Monoarticular Septic Arthritis Research Articles

Escherichia coli mono articular septic arthritis of shoulder joint in an elderly female

Septic arthritis of the shoulder joint is a very rare entity to encounter in clinical practice. Escherichia coli (E. coli) pathogen isolation is only seen to occur in individuals with multiple comorbidities. We report a similar case of gram-negative E. coli urosepsis in a veteran female that transmitted hematogenously to the shoulder joint and how a prompt diagnosis and treatment prevented extension and damage of the joint space.

O11 Neisseria Meningitidis as a cause of isolated bilateral polyarticular native knee joint septic arthritis

O11 <i>Neisseria Meningitidis</i> as a cause of isolated bilateral polyarticular native knee joint septic arthritis

DISSEMINATED BLASTOMYCOSIS PRESENTING AS MONOARTICULAR SEPTIC ARTHRITIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Blastomycosis is a dimorphic fungus that causes acute or chronic pneumonia with extrapulmonary involvement in a minority of cases. Rarely it is implicated in disseminated disease causing joint involvement leading to septic arthritis. Recognizing blastomycosis as an important cause of septic arthritis and starting treatment is necessary to prevent joint destruction and overwhelming disseminated infection. CASE PRESENTATION: A 29-year-old male with no significant past medical history presented to the hospital with chief complaint of right knee pain of 3 weeks' duration associated with recent onset of productive cough, dyspnea on exertion and chest pain. Admitting vitals were remarkable for tachycardia and fever of 101 F. Physical examination revealed right knee swelling and pain on active and passive range of motion without overlying erythema. Joint aspiration revealed 68,000 WBC with 88% neutrophils with negative crystals. Cultures from synovial fluid grew blastomyces dermatitidis. During the hospital stay, patient's respiratory status worsened, and he was transferred to the ICU and intubated. CT Chest showed diffuse bilateral pulmonary nodules, suspicious for atypical pneumonia versus acute respiratory distress syndrome. Bronchoscopy was done and specimens were sent for culture. He was initially started and then maintained on broad spectrum antibiotics. Once respiratory and synovial cultures grew blastomyces, patient was started on IV amphoterecin. Patient's condition improved dramatically after starting amphoterecin. His remaining ICU course involved extubation, tracheostomy and gradual weaning of pressors. His knee pain and swelling subsided after starting amphoterecin and patient was discharged to rehab in stable condition on itraconazole. DISCUSSION: This case highlights the rare presentation of disseminated blastomycosis as monoarticular septic arthritis. About 3% of patients with blastomycosis have joint involvement. Extrapulmonary blastomycosis is usually seen in association with pneumonia which can often be severe enough to cause ARDS and shock, like our patient. It is important to have a high index of suspicion for blastomycosis in patients presenting with septic arthritis with an active pulmonary process and B symptoms. Diagnosis of blastomycosis is with culture, urinary and serum antigens. Treatment involves amphoterecin B followed by itraconazole for patients with severe disseminated disease. CONCLUSIONS: Disseminated blastomycosis can present with symptoms of extrapulmonary spread of disease. Diagnosis is with antigen identification in serum and urine and by culture. Treatment involves amphoterecin B and itraconazole. REFERENCE #1: Chapman, Stanley W., Andrew C. Lin, Katherine A. Hendricks, Rathel L. Nolan, Mary M. Currier, Ken R. Morris, and Helen R. Turner. "Endemic blastomycosis in Mississippi: epidemiological and clinical studies." In Seminars in respiratory infections, vol. 12, no. 3, pp. 219-228. 1997. REFERENCE #2: Wheat, L. J. "Antigen detection, serology, and molecular diagnosis of invasive mycoses in the immunocompromised host." Transplant infectious disease 8, no. 3 (2006): 128-139. DISCLOSURES: No relevant relationships by Fatima Ayub, source=Web Response No relevant relationships by Muhammad Hasib Khalil, source=Web Response

A Mono-Articular Septic Arthritis and Multifocal Avascular Necrosis in Absence of Corticosteroid Use: An Unusual Presentation of Primary Antiphospholipid Syndrome

Osteonecrosis (ON) or avascular necrosis results from disruption of blood supply to bone marrow and trabecular bone leading to death of bone. Antiphospholipid Syndrome (APS) may be primary or secondary to other autoimmune disease. The involvement of multiple sites of ON has been documented with APS. Literature suggests that avascular necrosis predispose a septic arthritis in affected joints especially in immunosuppressed patients.

A Case of Neonatal Septic Arthritis Caused by Group B Streptococcus

Group B streptococcus (also indicated as streptococcus agalactiae) is a well-known cause of severe infections in younginfants but also an unusual microorganism to be isolated in case of septic arthritis, especially in newborns in Korea. Wereport a case of monoarticular septic arthritis caused by group B streptococcus in a 22-day-old baby.

Escherichia coli - Marauding masquerading microbe.

