RESUMO
Infections in the joints of the hand and wrist carry the risk of significant morbidity. Common presenting symptoms include joint redness, swelling, and pseudoparalysis that occurs several days following a penetrating trauma. Diagnostic workup should be expedited, including a laboratory evaluation and arthrocentesis. Imaging, including radiographs, ultrasound, computed tomography, and/or MRI, are helpful tools in diagnosis. Once infection is identified, prompt surgical debridement and antibiotics are required. Once the infection has been managed, hand therapy is initiated to decrease the risk of stiffness. Stiffness is the most common complication following infection; additional reported complications include arthritis, ankylosis, and amputation."
Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Articulações dos Dedos/microbiologia , Articulação do Punho/microbiologia , Algoritmos , Antibacterianos/uso terapêutico , Artroscopia , Desbridamento , Drenagem , Articulações dos Dedos/cirurgia , Humanos , Hospedeiro Imunocomprometido , Articulação do Punho/cirurgiaRESUMO
The incidence of infection by Mycobacterium marinum is rising, mainly due to the increasing popularity of home aquariums. The infection typically manifests as skin lesions, with septic arthritis being a rare presentation form. The disease is difficult to diagnose even when there is a high clinical suspicion, as culture in specific media may not yield positive findings. Thus, establishment of appropriate treatment is often delayed. Synovectomy, capsular thinning, and joint drainage together with prolonged, combined antibiotic therapy may be needed to cure the infection.
Assuntos
Artrite Infecciosa/diagnóstico , Articulações dos Dedos/microbiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium marinum/isolamento & purificação , Idoso , Artrite Infecciosa/microbiologia , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/complicaçõesAssuntos
Artrite Infecciosa/microbiologia , Articulações dos Dedos/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Desbridamento , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Humanos , Imunocompetência , Masculino , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , RadiografiaRESUMO
A 68-year-old woman developed tenosynovitis of the right second digit without a history of injury or animal bites. Apart from high titer anti-nuclear antibodies, serological studies were unremarkable. Tuberculin test and interferon gamma release assay were both negative. Several immunosuppressive therapies led only to partial relief of symptoms. Of note, clinical symptoms worsened significantly after introduction of adalimumab therapy. Tenosynovectomy was performed revealing a granulomatous inflammatory process. Seven weeks later, Mycobacterium malmoense could be cultured from the surgical specimen. A four drug antibiotic regimen was started and immunosuppressive therapy discontinued resulting in complete clinical remission. Our case highlights non-tuberculous mycobacterial (NTM) tenosynovitis as an important differential diagnosis of atypical arthritis. A negative tuberculin skin test as well as negative Ziehl-Neelsen stain does not argue against NTM infection. In fact, mycobacterial culture for extended periods remains the gold standard for diagnosis.
Assuntos
Articulações dos Dedos/patologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Membrana Sinovial/patologia , Tendões/patologia , Tenossinovite/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Quimioterapia Combinada , Feminino , Articulações dos Dedos/microbiologia , Articulações dos Dedos/cirurgia , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Sinovectomia , Membrana Sinovial/microbiologia , Tendões/microbiologia , Tendões/cirurgia , Tenossinovite/tratamento farmacológico , Tenossinovite/cirurgia , Falha de Tratamento , Resultado do TratamentoAssuntos
Articulações dos Dedos/microbiologia , Hospedeiro Imunocomprometido , Infecções por Mycobacterium não Tuberculosas/patologia , Dermatopatias Bacterianas/patologia , Infecções dos Tecidos Moles/microbiologia , Idoso , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/patologiaRESUMO
PURPOSE: A septic joint is a cartilage-threatening emergency requiring prompt treatment. The purpose of this study was to examine outcomes of septic arthritis of the metacarpophalangeal and interphalangeal joints. METHODS: We performed a retrospective review of patients diagnosed with joint infection between 1976 and 2008. The end point included the number of arthrodeses and amputations performed. RESULTS: Septic joints were identified in 110 patients. All patients had incision and irrigation and debridement (I and D) of the joint. The infection was successfully treated in 83 of 110 patients. The majority of septic joints (73 of 83 patients) treated successfully with I and D had only a penetrating joint injury. Forty-eight of these patients required more than one I and D to eradicate the infection. The remaining 27 of 110 patients required either arthrodesis (13 patients) or amputation (14 patients) despite I and D. Among the 13 patients requiring arthrodesis, postoperative infection (7 patients) accounted for the majority of septic joints. Of the 14 patients requiring amputation, penetrating joint injury accounted for the majority of septic joints. Overall, those patients requiring more than 3 I and D procedures were at higher risk of arthrodesis or amputation. Increasing comorbidities correlated with worsening outcomes. CONCLUSIONS: Pyarthrosis can often be treated successfully with 1 or more I and D procedures. Despite multiple I and D procedures, 27 patients required either arthrodesis or amputation. The time to diagnosis and treatment, the number of I and D procedures, patient comorbidities, and postoperative infection following non-joint surgery are major factors influencing outcome.
