Streptococcal Septic Arthritis Research Articles

241. A Comparison of Staphylococcal and Streptococcal Septic Arthritis with Lyme Arthritis

BackgroundSeptic arthritis is considered the most important differential diagnosis in suspected Lyme arthritis. The present study sheds light on the most frequent misdiagnoses in Lyme arthritis cases and clues for differentiation from Staphylococcal and Streptococcal septic arthritis.MethodsWe studied patients with positive joint fluid cultures with Staphylococcus aureus (SA) and streptococci and Lyme polymerase chain reaction (PCR) positive joint fluid in 9 hospitals in Eastern Pennsylvania and 1 in Warren county, New Jersey over a 3 year period.ResultsOne hundred and thirty four out of 7000 SA and 21 out of 1321 streptococcal isolates were from joint fluid. Twenty nine had Lyme arthritis, ages 5-74 ( 24 males,5 females). Twelve out of 29 were ages 10-18 with 20/29 under age 40. Predominant joint affected was a single knee 27/29. All had pain with or without swelling and little erythema. Two had fever. One reported a tick bite. None had other manifestations of Lyme disease. The diagnosis at the initial visit was sprain or sports injury in 5, osteoarthritis in 5, inflammatory arthritis or gout in 2 each, i septic arthritis, 1 viral syndrome and 1 ruptured Baker's cyst. Joint fluid count range was 3500-77,360 with only 3 over 50,000. White blood cell count (wbc) range was 3200-14,580. SA arthritis involved knee in 66 (49.3%), hip 31(23.9%), elbow 19 (14.2%), shoulder 14 (10.4%) with 2 wrist, 1 ankle and 1 sterno-clavicular joint. Fifty seven had a history of joint surgery. Eighty six were male and 48 female. age range 14-95 with a median age 65. Synovial fluid cell count was 335-470,000 and wbc 5,200-28,410 . Streptococcal septic arthritis ( 13 male 8 female) involved the knee in 17/21 with one each of hip, elbow, shoulder. The ages were 36-86 with 15/21 over age 60. Synovial fluid count was15,242-641,425 . Wbc count 11,140-25,080 .Nine out 21 had prior joint surgery.ConclusionLyme arthritis patients were younger, mostly involving 1 knee, majority male without other manifestations of Lyme disease. Highest synovial fluid count was 77,360 and highest wbc count 14,580. Most frequent misdiagnoses were sports injury/sprain or osteoarthritis. SA and Streptococcal arthritis were mostly in elderly, with higher joint fluid cell and wbc counts. Only 1/29 Lyme arthritis was initially misdiagnosed septic arthritis.Disclosures All Authors: No reported disclosures

Staphylococcal and Streptococcal Septic Arthritis in the Elderly

In our study, septic arthritis due to Staphylococcus aureus and Streptococcal species was more common in the elderly. This contrasts with Lyme arthritis which has a higher incidence in younger patients. The majority of joint infections were in the elderly, with a median age of 65 (range 14-95) for Staphylococcus aureus and 70 for Streptococcal species. The age range of Methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis was 27-95 (median 72) with 39/53 (73.6%) above age 60. The age range of Streptococcal arthritis patients was 36-86 (median 70). There were more males with septic arthritis for both Staphylococcus aureus (86/134) 64% and streptococci (12/22) 55%. The most frequently involved joint was the knee, 49.3% for S. aureus followed by hip (23.9%), elbow (14.3%), shoulder (14%), wrist (1.5%), ankle (0.75%) and sternoclavicular (0.75%). The knee was affected in 81% of Streptococcal infections, with the rest equally divided between the hip, elbow, acromioclavicular and ankle joints. The history of prior joint replacement in patients with septic arthritis was 21/28 (80%) for MRSA, 36/102 (35.3%) for methicillin-susceptible Staphylococcus aureus (MSSA) and 9/21 (43%) for streptococcal arthritis suggestive of healthcare-associated infections. Our results suggest a need for improvements to prevent the entry of pathogens into the surgical site during and after surgery.

