Septic Arthritis and Osteomyelitis

2016 ◽  
Author(s):  
Melissa Leber
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Vertebral Body ◽  
Joint Destruction ◽  
Vertebral Osteomyelitis ◽  
Initial Evaluation ◽  
Joint Disease ◽  
Diabetic Patients ◽  
Posttraumatic Osteomyelitis ◽  
Neuropathic Ulcers

Septic arthritis is an inflammatory condition within the joint in reaction to bacterial infection in the joint space. Emergent diagnosis and initiation of therapy are necessary to prevent joint destruction and, in some cases, serious systemic illness. This review covers the epidemiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of septic arthritis. Figures show the pathophysiology of bone infection; an algorithm for the initial evaluation and management of a suspected septic joint; a magnetic resonance image of vertebral body osteomyelitis; a cutaneous sinus in a patient with underlying chronic posttraumatic osteomyelitis at the site of a previous tibial fracture; the probe-to-bone test for diagnosing osteomyelitis in the diabetic foot; an algorithm for the initial evaluation and management of suspected vertebral body osteomyelitis; nonsurgical treatment of osteomyelitis of the foot in a patient with diabetes; and algorithms for the evaluation and management of osteomyelitis in diabetic patients with neuropathic ulcers and no or mild foot infection, osteomyelitis in diabetic patients with neuropathic ulcers and moderate or severe foot infection, and chronic posttraumatic osteomyelitis. Tables list supportive findings for diagnosis of chronic osteomyelitis, risk factors for the development of septic arthritis in patients with underlying joint disease, microbiology in septic arthritis, empirical antibiotic therapy for septic arthritis, microbiology in vertebral osteomyelitis, antibiotic therapy for vertebral osteomyelitis awaiting culture results, representative studies with likelihood ratios for diagnostic tests used in the evaluation of native joint septic arthritis, antibiotic therapy for vertebral osteomyelitis with unknown or established microbiology, and antibiotic therapy for diabetic pedal osteomyelitis with unknown or established microbiology.   Key words: osteomyelitis, probe-to-bone test, septic arthritis, septic joint, vertebral osteomyelitis This review contains 10 highly rendered figures, 9 tables, and 110 references.

scholarly journals Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Patrick Goetti ◽  
Nicolas Gallusser ◽  
Olivier Borens
Keyword(s):  
Joint Destruction ◽  
Young Patients ◽  
Joint Disease ◽  
Diabetic Patients ◽  
Type I ◽  
Bilateral Involvement ◽  
Satisfactory Outcome ◽  
History Of ◽  
Diabetes Type I ◽  
Low Incidence

Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease’s low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients.

Septic Arthritis, Septic Bursitis, and Osteomyelitis

2018 ◽  
Author(s):  
Cameron Ashbaugh
Keyword(s):  
Differential Diagnosis ◽  
Septic Arthritis ◽  
Vertebral Body ◽  
Bone Infection ◽  
Host Factors ◽  
Mechanical Support ◽  
Posttraumatic Osteomyelitis ◽  
Therapeutic Goal ◽  
Septic Bursitis

Infections of joints and bones are important causes of morbidity due to the potential for permanent injury to structures necessary for mechanical support and useful motion. The spectrum of disease is broad, with host factors, pathogen, site of infection, and comorbidities all influencing outcome. In some cases of bone infection, cure may not be possible, and the therapeutic goal becomes control. This review details the epidemiology, pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis of septic arthritis, septic bursitis, vertebral body osteomyelitis, pedal osteomyelitis in association with diabetes, and chronic posttraumatic osteomyelitis with union or malunion. This review contains 13 highly rendered figures, 16 tables, and 192 references.

Septic Arthritis, Septic Bursitis, and Osteomyelitis

2018 ◽  
Author(s):  
Cameron Ashbaugh
Keyword(s):  
Differential Diagnosis ◽  
Septic Arthritis ◽  
Vertebral Body ◽  
Bone Infection ◽  
Host Factors ◽  
Mechanical Support ◽  
Posttraumatic Osteomyelitis ◽  
Therapeutic Goal ◽  
Septic Bursitis

Infections of joints and bones are important causes of morbidity due to the potential for permanent injury to structures necessary for mechanical support and useful motion. The spectrum of disease is broad, with host factors, pathogen, site of infection, and comorbidities all influencing outcome. In some cases of bone infection, cure may not be possible, and the therapeutic goal becomes control. This review details the epidemiology, pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis of septic arthritis, septic bursitis, vertebral body osteomyelitis, pedal osteomyelitis in association with diabetes, and chronic posttraumatic osteomyelitis with union or malunion. This review contains 13 highly rendered figures, 16 tables, and 192 references.

