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Mansour E, El-Masri F. Bilateral Salmonella Septic Arthritis of the Hip in a Patient with Crohn Disease: A Case Report. JBJS Case Connect 2016; 6:e91. [PMID: 29252745 DOI: 10.2106/jbjs.cc.16.00045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 27-year-old immunocompromised man with Crohn disease presented with bilateral septic hip arthritis due to Salmonella enterica serotype Typhi. The diagnosis was confirmed by synovial membrane and effusion culture specimens that were obtained during arthroscopic debridement of both hips. CONCLUSION Prolonged antimicrobial therapy, bilateral femoral head resection, and placement of cement spacers for 5 months, followed by bilateral total hip arthroplasty, was a radical and effective treatment for a patient with Crohn disease and bilateral Salmonella septic arthritis of the hip.
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Affiliation(s)
- Elie Mansour
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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Nolla JM, Murillo O, Narvaez J, Vaquero CG, Lora-Tamayo J, Pedrero S, Cabo J, Ariza J. Pyogenic arthritis of native joints due to Bacteroides fragilis: Case report and review of the literature. Medicine (Baltimore) 2016; 95:e3962. [PMID: 27336895 PMCID: PMC4998333 DOI: 10.1097/md.0000000000003962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 11/25/2022] Open
Abstract
Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the literature to summarize the experience with this infectious entity.In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. A MEDLINE search (1981-2015) identified 19 additional cases.Of the 21 patients available for review (13 men and 8 women, with a mean age, of 54.4 ± 17 years), 19 (90%) presented a systemic predisposing factor for infection; the most common associated illness was rheumatoid arthritis (8 patients). Bacteremia was documented in 65% (13/20) of cases. In 5 patients (24%), 1 or more concomitant infectious process was found. Metronidazole was the most frequently used antibiotic. Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%.Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions.
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Affiliation(s)
- Joan M. Nolla
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Oscar Murillo
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Narvaez
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carmen Gómez Vaquero
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Salvador Pedrero
- Orthopedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Cabo
- Orthopedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
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Felden A, Vaz G, Kreps S, Anract P, Hamadouche M, Biau DJ. A cemented acetabular component with a reinforcement cross provides excellent medium-term fixation in total hip arthroplasty after pelvic irradiation. Bone Joint J 2015; 97-B:177-84. [DOI: 10.1302/0301-620x.97b2.34545] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Conventional cemented acetabular components are reported to have a high rate of failure when implanted into previously irradiated bone. We recommend the use of a cemented reconstruction with the addition of an acetabular reinforcement cross to improve fixation. We reviewed a cohort of 45 patients (49 hips) who had undergone irradiation of the pelvis and a cemented total hip arthroplasty (THA) with an acetabular reinforcement cross. All hips had received a minimum dose of 30 Gray (Gy) to treat a primary nearby tumour or metastasis. The median dose of radiation was 50 Gy (Q1 to Q3: 45 to 60; mean: 49.57, 32 to 72). The mean follow-up after THA was 51 months (17 to 137). The cumulative probability of revision of the acetabular component for a mechanical reason was 0% (0 to 0%) at 24 months, 2.9% (0.2 to 13.3%) at 60 months and 2.9% (0.2% to 13.3%) at 120 months, respectively. One hip was revised for mechanical failure and three for infection. Cemented acetabular components with a reinforcement cross provide good medium-term fixation after pelvic irradiation. These patients are at a higher risk of developing infection of their THA. Cite this article: Bone Joint J 2015;97-B:177–84.
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Affiliation(s)
- A. Felden
- Hôpital Cochin, 27
rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - G. Vaz
- Pavillon T de l'Hôpital Edouard Herriot, Hospices
Civils de Lyon, place d’Arsonval, 69003
Lyon, France
| | - S. Kreps
- Hôpital Européen Georges Pompidou, 20
Rue Leblanc, 75015 Paris, France
| | - P. Anract
- Hôpital Cochin, 27
rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - M. Hamadouche
- Hôpital Cochin, 27
rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - D. J. Biau
- Hôpital Cochin, 27
rue du Faubourg Saint-Jacques, 75014, Paris, France
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Walter G, Vernier M, Pinelli PO, Million M, Coulange M, Seng P, Stein A. Bone and joint infections due to anaerobic bacteria: an analysis of 61 cases and review of the literature. Eur J Clin Microbiol Infect Dis 2014; 33:1355-64. [DOI: 10.1007/s10096-014-2073-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
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Michalecki Ł, Gabryś D, Kulik R, Wydmański J, Trela K. Radiotherapy induced hip joint avascular necrosis-Two cases report. Rep Pract Oncol Radiother 2011; 16:198-201. [PMID: 24376980 PMCID: PMC3863280 DOI: 10.1016/j.rpor.2011.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 03/23/2011] [Accepted: 04/29/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Avascular necrosis (AVN) refers to the death of osteocytes and osteoblasts. Sites such as the femoral head, the head of the humerus and the mandibula with restricted access to local blood supply are particularly vulnerable to osteonecrosis. A COMBINATION OF SEVERAL FACTORS IS RESPONSIBLE FOR ISCHAEMIA AND IS ASSOCIATED WITH AVN: corticosteroids, alcohol abuse, Cushing's syndrome, SLE, systemic vasculitis, RA, scleroderma, haemoglobinopathies, radiotherapy. Management is based on proper diagnosis and treatment - conservative, pharmacological or surgical. Radiotherapy has become an integral part of the therapeutic programme of cancer patients. However, early and late after-effects of irradiation still constitute a significant issue in clinical practice. AIM The aim of this report is to present two cases of acetabular protrusion and femoral head deformities after a therapeutic pelvic irradiation and draw physicians' attention to that clinical problem which continues to be underestimated. MATERIALS AND METHODS This report documents two cases of acetabular protrusion and femoral head deformities after a therapeutic pelvic radiation. RESULTS Avascular necrosis (AVN) constitutes a severe and challenging long-term complication in radiation oncology. CONCLUSION It is necessary to take into account bone structures among organ at risk (OAR) involved in irradiation fields. The detailed analysis of the dose distribution and the use of collimators allow to decrease the total dose to OAR. An adequate management, early diagnosis and prompt, proper treatment may protect patients from long-term morbidities.
