Septic Arthritis Of Elbow Research Articles

Two consecutive melioidosis septic arthritis successfully cured with conservative and operative treatment respectively: a case report

Melioidosis or Whitmore’s disease is an uncommon infectious condition caused by the gram-negative bacterium Burkholderia pseudomallei. The clinical manifestation of melioidosis varies, including septicemia, pneumonia, deep organ and soft tissue abscess. Septic arthritis is a rare manifestation of melioidosis, which is associated with high mortality rate, especially in immunocompromised patients. We present here a 60-year-old male who was admitted to our hospital with high fever and acute left hip pain, who was subsequently confirmed to have hematogenous melioidosis septic arthritis with positive blood and synovial fluid cultures. His condition fully responded to a 2-week administration of intravenous meropenem plus oral trimethoprim+sulfamethoxazole, before he was transferred to his provincial hospital to continue the antibiotic regimen. For some reason, he inadvertently stopped the regimen and came back to us with a right elbow septic arthritis caused by the same microbial agent a month later. This time, he received an urgent elbow arthroscopic debridement and completed intensive antibiotic therapy before being discharged to continue the eradication phase for 6 months. Until now, he has recovered completely without recurrence. Melioidosis septic arthritis is rare but should be considered in high-risk patients and can be successfully treated with prompt antibiotics alone or in combination with surgery. Regardless of the method, eradication treatment is extremely important.

Elbow Septic Arthritis caused by Klebsiella pneumoniae in a Newborn - Case Report and Literature Review

Abstract Septic arthritis is a rare condition in children, especially in neonates. Early recognition and proper treatment are required to avoid serious complications. We present the case of a male newborn diagnosed with septic arthritis of the right elbow who was treated with repeated joint aspiration and i.v. antibiotics (Amikacin and Meropenem). Blood culture and joint cultures were positive for Klebsiella pneumoniae. The final outcome was good, with no apparent local or systemic complications. General considerations regarding this rare condition, etiology and treatment options are also included in the paper.

Septic elbow arthritis associated with poorly controlled atopic dermatitis.

Septic elbow arthritis associated with poorly controlled atopic dermatitis.

Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review.

Upper extremity arthritis in children can be treated with joint aspiration, arthroscopy or arthrotomy, followed by antibiotics. The literature seems inconclusive with respect to the optimal drainage technique. Therefore, the objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the upper extremity in children.Two independent investigators systematically searched the electronic MEDLINE, EMBASE and Cochrane databases for original articles that reported outcomes of aspiration, arthroscopy or arthrotomy for septic arthritis of the paediatric shoulder or elbow. Outcome parameters were clinical improvement, need for repetitive surgery or drainage, and complications.Out of 2428 articles, seven studies with a total of 171 patients treated by aspiration or arthrotomy were included in the systematic review. Five studies reported on shoulder septic arthritis, one study on elbow septic arthritis, and one study on both joints. All studies were retrospective, except for one randomized prospective study. No difference was found between type of treatment and radiological or clinical outcomes. Aspiration of the shoulder or elbow joint required an additional procedure in 44% of patients, while arthrotomy required 12% additional procedures.Conclusion: Both aspiration and arthrotomy can achieve good clinical results in children with septic arthritis of the shoulder or elbow joint. However, the scientific quality of the included studies is low. It seems that the first procedure can be aspiration and washout and start of intravenous antibiotics, knowing that aspiration may have a higher risk of additional drainage procedures. Cite this article: EFORT Open Rev 2021;6:651-657. DOI: 10.1302/2058-5241.6.200122

