1/40. Pneumococcal arthritis.Twelve patients with pneumococcal arthritis are described. Seven of the 12 patients had underlying diseases which predisposed them to pneumococcal infections; five were alcoholics and two had hypogammaglobulinemia. Five patients had pre-existing joint disease prior to the onset of septic arthritis. Seven patients had co-existent pneumococcal infection, including meningitis and/or endocarditis in five. The other five patients had pneumococcal arthritis without evidence of other foci of pneumococcal infection. With penicillin therapy and drainage of the purulent joint fluid (by needle aspiration in four and surgical drainage in seven), the function of the involved joint returned to normal or to the previous baseline level in all but one patient.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
2/40. Pneumococcal polyarticular septic arthritis in a patient with rheumatoid arthritis.Rheumatoid arthritis is the most commonly reported host-related risk factor for septic arthritis. This risk is highest in severe, seropositive, long-standing (mean, 10 years) rheumatoid arthritis responsible for extraarticular symptoms and treated with systemic glucocorticoids. The clinical presentation of the joint infection is often atypical, leading to diagnostic wanderings. In 25% of cases, the infection is polyarticular, with 3.5 involved joints on average. staphylococcus aureus is the most common causative organism. streptococcus pneumoniae causes 5% of all cases of septic arthritis and is more often responsible for polyarticular infections than other organisms. Polyarticular septic arthritis carries a poor prognosis, with a mortality rate of 50% in rheumatoid arthritis patients. Despite its low incidence, polyarticular septic arthritis should be routinely considered in the differential diagnosis of rheumatoid flares. We report a case of pneumococcal septic arthritis involving five joints in a patient with known rheumatoid arthritis. Three other cases with involvement of more than four joints have been published.- - - - - - - - - - ranking = 2.4285714285714keywords = arthritis (Clic here for more details about this article) |
3/40. Pneumococcal arthritis in the wrist and ankle. A case report and short review of the literature.In this paper we report a 48-year-old man with septic arthritis of the wrist and ankle due to streptococcus pneumoniae. No known predisposing factor was found. Only about 300 cases of pneumococcal arthritis have been reported in the literature since 1888 and less than 10% of these affect the wrist. The management of bacterial arthritis is reviewed.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
4/40. Recurrent pneumococcal arthritis as the presenting manifestation of X-linked agammaglobulinemia.Pneumococcal arthritis in children older than 24 months is unusual and can suggest underlying immunodeficiency. We report a case of recurrent pneumococcal arthritis as the presenting manifestation of X-linked agammaglobulinemia.- - - - - - - - - - ranking = 0.85714285714286keywords = arthritis (Clic here for more details about this article) |
5/40. Isolated septic arthritis caused by penicillin-resistant streptococcus pneumoniae.streptococcus pneumoniae is a common cause of infection in the pediatric population, as well as an important cause of septic arthritis. The increased prevalence of drug-resistant S pneumoniae in north america has renewed interest in the use of pneumococcal vaccines. We describe the case of a child with isolated acute septic arthritis caused by infection with penicillin-resistant S pneumoniae.- - - - - - - - - - ranking = 0.85714285714286keywords = arthritis (Clic here for more details about this article) |
6/40. Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept.patients with long-standing, severe, erosive rheumatoid arthritis who have extra-articular manifestations and have undergone joint replacement surgery are at increased risk for serious infection and premature mortality. New therapies, including cytokine antagonists, hold great promise for improving the course of rheumatoid arthritis. However, they have powerful anti-inflammatory effects that may mask symptoms of serious infection. We report a case of fatal pneumococcal sepsis occurring in a 37-year-old woman with rheumatoid arthritis treated with the tumor necrosis factor antagonist etanercept and suggest management strategies for early detection and management of this complication.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
