. The vasculitis ranged from fibrinoid necrosis with little inflammation to a marked infiltration of lymphocytes and plasma cells disrupting the architecture of the vessel wall, accumulating as perivascular cuffs, and involving surrounding meninges. Occasional arteries were undergoing thrombosis. Similar lesions were occasionally seen in renal, synovial, and splenic vessels. MS isolates from the brain, trachea, and joint showed similar protein-banding patterns by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. However, the protein profile differed markedly from the standard MS reference strain, WVU 1853. This is the first known field case of MS isolation from the brains of turkeys.

Susceptibility of normal human joint tissue to viruses

A model system has been developed to investigate the comparative ability of different viruses to replicate and persist intraarticularly. The viruses chosen for study were rubella, mumps, Coxsackie B4, adenovirus and varicella zoster, a selection of viruses with different degrees of association with joint symptoms in clinical studies. Our results showed that these viruses demonstrated a range of abilities to infect and persist in human joint tissue cultured in vitro. The most arthritogenic viruses, rubella, and to a lesser extent mumps, replicated and penetrated deeply into the synovial membrane. In contrast, the other 3 viruses were much less arthrotropic, and may only induce arthritis by immunopathological mechanisms.

Persistence of Borrelia burgdorferi and histopathological alterations in experimentally infected animals. A comparison with histopathological findings in human Lyme disease

Gerbils appear to be susceptible to infection by human isolates of Borrelia burgdorferi; we obtained 100% infection. Isolation of the B. burgdorferi from different organs six months post infection causes a generalized infection thus demonstrating that borreliae persist in these animals for a long period. Spirochetemia was present for 14 days, apparently in two intervals. The Borrelia burgdorferi specific antibody titers increased with time after infection thus indicating the persistence of spirochetes. The intraperitoneal inoculation of the B. burgdorferi to six gerbils of groups A and B induced significant histopathologic changes in most of the major organ systems and their surrounding adipose and fibrous connective tissues. The infiltrates consisted mainly of lymphocytes and histiocytes. Various numbers of plasma cells, eosinophils and high numbers of mast cells were also present. Three further animals which served as controls displayed no histological signs of inflammation in any organ system. No significant differences were noted between the histopathological findings seen in the animals of groups A and B (infected with cells from subcultures no. 25 and with no. 5, respectively). The persistence of B. burgdorferi and the high number of organs involved with slight to severe signs of inflammation in this series can be compared to persistence and to the multiorgan involvement seen in human Lyme disease. Thus gerbils can serve as suitable experimental animals to study the pathogenesis of Lyme disease and the extent of organ damage caused by B. burgdorferi.

Localisation of avian reovirus in the hock joints of chicks after entry through broken skin

Avian reoviruses are transmitted vertically via the egg and horizontally following the ingestion of infected faecal material. Experiments conducted on eight one-day-old specific pathogen free chicks provide evidence for occasional infection through broken skin and localisation in the hock joint.

Immunohistologic analysis of mycobacterial antigens by monoclonal antibodies in tuberculosis and mycobacteriosis

Four monoclonal antibodies (MoAbs), 60.15, 61.3, 105.10, and 2.16, directed to different proteins of Mycobacterium tuberculosis were used by an indirect avidin-biotin complex peroxidase-antiperoxidase method to detect mycobacterial antigens in lung, lymph node, and joint tissue specimens of tuberculous patients. Using MoAb 60.15, which recognizes a broad range of cross-reactive mycobacterial proteins with a molecular mass of 28 kilodaltons (kD), scattered materials (mycobacterial in origin) were observed, many of which were located within phagocyte cytoplasm. With MoAb 61.3, which reacts with a 35 kD protein present in M tuberculosis, Mycobacterium africanum, and Mycobacterium bovis, many clumped particles similar in size and shape to acid-fast bacilli were observed within the phagocyte cytoplasm (lung tissue) and positive macrophages with lysosomes were distributed throughout the cytoplasm (bronchoalveolar lavage). The specificity of this MoAb (61.3) was confirmed by the negative staining of positive lymph node specimens obtained from a patient infected with Mycobacterium kansasii. MoAbs 105.10 and 2.16 bind to the cross-reactive 65 kD heat shock protein that is present in mycobacteria and stain scattered particles and dark clumps of bacilli within the phagocyte cytoplasm. On the basis of this study, immunohistochemical detection of mycobacterial antigens appears to be useful in establishing the mycobacterial etiology of caseating granulomas and in avoiding the false-negative results obtained by traditional staining methods.