Septic arthritis due to streptococci and enterococci in native joints: a 13year retrospective study.

Streptococcal species are the second most common cause of native joint septic arthritis (SA). However, there are few systematic data about streptococcal SA. The medical records of adults with SA caused by streptococci, pneumococci, and enterococci at our tertiary care centre between 2003 and 2015 were reviewed. 71 patients (34% female) with 83 affected joints were included. Median age was 62years. A single joint was involved in 62 patients (87%). One or more comorbidities were present in 58 patients (82%). 16 patients (23%) had a concomitant soft-tissue infection overlying the affected joint. The hematogenous route was the dominating pathogenesis (42/71, 59%). 9 (13%) patients were diagnosed with endocarditis. The knee was the most commonly affected joint (27/83, 33%) followed by shoulder (13/83, 16%). ß-haemolytic streptococci were most commonly identified (37/71, 52%) followed by polymicrobial infections (12/71, 17%). Surgical interventions included arthroscopic irrigation and debridement in 31 (44%), arthrotomy in 23 (32%), and amputation in five patients (7%). Median duration of antimicrobial therapy was 42days. Antibiotic treatment without any surgical intervention was performed in 5 (7%) patients. Outcome was good in 55 (89%) patients; mortality was 13% with four of nine deaths attributed to joint infection. Age and pathogen group independently predicted poor outcome in recursive partitioning analysis. Streptococcal SA was mostly due to ß-haemolytic streptococci in older and polymorbid patients. Old age, anginosus group streptococci, enterococci, and polymicrobial infections predicted poor outcome, while antibiotic treatment duration can likely be shortened.

Group B Streptococcal Septic Arthritis of the Shoulder and Potential Association with Pelvic Examination and PAP Smear.

Group B streptococcal (GBS) infection of a native joint in a nonpregnant adult is uncommon. While many women are colonized with this flora, it rarely becomes pathogenic in its adult host. GBS associated joint infections have been reported, most of which have been related to hematogenous seeding from unknown sources. To our knowledge, there are no published case reports of a GBS joint infection in association with a pelvic exam and Papanicolaou (PAP) smear. In this case report, we present a case of GBS sepsis of a native shoulder, possibly resulting from a routine pelvic exam and PAP smear.

SAT0404 Fifty-Two Week Clinical Response to Brodalumab, an Anti-IL-17R Antibody, in Subjects with Psoriatic Arthritis

BackgroundCytokine-targeting strategies aimed at blocking IL-17 receptor signaling may be beneficial in treatment of psoriatic arthritis (PsA).ObjectivesTo assess long-term efficacy and safety of brodalumab, a human anti-interleukin-17 receptor A monoclonal...