Assuntos
Amputação Cirúrgica , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Artrodese , Articulações dos Dedos/microbiologia , Articulações dos Dedos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Comorbidade , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Irrigação Terapêutica , Resultado do TratamentoRESUMO
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.
Assuntos
Artrite Infecciosa/microbiologia , Enterobacter/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Ferimentos Penetrantes/microbiologia , Adolescente , Adulto , Artrite Infecciosa/sangue , Meios de Cultura , Infecções por Enterobacteriaceae/sangue , Feminino , Traumatismos dos Dedos/complicações , Articulações dos Dedos/microbiologia , Humanos , Traumatismos do Joelho/complicações , Articulação do Joelho/microbiologia , Masculino , Plantas , Madeira , Ferimentos Penetrantes/complicaçõesRESUMO
A 48-yr-old female on immunosuppressive therapy for fibrosing alveolitis and polymyositis developed a septic arthritis of the left middle finger proximal interphalangeal joint, tenosynovitis of the left palm and osteomyelitis of the right hindfoot due to infection with Mycobacterium marinum. Such widespread and severe bone and joint involvement has not been described previously with this organism.
Assuntos
Artrite Infecciosa/microbiologia , Articulações dos Dedos/microbiologia , Doenças do Pé/microbiologia , Infecções por Mycobacterium não Tuberculosas/etiologia , Mycobacterium marinum/isolamento & purificação , Osteomielite/microbiologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/tratamento farmacológico , Doxiciclina/uso terapêutico , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/efeitos dos fármacos , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Polimiosite/tratamento farmacológico , Fibrose Pulmonar/tratamento farmacológico , Tenossinovite/diagnóstico por imagem , Tenossinovite/microbiologia , Tomografia Computadorizada por Raios XRESUMO
We describe a 30-year-old female presenting with synovitis of the left 4th proximal interphalangeal joint. Anaerobic cultures of the synovial membrane grew Peptostreptococcus magnus. The synovitis resolved after a course of intravenous penicillin G. The role of the anaerobic bacterium Peptostreptococcus magnus in joint infections is reviewed.
Assuntos
Artrite Infecciosa/microbiologia , Articulações dos Dedos/microbiologia , Peptostreptococcus/isolamento & purificação , Adulto , Artrite Infecciosa/tratamento farmacológico , Feminino , Humanos , Penicilina G/uso terapêuticoRESUMO
Articular infection with Blastomyces dermatitidis frequently is difficult to diagnose as it resembles bacterial arthritis in several ways. This report of an elderly man who had initially monoarticular and eventually polyarticular arthritis illustrates the clinical and laboratory findings that should suggest blastomycosis. Treatment with amphotericin B and ketoconazole in sequence led to complete resolution of the infection.
Assuntos
Artrite Infecciosa/etiologia , Blastomicose , Articulações dos Dedos/microbiologia , Articulação do Joelho/microbiologia , Articulação Metacarpofalângica/microbiologia , Idoso , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/tratamento farmacológico , Blastomicose/tratamento farmacológico , Líquido da Lavagem Broncoalveolar/citologia , Diagnóstico Diferencial , Humanos , Cetoconazol/uso terapêutico , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/etiologia , Masculino , Articulação Metacarpofalângica/diagnóstico por imagem , RadiografiaRESUMO
A 48-year-old woman with infection of the tendon sheaths and proximal interphalangeal joint by Mycobacterium chelonei is described. Antibiotic therapy was not administered, and the patient recovered spontaneously.
Assuntos
Artrite Infecciosa/microbiologia , Articulações dos Dedos/microbiologia , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium/complicações , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Atypical mycobacteria have been recognised as saprophytic organisms for many years, but it was only with the development of better microbiological culture techniques that they became recognised as potentially pathogenic to man. Infections of tendon sheaths and joints by these organisms may present diagnostic problems, and we report here 3 cases in which Mycobacterium kansasii was responsible for disease at the hand and wrist.
Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium/microbiologia , Sinovite/microbiologia , Adulto , Idoso , Feminino , Articulações dos Dedos/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Articulação do Punho/microbiologiaAssuntos
Infecções Bacterianas/microbiologia , Dedos/microbiologia , Osteíte/microbiologia , Osteoartrite/microbiologia , Paroniquia/microbiologia , Infecções por Escherichia coli/microbiologia , Articulações dos Dedos/microbiologia , Humanos , Infecções por Proteus/microbiologia , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/microbiologiaRESUMO
A 10-year-old boy with confirmed congenital agammaglobulinaemia presented with polyarthritis while on gammaglobulin replacement therapy. Initial cultures of material aspirated from an abscess and of joint fluid were negative, and symptoms progressed despite antibiotic therapy. Synovial-biopsy material, cultured specifically for mycoplasmas, was positive for Ureaplasma urealyticum as were the blood, abscess fluids, throat-swab, and nasopharyngeal secretions. Therapy, based on in-vitro studies of antibiotic susceptibilities of the organism, resulted in the eradication of the infection and resolution of the arthritis. These findings suggest that U. urealyticum may be capable of inducing polyarthritis in man.