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Wongjarit K, Ukritchon S. Disseminated gonococcal infection during two decades in the university hospital, Thailand. ASIAN BIOMED 2024; 18:125-132. [PMID: 39175952 PMCID: PMC11338079 DOI: 10.2478/abm-2024-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Background Disseminated gonococcal infection (DGI) caused by Neisseria gonorrhoeae commonly presents with the classic triad of polyarthritis, tenosynovitis, and dermatitis. There is no clinical and microbiological data of DGI in Thailand. Objective To study the clinical features, outcomes of treatments, and antimicrobial susceptibility data of DGI patients. Methods All medical records of DGI patients at King Chulalongkorn Memorial Hospital (KCMH) from January 2002 through September 2019 were reviewed and analyzed. The patients were defined as definite DGI (the clinical features and the evidence of gonococcal infection) and probable DGI (clinical features with response to treatment with third-generation cephalosporins and with no evidence of gonococcal infection). Results There were 41 patients (27 definite and 14 probable DGI), with a male-to-female ratio of 1:1.4 and median age of 30 years. The middle-age and elderly group accounted for 20% of the patients. The clinical features were fever (90.27%), arthritis (92.7%), tenosynovitis (63.4%), and genitourinary symptoms (29.3%). The most common pattern of joint involvement was oligoarthritis (52.6%). The majority of the patients had good clinical outcomes, while complications occurred in 4.8% of the patients including osteomyelitis and pyomyositis. All 19 antimicrobial-susceptibility results were susceptible to ceftriaxone. Conclusions During the past 2 decades in KCMH, the age of the DGI patients tends to be older, and there is no gender difference as in the historical studies. The clinical features are still similar to the previous studies. The majority of the patients had good clinical outcomes. There is no case of ceftriaxone-resistant N. gonorrhoeae.
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Affiliation(s)
- Kanphai Wongjarit
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Sittichai Ukritchon
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
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Kobayashi S, Izaki T, Miyake S, Arashiro Y, Yamamoto T. Disseminated gonococcal infection of the shoulder mimicking rheumatoid arthritis. Shoulder Elbow 2023; 15:658-663. [PMID: 37981974 PMCID: PMC10656973 DOI: 10.1177/17585732221076049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2023]
Abstract
Introduction Gonococcal arthritis is a characteristic of disseminated gonococcal infection (DGI). DGI arthritis is one of the most serious orthopedic emergencies because it can result in rapidly progressive joint damage, but it is often difficult to diagnose. Delayed treatment can result in the development of osteomyelitis in the adjacent bone, similar to other types of bacterial arthritis. Method We report a case of gonococcal osteomyelitis associated with DGI that was initially treated as rheumatoid arthritis. The diagnosis was confirmed by DNA testing of synovium collected during arthroscopic debridement. Results Seven years after the initial consultation, there was no acute-phase reactant, the arthritic changes had improved over time and the range of motion had increased. DGI may be difficult to confirm, but it is one of the most important entities that should be differentiated in the treatment of arthritis. Conclusion Clinicians need to keep in mind that blood and synovial fluid cultures often do not lead to a definitive diagnosis.
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Affiliation(s)
- Shunsuke Kobayashi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Teruaki Izaki
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Miyake
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuhara Arashiro
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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3
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Wang CH, Lu CW. Images of the month 2: Disseminated gonococcal infection presenting as the arthritis-dermatitis syndrome. Clin Med (Lond) 2019; 19:340-341. [PMID: 31308120 PMCID: PMC6752240 DOI: 10.7861/clinmedicine.19-4-340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Chun-Wei Lu
- Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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4
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Germino KW, Street MH, Caudill KA, Barenkamp SJ. An unusual cause of acute polyarticular arthritis. Clin Pediatr (Phila) 2009; 48:220-3. [PMID: 18832545 DOI: 10.1177/0009922808323120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kevin W Germino
- Department of Pediatrics, Saint Louis University, Missouri 63104, USA.
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Abstract
Septic arthritis caused by N gonorrhoeae is monoarticular or pauciarticular, and is more commonly associated with positive synovial fluid cultures and negative blood cultures. Gonococcal bacteremia is more likely to be associated with polyarthralgias and skin lesions. The diagnosis of gonococcal arthritis or DGI is also secure if a mucosal gonococcal infection is documented in the presence of a typical clinical syndrome that responds promptly to appropriate antimicrobial therapy. Hospitalization is indicated in patients with suppurative arthritis or when the diagnosis is in doubt. Initial treatment with ceftriaxone or another advanced-generation cephalosporin is warranted until signs and symptoms have improved; continuation of treatment for a total period of therapy of 1 week can be accomplished with a fluoroquinolone.