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Affiliation(s)
- Łukasz Michalecki
- Department Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-100 Gliwice, Poland
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Dempsey KE, Riggio MP, Lennon A, Hannah VE, Ramage G, Allan D, Bagg J. Identification of bacteria on the surface of clinically infected and non-infected prosthetic hip joints removed during revision arthroplasties by 16S rRNA gene sequencing and by microbiological culture. Arthritis Res Ther 2008; 9:R46. [PMID: 17501992 PMCID: PMC2206354 DOI: 10.1186/ar2201] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 05/14/2007] [Indexed: 11/23/2022] Open
Abstract
It has been postulated that bacteria attached to the surface of prosthetic hip joints can cause localised inflammation, resulting in failure of the replacement joint. However, diagnosis of infection is difficult with traditional microbiological culture methods, and evidence exists that highly fastidious or non-cultivable organisms have a role in implant infections. The purpose of this study was to use culture and culture-independent methods to detect the bacteria present on the surface of prosthetic hip joints removed during revision arthroplasties. Ten consecutive revisions were performed by two surgeons, which were all clinically and radiologically loose. Five of the hip replacement revision surgeries were performed because of clinical infections and five because of aseptic loosening. Preoperative and perioperative specimens were obtained from each patient and subjected to routine microbiological culture. The prostheses removed from each patient were subjected to mild ultrasonication to dislodge adherent bacteria, followed by aerobic and anaerobic microbiological culture. Bacterial DNA was extracted from each sonicate and the 16S rRNA gene was amplified with the universal primer pair 27f/1387r. All 10 specimens were positive for the presence of bacteria by both culture and PCR. PCR products were then cloned, organised into groups by RFLP analysis and one clone from each group was sequenced. Bacteria were identified by comparison of the 16S rRNA gene sequences obtained with those deposited in public access sequence databases. A total of 512 clones were analysed by RFLP analysis, of which 118 were sequenced. Culture methods identified species from the genera Leifsonia (54.3%), Staphylococcus (21.7%), Proteus (8.7%), Brevundimonas (6.5%), Salibacillus (4.3%), Methylobacterium (2.2%) and Zimmermannella (2.2%). Molecular detection methods identified a more diverse microflora. The predominant genus detected was Lysobacter, representing 312 (60.9%) of 512 clones analysed. In all, 28 phylotypes were identified: Lysobacter enzymogenes was the most abundant phylotype (31.4%), followed by Lysobacter sp. C3 (28.3%), gamma proteobacterium N4-7 (6.6%), Methylobacterium SM4 (4.7%) and Staphylococcus epidermidis (4.7%); 36 clones (7.0%) represented uncultivable phylotypes. We conclude that a diverse range of bacterial species are found within biofilms on the surface of clinically infected and non-infected prosthetic hip joints removed during revision arthroplasties.
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Affiliation(s)
- Kate E Dempsey
- Infection and Immunity Research Group, Level 9, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - Marcello P Riggio
- Infection and Immunity Research Group, Level 9, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - Alan Lennon
- Infection and Immunity Research Group, Level 9, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - Victoria E Hannah
- Infection and Immunity Research Group, Level 9, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - Gordon Ramage
- Infection and Immunity Research Group, Level 9, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - David Allan
- The Queen Elizabeth National Spinal Injuries Unit, Scotland, South Glasgow University Hospitals Division, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Jeremy Bagg
- Infection and Immunity Research Group, Level 9, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
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Abstract
SUMMARY Bacteroides species are significant clinical pathogens and are found in most anaerobic infections, with an associated mortality of more than 19%. The bacteria maintain a complex and generally beneficial relationship with the host when retained in the gut, but when they escape this environment they can cause significant pathology, including bacteremia and abscess formation in multiple body sites. Genomic and proteomic analyses have vastly added to our understanding of the manner in which Bacteroides species adapt to, and thrive in, the human gut. A few examples are (i) complex systems to sense and adapt to nutrient availability, (ii) multiple pump systems to expel toxic substances, and (iii) the ability to influence the host immune system so that it controls other (competing) pathogens. B. fragilis, which accounts for only 0.5% of the human colonic flora, is the most commonly isolated anaerobic pathogen due, in part, to its potent virulence factors. Species of the genus Bacteroides have the most antibiotic resistance mechanisms and the highest resistance rates of all anaerobic pathogens. Clinically, Bacteroides species have exhibited increasing resistance to many antibiotics, including cefoxitin, clindamycin, metronidazole, carbapenems, and fluoroquinolones (e.g., gatifloxacin, levofloxacin, and moxifloxacin).
