1
|
Jetanalin P, Raksadawan Y, Inboriboon PC. Orthopedic Articular and Periarticular Joint Infections. Emerg Med Clin North Am 2024; 42:249-265. [PMID: 38641390 DOI: 10.1016/j.emc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Acute nontraumatic joint pain has an extensive differential. Emergency physicians must be adept at identifying limb and potentially life-threatening infection. Chief among these is septic arthritis. In addition to knowing how these joint infections typically present, clinicians need to be aware of host and pathogen factors that can lead to more insidious presentations and how these factors impact the interpretation of diagnostic tests.
Collapse
Affiliation(s)
- Pim Jetanalin
- Department Medicine, Division of Rheumatology, University of Illinois at College of Medicine, 818 South Wolcott Avenue, 6th Floor, MC 733, Chicago, IL 60612, USA.
| | - Yanint Raksadawan
- Department of Medicine, Weiss Memorial Hospital, Medical Education, 4646 N. Marine Drive, Chicago, IL 60640, USA
| | - Pholaphat Charles Inboriboon
- Department of Emergency Medicine, University of Illinois at College of Medicine, 808 South Wood Street MC 724, Chicago, IL, USA
| |
Collapse
|
2
|
Woods CR, Bradley JS, Chatterjee A, Kronman MP, Arnold SR, Robinson J, Copley LA, Arrieta AC, Fowler SL, Harrison C, Eppes SC, Creech CB, Stadler LP, Shah SS, Mazur LJ, Carrillo-Marquez MA, Allen CH, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics. J Pediatric Infect Dis Soc 2024; 13:1-59. [PMID: 37941444 DOI: 10.1093/jpids/piad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.
Collapse
Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Tennessee Health Sciences Center College of Medicine Chattanooga, Chattanooga, Tennessee
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, School of Medicine, and Rady Children's Hospital, San Diego, California
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Antonio C Arrieta
- Division of Infectious Diseases, Children's Hospital of Orange County and University of California, Irvine, California
| | - Sandra L Fowler
- Division of Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas
| | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Valéry Lavergne
- Department of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of Montreal Research Center, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Fukuzawa F, Uehara T, Yamashita S, Hayashi Y, Ikusaka M. Group B Streptococcus Bacteremia Mimicking Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Cureus 2022; 14:e27468. [PMID: 36060405 PMCID: PMC9421099 DOI: 10.7759/cureus.27468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Group B Streptococcus (GBS) causes septic arthritis in healthy adults, and a significant number of GBS septic arthritis cases involve multiple joints. Nevertheless, septic arthritis is commonly monoarticular. Here, we report a case of a 45-year-old man who complained of subacute fever and right shoulder and right buttock pain for three weeks despite undergoing garenoxacin treatment for one week. Although synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome could be a possible differential diagnosis for this patient, the fever and subacute clinical course could not be explained. Blood cultures revealed the presence of GBS; therefore, he was diagnosed with septic arthritis. After antibiotic treatment for six weeks, his symptoms resolved.
Collapse
|
4
|
Lujan AL, Croci DO, Rabinovich GA, Damiani MT. Galectins as potential therapeutic targets in STIs in the female genital tract. Nat Rev Urol 2022; 19:240-252. [PMID: 35105978 DOI: 10.1038/s41585-021-00562-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 12/12/2022]
Abstract
Every day, more than one million people worldwide acquire a sexually transmitted infection (STI). This public health problem has a direct effect on women's reproductive and sexual health as STIs can cause irreversible damage to fertility and can have negative consequences associated with discrimination and social exclusion. Infection with one sexually transmitted pathogen predisposes to co-infection with others, suggesting the existence of shared pathways that serve as molecular links between these diseases. Galectins, a family of β-galactoside-binding proteins, have emerged as endogenous mediators that facilitate cell-surface binding, internalization and cell invasion of many sexually transmitted pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans, HIV and herpes simplex virus. The ability of certain galectins to dimerize or form multimeric complexes confers the capacity to interact simultaneously with glycosylated ligands on both the pathogen and the cervico-vaginal tissue on these proteins. Galectins can act as a bridge by engaging glycans from the pathogen surface and glycosylated receptors from host cells, which is a mechanism that has been shown to be shared by several sexually transmitted pathogens. In the case of viruses and obligate intracellular bacteria, binding to the cell surface promotes pathogen internalization and cell invasion. Inflammatory responses that occur in cervico-vaginal tissue might trigger secretion of galectins, which in turn control the establishment, evolution and severity of STIs. Thus, galectin-targeted therapies could potentially prevent or decrease STIs caused by a diverse array of pathogenic microorganisms; furthermore, anti-galectin agents might reduce treatment costs of STIs and reach the most vulnerable populations.