Treatment with Melittin Induces Apoptosis and Autophagy of Fibroblast-like Synoviocytes in Patients with Rheumatoid Arthritis

2020 ◽  
Vol 21 (8) ◽  
pp. 734-740 ◽  
Author(s):  
Shou-di He ◽  
Ning Tan ◽  
Chen-xia Sun ◽  
Kang-han Liao ◽  
Hui-jun Zhu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Caspase 3 ◽  
Joint Destruction ◽  
Joint Disease ◽  
Enzyme Linked Immunosorbent Assay ◽  
Caspase 9 ◽  
Inflammatory Processes ◽  
Related Proteins ◽  
Local Stimulation ◽  
Fibroblast Like Synoviocytes

Background: Melittin, the major medicinal component of honeybee venom, exerts antiinflammatory, analgesic, and anti-arthritic effects in patients with Rheumatoid Arthritis (RA). RA is an inflammatory autoimmune joint disease that leads to irreversible joint destruction and functional loss. Fibroblast-Like Synoviocytes (FLS) are dominant, special mesenchymal cells characterized by the structure of the synovial intima, playing a crucial role in both the initiation and progression of RA. Objective: In this study, we evaluated the effects of melittin on the viability and apoptosis of FLS isolated from patients with RA. Methods: Cell viability was determined using CCK-8 assays; apoptosis was evaluated by flow cytometry, and the expression levels of apoptosis-related proteins (caspase-3, caspase-9, BAX, and Bcl-2) were also determined. To explore whether melittin alters inflammatory processes in RA-FLS, IL-1β levels were determined using an enzyme-linked immunosorbent assay (ELISA). Furthermore, we performed GFP-LC3 punctate fluorescence dot assays and western blotting (for LC3, ATG5, p62, and Beclin 1) to assess autophagy in RA-FLS. Results: Our results show that melittin can significantly impair viability, promote apoptosis and autophagy, and inhibit IL-1β secretion in RA-FLS. Conclusion: Melittin may be useful in preventing damage to the joints during accidental local stimulation.

scholarly journals Novel therapeutic interventions towards improved management of septic arthritis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian Wang ◽  
Liucai Wang
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Clinical Success ◽  
Treatment Protocol ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Medical Emergency ◽  
Success Rates ◽  
Joint Infections ◽  
Novel Therapeutic

AbstractSeptic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

SEPTIC ARTHRITIS IN INFANTS AND CHILDREN: A REVIEW OF 117 CASES

PEDIATRICS ◽  
1966 ◽  
Vol 38 (6) ◽  
pp. 966-971 ◽  
Author(s):  
John D. Nelson ◽  
Wayne C. Koontz
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Age Groups ◽  
Infants And Children ◽  
Joint Fluid ◽  
Hemophilus Influenzae ◽  
In Infants And Children

A review of 117 cases of septic arthritis in infants and children revealed that the concept of staphylococci and streptococci as the major etiologic organisms should be modified to stress the frequency of Hemophilus influenzae in the 6-month to 2-year age bracket and to emphasize the variety of bacteria that must be anticipated in individual cases. Suggestions are made for increasing the frequency of bacteriologic diagnoses and for initiating the antibiotic therapy of patients with septic arthritis based upon age groups and observations of bacterial stains of joint fluid.

scholarly journals The Novel Role of MIF in the Secretion of IL-25, IL-31, and IL-33 from PBMC of Patients with Rheumatoid Arthritis

Molecules ◽  
2021 ◽  
Vol 26 (16) ◽  
pp. 4968
Author(s):  
Samuel García-Arellano ◽  
Luis Alexis Hernández-Palma ◽  
Sergio Cerpa-Cruz ◽  
Gabriela Athziri Sánchez-Zuno ◽  
Melva Guadalupe Herrera-Godina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mononuclear Cells ◽  
Joint Destruction ◽  
Study Groups ◽  
Joint Disease ◽  
The Novel ◽  
Peripheral Blood Mononuclear ◽  
Cytokine Dysregulation ◽  
New Evidence

Rheumatoid arthritis (RA) is an autoimmune inflammatory joint disease with complex pathogenesis associated with cytokine dysregulation. Macrophage migration inhibitory factor (MIF) plays a role in systemic inflammation and joint destruction in RA and could be associated with the secretion of other immune-modulatory cytokines such as IL-25, IL-31, and IL-33. For the above, our main aim was to evaluate the IL-25, IL-31, and IL-33 secretion from recombinant human MIF (rhMIF)-stimulated peripheral blood mononuclear cells (PBMC) of RA patients. The rhMIF and lipopolysaccharide (LPS) plus rhMIF stimuli promote the secretion of IL-25, IL-31, and IL-33 (p < 0.05) from PBMC of RA patients. The study groups, the different stimuli, and the interaction between both showed a statistically significant effect on the secretion of IL-25 (p < 0.05) and IL-31 (p < 0.01). The study of the effect of the RA patient treatments and their interaction with the effect of stimuli did not show an interaction between them. In conclusion, our study generates new evidence for the role of MIF in the secretion of IL-25, IL-31, and IL-33 and its immunomodulatory effect on RA.

scholarly journals Thoracic cryptococcal osteomyelitis mimicking tuberculosis: A case report

2019 ◽  
Vol 10 ◽  
pp. 81
Author(s):  
Nitin Adsul ◽  
K. L. Kalra ◽  
Nikhil Jain ◽  
Mukesh Haritwal ◽  
R. S. Chahal ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vision Loss ◽  
Diagnostic Delay ◽  
Vertebral Osteomyelitis ◽  
Needle Aspiration ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Cytologic Examination ◽  
Cryptococcal Infection ◽  
Organ Systems