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Micha JP, Goldstein BH, Rettenmaier MA, Caillouette JT, Fee MJ, Brown JV. Pelvic radiation necrosis and osteomyelitis following chemoradiation for advanced stage vulvar and cervical carcinoma. Gynecol Oncol 2006; 101:349-52. [PMID: 16442607 DOI: 10.1016/j.ygyno.2005.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 12/01/2005] [Accepted: 12/02/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND The treatment regimen indicated for most advanced stage vulvar, vaginal, and cervical cancer usually involves adjuvant chemoradiation therapy. Although the risk of complications is low, there have been reported cases of radiation necrosis and osteomyelitis following treatment for vulvar, vaginal, and cervical cancer. CASES We present a vulvar cancer patient and a cervical cancer patient, both of whom were treated with radical surgery and postoperative chemoradiation. Following therapy, they were afflicted with pelvic radiation necrosis and osteomyelitis. The patients underwent surgery to resect the necrotic bone tissue and long-term antibiotic therapy to treat their osteomyelitis. They have since recovered and are followed closely by their gynecologic oncology and infectious disease physicians. CONCLUSION The radiotherapy utilized to treat advanced stage gynecologic cancer can cause intestinal, vaginal, and urologic complications from micro-vascular damage to the organs. Pelvic bone osteonecrosis is a rare but disabling complication of pelvic radiation. Fortunately, with aggressive therapy, these patients may do well clinically.
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Affiliation(s)
- John P Micha
- Gynecologic Oncology Associates, Hoag Memorial Hospital Cancer Center, 351 Hospital Road, Suite 507, Newport Beach, CA 92663, USA.
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Bouralexis S, Findlay DM, Evdokiou A. Death to the bad guys: targeting cancer via Apo2L/TRAIL. Apoptosis 2005; 10:35-51. [PMID: 15711921 DOI: 10.1007/s10495-005-6060-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
All higher organisms consist of an ordered society of individual cells that must communicate to maintain and regulate their functions. This is achieved through a complex but highly regulated network of hormones, chemical mediators, chemokines and other cytokines, acting as ligands for intra or extra-cellular receptors. Ligands and receptors of the tumor necrosis factor (TNF) superfamilies are examples of signal transducers, whose integrated actions influence the development, homeostasis and adaptive responses of many cells and tissue types. Apo2L/TRAIL is one of several members of the tumour necrosis factor superfamily that induce apoptosis through the engagement of death receptors. Apo2L/TRAIL interacts with an unusually complex receptor system, which in humans comprises two death receptors and three decoy receptors. This molecule has received considerable attention recently because of the finding that many cancer cell types are sensitive to Apo2L/TRAIL-induced apoptosis, while most normal cells appear to be resistant to this action of Apo2L/TRAIL. In this review, we specifically emphasise on the actions of Apo2L/TRAIL with respect to its apoptotic signaling pathways and summarise what is known about its physiological role. The potential therapeutic usefulness of Apo2L/TRAIL, especially in combination with chemotherapeutic agents, is also discussed in some detail.
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Affiliation(s)
- S Bouralexis
- St Vincent's Institute of Medical Research, Fitzroy, 3065, Victoria, Australia.
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Fornasier VL, Battaglia DM. Finding the unexpected: pathological examination of surgically resected femoral heads. Skeletal Radiol 2005; 34:321-8. [PMID: 15717199 DOI: 10.1007/s00256-004-0820-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 05/05/2004] [Accepted: 05/25/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the clinically diagnosed disease process but also identify additional, clinically undetected pathologies in femoral heads resected for replacement arthroplasty. DESIGN AND MATERIAL A retrospective review was carried out of the pathological findings in 460 surgically resected femoral heads. Serial sections were submitted to low-energy fine-detail radiography, then decalcified sections stained by the WHO method were examined. The preoperative clinical and imaging diagnoses were compared with the pathological findings and special interest was placed on assessing the clinical significance of any unexpected, clinically undetected findings. RESULTS The most common findings included the presence of bone islands (solitary osteomas) and areas of avascular necrosis in addition to the primary joint disease for which the patient underwent surgery. The preoperative symptomatology did not distinguish between the known primary disease and the additional pathological findings. CONCLUSION Some of the clinically unidentified lesions were of a size that fell below the ability of current clinical investigations to detect. However, the finding of lesions by tissue fine-detail radiography indicates that current, more sensitive clinical imaging techniques may identify them. Careful examination of surgically resected femoral heads is important to ensure that all pathologies are identified and assessed for clinical relevance.
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Affiliation(s)
- V L Fornasier
- Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada.
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