1.A case of unusual Gram-negative bacilli septic arthritis in an immunocompetent patient.
Singapore medical journal 2013;54(8):e164-8
The Gram-negative bacilli Acinetobacter baumannii, Burkholderia cepacia, Ochrobactrum anthropi, Pseudomonas mendocina, Ralstonia spp., Serratia marcescens and Stenotrophomonas maltophilia are ubiquitous environmental organisms of low virulence, and do not usually cause illness in immunocompetent hosts. We report a case of multiple concurrent opportunistic Gram-negative bacilli causing septic arthritis in a healthy patient following trauma to the knee. Repeated operations, including arthroscopy, arthrotomy and debridement, were required before tissue cultures became negative. The patient also required an extended duration of intravenous and oral antibiotic treatment before he was discharged. Gram-negative bacillary septic arthritis is an uncommon but significant condition that requires repeated debridement and washouts in order to achieve bacterial eradication. This case report highlights the importance of an awareness of the external environment at the time of injury, as it impacts the type of organisms causing the infection, and consequently, the choice of empiric antibiotics required for successful treatment.
Adult
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Anti-Bacterial Agents
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therapeutic use
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Arthritis, Infectious
;
microbiology
;
therapy
;
Arthroscopy
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Biopsy
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Combined Modality Therapy
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Debridement
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Gram-Negative Bacterial Infections
;
microbiology
;
therapy
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Humans
;
Knee Injuries
;
complications
;
Male
2.Prognostic Factors of Septic Arthritis of Hip in Infants and Neonates: Minimum 5-Year Follow-up.
Soon Chul LEE ; Jong Sup SHIM ; Sung Wook SEO ; Sung San LEE
Clinics in Orthopedic Surgery 2015;7(1):110-119
BACKGROUND: The authors conducted the present study to identify clinical and radiological prognostic factors in infants and neonates with septic arthritis of the hip. METHODS: The authors retrospectively reviewed the records of 31 patients with septic arthritis of the hip. All of the patients were younger than 18 months old. Follow-up periods ranged from 5 to 17 years. The following potential variables for predicting the prognosis were included in the assessment: gender, age, underlying diseases, duration of symptoms, changes of hip joint in X-ray, concomitant osteomyelitis, elevation of erythrocyte sedimentation rate and C-reactive protein, sepsis, pus drainage, synovial fluid culture, and infecting organisms. Clinical and radiological prognoses were analyzed at the final follow-up. RESULTS: Univariate analysis demonstrated that radiological prognoses were poorer in patients who had underlying diseases, a longer duration of symptoms, and pus drainage. However, on multivariate analysis, only the variable-duration of symptoms-was found to be statistically related with a poor radiological prognosis. CONCLUSIONS: Although poor prognosis for patients with several underlying diseases and radiological changes has already been established, a favorable outcome might be expected with prompt surgical drainage and appropriate antibiotics.
Arthritis, Infectious/*diagnosis/microbiology/therapy
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Female
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Follow-Up Studies
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*Hip Joint
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Humans
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Infant
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Infant, Newborn
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Male
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Prognosis
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Retrospective Studies
3.Candida tropicalis arthritis in a patient with acute leukemia.
Xiao-Rong HU ; Jing-Song HE ; Xiu-Jin YE ; Wei-Yan ZHENG ; Wen-Jun WU ; Mao-Fang LIN
Journal of Experimental Hematology 2008;16(5):1215-1218
Candida arthritis in patient with hematological malignancy is rare. A case of Candida tropicalis arthritis of knee occurred in a patient with acute monocytic leukemia was reported during the recovery phase of post chemotherapy myelosuppression and agranulocytosis. The patient was diagnosed as Candida tropicalis arthritis of knee according to the Candida tropicalis isolated from the synovial fluid. Itraconazole and amphotericin B were intravenously injected for therapy for 4 - 5 weeks based on the susceptibility test in vitro, which showed better efficacy. But the arthritis relapsed at 4 - 6 weeks after the drug withdrawal. The curative effect was found in patient after treatment with fluconazole injection and articular cavity douching with amphotericin B for 8 weeks. In conclusion, although Candida arthritis in patient with hematological malignancy is rare, it still occurred in the patient with hypoimmunity. The treatment emphasis showed be placed on the full dosage and full treatment course of antifungal agent.