Presentation and management of pediatric elbow septic arthritis: Case series

Amac: Septik artrit acil bir ortopedik durumdur. Dirsegin septik artriti diger eklemlere gore daha nadir gorulmektedir. Bu calismanin amaci, dirsek septik artritinin klinik ve radyolojik belirleyicilerini degerlendirmek ve orta donem klinik sonuclarini gozden gecirmektir. Yontemler: Ocak 2015-Ocak 2017 tarihleri arasinda ucuncu basamak bir cocuk hastanesine basvuran ve septik artrit tanisi alan ve ardindan drenaj ve debridman ile tedavi edilen hastalardan vaka serisi calismasi yapildi. Tum degerlendirmeler; hasta gecmisi, fiziksel muayene ve radyolojik ve laboratuvar incelemelerini iceriyordu. Laboratuvar testlerinde tam kan sayimi, eritrosit sedimantasyon hizi (ESR), C-reaktif protein (CRP) ve kan kulturu incelendi. Ayrica hastalarin son takiplerinde dirsek Mayo skorlari da incelendi. Bulgular: Degerlendirme; yas ortalamasi 79 ay (2-161 ay) olan 3 erkek ve 2 kadin olmak uzere 5 hasta (5 dirsek) uzerinde yapildi. Tum hastalar agri, lokal inflamasyon belirtileri (sislik, kizariklik, ates artisi) ve ates (>38.5 °) ile basvurdu. Laboratuvar tetkiklerinde lokosit sayisi >11.000 olarak tanimlanan tum hastalarda lokositoz tespit edildi ve tum hastalarin CRP ve ESR degerleri yuksekti. Hastanede yatis sirasinda ortalama CRP duzeyi 110,2 (17,5-285) ve ortalama ESR duzeyi 46 (24-85) idi. Hastalar ortalama 47 ay (31-58 ay) takip edildi. Son takip muayenesinde, tum hastalarin Mayo Dirsek Performans Skoru ortalama 82.3 (79-85) idi ve iyi bir sonuc olarak degerlendirildi. Sonuc: Acil servise siddetli dirsek fonksiyon kisitlamasi ile basvuran ates, kizariklik ve sislik ile basvuran ve onemli travma oykusu olmayan hastalarda septik artrit her zaman akilda tutulmalidir. Basarili klinik sonuclar elde etmek icin erken debridman, irigasyon ve antibiyotik kullanimi onemlidir.

An unusual case of neonatal elbow septic arthritis mimicking a distal humerus physeal injury/elbow dislocation

Neonatal septic arthritis is a rare entity and an important differential diagnosis of distal humeral epiphyseal separation (DHES). DHES is yet again an infrequent phenomenon seen in less than 3.9% of physeal injuries which often masquerades as elbow dislocation. We report on a 20-day old term neonate referred with a suspected diagnosis of elbow dislocation following trauma. Subsequent to evaluation in a tertiary care hospital this was found to be a rare case of septic arthritis of elbow in a neonate mimicking DHES. The diagnosis of septic arthritis in neonates is often delayed because the characteristic symptoms and signs seen in older children are absent or subtle. DHES is a rare injury, which to an untrained eye, may be misdiagnosed as an elbow dislocation. Septic arthritis and acute osteomyelitis are differential diagnoses of DHES, however, the history of incidental trauma hoodwinked us to provisionally diagnose it as the latter.

2 cases report of neonatal septic arthritis of elbow : Mid-term follow-up result of 6 and 8 years

2 cases report of neonatal septic arthritis of elbow : Mid-term follow-up result of 6 and 8 years

Septic elbow arthritis in children: Epidemiology and outcome

IntroductionSeptic elbow arthritis is a rare disease, especially in children. The aim of this study was to report the functional outcome of our pediatric population with both demographic and microbiological features. MethodsWe retrospectively reviewed all our cases of pediatric septic elbow arthritis between 2007 and 2017. Demographic, microbiological, biological, and radiological features were analyzed. Functional outcome was evaluated according to the Morrey Elbow Performance Score (MEPS). ResultsIn total, 14 cases were reviewed. The mean age was 9 years. Microbiological findings revealed Staphylococcus aureus in 10 cases. The mean white blood cells count in synovial fluid was 101,306 cells per mm 3. The skin was the most frequently reported entry portal. The mean MEPS score was 86.13 points (excellent in eight cases, good in three cases, fair in two cases, and poor in two cases). Stiffness was observed in three cases. No growth disturbance was reported. DiscussionSeptic elbow arthritis in children is rare. Biological inflammatory markers are sensitive but not specific. White blood cell count in the synovial fluid is specific. S. aureus is the most frequently cultured agent. Treatment is based on surgical debridement, antibiotics, and elbow immobilization. Concomitant osteomyelitis is frequent and should be diagnosed and treated simultaneously. Functional outcomes are usually satisfactory in contrast to osteomyelitis. ConclusionPediatric septic elbow arthritis is rare. It may be primary or secondary to trauma and surgery of the elbow. Demographic, biological, and microbial features are similar to those reported for osteomyelitis; however, functional outcomes are better with a negligible rate of growth disturbance.

Spontaneous Septic Arthritis of Canine Elbows: Twenty-One Cases.