7/40. Pneumococcal arthritis affects performance status in patients with chronic GVHD of the skin following allogeneic bone marrow transplantation.We encountered 2 patients with pneumococcal arthritis following bone marrow transplantation (BMT). Both patients received grafts from unrelated human lymphocyte antigen (HLA)-matched donors and had suffered from chronic graft-versus-host disease (GVHD). One, a 10-year-old boy, suffered from Epstein-Barr virus-related lymphoproliferative disease (EB-LPD) and received oral 6-mercaptopurine and methotrexate to manage lymphadenopathy. Twenty-four months after BMT and 7 months after the onset of EB-LPD, pneumococcal arthritis occurred in both knee joints. The other patient, a 10-year-old girl, received multiagent immunosuppressive therapy for her chronic GVHD. At 51 months following BMT, pneumococcal arthritis occurred in her left knee joint. Chronic GVHD of the skin delayed the recovery from the arthritis in both patients. This complication is quite rare but can be very serious, in regard to the patient's performance status following BMT. Although vaccination against pneumococcus or preventive antibiotics should be administered to high-risk patients, early diagnosis and treatment may be the best strategy for pneumococcal arthritis.- - - - - - - - - - ranking = 1.2857142857143keywords = arthritis (Clic here for more details about this article) |
8/40. Pneumococcal purulent genual arthritis after allogeneic bone marrow transplantation.A 21-year-old male patient with non-Hodgkin's lymphoma (diffuse large T-cell type, clinical stage IV) received allogeneic bone marrow transplantation (BMT) from a partially HLA-mismatched unrelated donor in July 1998 and achieved complete remission. Thereafter, he suffered from chronic graft-versus-host disease (GVHD) and was continuously administered immunosuppressive drugs for a long time. Two years after the BMT, he complained of severe pain in the right knee, which was swollen, and was diagnosed as having pneumococcal purulent genual arthritis. He underwent arthroscopic synovectomy and was administered systemic and intra-articular antibiotics, leading to a gradual improvement. Streptococcal infections are often seen in patients in the late phase after allogeneic BMT because of immunodeficiency associated with chronic GVHD and hyposplenism. Most streptococcal infections are respiratory tract infections and septicemia, and there have been very few reports on cases of purulent genual arthritis. Administration of prophylactic antibiotics and control of chronic GVHD, which is a risk factor of pneumococcal infection, seem to be important to prevent purulent genual arthritis.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
9/40. Pneumococcal septic arthritis of the shoulder. Case report and literature review.Septic arthritis due to streptococcus pneumoniae appears to be relatively uncommon. Single- or clustered-case histories constitute the majority of reports on pneumococcal septic arthritis. A 70-year-old man presented with a 7-day history of pain, erythema and swelling of the left shoulder. physical examination of the left shoulder revealed a warm, swollen, erythematous, and markedly tender to light palpation. The patient was unable to elevate his arm more than 30 degrees without pain. Arthrocentesis performed on admission produced 30 cc of grossly purulent fluid whose culture demonstrated S. Pneumoniae. The septic arthritis was treated with intravenous vancomycin and imipenem. The antibiotics were substituted when the sensitivities were known with oral ciprofloxacin and rifampycin to complete 8 weeks' total treatment. On follow-up examination 1 year later, the patient has remained afebrile and asymptomatic without evidence of increasing joint effusion or acute joint inflammation. Pneumococcal arthritis is classically described as a painful monoarticular arthritis complicating an active pneumococcal infection, generally a primary pulmonary infection. Pneumococcal arthritis appears to be predominantly a disease affecting the elderly. Clinical presentation ranges from septicemia to indolent infection with few systemic symptoms. With adequate antibiotic therapy and aspiration or drainage of the joint, the prognosis for return of normal joint function appears to be excellent. Although pneumococcal organisms are not likely causes, this bacteria should certainly be considered as a possible cause of arthritis or prosthetic infection.- - - - - - - - - - ranking = 1.5714285714286keywords = arthritis (Clic here for more details about this article) |
10/40. Septic arthritis in hiv positive haemophiliacs. Four cases and a literature review.Septic arthritis is rare in haemophiliacs. Four new cases who were also hiv positive are reported. In three, the knee was involved, and in the fourth the elbow. The organism was streptococcus pneumoniae and staphylococcus aureus in one patient each, and salmonella in two. Although all the patients were human immunodeficiency virus (hiv) positive at the time of diagnosis, only two patients developed autoimmune deficiency syndrome (AIDS) after their septic arthritis. These two died later due to AIDS complications. Treatment was conservative in all cases with antibiotic therapy and prompt rehabilitation. The results were fair in two and good in two. Therefore nonoperative management is advocated before surgical drainage is considered. It seems likely that a positive hiv status is related to the appearance of septic arthritis in haemophiliacs.- - - - - - - - - - ranking = 1keywords = arthritis (Clic here for more details about this article) |
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