Collapse
Affiliation(s)
- Agustin L Lujan
- Laboratorio de Bioquímica e Inmunidad, Instituto de Bioquímica y Biotecnología, Facultad de Ciencias Médicas, Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Universidad Nacional de Cuyo (UNCUYO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina.,Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Diego O Croci
- Laboratorio de Inmunopatología, Facultad de Ciencias Exactas y Naturales, Instituto de Histología y Embriología de Mendoza (IHEM), Universidad Nacional de Cuyo (UNCUYO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina
| | - Gabriel A Rabinovich
- Laboratorio de Glicomedicina, Instituto de Biología y Medicina Experimental (IBYME), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina. .,Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires (UBA), C1428AGE, Buenos Aires, Argentina.
| | - Maria T Damiani
- Laboratorio de Bioquímica e Inmunidad, Instituto de Bioquímica y Biotecnología, Facultad de Ciencias Médicas, Instituto de Medicina y Biología Experimental de Cuyo (IMBECU), Universidad Nacional de Cuyo (UNCUYO), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Mendoza, Argentina.
| |
Collapse
|
5
|
Whelan J, Ghoniem M, Médoc N, Apicella M, Beck E. Applying a novel approach to scoping review incorporating artificial intelligence: mapping the natural history of gonorrhoea. BMC Med Res Methodol 2021; 21:183. [PMID: 34488645 PMCID: PMC8418964 DOI: 10.1186/s12874-021-01367-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 08/02/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Systematic and scoping literature searches are increasingly resource intensive. We present the results of a scoping review which combines the use of a novel artificial-intelligence-(AI)-assisted Medline search tool with two other 'traditional' literature search methods. We illustrate this novel approach with a case study to identify and map the range of conditions (clinical presentations, complications, coinfections and health problems) associated with gonorrhoea infection. METHODS To fully characterize the range of health outcomes associated with gonorrhoea, we combined a high yield preliminary search with a traditional systematic search, then supplemented with the output of a novel AI-assisted Medline search tool based on natural language processing methods to identify eligible literature. RESULTS We identified 189 health conditions associated with gonorrhoea infection of which: 53 were identified through the initial 'high yield' search; 99 through the systematic search; and 124 through the AI-assisted search. These were extracted from 107 unique references and 21 International Statistical Classification of Diseases and Related Health Problems Ninth and Tenth Revision (ICD 9/10) or Read codes. Health conditions were mapped to the urogenital tract (n = 86), anorectal tract (n = 6) oropharyngeal tract (n = 5) and the eye (n = 14); and other conditions such as systemic (n = 61) and neonatal conditions (n = 7), psychosocial associations (n = 3), and co-infections (n = 7). The 107 unique references attained a Scottish Intercollegiate Guidelines Network (SIGN) score of ≥2++ (n = 2), 2+ (14 [13%]), 2- (30 [28%]) and 3 (45 [42%]), respectively. The remaining papers (n = 16) were reviews. CONCLUSIONS Through AI screening of Medline, we captured - titles, abstracts, case reports and case series related to rare but serious health conditions related to gonorrhoea infection. These outcomes might otherwise have been missed during a systematic search. The AI-assisted search provided a useful addition to traditional/manual literature searches especially when rapid results are required in an exploratory setting.
