Pyogenic arthritis caused by streptococcus equisimilis (group-C streptococcus) in a patient with AIDS

Early detection of septic arthritis caused by Streptococcus dysgalactiae subspecies equisimilis in a dog – a case report

In this report, a seven-year-old English Pointer male with Streptococcus dysgalactiae subsp. equisimilis arthritis joint infection is presented. The dog was referred to the Internal Medicine Department Policlinics with the symptoms of anorexia, weakness, swollen joints and ulcerative wounds on testes. On physical examination, the dog was depressed and manifesting discomfort during manipulation of the fore and hind legs’ joints. There were palpable effusions of the right carpal, elbow, and tibiotarsal joints. Haematological and serum biochemical analyses showed mild anaemia, moderate thrombocytopaenia, and elevated alanine aminotransferase. As soon as the synovial fluid aspirates were obtained aseptically from the right elbow, radiocarpal, and tibiotarsal joints, they were sent to bacteriological examination. Symptomatic and supportive treatment was initiated immediately. Empirical enrofloxacin therapy was initially started. Bacteria which were cultivated from the synovial fluid aspirates specimen were identified as S. equisimilis. The isolate was found to be resistant to enrofloxacin and susceptible to amoxycillin/clavulanic acid. According to the results of the antimicrobial susceptibility tests, enrofloxacin therapy was terminated and amoxycillin/clavulanic acid therapy was immediately started lasting for four weeks. The dog was treated successfully. To our knowledge, Streptococcus dysgalactiae subsp. equisimilis was isolated from the synovial fluid from a dog for the first time in Turkey, as it is rarely seen in dogs.

Streptococcal septic arthritis in adults. A study of 55 cases with a literature review

OBJECTIVES

To evaluate the rate of occurrence and characteristics of streptococcal septic arthritis.

METHODS

Retrospective single-center study of patients with bacteriologically documented septic arthritis admitted to a rheumatology department over a 20-year period.

RESULTS

Of 303 cases of septic arthritis, 55 (18%) were due to streptococci and 166 (55%) to Staphylococcus aureus (55%). As compared to patients with S. aureus arthritis, patients with streptococcal arthritis was more likely to be in female (56% vs. 36%, P < 0.006) and older than 60 years of age (71% vs. 58%), less likely to have comorbidities (36% vs. 56%), rheumatoid arthritis (5% vs. 19%, P < 0.01), or diabetes (2% vs. 15%, P < 0.01), and more likely to have cancer (13% vs. 7%). Involved joints and proportions of patients with arthritis in multiple joints were similar in two groups. Mortality was lower in the group with streptococcal infection (3.6% vs. 7.8%). The streptococci were distributed as follows: group A (n = 7), group B (n = 12), group C (n = 4), group D (n = 7), group F (n = 1), group G (n = 2), nongroupable (n = 14), nontypable (n = 1), and Streptococcus pneumoniae (n = 7). Groups A and B and nongroupable strains mainly affected women; group A selectively involved younger patients and group B very elderly patients. Comorbidity, most notably cancer, was common in patients with S. pneumoniae or group D streptococci. The portal of entry was often a skin lesion for groups A and B and a medical procedure for group D. Multiple joint involvement was common with groups A and B and prosthetic joint infection with groups B and C. Group A and S. pneumoniae were associated with severe systemic symptoms and extra articular foci of infection, whereas a smoldering course was more common with groups D and G and with nongroupable strains. Residual joint abnormalities were noted in half the patients, with no differences across groups.

CONCLUSIONS

The features of streptococcal septic arthritis vary according to the group of the causative organism and differ from those of S. aureus arthritis.

Acute bacterial arthritis caused by group C streptococci

OBJECTIVES

To summarize the characteristics of and clinical experience with joint infection by group C streptococcus.

METHODS

Two new cases of acute bacterial arthritis due to group C streptococci are reported, and a MEDLINE search was performed, which located 22 additional cases.

RESULTS

Mean age (+/- standard deviation) of all 24 patients was 46 +/- 25 years, and most patients were men (75%). The species most frequently identified was Streptococcus equisimilis (12 cases). Eight patients (33%) had a general risk factor for infection, and the same percentage had some type of arthropathy. Only 3 patients had previous contact with animals. The infection was polyarticular in a third of cases, and the joint most frequently involved was the knee. The majority of patients showed a good response to the treatment with intravenous penicillin. However, 3 patients had functional sequelae, 2 more had residual radiological lesions, and 3 died.

CONCLUSIONS

Acute bacterial arthritis due to group C streptococci is a serious but uncommon entity that can affect patients without risk factors. Rapid diagnosis and treatment may improve the outcome. Semin Arthritis Rheum 31:43-51.