This study provides information on clinical features, diagnosis, treatment and associated risk factors of spontaneous septic elbow arthritis in the dog. Medical records between March 2007 and June 2015 were searched for cases of spontaneous septic elbow arthritis with a diagnosis based on clinical signs, arthrocentesis, cytological and microbiological analysis of elbow joint synovial fluid, radiography and outcome following treatment. Twenty-one cases of septic arthritis were identified. Pre-existing osteoarthritis was present in 14/15 elbows for which diagnostic imaging was available. Although all cases had increased neutrophil count on synovial fluid cytology, culture was only positive in 12/21. Despite initial improvement in lameness scores (pre-treatment 9/10 [range: 1-10] versus post-treatment 3/10 [range: 1-5]), 11/12 had residual long-term lameness. Recurrence of infection was noted in 3/12 elbows for which long-term (>8 weeks) follow-up was available. There was an acute mortality rate of 2/21 associated with severe systemic sepsis. Septic arthritis, even in the absence of pyrexia, should be considered as a major differential diagnosis in middle aged, large breed dogs, with pre-existing elbow arthritis, that suffer an acute onset lameness, with elbow joint effusion and discomfort. Antibiotic therapy alone was effective for treatment with high initial response rates. Chronic lameness post-treatment was common, and a high rate of recurrence was seen with 3/12 dogs suffering more than one episode.

Septic arthritis of elbow in children, three cases report

Septic arthritis of elbow in children, three cases report

Total Elbow Arthroplasty Following Septic Arthritis with Staphylococcus aureus: A Case Report and Review of the Literature

Septic arthritis of the elbow seems to be a contraindication for total elbow arthroplasty (TEA). We here describe a 65-year-old male, American Society of Anesthesiologists (ASA) class 3-patient, with a severely destructed right elbow due to septic arthritis with Staphylococcus aureus. His treatment consisted of multiple irrigation and debridement procedures including resection of the distal humerus, soft tissue coverage by local rotational flap and the use of a gentamicin-vancomycin loaded PMMA spacer, i.v. and oral antibiotics. After eradication of infection, a constraint cemented TEA could then successfully be performed eight months after the initial surgery and twenty-five weeks after the last debridement procedure. Twenty-one months after the TEA, the patient remained infect free and shows excellent functional results: Disabilities of the Arm, Shoulder and Hand (DASH) score: 38.3, Broberg and Morrey score: 91/100, Mayo elbow score: 95/100. To the best of our knowledge this is the first case in the literature that demonstrates TEA after septic elbow arthritis with S. aureus. Although TEA is known as a typical surgical procedure with a low volume in numbers and higher complication rates, such as elevated infection rates compared to other types of arthroplasty, septic arthritis with S. aureus can successfully be performed after eradication of the infection and targeted antibiotic therapy.

Case of an Acute lymphoblastic Leukemia Presenting as Elbow Septic Arthritis

Case of an Acute lymphoblastic Leukemia Presenting as Elbow Septic Arthritis

Elbow Septic Arthritis Associated with Pediatric Acute Leukemia; A Case Report

Elbow Septic Arthritis Associated with Pediatric Acute Leukemia; A Case Report

Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl.

Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)).

Elbow arthroscopy: indications, techniques, outcomes, and complications.

Elbow arthroscopy is a tool useful for the treatment of a variety of pathologies about the elbow. The major indications for elbow arthroscopy include débridement for septic elbow arthritis, synovectomy for inflammatory arthritis, débridement for osteoarthritis, loose body extraction, contracture release, treatment of osteochondral defects and selected fractures or instability, and tennis elbow release. Contraindications, technical considerations, and favorable outcomes following treatment with elbow arthroscopy require careful patient evaluation, a thorough understanding of anatomic principles, and proper patient positioning and portal selection to guide preoperative planning and overall patient care. Elbow arthroscopy is an effective procedure for the treatment of inflammatory arthritis, osteoarthritis, and lateral epicondylitis.

Plant thorn synovitis of elbow in children.

Four rare cases of plant thorn synovitis of left elbow were admitted at our institution, which were initially misdiagnosed as partially treated septic arthritis of elbow or Juvenile inflammatory arthritis. All of them were of paediatric age group. Symptoms included pain, swelling, and decreased range of motion of affected joint. On examination synovitis was present in all patients. Roentgenograms & Ultrasonography were inconclusive in all patients, Definitive diagnosis was made only after arthrotomy, Thorn fragments (Acacia arabica) were recovered from the hypertrophied synovium & subtotal synovectomy was done and sent for histopathological examination. All patients improved after surgery with mean residual flexion deformity of 12.5±2.86°. Plant thorn induced synovitis of elbow is rare, it must be included in the differential diagnosis of monoarthritis of elbow and a high index of suspicion is needed for retained thorn fragments in elbow joint causing synovitis. Its optimal treatment is arthrotomy, foreign body removal and total/subtotal synovectomy.

