RESUMO
Iliopsoas abscess is an infrequent condition characterized by the collection of pus in the iliopsoas compartment. The prevalence of the disease has been increasing in recent years with the emergence of various comorbidities and risk factors. The availability of newer imaging modalities has also improved the detection of new cases. Salmonellosis is an uncommon etiology in iliopsoas abscess and sacroiliitis. Most cases reported in the literature are associated with Staphylococcus aureus, Streptococci species, and Escherichia coli. Diabetes, hematological malignancies, HIV, and other immunocompromised states are important comorbidities/risk factors for iliopsoas abscess. We report a case of an 18-year-old male who presented with a history of fever and right hip pain for 10 days. Radioimaging revealed right sacroiliitis and iliopsoas abscess. Blood culture revealed pan-sensitive Salmonella typhi. After the prolonged course of antibiotics (intravenous ceftriaxone followed by oral levofloxacin), the patient improved with no further relapse in symptoms. Salmonella typhi should be an important differential of iliopsoas abscess in endemic regions after ruling out the common etiology such as S. aureus and Mycobacterium tuberculosis.
Assuntos
Antibacterianos , Ceftriaxona , Abscesso do Psoas , Sacroileíte , Salmonella typhi , Humanos , Masculino , Abscesso do Psoas/microbiologia , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/diagnóstico por imagem , Adolescente , Sacroileíte/microbiologia , Sacroileíte/tratamento farmacológico , Sacroileíte/diagnóstico por imagem , Salmonella typhi/isolamento & purificação , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Febre Tifoide/tratamento farmacológico , Febre Tifoide/complicações , Febre Tifoide/diagnóstico , Febre Tifoide/microbiologia , Levofloxacino/uso terapêutico , ImunocompetênciaRESUMO
Septic sacroiliitis is one of the infectious causes of sacroiliitis and it is seen rarely. In current literature, cases of septic sacroiliitis caused by several microorganisms have been reported so far. This case report presents the first case of septic sacroiliitis caused by Staphylococcus xylosus and also complicated with an abscess formation.
Assuntos
Abscesso , Sacroileíte , Infecções Estafilocócicas , Staphylococcus , Humanos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Sacroileíte/microbiologia , Sacroileíte/diagnóstico , Staphylococcus/isolamento & purificação , Abscesso/microbiologia , Abscesso/diagnóstico , Masculino , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , FemininoAssuntos
Artrite Infecciosa/diagnóstico , Sacroileíte/diagnóstico por imagem , Infecções por Serratia/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/fisiopatologia , Artrocentese , Ceftriaxona/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Radiologia Intervencionista , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Sacroileíte/fisiopatologia , Infecções por Serratia/tratamento farmacológico , Infecções por Serratia/microbiologia , Infecções por Serratia/fisiopatologia , Serratia marcescens , Abuso de Substâncias por Via IntravenosaRESUMO
Objective: To investigate the clinical and imaging characteristics of infectious sacroiliitis. Methods: A total of 110 patients diagnosed with infectious sacroiliitis were retrospectively analyzed between 2008 and 2017.Clinical manifestations and therapeutic responses, laboratory tests such as HLA-B(27), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), T cell spot test for tuberculosis infection(TB-SPOT), Brucella agglutination test ect., blood culture of pathogens, pathological findings as well as magnetic resonance imaging were all recorded and analyzed. Results: Among the 110 patients, the male to female ratio was 44 to 66 with an average age 15-58(29.4±10.8) years and the course of disease 0.3-60 (5.7±13.2) months. As to the pathogens, 71 cases were pyogenic, 24 cases with tuberculous sacroiliitis, and 15 cases were brucellosis infections. The majority of patients (97.3%) had unilateral sacroiliac joint involvement. Ten (9.1%) patients suffered infectious sacroiliac arthritis after delivery. Hip pain was the main clinical manifestation (83/110,75.5%) and fever as the second (77/110,70.0%). HLA-B(27) was positive in 11 patients (10.0%). Both ESR and CRP were elevated in the majority. There were 103 patients receiving sacroiliac joint puncture biopsy. Seven patients were diagnosed through blood culture or brucellosis agglutination test. Bone marrow edema and osteolytic lesions in magnetic resonance imaging (MRI) were more common in pyogenic or tuberculous sacroiliitis than in brucellosis infections. Conclusion: Infectious sacroiliitis should be differentiated from spondyloarthritis, which develops more in female patients, with short disease duration and fever, mostlynegative HLA-B(27). The majority patients present unilateral sacroiliitis. Active inflammatory lesions are usually beyond sacroiliac joints with osteolytic changes in MRI examinations.
