Pyarthrosis of the small joints of the hand resulting in arthrodesis or amputation

PURPOSE

A septic joint is a cartilage-threatening emergency requiring prompt treatment. The purpose of this study was to examine outcomes of septic arthritis of the metacarpophalangeal and interphalangeal joints.

METHODS

We performed a retrospective review of patients diagnosed with joint infection between 1976 and 2008. The end point included the number of arthrodeses and amputations performed.

RESULTS

Septic joints were identified in 110 patients. All patients had incision and irrigation and debridement (I and D) of the joint. The infection was successfully treated in 83 of 110 patients. The majority of septic joints (73 of 83 patients) treated successfully with I and D had only a penetrating joint injury. Forty-eight of these patients required more than one I and D to eradicate the infection. The remaining 27 of 110 patients required either arthrodesis (13 patients) or amputation (14 patients) despite I and D. Among the 13 patients requiring arthrodesis, postoperative infection (7 patients) accounted for the majority of septic joints. Of the 14 patients requiring amputation, penetrating joint injury accounted for the majority of septic joints. Overall, those patients requiring more than 3 I and D procedures were at higher risk of arthrodesis or amputation. Increasing comorbidities correlated with worsening outcomes.

CONCLUSIONS

Pyarthrosis can often be treated successfully with 1 or more I and D procedures. Despite multiple I and D procedures, 27 patients required either arthrodesis or amputation. The time to diagnosis and treatment, the number of I and D procedures, patient comorbidities, and postoperative infection following non-joint surgery are major factors influencing outcome.

Isolation of Pantoea agglomerans in two cases of septic monoarthritis after plant thorn and wood sliver injuries

Arthritis after plant injury is often apparently aseptic. We report two cases due to Pantoea agglomerans. In one case, the bacterium was isolated only from the pediatric blood culture media, BACTEC Peds Plus, monitored in BACTEC 9240, and not from the other media inoculated with the joint fluid. This procedure could help improve the diagnosis of septic arthritis.

Mycobacterium marinum infection causing septic arthritis and osteomyelitis

A 48-yr-old female on immunosuppressive therapy for fibrosing alveolitis and polymyositis developed a septic arthritis of the left middle finger proximal interphalangeal joint, tenosynovitis of the left palm and osteomyelitis of the right hindfoot due to infection with Mycobacterium marinum. Such widespread and severe bone and joint involvement has not been described previously with this organism.

Peptostreptococcus magnus septic arthritis--a report and review of the English literature

We describe a 30-year-old female presenting with synovitis of the left 4th proximal interphalangeal joint. Anaerobic cultures of the synovial membrane grew Peptostreptococcus magnus. The synovitis resolved after a course of intravenous penicillin G. The role of the anaerobic bacterium Peptostreptococcus magnus in joint infections is reviewed.

Blastomycosis presenting as polyarticular septic arthritis

Articular infection with Blastomyces dermatitidis frequently is difficult to diagnose as it resembles bacterial arthritis in several ways. This report of an elderly man who had initially monoarticular and eventually polyarticular arthritis illustrates the clinical and laboratory findings that should suggest blastomycosis. Treatment with amphotericin B and ketoconazole in sequence led to complete resolution of the infection.

Monoarthritis due to Mycobacterium chelonei

A 48-year-old woman with infection of the tendon sheaths and proximal interphalangeal joint by Mycobacterium chelonei is described. Antibiotic therapy was not administered, and the patient recovered spontaneously.

Synovial infection with Mycobacterium kansasii

Atypical mycobacteria have been recognised as saprophytic organisms for many years, but it was only with the development of better microbiological culture techniques that they became recognised as potentially pathogenic to man. Infections of tendon sheaths and joints by these organisms may present diagnostic problems, and we report here 3 cases in which Mycobacterium kansasii was responsible for disease at the hand and wrist.

Identification of Ureaplasma urealyticum (T-strain Mycoplasma) in patient with polyarthritis

A 10-year-old boy with confirmed congenital agammaglobulinaemia presented with polyarthritis while on gammaglobulin replacement therapy. Initial cultures of material aspirated from an abscess and of joint fluid were negative, and symptoms progressed despite antibiotic therapy. Synovial-biopsy material, cultured specifically for mycoplasmas, was positive for Ureaplasma urealyticum as were the blood, abscess fluids, throat-swab, and nasopharyngeal secretions. Therapy, based on in-vitro studies of antibiotic susceptibilities of the organism, resulted in the eradication of the infection and resolution of the arthritis. These findings suggest that U. urealyticum may be capable of inducing polyarthritis in man.