Escherichia coli is a rare cause of monoarticular septic arthritis, but is an even rarer cause of polyarticular septic arthritis. We report an unusual case of polyarticular septic arthritis with an atypical presentation caused by E. coli, the source of which was a left pyelonephritis. Our patient developed E coli sepsis resulting in polyarticular septic arthritis (PASA) in the absence of typical risk factors except for pre-existing osteoarthritis. The joints involved were the hip, ankle, sternoclavicular and L5/S1 joints. Of interest, ankle pain was not reported or evident until correlated with nuclear medicine scans. Furthermore, sternoclavicular joint involvement presented as left shoulder pain, resulting in an initial misdiagnosis of left shoulder septic arthritis. The patient was treated with surgical washout and antibiotic therapy. He was subsequently discharged from rehabilitation having returned to his baseline level of mobility. Future consideration will be given to total hip arthroplasty. There are no reported cases of E. coli PASA involving more than three joints in the absence of any recognized risk factors for septic arthritis. Asymptomatic involvement of joints can occur in polyarticular septic arthritis and should be considered in all cases of monoarticular septic arthritis (MASA). We believe that clinical suspicion is the key to early and comprehensive diagnosis of polyarticular septic arthritis particularly when presenting in an atypical fashion with an atypical pathogen. Strong consideration should be given to performing nuclear imaging in cases of monoarticular septic arthritis where polyarticular involvement cannot be definitively ruled out.

The Epidemiology of Pediatric Bone and Joint Infections in Cambodia, 2007-11

There are limited data on osteoarticular infections from resource-limited settings in Asia. A retrospective study of patients presenting to the Angkor Hospital for Children, Cambodia, January 2007–July 2011, identified 81 cases (28% monoarticular septic arthritis, 51% single-limb osteomyelitis and 15% multisite infections). The incidence was 13.8/100 000 hospital attendances. The median age was 7.3 years, with a male/female ratio of 1.9:1; 35% presented within 5 days of symptom onset (median 7 days). Staphylococcus aureus was cultured in 29 (36%) cases (52% of culture-positive cases); one isolate was methicillin-resistant (MRSA). Median duration of antimicrobial treatment was 29 days (interquartile range 21–43); rates of surgical intervention were 96%, and 46% of children had sequelae, with one fatality. In this setting osteoarticular infections are relatively common with high rates of surgical intervention and sequelae. Staphylococcus aureus is the commonest culturable cause, but methicillin-resistant S. aureus is not a major problem, unlike in other Asian centers.

Medical vs surgical treatment for the native joint in septic arthritis: a 6-year, single UK academic centre experience

Medical treatment (serial closed-needle aspiration) and surgical treatment (arthroscopy/arthrotomy combined with joint washout) are well-recognized methods to treat septic arthritis (SA) of native joints. We compared the outcome of proven SA based on the method of treatment. We reviewed case notes of adult patients who were admitted to our institution from January 2001 to December 2006 with proven SA (Newman Grade A organism isolated from the joint). Thirty-two episodes were treated medically and 19 surgically (4 with arthrotomy, 15 with arthroscopy) in the study period. All had mono-articular SA. No significant difference in the age, symptom duration before treatment and duration of intravenous antibiotic therapy was present between the two groups. Medical treatment resulted in complete recovery in more patients (69 vs 53%, P = 0.24) but longer period of hospitalization [median (interquartile range), 16.5 (14-19) vs 15 (11-17), P = 0.34], although the difference between the groups was not significant. More surgically treated patients had deterioration in functional status at the time of discharge from the hospital (29 vs 44%, P = 0.27), but the difference between the groups was not statistically significant. Surgically treated patients required significantly more sessions of physiotherapy (mean +/- S.D., 7 +/- 2 vs 10 +/- 3, P = 0.002). Mortality was similar (one in each group). Results from this study show that for the native joint SA, surgical treatment was not superior to the medical treatment and, therefore, highlight the need for careful case selection for surgical intervention.

Lab Tests of Limited Value for Diagnosing Monoarticular Septic Arthritis

Many medical reference works state that a white blood cell count of the joint fluid (jWBC) higher than 100,000 cells/mm3 suggests septic arthritis, but

Methicillin-Resistant Staphylococcus Aureus Septic Arthritis of the Knee Secondary to Steroid/Anesthetic Injection

Methicillin-Resistant Staphylococcus Aureus Septic Arthritis of the Knee Secondary to Steroid/Anesthetic Injection

Pyogenic Arthritis Complicating Varicella Infection

Arthritis has not previously been reported as a complication in adult patients with chickenpox. In pediatric patients, the arthritis that complicates chickenpox is most commonly aseptic but does rarely result from bacterial infection. We report the case of a 21-year-old man who developed acute monoarticular septic arthritis due to Lancefield Group A beta-hemolytic streptococci. Despite the more common viral cause of arthritis in pediatric patients, physicians should not attribute arthritis associated with varicella in adults to a viral cause without diagnostic arthrocentesis.