Antifungal Agents
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therapeutic use
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Arthritis, Infectious
;
drug therapy
;
microbiology
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Candida tropicalis
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isolation & purification
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Candidiasis
;
drug therapy
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Female
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Humans
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Leukemia
;
microbiology
;
Middle Aged
4.Acromioclavicular Septic Arthritis and Sternoclavicular Septic Arthritis with Contiguous Pyomyositis.
Sally A COREY ; William A AGGER ; Andrew T SATERBAK
Clinics in Orthopedic Surgery 2015;7(1):131-134
Acromioclavicular (AC) and sternoclavicular (SC) septic arthritis with contiguous pyomyositis are rare, especially in immunocompetent individuals. We report a case of septic AC joint with pyomyositis of the deltoid and supraspinatus muscles and a separate case with septic SC joint with pyomysitis of the sternocleidomastoid muscle. Both patients had similar presentations of infections with Staphylococcus aureus and were successfully treated with surgical incision and drainage followed by prolonged antibiotic therapy.
*Acromioclavicular Joint/microbiology
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Adult
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Anti-Bacterial Agents/administration & dosage
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Arthritis, Infectious/diagnosis/microbiology/*therapy
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Female
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Humans
;
Magnetic Resonance Imaging
;
Pyomyositis/diagnosis/microbiology/*therapy
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Staphylococcal Infections/complications/*therapy
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*Staphylococcus aureus
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*Sternoclavicular Joint/microbiology
5.Septic monoarthritis and osteomyelitis in an elderly man following Klebsiella pneumoniae genitourinary infection: case report.
Annals of the Academy of Medicine, Singapore 2006;35(2):100-103
INTRODUCTIONKlebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint.
CLINICAL PICTUREThe patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of the ankle. On admission, he was in septic shock. Investigations suggested an infective cause, as evidenced by raised total white cell count and pyuria. K. pneumoniae was cultured from both urine and ankle synovial fluid. Imaging confirmed multiple liver and prostatic abscesses, as well as osteomyelitis of the foot bones adjacent to the ankle.
TREATMENTTreatment in this case included surgical drainage of the affected joint and surrounding soft tissue structures, in addition to a 6-week course of systemic antibiotics.
OUTCOMEThe patient had good clinical response following treatment. In addition, we noted a normalisation of his laboratory parameters and resolution of the intraabdominal and pelvic abscesses.
CONCLUSIONThis case emphasises the importance of timely and accurate diagnosis followed by appropriate treatment in disseminated K. pneumoniae infection to prevent significant morbidity and mortality.
Aged ; Ankle Joint ; microbiology ; surgery ; Anti-Bacterial Agents ; therapeutic use ; Arthritis, Infectious ; diagnosis ; microbiology ; therapy ; Combined Modality Therapy ; Drainage ; Foot Bones ; microbiology ; Humans ; Klebsiella Infections ; diagnosis ; therapy ; Klebsiella pneumoniae ; Liver Abscess ; microbiology ; Magnetic Resonance Imaging ; Male ; Osteomyelitis ; drug therapy ; epidemiology ; microbiology ; surgery ; Prostatic Diseases ; microbiology ; Synovial Fluid ; microbiology ; Tomography, X-Ray Computed ; Urinary Tract Infections ; drug therapy ; microbiology
6.A Case of Fungal Arthritis Caused by Hansenula Anomala.
Sung Wook CHOI ; Tong Joo LEE ; Myung Ku KIM ; Moon LEE ; Jae Ho JUNG
Clinics in Orthopedic Surgery 2010;2(1):59-62
Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic therapy and surgery. Consequently, knee joint aspiration was performed again, which identified fungal arthritis caused by H. anomala. It was treated successfully with amphotericin B and fluconazole. When treating arthritis patients with diabetes, it is important to consider the possibility of septic arthritis by H. anomala and provide the appropriate treatment.
