Gonorrhoea infection presenting in pregnancy with septic arthritis of the sternoclavicular joint

Gonococcal septic arthritis of the sternoclavicular joint: A case report

Gonococcal septic arthritis is a rare condition that most frequently involves the interphalangeal joints of the hands, wrists, knees, and ankles. We report a case of monoarticular gonococcal septic arthritis of the sternoclavicular joint in the absence of pharyngeal or genitourinary symptoms in a patient with a history of arthropathy and intravenous drug use. This case report aims to describe the clinical features and management of gonococcal arthritis.

Diagnosis and management of sternoclavicular joint infections: a literature review

The sternoclavicular joint (SCJ) is anatomically and clinically significant considering its proximity to important neuro-vascular structures like the subclavian vessels and the phrenic nerve. Infections of this joint masquerade multiple disorders, delay diagnosis and spread to the bone and deep tissues. There is no standardized workup and treatment protocol for sternoclavicular joint infections (SCJI) as defined in literature. Here, we review the existing literature to understand the current knowledge of the diagnosis and treatment of SCJI. We searched English publications in PubMed and included clinical trials, case reports, case series, retrospective cohort studies, literature and systematic reviews after excluding non-infectious etiology of SCJ pathologies. There are many risk factors for SCJI, such as immunocompromised status, intravenous drug use, trauma and arthropathies. But a large percentage of patients with disease have none of these risk factors. SCJIs can present with fever, joint swelling, immobility, and rarely with vocal cord palsy or dysphagia. While Staphylococcus aureus causes over 50% of SCJI cases, other pathogens such as Pseudomonas and Mycobacterium are frequently seen. When diagnosed early, the infection can be medically managed with antibiotics or joint aspirations. Most cases of SCJI, however, are diagnosed after extensive spread to soft tissue and bones requiring en-bloc resection with or without a muscle flap. Complications of undertreatment can range from simple abscess formation to mediastinitis, even sepsis. SCJIs are rare but serious infections prompting early detection and interventions. Most cases of SCJI treated adequately show complete resolution in months while retaining maximum functionality. Key features of proper healing include aggressive physiotherapy to prevent adhesive shoulder capsulitis and decreased range of motion.

Gonococcal polyarthritis with sternoclavicular joint involvement in pregnant woman: a case report

Pregnancy is one of conditions that increase the risk of gonococcal arthritis which result from blood dissemination of neisseria gonorrhoeae. A 20-year-old africain female patient (in the second trimester of pregnancy), was admitted to hospital because of fever, asymmetric joint swollen affecting the hands, wrists, left ankle, and right sternoclavicular joint. Laboratory findings (erythrocyte sedimentation rate was 117 mm in first hour, The serum C-reactive protein level was 152 mg/L) the gram stain of genital sample was positif of neisseria gonorrhoeae and trichomonas vaginalis. With antibiotics, outcome of pregnancy was timely and uneventful. Patients should be educated about the mode of transmission of gonorrhea. Sexual partners should also be treated to prevent dissemination and gonococcal re-infection.

Treatment of sternoclavicular joint osteomyelitis with debridement and delayed resection with muscle flap coverage improves outcomes

The objective of this study was to evaluate the efficacy of various treatment options for sternoclavicular joint osteomyelitis. We evaluated patients with a diagnosis of sternoclavicular joint osteomyelitis, treated at our hospital from 2002 to 2012. Four treatment options were compared. Three out of twelve patients were successfully cured with antibiotics alone (25%). Debridement with or without negative pressure therapy was successful for one of three patients (33%). Simultaneous debridement, bone resection, and muscle flap coverage of the acquired defect successfully treated one of two patients (50%). Debridement with delayed bone resection and muscle flap coverage was successful in five of five patients (100%). Osteomyelitis of the sternoclavicular joint is a rare disease that has become more prevalent in recent years and can be associated with increasing use of long-term indwelling catheters. Initial debridement with delayed bone resection and pectoralis major muscle flap coverage can effectively treat sternoclavicular joint osteomyelitis.

Disseminated gonococcal infection in women

OBJECTIVE

To review the clinical presentation, complications, and response to treatment of pregnant and nonpregnant women admitted for management of disseminated gonococcal infection over a 34-year period.

METHODS

This was a review of all women diagnosed with disseminated gonococcal infection who were admitted to Parkland Memorial Hospital from 1975 through 2008. Medical records were reviewed and data extracted that included demographic information, clinical and laboratory findings, and response to antimicrobial treatment. In addition to determining perinatal outcomes, the clinical findings of women in the pregnant cohort were compared with those of nonpregnant women.

RESULTS

Of 112 women hospitalized for treatment during the study period, 80 (71%) were nonpregnant and 32 (29%) were pregnant. In both groups, the frequency of disseminated infections declined substantively over the last 34 years. Presenting symptoms were similar for pregnant and nonpregnant women, and with one exception, all had arthritis that involved a mean of two joints, most commonly the knee and wrist. Two notable differences between the cohorts were that pregnant women sought care a mean of 2 days after symptoms began compared with that of 5 days for nonpregnant women (P=.003). Related to this, only 50% of pregnant women had a joint effusion compared with 70% of nonpregnant women (P=.05).

CONCLUSION

The frequency of disseminated gonococcal infection decreased remarkably over the 34-year study period, paralleling the decreasing prevalence of mucosal Neisseria gonorrhoeae infections reported nationwide. In women with disseminated infections, prompt recognition and antimicrobial treatment will usually result in a favorable outcome.