Osteomyelitis presenting as a swollen elbow in a patient with the acquired immune deficiency syndrome

Musculoskeletal infections in patients with human immunodeficiency virus infection

Musculoskeletal infections constitute an unusual clinical manifestation in patients with human immunodeficiency virus (HIV) infection. Available information about patients' characteristics and their clinical course has been obtained mainly from case reports and small retrospective studies. Our retrospective study is the largest in the literature providing detailed information about the clinical and laboratory characteristics of HIV-infected patients with different musculoskeletal infections. We identified 30 patients with various infections of the musculoskeletal system during a 5-year period among a cohort of 3,000-4,000 HIV-infected patients, and we describe them along with all cases of musculoskeletal infections in patients with HIV reported in the literature since 1985. Septic arthritis was the most commonly reported infection of the musculoskeletal system. It usually affects young men with a median CD4 count of 241. The exact contribution of a previous history of intravenous drug abuse in the pathogenesis of septic arthritis is unclear from the present and previous studies. Staphylococcus aureus was the most commonly isolated agent (31.3%). Numerous atypical pathogens were also identified as causes of septic arthritis. Approximately 90% of patients recovered with appropriate antibiotic treatment. Osteomyelitis was a more serious infection which also affected young individuals but with lower CD4 counts (median, 41). Half the cases were due to atypical mycobacteria. The mortality rate in the previously reported cases and in our series was high (20%). Pyomyositis is an increasingly recognized infection of the striated muscles in HIV-infected patients. It affects almost exclusively males with advanced HIV infection (median CD4 count, 24). Most cases are due to Staphylococcus aureus (67%). Drainage of the involved muscle(s) accompanied by proper antibiotic treatment resulted in resolution of the infection in the majority of patients (90%). Although the incidence of musculoskeletal infections in patients with HIV from this and previous studies appears to be low (0.3%-3.5%), these infections add a significant morbidity and mortality in the affected individuals. Better understanding of their pathogenesis and clinical course would aid the proper diagnosis and management of these infections.

Diagnostic imaging in pediatric AIDS

The manifestations of acquired immune deficiency syndrome (AIDS) in children are mainly secondary to opportunistic infection, lymphoproliferative diseases, and AIDS-related neoplasms. This article reviews the pathologic findings of various disorders afflicting children with AIDS and emphasizes the imaging of these disorders. Although many of the radiologic findings are not specific for a particular infection or neoplasm, the differential diagnostic possibilities for an abnormality can be narrowed down significantly with proper clinical correlation and knowledge of the imaging findings and pathologies specific to children with AIDS.

Osteoarticular infection in intravenous drug abusers: influence of HIV infection and differences with non drug abusers

OBJECTIVES

To determine (a) the influence of HIV in developing osteoarticular infections in intravenous drug abusers (IVDAs) and (b) the differences between the clinical features of osteoarticular infections in IVDAs and a control group of non-IVDAs.

METHODS

A comparative study of the clinical features of osteoarticular infections in all HIV positive and HIV negative IVDAs admitted to the departments of rheumatology and internal medicine during a 10 year period was carried out. The joint infections of all IVDAs, irrespective of HIV status, were compared with those of a control group of non-IVDAs lacking risk factors for HIV infection.

RESULTS

A total of 482 HIV positive and 85 HIV negative IVDAs was studied, in whom 25 (5%) and six (7%) osteoarticular infections were found respectively. There were no differences in age, sex, joints affected, and causative agents between these two groups. A comparison of the 31 (5.5%) osteoarticular infections in all IVDAs with 21 infections in 616 (3.4%) non-IVDAs showed significant differences in the mean age (27.5 v 54), the frequency of affection of the axial joints (hip, sacroiliac, and sternocostal joints) (64.5% v 16.6%), and in the incidence of Candida albicans (19% v 0%).

CONCLUSIONS

(1) HIV may not predispose to osteoarticular infections in IVDAs. (2) The hip, sacroiliac, and sternocostal joints (axial joints) were most commonly affected in IVDAs. (3) In Spain, unlike other countries, Gram positive bacteria and C albicans seem to be predominant agents in osteoarticular infections in IVDAs, with a low incidence of Gram negative bacteria.

Musculoskeletal Manifestations of Human Immunodeficiency Virus Infection

Human immunodeficiency virus (HIV) causes an infection characterized by a wide spectrum of clinical manifestations, including musculoskeletal conditions that have been recognized with increasing frequency in recent years. Arthralgia, usually of moderate intensity, intermittent, and oligoarticular, is the most frequent rheumatic manifestation of HIV; it occurs in approximately 35% of the cases. Knees, shoulders, and elbows are the most frequently involved joints. A “painful articular syndrome,” characterized by severe articular or bone pain of short duration and absence of inflammation, can be observed in up to 10% of cases. Reiter's syndrome was the first rheumatological disorder recognized in association with HIV infection. The reported frequency has ranged from 0.5 to 9-9%. Most of the patients with this syndrome develop the incomplete form, and they usually are positive for human lymphocyte antigen B27. HIV-associated arthropathy has been observed by several groups. It is characterized by absence of recognizable rheumatic disease or syndrome, an oligoarticular pattern, and a subacute course. Psoriasis and psoriatic arthritis may flare up or develop in the course of an HIV infection and have been reported with increased prevalence in HIV patients. Psoriatic arthritis usually has a polyarticular and asymmetrical pattern. Several forms of myopathy have also been reported. Myalgia and a myopathy similar to polymyositis are the most frequent patterns observed. Two forms of the latter have been recognized, one attributed to HIV infection itself and the other to the use of zidovudine. Septic conditions in joint, bursa, bone, and muscle have rarely been described despite the immunodeficiency state. A Sjogren's syndrome-like disorder, termed “diffuse infiltrative lymphocyte syndrome,” may be seen in HIV patients, and it has many features that distinguish it from primary Sjögren's syndrome. Several types of vasculitis have been described; the necrotizing type is the most frequent type found. Fibromyalgia, hypertrophie osteo-arthropathy, and soft-tissue lesions have also been described. The pathogenetic mechanisms underlying the rheumatic manifestations of HIV infection are not well known. Their treatment is not well defined, but includes conventional antirheumatic therapy. Methotrexate and other immunosuppressive drugs should be used cautiously because they can precipitate the acquired immunodeficiency syndrome in an HIV-positive patient.

Septic acromioclavicular arthritis and osteomyelitis in a patient with acquired immunodeficiency syndrome

We describe a patient with acquired immunodeficiency syndrome who developed Staphylococcus aureus septic arthritis and osteomyelitis of the acromioclavicular joint. The case is unusual because of the rarity of reported bone and joint infections in patients with acquired immunodeficiency syndrome and because of the indolent nature of the infection.