Caprine mycoplasmosis: an outbreak of mastitis and arthritis requiring the destruction of 700 goats

An acute outbreak of mastitis and arthritis in a herd of 700 goats required the destruction of all but the few animals that were held for observation. The milk of nearly all of about 400 lactating does contained almost pure cultures of Mycoplasma putrefaciens with counts in 150 samples up to 1 X 10(9) colony forming units/ml. At post mortem examination the joints of both the adults and kids contained a fibrinopurulent discharge. M putrefaciens was isolated in pure cultures and large numbers from joints, tissues and fluid not previously known to harbour this mycoplasma: brain, kidneys, lungs, lymph nodes, uterus and urine. The outbreak was milkborne and initiated by infusion of the pathogen into the teat canal by poor hygiene in the milking parlour and by feeding raw colostrum to kids. All but 12 of the herd of 700 goats were killed or sold for slaughter.

Septic arthritis in the elderly

The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Fifteen patients had pre-existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Eight patients had underlying systemic illnesses, and eight patients were receiving systemic corticosteroid therapy prior to the development of septic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2 per cent of patients), enteric gram-negative bacilli were found in seven of 23 patients (30.4 per cent). Five patients died (21.7 per cent mortality), two as a result of their infection and three of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4 per cent) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre-existing joint disease is very common and enteric gram-negative bacilli are often the causative organisms.

The distribution and effect of Chlamydia trachomatis in CBA mice inoculated genitally, intra-articularly or intravenously

A "fast" egg-killing human strain of Chlamydia trachomatis was inoculated into normal CBA and congenic CBA/nu mice, which have an impairment of T-cell function and do not produce anti-chlamydial antibodies. The mice were inoculated by the intra-uterine, intra-articular, or intravenous routes. Some of the mice were first treated with progesterone, which allows successful chlamydial infection of the mouse genital tract when the organisms are introduced genitally. Mice were sacrificed up to 27 days after inoculation. Homogenates of joints, genital tract, spleen, liver, kidneys, eyes and lungs were prepared and tested for chlamydiae in cycloheximide-treated McCoy cell cultures. Chlamydiae were detected in the genital tracts and spleens, but not in the joints, of mice inoculated via the intra-uterine route. They were found in the joints and spleens of mice inoculated intra-articularly, and were detected also in spleens and, from the 4th to 6th day after inoculation, in joints of mice given the organisms intravenously. These results were obtained irrespective of whether or not the mice had received progesterone. The numbers of chlamydiae in the spleens and joints of the nude mice were larger and they persisted longer than in the corresponding immunocompetent animals, although this was not true for chlamydiae in the genital tract of mice inoculated via the intra-uterine route. Compartmentalisation of chlamydiae was evident although the spleen was infected consistently irrespective of the route of inoculation and, as mentioned, chlamydiae were found transiently in the joints following intravenous inoculation. This suggests that chlamydiae might also enter the human joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Pasteurella pneumotropica isolated from bone and joint infections

Pasteurella pneumotropica is a normal inhabitant of the oropharynx of mice, rats, cats, and dogs. We describe here the first reported case of joint and bone involvement in a human. The need for culturing and adequate prophylactic treatment is discussed.