Assuntos
Artrite Infecciosa/diagnóstico , Infecções Bacterianas/complicações , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Adolescente , Adulto , Artrite Infecciosa/microbiologia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Biópsia , Brucella , Brucelose , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Articulação Sacroilíaca/microbiologia , Sacroileíte/microbiologia , Adulto JovemRESUMO
Cryptococcosis is an opportunistic infection caused by the Basidiomycota Cryptococcus neoformans (Cryptococcus gattii), which affects immunosuppressed patients and less frequently immunocompetent patients. Solid-organ transplant recipients are a particularly high-risk group, depending on the net state of immunosuppression. In these patients, the infection usually appears after the first year after transplant, although it may occur earlier in liver transplant recipients. In most cases, the infection is secondary to the reactivation of a latent infection, although it may be due to an unidentified pretransplant infection by primary infection. Less frequently, it may be transmitted by the graft. The lung and central nervous system are most frequently involved. Extrapulmonary involvement is seen in 75% of the cases, and disseminated disease occurs in 61%, with mortality ranging from 17% to 50% when the central nervous system is involved. Here, we report a case of disseminated cryptococcosis (lymphadenitis, meningitis, pulmonary nodules, and possibly sacroiliitis) in a patient after liver transplant, with good clinical and microbiological outcomes and without relapse.
Assuntos
Criptococose/microbiologia , Transplante de Fígado/efeitos adversos , Pneumopatias Fúngicas/microbiologia , Linfadenite/microbiologia , Infecções Oportunistas/microbiologia , Sacroileíte/microbiologia , Adulto , Antifúngicos/uso terapêutico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/imunologia , Linfadenite/diagnóstico , Linfadenite/tratamento farmacológico , Linfadenite/imunologia , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/imunologia , Meningite Criptocócica/microbiologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Sacroileíte/diagnóstico , Sacroileíte/tratamento farmacológico , Sacroileíte/imunologia , Resultado do TratamentoAssuntos
Infecções Pneumocócicas/microbiologia , Sacroileíte/microbiologia , Sorogrupo , Streptococcus pneumoniae/patogenicidade , Antibacterianos/uso terapêutico , Criança , Feminino , Humanos , Japão , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/tratamento farmacológico , Vacinas Pneumocócicas/uso terapêutico , Sacroileíte/diagnóstico , Sacroileíte/tratamento farmacológico , Streptococcus pneumoniae/genética , Resultado do TratamentoRESUMO
INTRODUCTION: Pyogenic sacroiliitis (PSI) is a rare condition that amounts to 1% to 2% of all joint infections in the paediatric age group. Its diagnosis is often difficult and delayed due to its nonspecific signs, symptoms and physical findings. Also, the identification of the causative microorganism is frequently challenging due to a high proportion of negative blood cultures and the risks involved in joint aspiration in this site. PATIENTS AND METHODS: We performed a retrospective review of the health records of all patients aged less than 18 years admitted to a tertiary children's hospital due to PSI between 2008 and 2016. RESULTS: We identified 6 cases of paediatric PSI. The blood cultures were negative, and the identification of the causative agent required joint fluid aspiration in one patient with infection by Aggregatibacter aphrophilus, and specific screening tests for less frequent agents in the other patients: Kingella kingae (n=2), Brucella melitensis (n=1) and Bartonella henselae (n=1). The patients were treated with specific antimicrobial regimens, and all had favourable clinical outcomes and were free from sequelae during the follow-up. CONCLUSIONS: Despite the small sample size, our study evinced the low effectiveness of blood cultures for diagnosis of paediatric PSI. It also highlights the need for a high level of suspicion for atypical agents and the early use of adequate diagnostic methods, including imaging and serological testing or polymerase chain-reaction (PCR) analysis of blood samples, as well as prescription of effective antimicrobial therapy.