Collapse
Affiliation(s)
| | - Mohammad Ghoniem
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | - Nicolas Médoc
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | | | | |
Collapse
|
6
|
Nossent J, Raymond W, Keen H, Preen DB, Inderjeeth CA. Septic arthritis due to Neisseria gonorrhoea in Western Australia. Intern Med J 2020; 52:1029-1034. [PMID: 33347691 DOI: 10.1111/imj.15169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the frequency, risk factors and long-term outcome of gonococcal arthritis in Western Australia (WA). METHODS A population-based data linkage study of patients with a hospital-based diagnosis of gonococcal arthritis (GA) in WA between 1990-2014. Demographics, standardised incidence rates (IR) per million and comorbidity accrued before (lookback 186 months ,IQR 86-267) and after the index hospital contact for GA (follow-up 100 months, IQR 60-209). are presented as frequency (%), median (interquartile range) or rates /1,000 months. RESULTS In total 98 patients were diagnosed with GA. The annual incidence of GA increased from 1.35 to 2.10 per million between 1990 and 2014, but the rate of GA complicating all gonococcal infections was stable around 0.25%. Female patients with GA (54%, n=53/98) were younger (24 vs 38 years), and more frequently identified as Indigenous (88% vs 49%) than male patients (46%, n=45/98) (p=0.002). Female patients had higher rates of prior infections (15.5 vs 8.1 per 1,000 months, p=0.002) and diabetes mellitus (15.9% vs 2.5%, p=0.03) and a longer hospital stay (10 vs 8 days, p=0.02). GA recurrence rate during follow-up was low (2%), but a broad range of comorbidities developed contributing to a 14% crude death rate. CONCLUSIONS GA stably complicates 0.25% of gonococcal infections in WA with young Indigenous females and middle-aged non-Indigenous males most affected. Prior infectious disease and diabetes mellitus are potential risk factors for GA in females. GA recurs rarely, but its development reflects a high risk of morbidity and mortality over the following ten years. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Johannes Nossent
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, University, Western Australia
| | - Warren Raymond
- Rheumatology Group, School of Medicine, University, Western Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, University, Western Australia.,Dept. Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University, Western Australia
| | - Charles A Inderjeeth
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, University, Western Australia
| |
Collapse
|
7
|
Boff D, Oliveira VLS, Queiroz Junior CM, Galvão I, Batista NV, Gouwy M, Menezes GB, Cunha TM, Verri Junior WA, Proost P, Teixeira MM, Amaral FA. Lipoxin A 4 impairs effective bacterial control and potentiates joint inflammation and damage caused by Staphylococcus aureus infection. FASEB J 2020; 34:11498-11510. [PMID: 32741032 DOI: 10.1096/fj.201802830rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023]
Abstract
Staphylococcus aureus is the main cause of septic arthritis in humans, a disease associated with high morbidity and mortality. Inflammation triggered in response to infection is fundamental to control bacterial growth but may cause permanent tissue damage. Here, we evaluated the role of Lipoxin A4 (LXA4 ) in S aureus-induced arthritis in mice. Septic arthritis was induced by S aureus injection into tibiofemoral joints. At different time points, we evaluated cell recruitment and bacterial load in the joint, the production of pro-inflammatory molecules, and LXA4 in inflamed tissue and analyzed joint damage and dysfunction. LXA4 was investigated using genetically modified mice or by pharmacological blockade of its synthesis and receptor. CD11c+ cells were evaluated in lymph nodes by confocal microscopy and flow cytometry and dendritic cell chemotaxis using the Boyden chamber. Absence or pharmacological blockade of 5-lipoxygenase (5-LO) reduced joint inflammation and dysfunction and was associated with better control of infection at 4 to 7 days after the infection. There was an increase in LXA4 in joints of S aureus-infected mice and administration of LXA4 reversed the phenotype in 5-LO-/- mice. Blockade or absence of the LXA4 receptor FPR2 has a phenotype similar to 5-LO-/- mice. Mechanistically, LXA4 appeared to control migration and function of dendritic cells, cells shown to be crucial for adequate protective responses in the model. Thus, after the first days of infection when symptoms become evident therapies that inhibit LXA4 synthesis or action could be useful for treatment of S aureus-induced arthritis.
Collapse
Affiliation(s)
- Daiane Boff
- Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Vivian Louise Soares Oliveira
- Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Celso M Queiroz Junior
- Department of Morphology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Izabela Galvão
- Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nathalia Vieira Batista
- Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mieke Gouwy
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Gustavo Batista Menezes
- Departamento de Morfologia, Centro de Biologia Gastrointestinal, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Mattar Cunha
- Department of Pharmacology, Faculdade de Medicina de Ribeirao Preto, Center for Research in Inflammatory Diseases, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paul Proost
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Mauro Martins Teixeira
- Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávio Almeida Amaral
- Immunopharmacology, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
8
|
Achebe I, Hussain K, Abraham A, Asotibe JC, Shaka H. Acute Rheumatic Fever Presenting as a Mimicker of Septic Arthritis. Cureus 2020; 12:e9431. [PMID: 32864256 PMCID: PMC7450879 DOI: 10.7759/cureus.9431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Acute rheumatic fever (ARF) describes the non-suppurative and autoimmune inflammation of joint, muscle, and fibrous tissue that occurs after group A streptococcal (GAS) pharyngitis. This report describes a rare case of a 39-year-old male with migratory arthralgias as a presenting sign of ARF. Through this case, we review the current literature on ARF and highlight clinical and objective findings that differentiate ARF from similar presenting arthralgias, specifically post-streptococcal reactive arthritis (PSRA). With this report, we hope to increase clinical suspicion for ARF in patients with acute joint pain, as differentiating ARF from other arthritides, PSRA specifically, determines management strategy and need for secondary prophylaxis against rheumatic heart disease.