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Affiliation(s)
- Peter A Rice
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Lazare Research Building (LRB), Room 321, Worcester, MA 01605, USA.
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Shibata Y, Kumano T, Shinoda T, Hanada H, Notomi T, Nagayama A, Naito M. Gonococcal osteomyelitis of the shoulder extended from gonococcal arthritis: diagnosis by a polymerase chain reaction assay. J Shoulder Elbow Surg 2004; 13:467-71. [PMID: 15220891 DOI: 10.1016/j.jse.2004.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yozo Shibata
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
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7
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Craig JG, van Holsbeeck M, Alva M. Gonococcal arthritis of the shoulder and septic extensor tenosynovitis of the wrist: sonographic appearances. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:221-224. [PMID: 12562127 DOI: 10.7863/jum.2003.22.2.221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Joseph G Craig
- Department of Radiology, Henry Ford Hospital, Detroit Michigan 48202, USA
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Abstract
Because of its seriousness, septic arthritis should be considered early in the differential diagnosis of any child presenting with joint inflammation. Physicians who care for children should be aware of the early signs and symptoms of septic arthritis and be aggressive about establishing the diagnosis so that treatment is not delayed. Early orthopedic consultation and a low threshold for performing arthrocentesis are prudent. Prolonged and appropriate antimicrobial therapy is warranted to achieve optimal results.
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Affiliation(s)
- A K Shetty
- Department of Pediatrics, Louisiana State University Medical Center, New Orleans, USA
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Affiliation(s)
- J J Mesa
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, USA
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Affiliation(s)
- J D Ross
- Department of Genitourinary Medicine, Edinburgh Royal Infirmary, UK
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11
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Li F, Bulbul R, Schumacher HR, Kieber-Emmons T, Callegari PE, Von Feldt JM, Norden D, Freundlich B, Wang B, Imonitie V, Chang CP, Nachamkin I, Weiner DB, Williams WV. Molecular detection of bacterial DNA in venereal-associated arthritis. ARTHRITIS AND RHEUMATISM 1996; 39:950-8. [PMID: 8651989 DOI: 10.1002/art.1780390612] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the utility of polymerase chain reaction (PCR) amplification in detecting DNA from venereal-associated microorganisms in the synovial fluid of patients with inflammatory arthritis. METHODS Oligonucleotide primers were developed for nested PCR based on Chlamydia, Ureaplasma, and Neisseria DNA sequences. PCR products were detected by gel electrophoresis and dot-blot hybridization. Primers specific for the target bacterial DNA were used to search for bacterial DNA in 61 synovial fluid specimens from patients with inflammatory arthritis, including several clinically associated with venereal infection. RESULTS Five of the 61 synovial fluid specimens were positive for Neisseria gonorrhoeae DNA. Four of the 5 patients had clinical diagnoses of gonococcal arthritis; the other patient had an unexplained monarthritis. One specimen from a patient with a clinical diagnosis of gonococcal arthritis was negative for N gonorrhoeae. Three of the 61 specimens were positive for Chlamydia DNA. Two were derived from patients with clinical diagnoses of reactive arthritis or Reiter's syndrome, and 1 was from a patient with unexplained monarthritis. One of the 61 specimens was positive from Ureaplasma DNA; this sample was from a patient with a clinical diagnosis of Reiter's syndrome. In an additional patient with Reiter's syndrome, Ureaplasma DNA was also found in prostate biopsy tissue and a urine sample obtained after prostate massage (synovial fluid not available). CONCLUSION These data support the classification of these 3 venereal-associated arthritides as infectious processes, and suggest that PCR for bacterial DNA is a useful method for detecting infectious agents in synovial fluid.
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Affiliation(s)
- F Li
- University of Pennsylvania Medical Center, Philadelphia 19104, USA
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12
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Sorokin R, Ward SB. Joint pain. Med Clin North Am 1995; 79:247-60. [PMID: 7877389 DOI: 10.1016/s0025-7125(16)30066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article reviews the approach an internist might take with a patient with joint pain. It emphasizes aspects of the history and physical examination that help yield a diagnosis. The use of simple laboratory tests is reviewed, and common questions are answered. Some general management issues are discussed, although disease-specific therapy is beyond the scope of this article. It is hoped that this article will help an internist successfully diagnose most patients who present with joint pain.