Epidemic polyarthritis in Australia, 1980-1981

Information concerning their clinical illness was obtained by self-administered questionnaire from 528 patients who suffered from epidemic polyarthritis in Australia during 1980 and 1981. The clear and uniform clinical picture which has emerged from this study should facilitate the diagnosis of this disease. The illness begins suddenly with the onset of acute aching in the muscles and joints, followed by a maculopapular rash in between 40% and 78% of patients, and extensive polyarthritis. This affects chiefly the ankles, fingers, knees and wrists, usually serially, but no joint is spared. Estimates of incubation time suggest that it ranges from three to 21 days (mean, nine days). Women, especially housewives, are the group most frequently affected. Exposure to mosquitoes is an important predisposing factor; the implications of this for prevention and future research are considered. The mechanism of the survival of the virus in nature remains poorly understood.

Pathogenicity of avian reoviruses: examination of six isolates and a vaccine strain

Six avian reovirus isolates and a vaccine reovirus strain were compared for invasiveness, virulence, and pathological characteristics upon infection of day-old specific-pathogen-free chicks by the footpad, subcutaneous, and oral routes of inoculation. No significant differences were noted regarding the ability of individual isolates to infect target tissues. However, virulence (measured as the 50% lethal dose) among the isolates varied markedly from 2 x 10(5) to less than 10 PFU per chick for the most virulent isolate; between the parental wild-type virus and the derivative vaccine virus strain, a million-fold (10(6)) difference in virulence was demonstrated. All strains revealed, with considerable variation, arthrogenic potential.

Clinical microbiological, and histological manifestations of Streptobacillus moniliformis-induced arthritis in mice

Intravenous inoculation of Streptobacillus moniliformis into mice resulted in an infection in which the predominant feature was progressive polyarthritis that rendered some joints immobile within 6 months. No migration of arthritis from joint to joint or remission and exacerbation were apparent. Viable organisms were apparently removed by the host from blood, liver, and spleen within 28 days post inoculation but persisted in joints for approximately 6 months in some animals. Specific antibody was detectable by complement fixation 7 days post-inoculation and persisted throughout the course of the disease. The inflammatory responses, which was initiated by the appearance of neutrophils in the joint space within 24 h of inoculation, culminated in obliteration of the joint space by fibrosis and exostosis.

Enhanced resistance of mice to Mycoplasma pulmonis-induced arthritis by administration of killed Corynebacterium parvum

Inoculation of mice with Corynebacterium parvum 14 days before intraperitoneal inoculation of Mycoplasma pulmonis resulted in arthritis of significantly lesser magnitude than in control mice as measured both clinically and histologically. Mycoplasmas were isolated from the joints of mice inoculated with C. parvum less frequently than from control mice when the arthritis was maximal. Mycoplasmas were also isolated in smaller numbers from the blood and joints of mice pretreated with C. parvum within 2 hr after M. pulmonis inoculation. Complement-fixing antibody to M. pulmonis did not account for the differences observed. C. parvum given during an established mycoplasmal infection, although capable of enhancing elimination of M. pulmonis from the joints of infected mice, had no effect upon the arthritis as measured clinically or histologically. The results provide evidence that immunomodulators such as C. parvum are capable of enhancing elimination of mycoplasmas from the joints of infected mice prior to or after the induction of arthritis.

Curative effects of tobramycin or gentamicin therapy on mouse arthritis caused by Mycoplasma pulmonis

Inbred mice infected intravenously with Mycoplasma pulmonis develop a severe and persistent arthritis. Maximal severity of the arthritis is reached 10 to 14 days postinfection, and in some animals, ian arthritic condition subsequently persists throughout life. Chemotherapy was given either at the time of infection or during the acute phase of the disease. Tobramycin, gentamicin, and, to a lesser extent, kanamycin delayed the development of arthritis when administered at the time of infection, and, when given therapeutically, they all reduced inflammation and swelling of arthritic joints. Recovery of the mycoplasma was lowest from the joints of more treated with tobramycin or gentamicin, indicating that these two antibiotics were mycoplasmacidal and that the remission of arthritis was correlated with the eradication of the organisms.