Streptobacillus hongkongensis sp. nov., isolated from patients with quinsy and septic arthritis, and emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis.

Two bacterial strains, HKU33(T) and HKU34, were isolated in Hong Kong from the pus aspirated from the right peritonsillar abscess of a patient with quinsy and the left elbow joint fluid of another patient with tophaceous gout and left elbow septic arthritis, respectively. The bacteria were Gram-stain-negative, non-motile, non-spore-forming, non-haemolytic pleomorphic bacilli. They grew best on Columbia agar with 5 % defibrinated sheep blood in an anaerobic environment or aerobic environment with 5 % CO2. They also grew on chocolate agar but not on MacConkey agar. They were catalase- and cytochrome oxidase-negative. They showed a unique profile of enzyme activities distinguishable from their closely related species. Phylogenetic analysis of the complete 16S rRNA gene, and partial groEL, gyrB and recA gene sequences showed the two isolates formed a distinct branch within the family Leptotrichiaceae, being related most closely to Streptobacillus moniliformis. Hierarchical cluster analysis of mass spectra of whole-cell protein contents showed that strains HKU33(T) and HKU34 were closely related to each other, but were distinct from Streptobacillus moniliformis, Sneathia sanguinegens and 'Leptotrichia amnionii'. The DNA G+C content of strain HKU33(T) was 26.0±2.1 mol% (mean±sd; n = 3). DNA-DNA hybridization demonstrated ≤45.02 % DNA relatedness between the two isolates and Streptobacillus moniliformis CCUG 13453(T). A novel species, Streptobacillus hongkongensis sp. nov., is proposed to accommodate strains HKU33(T) and HKU34, with HKU33(T) ( = JCM 18691(T) = NCTC 13659(T) = DSM 26322(T)) designated the type strain. Emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis are also given.

Ceftazidime resistance in Burkholderia pseudomallei: First report from India

Melioidosis, a disease of public health importance in Southeast Asia and Northern Australia, of late has shown an increasing trend in India, particularly Southern India. We describe a case of a 39-year-old diabetic patient with left elbow septic arthritis, multiple liver, splenic abscesses, pneumonia, pleural effusion, followed by sepsis syndrome. Blood cultures and culture of the joint aspirate yielded pure growth of Burkholderia pseudomallei (B. pesudomallei), sensitive to carbapenem, co-trimoxazole and resistant to ceftazidime. The patient was successfully treated with imipenem- cilastin. He was discharged on co-trimoxazole to complete the 24 weeks course and follow-up has continued to date. The patient continues to remain asymptomatic. The case re-emphasizes the need to monitor the trend of B. pseudomallei in India, particularly the development of ceftazidime resistance, which incidentally is the drug of choice.

Arthroscopic treatment of septic arthritis of the elbow

Septic arthritis of the elbow is a serious orthopedic concern associated with high morbidity and mortality rates, traditionally treated with open exposure of the elbow joint. This study was performed to describe the outcome of arthroscopic treatment of septic elbow arthritis. From May 2000 through January 2008, 12 patients with septic elbow arthritis were treated arthroscopically at the Mayo Clinic, Rochester, Minnesota, a large medical center. We reviewed the patients' medical records concerning variables such as history and clinical findings, previous elbow history, surgical procedure, cultured organism, and follow-up. Using the Oxford Elbow Score and the Mayo Elbow Score, we examined current level of pain, function, and social-psychological aspects. Six patients died before initiation of this study and were therefore only studied retrospectively. Septic elbow arthritis without pre-existing elbow problems shows excellent outcomes after arthroscopic treatment, with scores for absence of pain, function, social-psychological well-being, and range of motion of 97.9%, 100%, 95.8%, and 100%, respectively. When elbows were treated arthroscopically within 2 days after the onset of clinical symptoms suggesting bacterial elbow arthritis, maximum scores of 100% were noted for all aspects. Positive elbow history before infection and reoperation were associated with poor outcome scores, with 62.5%, 85.4%, and 50% for absence of pain, function, and social-psychological well-being, respectively. Septic elbow arthritis occurs often in the debilitated, immunocompromised patient. Arthroscopic intervention is a reasonable alternative to open treatment. In this small series, the acutely septic elbow was successfully treated in the majority of patients, although the overall patient mortality rate remains high.

Septic arthritis due to a Sneathia species most closely related to Sneathia sanguinegens

Sneathia sanguinegens is an infrequent bacterium in clinical specimens. We describe a case of right elbow septic arthritis due to a Sneathia species most closely related to S. sanguinegens in a young immunocompetent woman. S. sanguinegens has never been implicated in osteoarticular infections.