Collapse
|
9
|
Vidaurrazaga MM, Perlman DC. A case of purulent gonococcal arthritis. IDCases 2019; 19:e00662. [PMID: 31768312 PMCID: PMC6872861 DOI: 10.1016/j.idcr.2019.e00662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022] Open
Abstract
We present a case of a generally healthy, immunocompetent, 57 year old male on HIV pre-exposure prophylaxis (PrEP) who developed the sudden onset of right wrist pain and swelling with associated left second finger tenosynovitis, due to a disseminated gonococcal infection (DGI) with purulent arthritis. This case’s aim is to demonstrate a well-documented but infrequently seen manifestation of Neisseria gonorrhoeae infection and to highlight the need for awareness of extragenital manifestations of gonococcal infection in the era of HIV PrEP. DGI accounts for less than 3 % of N. gonorrhoeae infections, with purulent arthritis being one presentation. The incidence of N. gonorrhoeae infections has increased in recent years and is high among those taking PrEP. Providers should be aware of the possibility of DGI and N. gonorrhoeae as a potential etiologic agent in septic bacterial arthritis.
Collapse
Affiliation(s)
| | - David C Perlman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, United States
| |
Collapse
|
10
|
Acute Extensor Tenosynovitis due to Disseminated Gonococcal Infection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2432. [PMID: 31942394 PMCID: PMC6908399 DOI: 10.1097/gox.0000000000002432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/12/2019] [Indexed: 11/26/2022]
Abstract
Infections from Neisseria gonorrhoeae (N. gonorrhoeae) are on the rise. Disseminated gonorrhea infections have the unique propensity for causing extensor tenosynovitis of the hand, a topic which has not recently been discussed in the plastic surgery literature. We therefore present a case report of a patient with extensor tenosynovitis of the hand from disseminated gonorrhea and review the literature. A 78-year-old man arrived in the Emergency Department with extensor tenosynovitis of the wrist, dermatitis, and polyarthralgias. He was taken to the operating room for washout of his extensor tendons at the wrist and was subsequently diagnosed with disseminated N. gonorrhoeae and treated with a third-generation cephalosporin. The patient ultimately recovered and regained normal active range of motion of the wrist. With the increasing incidence of N. gonorrhoeae, it is important for hand surgeons to recognize and treat the infection early in its course. This article serves to alert hand surgeons of the unique clinical patterns of N. gonorrhoeae infection, specifically focusing on presentations that include extensor tenosynovitis of the hand.
Collapse
|
11
|
Torres-Navarro I, de Unamuno-Bustos B, López-Davia J. Sparse pustules and tenosynovitis in a young man. Eur J Intern Med 2019; 66:99-101. [PMID: 31109850 DOI: 10.1016/j.ejim.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ignacio Torres-Navarro
- Dermatology Department, Hospital Universitario y Politécnico la Fe, 106 Fernando Abril Martorell Avenue, 46026, Valencia, Spain.
