1/22. Varicella arthritis diagnosed by polymerase chain reaction.We report a 2-year-old girl who developed acute arthritis of the left knee 4 days after the onset of a typical varicella infection. She was first thought to have pyogenic arthritis caused by staphylococcus aureus. Accordingly, oxacillin was administered upon hospitalization. On the third day after hospitalization, bacterial cultures of the synovial fluid and blood showed no growth and oxacillin was discontinued. Although a viral culture of the synovial fluid for varicella-zoster virus (VZV) was negative, varicella dna was identified by means of polymerase chain reaction (PCR) with VZV-specific primers. The patient recovered spontaneously. To differentiate this condition from septic arthritis is important. PCR is a sensitive technique that can demonstrate the presence of VZV dna in synovial fluid, even if viral cultures are negative.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
2/22. Chronic destructive oligoarthritis associated with propionibacterium acnes in a female patient with acne vulgaris: septic-reactive arthritis?propionibacterium acnes is an anaerobic bacillus implicated in certain chronic arthritides. This report describes an HLA-B27 17-year-old woman with acne vulgaris who presented with rapidly destructive arthritis in the left shoulder as well as an evolving left subclavicular adenopathy. One year later, arthritis was detected in the left knee; the inflammatory synovial fluid was sterile. growth of P acnes was observed in cultures of the shoulder synovium and lymph nodes, but polymerase chain reaction was negative for Borrelia, chlamydia, and Ureaplasma dna. Three months of treatment with amoxicillin and rifampicin led to clinical disappearance of the oligoarthritis, but arthritis recurred in the left knee after discontinuation of therapy. On biopsy, bacteria were undetectable in the knee synovium, but chronic arthritis was evident histologically. Antibiotics were reintroduced for 12 months and were again effective against the clinical symptoms. Although the asymmetry, histologic features, arthritis-acne association, and genetic predisposition of this chronic destructive oligoarthritis would seem to indicate a reactive arthropathy, the isolation of P acnes from 2 distinct specimens prompted us to propose calling this a case of septic-reactive arthritis, which is further supported by the absence of progression after antibiotic therapy and the persistence of the rheumatism. To our knowledge, this is the first demonstration of the efficacy of prolonged antibiotic therapy on the joint manifestations of chronic rheumatism associated with acne.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
3/22. Lyme arthritis.infection with B. burgdorferi can cause a large joint inflammatory arthritis in patients who have not been treated for early lyme disease; the knee is the most common joint affected. The diagnosis depends on a history of known exposure to the spirochete, characteristic clinical features, and serologic studies (ELISA and Western blot) confirming exposure to the spirochete. In most patients, antibiotic therapy is curative, but in a smaller percentage of patients, the presence of the HLA-DR beta 1*0401 haplotype can trigger treatment-resistant arthritis, in which antibiotic therapy is ineffective; in these instances, remittive agents, such as hydroxychloroquine and methotrexate, are indicated. Arthroscopic synovectomy may be considered when antibiotic therapy is not curative. fibromyalgia can follow infection with B. burgdorferi but is unresponsive to antibiotic therapy; it is treated with tricyclic antidepressants and an exercise program. Lyme arthritis is the only chronic inflammatory arthritis in which the specific cause is known and can be cured. As such, it serves as an excellent model with which to study the pathogenesis of more common inflammatory arthritides, such as rheumatoid arthritis.- - - - - - - - - - ranking = 5.6786269871353keywords = burgdorferi (Clic here for more details about this article) |
4/22. Gonarthritis in the course of lyme disease in a one-and-a-half-year-old child.A case of a one-and-a-half-year-old girl is reported in whom gonarthritis in the course of lyme disease was diagnosed. The girl was brought up in an urban environment. She never was in a forest and had no contact with animals (except for a healthy pet-dog, which was under veterinary supervision). She did not attend a nursery, and went for walks only within urban area under the careful guidance of her parents. In spite of the negative family history the level of antibodies against borrelia burgdorferi was estimated. A very high level of IgG antibodies and a low level of IgM borrelia burgdorferi antibodies, accompanied by physical symptoms allowed to diagnose the second stage of lyme disease. We considered the described case as worth presentation due to the child's very early age. Moreover, the infection was caused supposedly due to the contact with a dog (which may be unusual carrier of ticks), and not--as in most cases--in a forest.- - - - - - - - - - ranking = 5.6786269871353keywords = burgdorferi (Clic here for more details about this article) |