Background: Isolated cryptococcal osteomyelitis of the spine is extremely uncommon; there have been only seven cases identified in literature. The majority were originally misdiagnosed as tuberculosis. Here, we present a patient with cryptococcal osteomyelitis of the thoracic spine with associated fungal retinal deposits. Case Description: A 45-year-old, type II diabetic female presented with a 5-month history of severe back pain. Her magnetic resonance imaging (MRI) revealed osteomyelitis involving the T4 vertebral body with epidural and prevertebral extension; notably, the intervertebral disc spaces were not involved. Although the fine-needle aspiration cytologic examination was inconclusive, the patient was empirically placed on antitubercular drug therapy. One month later, she became fully paraplegic. The MRI now demonstrated osteolytic lesions involving the T4 vertebral body with cord compression. She underwent biopsy of the T4 vertebral body and a transfacet T4 decompression with T2-T6 pedicle screw fixation. Culture and histopathological examinations both documented a cryptococcal infection, and she was placed on appropriate antifungal therapy. Notably, 3 weeks after surgery, she developed a sudden loss of vision loss due to retinal fungal endophthalmitis. She recovered vision in one eye after the administration of intravitreal voriconazole but lost vision in the other eye despite a vitrectomy. Over the next 8 months, she gradually recovered with motor function of 4/5 in both lower extremities without evidence of recurrent disease. Conclusion: Cryptococcal infection should be among the differential diagnostic considerations for patients with vertebral osteomyelitis. Notably, diagnostic delay can lead to devastating neurological deficits and involvement of other organ systems.

scholarly journals Fatal Chromobacterium violaceum septicemia in a South Indian adult

2012 ◽  
Vol 6 (10) ◽  
pp. 751-755 ◽  
Author(s):  
Rajiv Karthik ◽  
Padmaja Pancharatnam ◽  
Veeraraghavan Balaji
Keyword(s):  
Mortality Rate ◽  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
High Mortality ◽  
South India ◽  
Chromobacterium Violaceum ◽  
Human Pathogen ◽  
Tropical Regions ◽  
First Case ◽  
South Indian

Chromobacterium violaceum is a rare human pathogen that causes potentially fatal infections especially in the tropical regions. Limited awareness about this pathogen and inappropriate antibiotic therapy are some of the factors contributing to the high mortality rate. To date there have been only eight cases reported from India of which only one is an adult. To the best of our knowledge, we report here the first case of a 40-year-old man from South India with septicemic C. Violaceum infection and septic arthritis.

Bone and Joint Infections

2019 ◽  
Author(s):  
Jayshree Dave ◽  
Rohma Ghani
Keyword(s):  
Septic Arthritis ◽  
Group A Streptococcus ◽  
Clinical History ◽  
Liver Function Tests ◽  
Joint Disease ◽  
Joint Fluid ◽  
Response To Treatment ◽  
Range Of Movement ◽  
Joint Infections ◽  
Bone And Joint Infections

Patients with bone and joint infections can present with native joint septic arthritis, osteomyelitis, or implant-associated bone and joint infections. Patients often present with an acute onset of hot, swollen, painful joint with restricted function in one or more joints over a couple of weeks. On examination the affected joint is painful with a limited range of movement, and fever is present. Risk factors for septic arthritis include an abnormal joint architecture due to pre-existing joint disease, e.g. patients with rheumatoid arthritis, or patients on haemodialysis, with diabetes mellitus, or older than 80 years of age. The differential diagnosis includes reactive arthritis, pre-patellar bursitis, gout, Lyme disease, brucellosis, and Whipples disease. Staphylococcus aureus is the most common cause of septic arthritis, followed by Group A streptococcus and other haemolytic streptococci including B, C and G. Gram-negative rods such as Escherichia coli are implicated in the elderly, immunosuppressed, or patients with comorbidities. Pseudomonas aeruginosa is implicated in intravenous (IV) drug users and patients post-surgery or intra-articular injections. Kingella kingae causes septic arthritis in children younger than four years of age. Neisseria gonorrhoeae, Neisseria meningitidis, and Salmonella species can also cause septic arthritis as part of a disseminated infection. Septic monoarthritis commonly occurs in patients with disseminated gonococcal infection. Blood cultures, white blood cell count, C reactive protein (CRP), electrolytes, and liver function tests are indicated. Serial CRP is useful in monitoring response to treatment. If there is a history of unprotected sexual intercourse, gonococcal testing is recommended. Brucella serology and Tropheryma whippei serology may be considered based on the clinical history. Joint fluid aspiration should be performed by a specialist within the hospital. Joint fluid aspirate is processed in the laboratory for microscopy, culture, and sensitivity. Gram stain can show an increase in neutrophils and presence of bacteria. The guidelines provided by the British Society for Rheumatology on the management of hot swollen joints in adults has provided advice for empirical treatment for suspected septic arthritis, but the local antibiotic policy should also be considered. Initial treatment is with intravenous flucloxacillin 2g four times daily, or 450– 600mg four times daily of intravenous clindamycin to cover S. aureus.

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