| | - Blanca de Unamuno-Bustos
- Dermatology Department, Hospital Universitario y Politécnico la Fe, 106 Fernando Abril Martorell Avenue, 46026, Valencia, Spain
| | - Javier López-Davia
- Dermatology Department, Hospital Universitario y Politécnico la Fe, 106 Fernando Abril Martorell Avenue, 46026, Valencia, Spain
| |
Collapse
|
12
|
Boff D, Crijns H, Teixeira MM, Amaral FA, Proost P. Neutrophils: Beneficial and Harmful Cells in Septic Arthritis. Int J Mol Sci 2018; 19:E468. [PMID: 29401737 PMCID: PMC5855690 DOI: 10.3390/ijms19020468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Septic arthritis is an inflammatory joint disease that is induced by pathogens such as Staphylococcus aureus. Infection of the joint triggers an acute inflammatory response directed by inflammatory mediators including microbial danger signals and cytokines and is accompanied by an influx of leukocytes. The recruitment of these inflammatory cells depends on gradients of chemoattractants including formylated peptides from the infectious agent or dying cells, host-derived leukotrienes, complement proteins and chemokines. Neutrophils are of major importance and play a dual role in the pathogenesis of septic arthritis. On the one hand, these leukocytes are indispensable in the first-line defense to kill invading pathogens in the early stage of disease. However, on the other hand, neutrophils act as mediators of tissue destruction. Since the elimination of inflammatory neutrophils from the site of inflammation is a prerequisite for resolution of the acute inflammatory response, the prolonged stay of these leukocytes at the inflammatory site can lead to irreversible damage to the infected joint, which is known as an important complication in septic arthritis patients. Thus, timely reduction of the recruitment of inflammatory neutrophils to infected joints may be an efficient therapy to reduce tissue damage in septic arthritis.
Collapse
Affiliation(s)
- Daiane Boff
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| | - Helena Crijns
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| | - Mauro M Teixeira
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Flavio A Amaral
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Paul Proost
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| |
Collapse
|
13
|
Rouanes N, Sanchez R, Cazanave C. [A case of gonococcal arthritis: Diagnostic difficulties and usefulness of synovial fluid PCR]. Rev Med Interne 2017; 39:54-56. [PMID: 28844395 DOI: 10.1016/j.revmed.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The incidence of Neisseria gonorrhoeae septic arthritis remains low in the general population. Its clinical and microbiological diagnostic remains difficult. CASE REPORT We report a 44-year-old man who presented with a monoarthritis of the right ankle. The diagnosis of gonoccocal septic arthritis was obtained by PCR from the joint fluid. Treatment with ceftriaxone was effective. CONCLUSION In patients with high risk of N. gonorrhoeae infection, PCR for detection of gonorrhea in synovial fluid could potentially facilitate the diagnostic of gonococcal septic arthritis.
Collapse
Affiliation(s)
- N Rouanes
- Service de médecine interne et maladies infectieuses, centre hospitalier de Périgueux, 80, avenue G.-Pompidou, CS 61205, 24019 Périgueux cedex, France.
| | - R Sanchez
- Laboratoire de biologie médicale, centre hospitalier de Périgueux, 80, avenue G.-Pompidou, CS 61205, 24019 Périgueux cedex, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| |
Collapse
|
14
|
Gassiep I, Gilpin B, Douglas J, Siebert D. Gonococcal Prosthetic Joint Infection. J Bone Jt Infect 2017; 2:160-162. [PMID: 28894691 PMCID: PMC5592376 DOI: 10.7150/jbji.20791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/27/2017] [Indexed: 11/05/2022] Open
Abstract
Neisseria gonorrhoea is a common sexually transmitted infection worldwide. Disseminated gonococcal infection is an infrequent presentation and rarely can be associated with septic arthritis. Incidence of this infection is rising, both internationally and in older age groups. We present the first documented case of N. gonorrhoea prosthetic joint infection which was successfully treated with laparoscopic debridement and antimicrobial therapy.
Collapse
Affiliation(s)
- Ian Gassiep
- Department of Infectious Diseases, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Bradley Gilpin
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Orthopaedic Surgery, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia
| | - Joel Douglas
- Department of Infectious Diseases, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia
| | - David Siebert
- Department of Infectious Diseases, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
15
|
Monti JD, Cronin A. Orthopedic Pearls and Pitfalls. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Misra DP, Chowdury AC, Edavalath S, Aggarwal A, Kumar S, Agarwal V. Endocarditis: the great mimic of rheumatic diseases. Trop Doct 2016; 46:180-186. [PMID: 27694317 DOI: 10.1177/0049475515624031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Rheumatic manifestations may be prevalent in more than 30% of patients with infective endocarditis (IE), often predating this diagnosis by several months. A case series of five patients recorded at a tertiary care Rheumatology and Clinical Immunology unit over a period of 1 year emphasises that varied presentations of endocarditis may mimic uncommon rheumatic diseases.
