Acute septic arthritis due to Streptococcus sanguis

Streptococcus gordonii finger infection: Case report and a review of the literature

RATIONALE

Streptococcus gordonii is a rare cause of finger suppurative infection. Very few cases have been reported of its treatment.

PATIENT CONCERNS

A 68-year-old male of severe finger infection. Bacterial culture of synovial fluid revealed S gordonii.According to the patient's history and auxiliary examination, the patient was diagnosed with S gordonii infection. Here, we review the diagnosis and treatment of this patient and describe the clinical and epidemiological characteristics of the patient.

DIAGNOSES

Streptococcus gordonii finger infection.Interventions: In the case of ineffective oral antibiotics, this patient chose to pursue an abscess incision, but in the course of treatment,the flexor digitorum tendon dissolved and eventually ruptured.

OUTCOMES

The infection was controlled after intravenous injection of vancomycin. The incision was sutured 2 weeks later. No recurrence of infection was found after 3 months of follow-up.

LESSONS

The treatment included antibacterial and abscess treatments. In the absence of drug sensitivity results, antibiotics can be used empirically. If empirical anti-microbial treatment fails, the antibiotic regimen should be changed in a timely manner, Vancomycin may be an antibiotic choice.

Acute haematogenous periprosthetic joint infection due to Streptococcus sanguinis along with coexistent crystalline arthropathy after total knee arthroplasty: a rare combination

A man in his 60s, with a medical history of gout, underwent total knee arthroplasty of his right knee followed by expeditious rehabilitation. Seven months after surgery, he was referred to the emergency ward with sudden onset of pain and swelling of his right knee accompanied with fever. Further inquiry revealed no trauma, infection or skin lesions besides a tongue bite several weeks earlier. An impaired range motion of the knee was seen on physical examination along with a tachycardia. Laboratory studies showed a C reactive protein of 345 mg/L, after which a debridement, antibiotics and implant retention procedure was performed. Intraoperatively obtained synovial fluid showed monosodium urate crystals consistent with crystalline arthropathy (ie, gout). However, unexpectedly, Streptococcus sanguinis was identified in all microbiological cultures too, confirming a coexistent periprosthetic joint infection. After comprehensive antibiotic treatment and gout flare therapy, this patient made a full recovery with retention of the implant.

Streptococcus gordonii septic arthritis of the glenohumeral joint following deltoid intramuscular vaccination

A 68-year-old woman presented for left shoulder pain, decreased range of motion (ROM) and fever 7 days following COVID-19 vaccination. Investigations showed a tender left deltoid mass, decreased shoulder ROM and elevated inflammatory markers. MRI demonstrated a large glenohumeral effusion with synovitis, and arthrocentesis confirmed septic arthritis (SA). She required subtotal bursectomy. Intraoperative joint cultures grew Streptococcus gordonii She completed 6 weeks of antibiotics and is undergoing physical therapy for post-infectious adhesive capsulitis. SA is most commonly due to Staphylococcus aureus and β-haemolytic streptococci, and rarely due to viridans group streptococci including S. gordonii To avoid inadvertent injection into the glenohumeral joint, vaccination should be performed posteriorly and inferiorly into the deltoid musculature. Progressive pain, fever or decreased passive ROM following vaccination should raise concern for SA. Given its rarity, however, concern for secondary SA should not affect the general population's consideration for vaccination.

Rare Occurrence of Prosthetic Knee Septic Arthritis Due to Streptococcus viridans in the Background of a Dental Procedure

The American Academy of Oral Medicine, American Dental Association (ADA), in conjunction with the American Academy of Orthopedic Surgeons (AAOS) and the British Society for Antimicrobial Chemotherapy, advises against the universal use of antimicrobial prophylaxis prior to dental procedures for the prevention of prosthetic joint infection (PJI). Here, we discuss the case of a patient with PJI in the background of periodontal scaling, which was done a week prior to presentation to the hospital. The PJI occurred with Streptococcus (S.) viridans, a rare organism for PJI but a common oral commensal. As the number of prosthetic joint surgeries are increasing and more data become available, prophylactic antibiotics might be considered to prevent PJI, especially in high-risk patients.

Acute Streptococcus mitis Sacroiliitis in a Teenager with Unclear Source of Bacteremia: A Case Report and Literature Review

Septic arthritis is an orthopedic emergency that is commonly caused by Staphylococcus aureus. Old age, diabetes mellitus, rheumatoid arthritis, prosthetic joint, and recent surgery are the main predisposing risk factors. Most cases of septic arthritis are caused by hematogenous spread of infection. Infectious sacroiliitis is a rare form of septic arthritis which is often clinically challenging to diagnose due its various and nonspecific presentations. Streptococcus mitis belongs to viridans group streptococci (VGS) bacteria, which is a component of body flora that is commonly involved in bacterial endocarditis. VGS in general and S. mitis specifically is an uncommon cause of osteoarticular infections. Here, we report a case of spontaneous Streptococcus mitis bacteremia complicated by septic sacroiliitis in a healthy teenager in the absence of infective endocarditis or a clear source of bacteremia.

Systemic endotoxin levels in chronic indolent periodontal infections

BACKGROUND AND OBJECTIVE

Periodontal disease has been linked with an increased risk of various systemic diseases. A plausible biologic explanation for this link includes the opportunity for oral pathogens to translocate to the circulation as a result of breakdown in integrity of the oral epithelium. This study refined a methodology used to detect endotoxin activity in the serum of subjects with indolent periodontal infections.

MATERIAL AND METHODS

The QCL Kinetic Chromogenic Assay (Cambrex) is a kinetic measure of endotoxin activity. Sera from 211 pregnant women with periodontitis enrolled in the Obstetrics and Periodontal Therapy Trial were used to develop the assay further and to evaluate the detection of endotoxin activity that might accompany a low-level bacteremia in chronic periodontitis.

RESULTS

We optimized the system to increase the sensitivity and reproducibility of the assay. The refined system was able to detect endotoxin activity in serum at > 0.0125 EU/mL. At baseline (13-16 wk of gestation), 35.5% of the women were positive for endotoxin activity (1.62 +/- 2.21; range: 0.38-15 EU/mL).

CONCLUSION

This report describes a sensitive measure of endotoxin activity in serum. The procedure allowed us to document levels of this microbial virulence factor in serum of individuals with indolent infections such as periodontal disease.