Assuntos
Antibacterianos/administração & dosagem , Bactérias/isolamento & purificação , Sacroileíte/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Hospitais Pediátricos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Resultado do TratamentoRESUMO
Although sacroiliitis is not uncommon in patients with inflammatory bowel diseases (IBD), bacterial infection of the sacroiliac joint is rare. The diagnosis is often delayed because of low clinical suspicion, a vague clinical picture and poorly defined localization of symptoms. We report a case of pyogenic sacroiliitis in a patient with Crohn's disease caused by Clostridia spp. and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.
Assuntos
Artrite Infecciosa/diagnóstico , Infecções por Clostridium/diagnóstico , Doença de Crohn/complicações , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Infecções por Clostridium/tratamento farmacológico , Clostridium perfringens/isolamento & purificação , Feminino , Humanos , Sacroileíte/microbiologia , Tomografia Computadorizada por Raios XRESUMO
A 53-year-old woman with no significant medical history presented with 10/10 right buttock pain that radiated to the right groin. With no reported recent injury, the absence of fever, and no identifiable risk factors, an infectious etiology, including septic sacroiliitis (SSI), is at the end spectrum of the differential. SSI is a rare condition with nonspecific findings that can lead to major complications, including death. To our knowledge, there are only 4 recent major literature reviews on SSI, with most cases reported to have at least 1 risk factor or clinical sign indicating the possibility of an infectious etiology. The patient reported in this case had no identifiable risk factors; therefore, high clinical suspicion is needed to prevent debilitating consequences from prolonged infection. LEVEL OF EVIDENCE: V.
Assuntos
Artrite Infecciosa/diagnóstico , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Articulação Sacroilíaca/microbiologia , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
Infectious sacroiliitis is an infection of the sacroiliac joint, not easy to diagnose because of its non-specific signs, symptoms and laboratory abnormalities. We describe a case of a 16 year-old male with 5 days' history of fever, abdominal pain, constipation, low-back and left hip pain extended to the left knee associated with sudden inability to walk. In the first place, magnetic resonance imaging (MRI) examination of his sacroiliac joint revealed an enlarged corpuscolated fluid collection near the left iliopsoas muscle, extended to homolateral paravertebral muscles and a little fluid at the left sacroiliac joint. Drainage by aspiration of the iliopsoas abscess was applied; Staphylococcus aureus was found in the aspirated fluid and isolated from the blood too. Therefore intravenous antibiotic therapy was begun. Follow-up MRI exams confirmed the muscle abscess and revealed also a spongy bone edema of the left sacroiliac joint, persisting despite the disappearance of symptoms and the normalization of inflammatory values. It is important to make an early diagnosis of infectious sacroiliitis in order to begin antibiotic therapy as soon as possible, because of the increasing morbidity of infection of sacroiliac joint. In our case MR findings have provided significant orientation towards the final diagnosis of infectious sacroiliitis.