Collapse
Affiliation(s)
- Durga Prasanna Misra
- Senior Resident, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhra Chandra Chowdury
- Senior Resident, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sukesh Edavalath
- Senior Resident, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amita Aggarwal
- Professor, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sudeep Kumar
- Additional Professor, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Agarwal
- Additional Professor, Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
17
|
Evrard G, Alamo S, Gousselot C. Polyarthrite révélatrice d’une atteinte disséminée gonococcique. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-015-0598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
18
|
Abstract
Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogenesis of chronic inflammatory arthritides such as rheumatoid arthritis is increasingly being recognized. We discuss the various causative agents of infective arthritis and emphasize on the approach to each type of arthritis, highlighting the diagnostic tests, along with their statistical accuracy. Various investigations including newer methods such as nucleic acid amplification using polymerase chain reaction are discussed along with the pitfalls in interpreting the tests.
Collapse
Affiliation(s)
- Ashish Jacob Mathew
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | | |
Collapse
|
19
|
Zaia BE, Soskin PN. Man With Severe Shoulder Pain. Ann Emerg Med 2014; 63:528, 571. [DOI: 10.1016/j.annemergmed.2013.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 07/16/2013] [Accepted: 09/03/2013] [Indexed: 01/08/2023]
|
20
|
|
21
|
Espinoza LR, García-Valladares I. Of bugs and joints: the relationship between infection and joints. ACTA ACUST UNITED AC 2012; 9:229-38. [PMID: 22944142 DOI: 10.1016/j.reuma.2012.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 03/22/2012] [Accepted: 06/08/2012] [Indexed: 01/18/2023]
Abstract
The association between microbes and joints has existed since antiquity, and remains complex. Diagnosis is often times difficult to determine despite highly suspicious clinical characteristics for the presence of an underlying infection. Over the several past decades, considerable advances have occurred in diagnostic methodologies and therapy. However, the morbidity and mortality of septic arthritis remains high. Great advances have occurred in the diagnosis, pathogenesis, and therapeutic management of reactive arthritis, and there is evidence that when the responsible microorganism is Chlamydia trachomathis, complete remission and cure is possible. Emergent infections, especially viral, has been recognized, i.e. HIV, hepatitis C, and most recently Chikengunya virus, and in the case of HIV associated articular manifestations, the introduction of HAART has resulted in a decrease in the incidence and development of newer complications such as the immune reconstitution syndrome. The infectious etiology of rheumatoid arthritis is being strongly considered once again, and the exciting association with periodontal disease is at the forefront of intense research. The gut microbiota is also being investigated and new and most interesting data is being gathered of the potential role of commensal gut organisms and the pathogenesis of rheumatoid arthritis.
Collapse
Affiliation(s)
- Luis R Espinoza
- Departamento de Medicina Interna, Sección de Reumatología, Louisiana State University Health Sciences Center, Nueva Orleans, Estados Unidos.
| | | |
Collapse
|
22
|
Diagnostic considerations for monoarticular arthritis of the hand and wrist. J Hand Surg Am 2012; 37:1480-5. [PMID: 22633228 DOI: 10.1016/j.jhsa.2012.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 03/13/2012] [Accepted: 04/08/2012] [Indexed: 02/02/2023]
|
23
|
Abstract
Juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis, is a heterogeneous group of diseases characterized by onset of chronic arthritis in childhood. Diagnosis requires onset of disease by age 16 years, persistent arthritis in any joint for ≥ 6 weeks, and exclusion of other conditions that cause arthritis (eg, infection, malignancy, acute rheumatic fever, inflammatory bowel disease). Most patients with juvenile idiopathic arthritis present with subacute arthritis with minimal pain and few constitutional symptoms. Laboratory evaluation and imaging are useful to exclude other diagnoses and establish the presence of systemic inflammation. However, these modalities are of limited value in screening for rheumatic diseases, and they may be misleading because of the high rate of false-positive results. Most rheumatologic conditions are diagnosed based on pattern recognition, which is established with a thorough history and physical examination.
Collapse
|
24
|
Arthrocentesis and Therapeutic Joint Injection: An Overview for the Primary Care Physician. Prim Care 2010; 37:691-702, v. [DOI: 10.1016/j.pop.2010.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
25
|
Beyond Osteoarthritis: Recognizing and Treating Infectious and Other Inflammatory Arthropathies in Your Practice. Prim Care 2010; 37:713-27, vi. [DOI: 10.1016/j.pop.2010.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|