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Affiliation(s)
- R Sorokin
- Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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13
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Martin DH, Mroczkowski TF. DERMATOLOGIC MANIFESTATIONS OF SEXUALLY TRANSMITTED DISEASES OTHER THAN HIV. Infect Dis Clin North Am 1994. [DOI: 10.1016/s0891-5520(20)30610-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T, Louie JS. Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction. ARTHRITIS AND RHEUMATISM 1994; 37:702-9. [PMID: 8185697 DOI: 10.1002/art.1780370514] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze synovial fluid (SF) for the presence of Neisseria gonorrhoeae DNA using the polymerase chain reaction (PCR). METHODS We used a modified, nested PCR to detect the presence of N gonorrhoeae DNA in 41 samples of SF obtained from 10 patients with clinical gonococcal arthritis whose SF samples were sterile by culture and from 27 controls, including 11 patients with Reiter's syndrome. Results obtained using this method were compared with those obtained using the GEN-PROBE system, an RNA-DNA hybridization technique. RESULTS With nested PCR, N gonorrhoeae DNA was detected in 11 of 14 SF samples obtained from patients with culture-negative clinical gonococcal arthritis but in none of the 11 SF samples from Reiter's syndrome patients. The specificity of this technique was 96.4%, with a sensitivity of 78.6%. The rate of false-positive results was 3.6%. The GEN-PROBE technique was unable to detect N gonorrhoeae ribosomal RNA in any of the samples. CONCLUSION These findings demonstrate the potential utility of the PCR in confirming the clinical diagnosis of gonococcal arthritis as well as providing insight into the pathogenesis of this disorder in patients whose SF are sterile by standard culture techniques. PCR may also prove helpful in differentiating N gonorrhoeae arthritis from acute Reiter's syndrome.
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Affiliation(s)
- M R Liebling
- Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA 90509
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Simms RW, Zerbini CAF. Rheumatic Disease in the Intensive Care Unit: Acute Septic Arthritis and Giant-Cell Arteritis. J Intensive Care Med 1993. [DOI: 10.1177/088506669300800601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert W. Simms
- Arthritis Section, Boston University School of Medicine, Department of Medicine, and Thorndike Memorial Laboratories, Boston City Hospital, Boston, MA
| | - Cristiano A. F. Zerbini
- Arthritis Section, Boston University School of Medicine, Department of Medicine, and Thorndike Memorial Laboratories, Boston City Hospital, Boston, MA
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Ostlere LS, Harris D, Johnson M, Rustin MH. Gastrointestinal and cutaneous vasculitis associated with gonococcal infection in an HIV-seropositive patient. J Am Acad Dermatol 1993; 29:276-8. [PMID: 8335755 DOI: 10.1016/s0190-9622(08)81851-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- L S Ostlere
- Department of Dermatology, Royal Free Hospital and School of Medicine, London, United Kingdom
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18
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Rúa Figueroa I, Loza Cortina E, González Suárez S, Arruabarrena CE, Peña Sagredo JL. Disseminated gonococcal infection in an elderly patient. Ann Rheum Dis 1993; 52:83. [PMID: 8427526 PMCID: PMC1004967 DOI: 10.1136/ard.52.1.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Gonococcal endocarditis is a devastating albeit rare complication of disseminated gonorrhea. It virtually disappeared as a disease entity with the advent of antibiotic therapy. Recently, it has reappeared with surprisingly high frequency for unclear reasons. Since 1983, the authors have observed six episodes of this disease in five patients, the largest series reported to date. It is predominantly a disease of young people without underlying valvular heart disease. Characteristic clinical features include a high frequency of congestive heart failure and nephritis and a proclivity for aortic valve involvement, commonly with associated ring abscess, and large vegetations. Genitourinary symptoms, arthralgias, and rash are uncommon. Previously undescribed features include involvement of all four valves simultaneously, recurrence on an aortic valve prosthesis, and a high frequency of terminal complement deficiencies. Precipitous hemodynamic deterioration despite appropriate therapy is not uncommon, and overall mortality rate remains an alarming 19%.