Aged
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Amphotericin B/therapeutic use
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Antifungal Agents/therapeutic use
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Arthritis, Infectious/*diagnosis/drug therapy/microbiology
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Fluconazole/therapeutic use
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Humans
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*Knee Joint
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Male
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Mycoses/*diagnosis/drug therapy
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*Pichia
7.Mycobacterium Avium Arthritis with Extra-articular Abscess in a Patient with Mixed Connective Tissue Disease.
Choong Won LEE ; Han Dong SUNG ; Byong Moon CHOI ; Chun Wook KIM ; Su Jin JUN ; Sang Jo MIN
The Korean Journal of Internal Medicine 2003;18(2):119-121
A case of Mycobacterium avium arthritis in a 39-year-old female patient with mixed connective tissue disease (MCTD) was reported. An extra-articular abscess had formed outside the knee joint and extended down the calf. A culture was taken of the abscess and synovial fluid disclosed Mycobacteriun avium. This was resistant to most anti-tuberculosis agents. A combination of anti-tuberculosis drugs followed a total resection of the abscess. We concluded that M avium septic arthritis could insidiously develop into an extra-articular abscess. A combination of anti-tuberculosis drugs with a total resection of the abscess was an effective treatment.
Adult
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Antitubercular Agents/therapeutic use
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Arthritis, Infectious/*microbiology/therapy
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Female
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Human
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Knee Joint/*microbiology/surgery
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Mixed Connective Tissue Disease/*complications
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Mycobacterium avium/drug effects/*isolation & purification
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Mycobacterium avium-intracellulare Infection/*complications/therapy
8.In vivo pefloxacin-resistant Campylobacter fetus responsible for gastro-intestinal infection and bacteremia associated with arthritis of the hip.
Watine JOSEPH ; Martorell JEAN ; Bruna THIERRY ; Gineston Jean LOUIS ; Poirier Jean LUC ; Lamblin GERALDINE
Yonsei Medical Journal 1995;36(2):202-205
The authors report a case of Campylobacter fetus subsp. fetus gastro-intestinal infection and bacteremia with poly-arthritis, mainly of the hip, in a French patient simultaneously suffering from cirrhosis of the liver. The outcome was eventually favorable, however only after a trial of ineffective pefloxacin-gentamicin therapy. The authors suggest: (i) gentamicin should not be given alone in C. fetus subsp. fetus infections, and (ii) pefloxacin should not be given if antibiotic sensitivities data are not available. The inconclusive reliability of disk diffusion tests for C. fetus subsp. fetus should be recognized.
Antibiotics, Combined/*administration & dosage
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Arthritis, Infectious/*drug therapy/microbiology
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Bacteremia/*drug therapy/microbiology
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Campylobacter Infections/*drug therapy/microbiology
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Campylobacter fetus/*drug effects
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Case Report
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Drug Resistance, Microbial
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Gastrointestinal Diseases/*drug therapy/microbiology
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Gentamicins/administration & dosage
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*Hip Joint
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Human
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Male
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Middle Age
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Pefloxacin/*administration & dosage
9.Repeated Serum Alkaline Phosphatase Measurements in the Treatment of Childhood Acute Bone and Joint Infections with High Doses of Antibiotics.
Markus PAAKKONEN ; Markku J T KALLIO ; Pentti E KALLIO ; Heikki PELTOLA
Annals of Laboratory Medicine 2013;33(5):375-378
No abstract available.
Acute Disease
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Adolescent
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Alkaline Phosphatase/*blood
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Anti-Bacterial Agents/*therapeutic use
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Arthritis, Infectious/*drug therapy/*enzymology/microbiology
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*Bacterial Infections/drug therapy/enzymology/microbiology
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Child
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Child, Preschool
;
Haemophilus influenzae type b/isolation & purification
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Humans
;
Infant
;
Osteomyelitis/*drug therapy/*enzymology/microbiology
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Staphylococcus aureus/isolation & purification
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Streptococcus pneumoniae/isolation & purification
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Streptococcus pyogenes/isolation & purification