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Primary septic arthritis of the knee caused by Neisseria meningitidis serogroup B in an elderly patient. Case report and review of the literature. Infection 2022; 51:499-506. [PMID: 36181635 DOI: 10.1007/s15010-022-01928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Primary meningococcal arthritis (PMA) represents an uncommon clinical presentation of meningococcal infection, mainly reported among young people. Herein, a case of PMA of the knee in an elderly patient is described. CASE PRESENTATION On January 2022, an 87-year-old patient arrived at hospital with continuous fever persisting for three days and a picture of pain, swelling, redness, and warmth of her left knee. An arthrocentesis was promptly performed and the inoculated synovial fluid turned positive with numerous Gram-negative diplococci at the microscopic examination. The identification of bacteria was done in 48 h using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) MS systems (VITEK®MS-bioMérieux) and standard microbiological procedures (VITEK®2 NH ID card-bioMérieux). Both methods identified the strain as N. meningitidis. The meningococcal isolate belonged to the serogroup B (MenB), Sequence type (ST)-162/clonal complex (cc)162. Two grams of ceftriaxone twice a day were administered for 21 days; than cefditoren pivoxil 400 mg twice a day for further 6 weeks after discharge. In Italy, from 2018 to January 2022, among 135 MenB, 31 MenB/cc162 were identified, of which only the case here reported was associated with an atypical clinical presentation. REVIEW OF THE LITERATURE A total of 41 cases of PMA caused by N. meningitidis was reported in the literature, but only four occurred in elderly. To our knowledgements, no cases of PMA caused by MenB were previously reported among patients of more than 65 years of age.
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Ahmed S, Walton T, Sundram F, Ugwoke A, Borrow R. Neisseria meningitidis as a cause of isolated bilateral polyarticular native knee joint septic arthritis. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Straticiuc S, Ignat A, Hanganu E, Lupu VV, Ciubara AB, Cretu R. Neisseria meningitidis Serogroup C Causing Primary Arthritis in a Child: Case Report. Medicine (Baltimore) 2016; 95:e2745. [PMID: 26844522 PMCID: PMC4748939 DOI: 10.1097/md.0000000000002745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Neisseria meningitidis (N. meningitidis) is associated with severe invasive infections such as meningitis and fulminant septicemia. Septic arthritis due to N. meningitidis is rare and bone infections have been reported exceptionally. We report the case of a 1-year old girl who presented with a painful, swollen right knee, accompanied by fever and agitation. Arthrocentesis of the right knee, while patient was under anesthesia, yielded grossly purulent fluid, so we made arthrotomy and drainage. The culture from synovial fluid revealed N. meningitidis, sensitive to Ceftriaxone. The patient received intravenous antibiotherapy with Ceftriaxone. The status of the patient improved after surgical drainage and intravenous antibiotic therapy. She recovered completely after 1 month. CONCLUSION This observation illustrates an unusual presentation of invasive meningococcal infection and the early identification of the bacteria, combined with the correct treatment, prevent the complications and even death.
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Affiliation(s)
- Sergiu Straticiuc
- From the Pediatric Orthopaedic Department, "St. Mary" Emergency Children Hospital (SS, RC); Pediatrics Department (AI, VVL); Pediatric Surgery Department (EH); and Anatomy Department, University of Medicine and Pharmacy "Gr. T. Popa"; Orthopaedics Clinic, "St. Spiridon" Emergency Clinical Hospital, Iasi, Romania (ABC)
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Primary meningococcal polyarthritis in an adult woman. Case Rep Med 2015; 2015:563672. [PMID: 25838827 PMCID: PMC4369937 DOI: 10.1155/2015/563672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/27/2015] [Accepted: 03/02/2015] [Indexed: 12/02/2022] Open
Abstract
Primary joint infection caused by the Gram-negative bacteria Neisseria meningitidis is rare. Normally, joint involvement comes secondary to meningitis or severe sepsis caused by this agent. When primary arthritis is seen, monoarthritis is the most common presentation. A meningococcal polyarthritis is described in less than 10 case reports according to current literature. This case report aims to briefly review this rare clinical event in an adult woman with no previous history of rheumatological disease. Early diagnosis of polyarthritis caused by meningococcal bacteria usually present a good prognosis when properly treated.