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20
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Abstract
Sexually transmitted infections may provoke a wide variety of rheumatic lesions. Disseminated N. gonorrhoeae infection leads to septic arthritis, which may be rapidly destructive but which responds promptly to appropriate antibiotic therapy. In contrast, both gonococcal and nongonococcal infections may lead to aseptic "reactive" arthritis or Reiter's syndrome. Inheritance of HLA B27 confers a relative risk of 30 to 50 times for the development of this condition. The demonstration of C. trachomatis antigen in joint material from a minority of patients suggests that direct interaction between microbial components and class I HLA antigens in the joint may be central to the pathogenesis of this disease. Arthralgia and arthritis occur in up to 50% of individuals in the prodrome of hepatitis B infection. Joint symptoms may be accompanied by urticarial or cutaneous vasculitic lesions, especially on the legs; both features resolve with the onset of jaundice. Hepatitis B infection is also a major cause of necrotizing vasculitis, which may or may not be associated with overt hepatitis. Seronegative arthritis, including Reiter's syndrome, psoriatic arthritis, and undifferentiated arthritis, a Sjögren's-like syndrome, vasculitis, and myopathies have been described in association with HIV infection. It is clear that synovitis occurs in those patients despite the fact that HIV is present in immune cells within the joint during inflammatory arthritis and that both antigen presentation and lymphocyte responsiveness within the joint are impaired. Nevertheless, synovitis may occur in the presence of marked CD4-positive lymphocyte depletion. Rheumatic syndromes, including arthralgia, inflammatory arthritis, and neuropathic arthritis, may occur during any stage of congenital or acquired syphilis. Syphilitic synovitis responds well to antibiotic therapy, but neuropathic lesions cannot be treated effectively. Septic arthritis has rarely been described as a complication of disseminated Mycoplasma or Urea-plasma infections, and joint lesions sometimes associated with erythema nodosum have also been reported in lymphogranuloma venereum and granuloma inguinale.
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Affiliation(s)
- A Keat
- Department of Rheumatology, Charing Cross and Westminster Medical School, Westminster Hospital, London, England
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Affiliation(s)
- O Shapira
- Department of Orthopedic Surgery, Kaplan Hospital, Rehovot, Israel
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Affiliation(s)
- P A Rice
- Maxwell Finland Laboratory for Infectious Disease, Boston City Hospital, Massachusetts
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McCune WJ, Matteson EL, MacQuire A. Evaluation of Knee Pain. Prim Care 1988. [DOI: 10.1016/s0095-4543(21)01296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- S Pérès
- Service d'immuno-rhumatologie et réadaptation fonctionnelle, Centre Gui-de-Chauliac, hôpital Saint-Eloi, Montpellier
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Densen P, Gulati S, Rice PA. Specificity of antibodies against Neisseria gonorrhoeae that stimulate neutrophil chemotaxis. Role of antibodies directed against lipooligosaccharides. J Clin Invest 1987; 80:78-87. [PMID: 2439546 PMCID: PMC442204 DOI: 10.1172/jci113067] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Five strains each of Neisseria gonorrhoeae sensitive or resistant to complement (C) dependent killing by normal human serum (NHS) were examined for their ability to stimulate chemotaxis of polymorphonuclear leukocytes (PMNs) after preincubation with NHS; or IgM or IgG derived from NHS. Serum-sensitive N. gonorrhoeae stimulated C-dependent chemotaxis when opsonized with IgM, but not IgG, however, serum-resistant strains, taken as a whole, failed to promote chemotaxis when opsonized with either isotype. IgM titers in NHS against lipooligosaccharide (LOS) antigens from individual serum-sensitive, but not serum-resistant strains, correlated with the magnitude of chemotaxis generated by the corresponding opsonized strains (r = 0.99). Western blots demonstrated that IgM and IgG from NHS recognized different antigenic determinants on LOS from serum-sensitive gonococci. IgM from NHS immunopurified against serum-sensitive LOS accounted for two-thirds of the chemotaxis promoting activity present in whole serum. IgG titers in NHS against LOS antigens from individual serum-resistant strains also correlated with magnitude of chemotaxis generated by the corresponding opsonized strains (r = 0.87), although most opsonized serum-resistant strains did not generate significantly higher magnitudes of chemotaxis than controls. In contrast, a serum-resistant isolate from a patient with disseminated gonococcal infection (DGI) stimulated chemotaxis when opsonized with IgG obtained from the patient's convalescent serum. By Western blot, convalescent IgG antibody recognized an additional determinant on serum-resistant LOS not seen by normal IgG.
