Cases reported "Arthritis, Infectious"

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1/210. tuberculosis of the ankle: report of four cases.

    tuberculosis of the ankle joint is relatively uncommon, and the treatment usually includes chemotherapy, immobilization and non-weight bearing protection. It is easily confused with pyogenic arthritis, which often leads to delayed diagnosis. We reviewed the records of 4 patients with ankle tuberculosis with advanced articular lesions without evidence of pulmonary tuberculosis. They took antituberculous agents for 5 to 6 months. Two of them had positive bacterial cultures, and all four had initially received surgical management under the impression of pyogenic osteomyelitis. Two patients underwent arthrodesis and the other two synovectomy with debridement. The clinical and radiologic results were better in the patients who underwent arthrodesis. We consider surgery with open biopsy of a painful swelling ankle to be helpful in the differential diagnosis of tuberculous and pyogenic arthritis. arthrodesis in patients with severe osteoarticular destruction of the ankle provides a better prognosis and more stable joint than other treatment methods.
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2/210. 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.
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3/210. mycobacterium kansasii septic arthritis: French retrospective study of 5 years and review.

    Septic arthritis due to mycobacterium kansasii is rare; only 40 cases have been published. A French national inquiry revealed the occurrence of 10 new cases between 1992 and 1997 (8 men and 2 women: mean age, 37 years; range, 25-54 years). Seven had an underlying condition: AIDS (n=4), chronic skin psoriasis and AIDS (n=2), or a renal transplant (n=1). Trauma to the joint, use of intra-articular corticosteroid(s) 1 month to 2 years after the event, and chronic skin psoriasis were risk factors. The mean interval between appearance of the first symptoms of arthritis and the diagnosis was 5 months. Monarthritis was localized to the knee (n=4), wrist (n=3), finger (n=1), elbow (n=1), or ankle (n=1). The main diagnostic procedure was culture of a synovial biopsy specimen. In all cases, debridement was associated with antimycobacterial treatment. Three patients died of AIDS during treatment, and another is still undergoing treatment; the other 6 patients were cured. M. kansasii infection should be considered in all cases of indolent arthritis with any of the following risk factors: local trauma, local or systemic corticosteroid therapy, chronic skin psoriasis, and immunodepression, especially that due to human immunodeficiency virus infection.
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4/210. Septic arthritis secondary to vesicoureteral reflux into single ectopic ureter.

    A 3-week-old male infant, born full term without complication, developed septic arthritis of his left shoulder. His joint fluid, blood, and bone marrow were all positive for escherichia coli. urinalysis demonstrated pyuria. urine culture obtained after one dose of ceftriaxone and several doses of nafcillin was negative. work-up revealed a refluxing, right single ectopic ureter with severe hydroureteronephrosis and a non-functioning ipsilateral kidney. After appropriate management of the musculoskeletal infection, he underwent a right nephroureterectomy. Coliform septic arthritis is exceedingly rare in children, with only a few cases reported. We report the first case of septic arthritis with anomalous genitourinary tract development as the source of bacterial seeding. This report re-emphasizes the need to screen the urinary tract in all cases of pediatric gram-negative sepsis.
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5/210. Isolation of pantoea agglomerans in two cases of septic monoarthritis after plant thorn and wood sliver injuries.

    arthritis after plant injury is often apparently aseptic. We report two cases due to pantoea agglomerans. In one case, the bacterium was isolated only from the pediatric blood culture media, BACTEC Peds Plus, monitored in BACTEC 9240, and not from the other media inoculated with the joint fluid. This procedure could help improve the diagnosis of septic arthritis.
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6/210. Acute arthritis caused by Aeromonas hydrophola: clinical and therapeutic aspects.

    Two cases of aeromonas hydrophila arthritis are reported and a third case present in the literature is reviewed. All three cases occurred in patients with myelogenous leukemia; the knee joint was involved in 2 patients and the metacarpal-phalangeal joint in the third. In the 2 patients presented here, synovial fluid antibiotic levels were measured and were adequate; but A hydrophila was repeatedly cultured from the knee joints, a fact suggesting that other factors, such as normal functioning leukocytes and specific opsonizing antibody against the organism, are also necessary to kill A hydrophila.
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7/210. kingella kingae infections in children.

    OBJECTIVE: To increase awareness of kingella kingae infections in children by presenting four cases seen at the gold Coast Hospital, Southport, queensland, and reviewing the literature. METHODOLOGY: Records of the four cases were reviewed and relevant information described. A medline search of the English literature from 1983 to 1998 was conducted. RESULTS: Osteoarticular infections are the commonest type of invasive paediatric infection but bacteraemia and endocarditis also occur. Isolation of the organism is difficult but inoculation of the specimen into enriched blood culture systems improves the recovery rate. The majority of isolates are sensitive to beta-lactam antibiotics but resistance has been described. CONCLUSIONS: kingella kingae infections in children are more common than previously recognized. The organism should be actively sought in any child with suspected osteoarticular infections. Recommended empiric therapy is a third generation cephalosporin until susceptibility to penicillin is confirmed.
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8/210. Septic arthritis caused by a gram-negative bacterium representing a new species related to the bordetella-Alcaligenes complex.

    A knee-joint exudate culture yielded on two occasions a gram-negative bacterium. Regular methods for speciation did not provide an identification. The infection was successfully treated with ciprofloxacin. The unknown isolate, CCUG 36768, was subjected to further investigation, including 16S rDNA sequencing, protein profiling, cellular fatty acid analysis, and various biochemical tests, in order to produce a species identification. The 1469 bp-long 16S rDNA sequence did not reveal identity with any known species sequence. CCUG 36768 clustered in a group of species, including Alcaligenes defragrans, Denitrobacter permanens, taylorella equigenitalis, alcaligenes faecalis, and four strains of Alcaligenes species without a specific species name. bordetella species also showed a high degree of similarity with CCUG 36768. Protein profiling, cellular fatty acid analysis and computer-assisted analysis of biochemical profiles indicated similarity with bordetella-Alcaligenes species, often close to B. holmesii and B. avium. API 20 NE indicated the profile of moraxella species of poor identity. It is concluded that CCUG 36768 represents a new bacterial species of pathogenic potential in humans. It is related to the bordetella-Alcaligenes group. Powerful new methods for speciation are available and it is recommended that unknown isolates from normally sterile sites be submitted for further analysis. Several isolates are required for the definition of new species.
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9/210. Septic arthritis of a lumbar facet joint caused by staphylococcus aureus.

    STUDY DESIGN: Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint. OBJECTIVES: To report a rare case of severe low back pain and the specific differential diagnostic problems. SUMMARY OF BACKGROUND DATA: Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion. methods: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient. CONCLUSIONS: With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.
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10/210. Septic arthritis of the spine facet joint: early positive diagnosis on magnetic resonance imaging. review of two cases.

    We report two cases of septic arthritis of the spine facet joint in two patients with no previous medical history. Clinical symptoms were consistent with a spondylodiscitis. blood cultures were positive for staphylococcus aureus. The infection was initially shown and precisely localised with magnetic resonance imaging, despite an initially negative or aspecific bone scintigraphy. magnetic resonance imaging of the spine demonstrated infection involving the epidural space and paraspinal musculature and enhancement of the infected thoracic and lumbar facet joint after gadolinium injection.
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