Role of viable mycoplasmas in the pathogenesis of arthritis induced by M. pulmonis

The role of viable M. pulmonis organism in the pathogenesis of both the acute and chronic phases of M. pulmonis-induced arthritis was examined. In the acute phase of the arthritis most clinically involved joints contained organisms and the degree of clinical arthritis in a given joint correlated with the number of organisms isolated. The more severe the acute arthritis, the more frequently the M. pulmonis organism was isolated from the joints during the chronic phase. In the chronic phase, arthritis defined histologically correlated with the presence of M. pulmonis organisms within a given joint. No correlation was observed between clinical arthritis during the chronic phase and histopathology or the presence of M. pulmonis organisms within the joint. In chronically infected mice, M. pulmonis was isolated from the joints only but not from the blood, liver, spleen, lung or kidney of any mouse examined. The results support the concept that viable organisms play an essential role in the pathogenesis of the acute and chronic phases of M. pulmonis-induced arthritis in mice.

Inoculation of pigs with Streptococcus spp. isolated from arthritic porcine joints

The intricacies of the serological grouping of streptococci are discussed. The pathogenicity and accurate classification of streptococci isolated from arthritic porcine joints were in doubt. Pure cultures of these isolates were inoculated intravenously into healthy pigs to ascertain their pathogenicity and in an attempt to fulfil Koch's postulates. The pathogenesis of streptococcal arthritis in swine is discussed. On intravenous inoculation into experimental pigs the streptococcal isolates showed varying degrees of pathogenicity and arthritogenesis.

An association between arthritis and persistent serological reactions to Brucella abortus in cattle from apparently brucellosis-free herds

Twenty-four cases of stifle (femoro-tibial joint) arthritis, in Friesian heifers that had failed their first blood test for brucellosis, were examined pathologically and by serological and cultural tests for brucella. The arthritis was confined to the stifle and was non-purulent. The cases showed several other similar features, including evidence of trauma, erosions of articular surfaces, synovial proliferations and granulomata containing germinal centres and plasma cells. The synovial fluid was turbid, discoloured and usually increased in volume, with high antibody titres to brucella. Cultures were invariably negative for brucella, but examinations of cryostat sections stained by fluorescent antibody against B abortus were positive in five out of six cases examined some showing particles with a morphology resembling that of brucella.

Polyarthritis of pigs in western Australia: the role of Erysipelothrix rhusiopathiae

A 3-month survey of polyarthritis in pigs was carried out at 3 metropolitan abattoirs in Western Australia. The incidence of total carcass condemnations for polyarthritis was 0.46% and partial condemnation for "arthritis" 1.66% of 15,919 pigs. It was demonstrated that the majority of joint lesions found in either total or partial condemnations were identical pathological conditions, usually differing only in the number of joints involved. Erysipelothrix rhusiopathiae was isolated from the joints of 63% of pigs condemned for polyarthritis; it appears that this organism is the most significant aetiological agent of polyarthritis in Western Australia. The role of mycoplasmas has not been determined. The groww and microscopic lesions seen in affected joints were those of a non-suppurative proliferative polysynovitis. The stifle and elbow joints showed the highest incidence of the most severe lesions. Pigs condemned for polyarthritis over a 6-month period were traced back to 125 farms. Eighty per cent of pigs that had been condemned for polyarthritis had not been vaccinated against erysipelas or were of doubtful vaccination status. Only 3% of pigs had been vaccinated as recommended. The results would suggest that erysipelas vaccine is not directly implicated in the pathogenesis of polyarthritis. The majority of pigs condemned for polyarthritis originated from poorly managed small piggeries run as sideline enterprises. There was no significant pattern to the geographical distribution of polyarthritis cases in Western Australia. Likewise, no significant realtionship was established between polyarthritis condemnations and either breed, sex or bodyweight of thepigs involved.