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Shiel WC, Andrews BS, Friou GJ, Barada FA, Scopelitis E, Martin DA. Immune complexes in synovial fluid and serum from patients with disseminated gonococcal infection: evidence for local immune complex formation within the joint. Ann Rheum Dis 1986; 45:816-20. [PMID: 3789817 PMCID: PMC1002002 DOI: 10.1136/ard.45.10.816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty one patients with acute arthritis associated with disseminated gonococcal infection (DGI) were studied. Synovial fluid (SF) from 14 and serum from 15 (matched in eight) were assayed for the presence of immune complexes (IC) by the Raji cell immunofluorescent assay (Raji IFA) and the 125I-Clq polyethylene glycol (PEG) binding assay. Higher levels and frequency of IC were detected in the SF by both IC assays and these were associated with a significant increase in complexes containing IgM over serum (p less than 0.02). Complexes containing IgG were found predominantly in serum and were infrequent in SF (p less than 0.003). These data suggest that the arthritis of DGI may result from primary immune complex formation within the synovial cavity after local antibody synthesis within the synovium in response to gonococcal seeding.
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Kidd BL, Hart HH, Grigor RR. Clinical features of meningococcal arthritis: a report of four cases. Ann Rheum Dis 1985; 44:790-2. [PMID: 3933440 PMCID: PMC1001779 DOI: 10.1136/ard.44.11.790] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Four patients with Neisseria meningitidis infection complicated by arthritis are described. Three patients had an acute polyarthritis which responded quickly to antimicrobial therapy. A fourth patient developed a prolonged arthritis which occurred after the initial infection had been successfully treated. Tenosynovitis occurred as a complication in one case. Attention is drawn to possible confusion with gonococcal infection, and postulated pathological mechanisms are discussed.
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Withrington RH, Seifert MH. Disseminated gonococcal infection in a married couple. Clin Rheumatol 1985; 4:181-2. [PMID: 4006387 DOI: 10.1007/bf02032290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The rare occurrence of disseminated gonococcal infection in a married couple is reported. These cases support the concept that bacterial rather than host factors are more important in determining the disease manifestations in gonorrhoea.
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Rosen MS, Myers AR, Dickey B. Meningococcemia presenting as septic arthritis, pericarditis, and tenosynovitis. ARTHRITIS AND RHEUMATISM 1985; 28:576-8. [PMID: 3924058 DOI: 10.1002/art.1780280519] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pustular Vasculitis: Common Ground Among Behçet's, Bowel Bypass, and Disseminated Gonorrhea Syndromes. Dermatol Clin 1983. [DOI: 10.1016/s0733-8635(18)31014-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sugar AM, Utsinger PD, Santoro J. Gonococcal endocarditis in a patient with mitral valve prolapse: study of host immunology and organism characteristics. Am J Med Sci 1982; 283:165-8. [PMID: 7081290 DOI: 10.1097/00000441-198205000-00009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The first case of gonococcal endocarditis on a prolapsing mitral valve is reported. The organism was found to be highly sensitive to penicillin G, Arg- Hyp- Ura-, and sensitive to the bactericidal action of normal serum. This combination of characteristics in a strain of Neisseria gonorrheae causing systemic disease is distinctly unusual. With high dose penicillin therapy the immunologic parameters returned to normal and the patient made an uneventful recovery. High levels of circulating immune complexes were detected in the patient's serum.
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Eisenstein BI, Masi AT. Disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA): I. Bacteriology, epidemiology, host factors, pathogen factors, and pathology. Semin Arthritis Rheum 1981; 10:155-72. [PMID: 6112797 DOI: 10.1016/s0049-0172(81)80001-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Masi AT, Eisenstein BI. Disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA): II. Clinical manifestations, diagnosis, complications, treatment, and prevention. Semin Arthritis Rheum 1981; 10:173-97. [PMID: 6785887 DOI: 10.1016/s0049-0172(81)80002-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This is the second part of an integrated review of disseminated gonococcal infection (DGI) and gonococcal arthritis (GCA). It covers clinical manifestations, spectrum of GCA, diagnosis and treatment. These disorders are important since DGI may be the most frequent form of acute arthritis in sexually active younger females, and other selected groups. Although the spectrum of disease is varied, it may be classified into stages and clinical subgroups. N. gonorrhoeae strains causing DGI in the U.S. have been highly sensitive to penicillin. Such findings require revision in beliefs that high-dose intravenous penicillin is needed for effective initial therapy of GCA. Recommended treatment protocols for localized gonorrhea and DGI are reviewed as well as the occurrence and implications for treatment of penicillinase-producing N. gonorrhoeae (PPNG) infection in the U.S.
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Abstract
The primary care physician can diagnose gonococcal arthritis with virtual certainty in the presence of migratory polyarthralgia, tenosynovitis of the upper extremity, and characteristic skin lesions. The exquisite antibiotic sensitivity of most gonococcal organisms has made outpatient oral therapy reasonable, with rapid resolution of symptoms usually resulting.
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