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Klatte TO, Lehmann W, Rueger JM. [Primary meningococcal infection of the knee. A rare cause of septic arthritis]. Unfallchirurg 2015; 118:885-9. [PMID: 25648871 DOI: 10.1007/s00113-014-2716-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article presents a case of primary septic arthritis of the knee due to serogroup C Neisseria meningitidis. A 19-year-old female presented to the emergency department with a painless but swollen knee joint which had started 2 days previously and fever (38 °C). The patient reported that she suddenly felt unwell 3 days ago and developed a rush at the same time which had almost disappeared when arrived at the emergency department. The patient was admitted to hospital and an antibiotic therapy was started with sulbactam and ampicillin. Initially, incubation of synovial fluid over the next 3 days did not result in detection of any pathogens; therefore, a reactive arthritis was assumed until Neisseria meningitidis was detected in cultures of the synovial fluid. Therapy was then switched to antibiotic therapy with ceftriaxon and arthroscopic irrigation was performed. The patient quickly recovered and was discharged from hospital after 14 days. This case example shows the difficulties of the clinical and microbiological diagnostics of a primary septic meningococcal arthritis; however, the treatment is relatively easy and mostly successful compared to other forms of bacterial joint infection.
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Affiliation(s)
- T O Klatte
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - W Lehmann
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - J M Rueger
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Nihonyanagi S, Sunakawa K, Cui L, Masaki T, Wada T, Hoshiyama T, Nakamura M, Takayama Y, Kanoh Y, Ogawa A, Shichiri M, Hanaki H. A very rare case of primary meningococcal arthritis in an adult male. Clin Case Rep 2014; 3:76-80. [PMID: 25767700 PMCID: PMC4352356 DOI: 10.1002/ccr3.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/05/2014] [Accepted: 08/24/2014] [Indexed: 11/25/2022] Open
Abstract
We report here a very rare case of primary meningococcal arthritis of the knee joint without clinical features associated with meningococcemia, meningitis, or meningococcal complications. The patient suffered from diabetes mellitus and had experienced two episodes of joint trauma. Intravenous infusion of ampicillin/sulbactam for 18 consecutive days was successful.
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Affiliation(s)
- Shin Nihonyanagi
- Department of Medical Laboratory, Kitasato University Hospital 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan ; Kitasato Institute for Life Sciences and Laboratory for Antimicrobial Agents, Kitasato University 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Keisuke Sunakawa
- Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Longzhu Cui
- Kitasato Institute for Life Sciences and Laboratory for Antimicrobial Agents, Kitasato University 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Tsuguto Masaki
- Department of Endocrinology and Metabolism, Kitasato University School of Medicine 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Tatsuhiko Wada
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Takayuki Hoshiyama
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Masaki Nakamura
- Kitasato Institute for Life Sciences and Laboratory for Antimicrobial Agents, Kitasato University 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan ; Department of Microbiology, Kitasato University School of Allied Health Sciences 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yoko Takayama
- Department of Infection Control and Prevention, Kitasato University Hospital 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yuhsaku Kanoh
- Department of Medical Laboratory, Kitasato University Hospital 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan ; Department of Laboratory Medicine, Kitasato University Hospital 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Akifumi Ogawa
- Department of Endocrinology and Metabolism, Kitasato University School of Medicine 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Masayoshi Shichiri
- Department of Endocrinology and Metabolism, Kitasato University School of Medicine 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Hideaki Hanaki
- Kitasato Institute for Life Sciences and Laboratory for Antimicrobial Agents, Kitasato University 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
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