13. Septic Sacroilitis Mimicking an Inflammatory Spondyloarthropathy

Background: Post-partum back pain may herald the onset of an inflammatory arthritis or SpA. However, rarely a similar picture is seen with infection. Given that the treatment is immunosuppression vs antibiotics, correct diagnosis is extremely important. Methods: We present a lady with post-partum lower back pain and clinical and radiological features consistent with sacroiliitis who was found to have a multifocal septic arthritis. Results: A 40 year old woman presented 4 weeks post-partum with left hip and lower back pain. She had a healthy baby through a normal delivery after being induced at 40 weeks but had required an episiotomy. Approximately 12 h after delivery she developed left hip and lower back pain spreading to her left shoulder, wrist and hands with reduced range of movement. She then developed pain in her right shoulder, chest pain at the costochondral junctions and pain and swelling of her right knee. She reported ongoing vaginal bleeding since the birth of her child. Examination revealed a subtle swelling around the right sternoclavicular joint and second costochondral junction. Her lumbar spine was tender on movement and stressing her right sacroiliac joint provoked pain. Blood tests showed CRP 83, ESR >120, haemoglobin of 7.4, MCV 88, white cell count 5.6, neutrophils 4.4, lymphocytes 0.7 and platelets 283. MRI showed abnormal fluid signal within the right sternoclavicular joint space extending into the surrounding tissues, particularly the interclavicular recess and suprasternal notch and sub-chondral bony oedema. A large amount of abnormal fluid was present in the left sacroiliac joint extending into the surrounding tissues with pockets of fluid or pus within the paravertebral and left iliacus muscles and extensive bony oedema. A nuclear medicine bone scan showed marked uptake at the left sacroiliac joint and the right sternoclavicular joint. Synovial biopsies of her left sacroiliac and right sternoclavicular joints identified a fully sensitive Group B streptococcus. Due to penicillin allergy she was treated with i.v. ceftriaxone for 3 weeks, followed by 6 weeks of oral clindamycin. She had a good clinical response with resolution of the polyarthritis, back pain and inflammatory markers. ERPC showed retained products of conception that were evacuated. An MRI 6 months later showed a significant improvement of the inflammation previously seen. An echocardiogram was performed which excluded endocarditis. Conclusion: Recently there has been an increase in both the rates of adult native joint septic arthritis and Group B streptococcal disease in non-pregnant adults. Classically an acute monoarthritis, septic arthritis can present as oligoarthritis, or indeed sacroiliitis. Our patient’s multifocal Group B streptococcal septic arthritis was likely due to the retained products of conception as pre-natal screening had been negative. We highlight the importance of identifying such uncommon presentations in order to ensure correct treatment. Disclosure statement: The authors have declared no conflicts of interest.

Septic Arthritis of the Hip Caused by Group B Streptococcus in a Postpartum Patient: A Case Report.

Mehta, Anokhi D. BA1; Beebe, Kathleen S. MD1; Seigerman, Daniel A. MD1; Koerner, John D. MD1; Hwang, John S. MD1; Patterson, Francis R. MD1 Author Information

Streptococcal septic arthritis in adults. A study of 55 cases with a literature review

Objectives. – To evaluate the rate of occurrence and characteristics of streptococcal septic arthritis. Methods. – Retrospective single-center study of patients with bacteriologically documented septic arthritis admitted to a rheumatology department over a 20–year period. Results. – Of 303 cases of septic arthritis, 55 (18%) were due to streptococci and 166 (55%) to Staphylococcus aureus (55%). As compared to patients with S. aureus arthritis, patients with streptococcal arthritis was more likely to be in female (56% vs. 36%, P < 0.006) and older than 60 years of age (71% vs. 58%), less likely to have comorbidities (36% vs. 56%), rheumatoid arthritis (5% vs. 19%, P < 0.01), or diabetes (2% vs. 15%, P < 0.01), and more likely to have cancer (13% vs. 7%). Involved joints and proportions of patients with arthritis in multiple joints were similar in two groups. Mortality was lower in the group with streptococcal infection (3.6% vs. 7.8%). The streptococci were distributed as follows: group A ( n = 7), group B ( n = 12), group C ( n = 4), group D ( n = 7), group F ( n = 1), group G ( n = 2), nongroupable ( n = 14), nontypable ( n = 1), and Streptococcus pneumoniae ( n = 7). Groups A and B and nongroupable strains mainly affected women; group A selectively involved younger patients and group B very elderly patients. Comorbidity, most notably cancer, was common in patients with S. pneumoniae or group D streptococci. The portal of entry was often a skin lesion for groups A and B and a medical procedure for group D. Multiple joint involvement was common with groups A and B and prosthetic joint infection with groups B and C. Group A and S. pneumoniae were associated with severe systemic symptoms and extra articular foci of infection, whereas a smoldering course was more common with groups D and G and with nongroupable strains. Residual joint abnormalities were noted in half the patients, with no differences across groups. Conclusions. – The features of streptococcal septic arthritis vary according to the group of the causative organism and differ from those of S. aureus arthritis.