5/22. Nodular fasciitis, erythema migrans, and oligoarthritis: manifestations of Lyme borreliosis caused by Borrelia afzelii.We describe a 35-year old patient with nodular fasciitis, erythema migrans, and gonarthritis four months after a bite of a Borrelia afzelii infected tick. The Borrelia afzelii infection was identified by a polymerase chain reaction and direct sequencing of the amplification product. Borrelia-specific dna was also detectable in nodular fasciitis tissue. We therefore conclude that Borrelia afzelii can be a causative agent of nodular fasciitis and Lyme arthritis in a highly endemic region of Northern germany.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
6/22. Whipple arthritis: diagnosis by molecular analysis of synovial fluid--current status of diagnosis and therapy.Whipple's disease (WD) is an uncommon polysystem infectious disease. In the present report, we describe a patient who presented with a chronic illness consistent with WD and an avascular necrosis of the right hip joint. WD and its proposed causative bacillus, tropheryma whippelii, was identified by molecular analysis (polymerase chain reaction) in bacterial dna extracted from the synovial fluid. The diagnosis was additionally confirmed by upper gastrointestinal endoscopy and a small bowel biopsy with macrophages positive for periodic acid-Schiff reagent demonstrated by light and electron microscopy. This demonstrates that WD can be diagnosed without tissue biopsy. False diagnosis of the polymorphous signs and symptoms of WD can lead to invalidism and even death, whereas correct therapy leads to a cure in most cases. Thus, the current status of diagnosis and therapy is of key importance in the treatment of WD.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
7/22. polymerase chain reaction confirmed mycoplasma pneumoniae arthritis: a case report.We report here a case of polyarthritis caused by mycoplasma pneumoniae in a 30 years old male who initially triggered suspicion of tuberculosis. synovial fluid subjected to AFB smear, culture and PCR for mycobacterium tuberculosis along with culture for aerobic and anaerobic bacteria by standard methods were negative. synovial fluid was found to be positive by PCR for M. pneumoniae amplifying 543 bp fragment of P1 gene, however it could not be grown in culture. Specific IgG immunoglobulins to M. pneumoniae were also detected in synovial fluid as well as serum by ELISA which were further confirmed by IgG immunoblotting showing response to M. pneumoniae proteins specially immunodominant protein P1. The finding that both M. pneumoniae dna and specific antibodies to M. pneumoniae are present in synovial fluid of the patient suggests that M. pneumoniae play an important role in arthritis. To the best of our knowledge, this is the first PCR confirmed M. pneumoniae infection in synovial fluid from a case of polyarthritis.- - - - - - - - - - ranking = 0.8keywords = lyme (Clic here for more details about this article) |
8/22. Disseminated pyogenic mycoplasma pneumoniae infection in a renal transplant recipient, detected by broad-range polymerase chain reaction.Although extrapulmonary manifestations of mycoplasma pneumoniae infection are generally immune-mediated, disseminated infections occasionally occur. We describe a renal transplant recipient who developed disseminated pyogenic M. pneumoniae infection that was detected by broad-range polymerase chain reaction and that manifested by prosthetic arterial graft infection, psoas abscess, and septic arthritis.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
9/22. Molecular diagnosis of ureaplasma urealyticum septic arthritis in a patient with hypogammaglobulinemia.OBJECTIVE. We report a hypogammaglobulinemic patient with a destructive oligoarticular arthritis, whose synovial fluid cultures were repeatedly sterile. methods AND RESULTS. We identified a ureaplasma urealyticum infection in his affected joints, using a polymerase chain reaction (PCR) assay. CONCLUSION. The PCR technique promises to be extremely valuable in the rapid and specific diagnosis of infectious arthritis.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
10/22. Rat bite fever mimicking rheumatoid arthritis.We report a case of streptobacillus moniliformis polyarthritis mimicking a rheumatoid arthritis, in a pet shop employee. In culture of fluid joint growth a curious Gram-negative bacillus was identified by polymerase chain reaction as streptobacillus moniliformis. The outcome was good after surgical debridment and rifampin-clindamycin combination during 4 weeks.- - - - - - - - - - ranking = 0.2keywords = lyme (Clic here for more details about this article) |
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