Les arthrites septiques streptococciques de l’adulte : 55 cas et revue de la littérature

Objectives. – To evaluate the rate of occurrence and characteristics of streptococcal septic arthritis. Methods . – Retrospective single-center study of patients with bacteriologically documented septic arthritis admitted to a rheumatology department over a 20-year period. Results. – Of 303 cases of septic arthritis, 55 (18%) were due to streptococci and 166 (55%) to S. aureus (55%). As compared to patients with S. aureus arthritis, patients with streptococcal arthritis were more likely to be female (56% vs. 36%, P < 0.006) and older than 60 years of age (71% vs. 58%), less likely to have comorbidities (36% vs. 56%), rheumatoid arthritis (5% vs. 19%, P < 0.01), or diabetes (2% vs. 15%, P < 0.01), and more likely to have cancer (13% vs. 7%). Involved joints and proportions of patients with arthritis in multiple joints were similar in the two groups. Mortality was lower in the group with streptococcal infection (3.6% vs. 7.8%). The streptococci were distributed as follows: Group A ( n = 7), Group B ( n = 12), Group C ( n = 4), Group D ( n = 7), Group F ( n = 1), Group G ( n = 2), nongroupable ( n = 14), nontypable ( n = 1), and S. pneumoniae ( n = 7). Groups A and B and nongroupable strains mainly affected women; Group A selectively involved younger patients and Group B very elderly patients. Comorbidity, most notably cancer, was common in patients with S. pneumoniae or Group D streptococci. The portal of entry was often a skin lesion for Groups A and B and a medical procedure for Group D. Multiple joint involvement was common with Groups A and B and prosthetic joint infection with Groups B and C. Group A and S. pneumoniae were associated with severe systemic symptoms and extraarticular foci of infection, whereas a smoldering course was more common with Groups D and G and with nongroupable strains. Residual joint abnormalities were noted in half the patients, with no differences across groups. Conclusions . – The features of streptococcal septic arthritis vary according to the group of the causative organism and differ from those of S. aureus arthritis.

Multifocal Streptococcal Pyomyositis Complicated by Acute Compartment Syndrome: Case Report

A 5-year-old girl sought treatment for pyrexia of unknown origin. Despite prompt surgical drainage of a streptococcal septic arthritis of the ankle joint, her condition deteriorated. Multifocal pyomyositis was subsequently diagnosed. This was complicated by acute compartment syndrome in three extremities. With aggressive surgical and medical management, the child made a complete recovery. Orthopaedic clinicians in nontropical areas must familiarize themselves with this rare, potentially life-threatening, but eminently curable disease.

Multifocal Streptococcal Pyomyositis Complicated by Acute Compartment Syndrome: Case Report

Summary: A 5-year-old girl sought treatment for pyrexia of unknown origin. Despite prompt surgical drainage of a streptococcal septic arthritis of the ankle joint, her condition deteriorated. Multifocal pyomyositis was subsequently diagnosed. This was complicated by acute compartment syndrome in three extremities. With aggressive surgical and medical management, the child made a complete recovery. Orthopaedic clinicians in nontropical areas must familiarize themselves with this rare, potentially lifethreatening, but eminently curable disease.

Group G streptococcal septic arthritis and bacteremia in a parenteral drug abuser

Group G streptococcal septic arthritis and bacteremia in a parenteral drug abuser

Septic Arthritis due to Group G Streptococcus

A VARIETY of serious infections due to Lancefield group<i>G Streptococcus</i>have been reported.^1-6These infections often have occurred in patients with underlying debilitating conditions. We describe a chronic alcoholic patient with group G streptococcal septic arthritis, who had a complicated course despite high-dose penicillin therapy. The case is compared with two previously reported cases of group G streptococcal arthritis. <h3>Report of a Case</h3> A 67-year-old man, who was a chronic alcoholic, fell down a flight of stairs five days before hospitalization. He sustained multiple skin abrasions and experienced pain and swelling of his left knee. He sought medical help because of persistent left-knee swelling associated with diaphoresis. He had no other underlying medical problems. His temperature was 37 °C. He had multiple skin abrasions without evidence of infection. He had poor dentition and a tender, warm, and swollen left knee. On laboratory examination, peripheral leukocyte count was 18,000/cu