Assuntos
Imageamento por Ressonância Magnética , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/microbiologia , Sacroileíte/diagnóstico por imagem , Sacroileíte/microbiologia , Infecções Estafilocócicas , Adolescente , Humanos , Masculino , Abscesso do Psoas/complicações , Sacroileíte/complicações , Infecções Estafilocócicas/complicaçõesRESUMO
Systemic lupus erythematosus (SLE) patients are at higher risk of developing opportunistic infections such as tuberculosis (TB), especially extrapulmonary forms like osteoarticular TB, compared to the general population. However, tuberculous sacroiliitis has been scarcely reported in these patients. We present a 34-year-old woman with SLE who developed articular tuberculosis simultaneously affecting the right sacroiliac joint and the left knee. The patient was successfully treated with antituberculosis therapy for nine months. In this case, in addition to the immunological abnormalities of lupus, the long-term glucocorticoid therapy at high dosages was the main risk factor for the development of osteoarticular tuberculosis.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Sacroileíte/microbiologia , Tuberculose Osteoarticular/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Feminino , Glucocorticoides/efeitos adversos , Humanos , Joelho/microbiologia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Imageamento por Ressonância Magnética , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Fatores de Risco , Articulação Sacroilíaca/microbiologia , Articulação Sacroilíaca/patologia , Sacroileíte/patologia , Tuberculose Osteoarticular/tratamento farmacológicoRESUMO
We report here on four cases of patients with strongly positive anti-citrullinated cyclic peptides (anti-CCP) antibodies and clinical features of seronegative spondyloarthritis (SpA) and reactive arthritis. The four patients had various clinical presentations: one had an initial diagnosis of seropositive rheumatoid arthritis (RA) with involvement of the sacroiliac joints (similar to previous reports of the association of two diseases); one had a clinical picture of reactive arthritis following an episode of an Escherichia coli positive urinary tract infection; and two had asymmetrical sacroiliitis (SII), but no evidence of peripheral joint involvement (never reported before). In all cases, high titers of anti-CCP antibodies were found. We present a comparison of the clinical manifestations, radiographic features and treatment regimens of these cases. Our report supports previous literature data of possible overlap existing between RA and SpA, but also presents for the first time the association of high titers of anti-CCP antibodies with SII and reactive arthritis in patients with no peripheral small joint involvement.
Assuntos
Anticorpos Antiproteína Citrulinada/sangue , Artrite Reativa/imunologia , Infecções por Escherichia coli/imunologia , Sacroileíte/imunologia , Infecções Urinárias/imunologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reativa/sangue , Artrite Reativa/diagnóstico por imagem , Artrite Reativa/microbiologia , Biomarcadores/sangue , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Sacroileíte/sangue , Sacroileíte/diagnóstico por imagem , Sacroileíte/microbiologia , Testes Sorológicos , Resultado do Tratamento , Regulação para Cima , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologia , Adulto JovemRESUMO
CASE: We present a case of isolated Salmonella species group B sacroiliitis in a healthy 19-year-old collegiate-level swimmer with no known risk factors. To our knowledge, there are no similar cases described in the current literature. CONCLUSION: Pyogenic sacroiliitis (PS) is a rare form of septic arthritis, especially in adults. PS is most commonly seen in the setting of intravenous drug use or in an immunocompromised patient. If a patient does not fit either of these demographics, PS initially can be a difficult diagnosis because of its rarity and vague symptomatology.
Assuntos
Artrite Infecciosa/microbiologia , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/microbiologia , Sacroileíte/microbiologia , Salmonella/isolamento & purificação , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/patologia , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética , Articulação Sacroilíaca/patologia , Sacroileíte/diagnóstico por imagem , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Líquido Sinovial/microbiologia , Resultado do Tratamento , Adulto JovemRESUMO
A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%-2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.
Assuntos
Artrite Infecciosa/microbiologia , Quadril/microbiologia , Transtornos dos Movimentos/diagnóstico , Articulação Sacroilíaca/microbiologia , Sacroileíte/diagnóstico por imagem , Sacroileíte/microbiologia , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/patologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Criança , Diagnóstico Diferencial , Quadril/diagnóstico por imagem , Quadril/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Transtornos dos Movimentos/complicações , Transtornos dos Movimentos/etiologia , Dor/diagnóstico , Dor/etiologia , Doenças Raras , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/patologia , Sacroileíte/tratamento farmacológico , Resultado do TratamentoRESUMO
We report a case of Aggregatibacter aphrophilus sacroiliitis in a young sportsman, presenting 48 hours after endoscopy and biopsy. Microbiological diagnosis was made only after repeated attempt at joint aspiration. The patient was cured after radiologically guided drainage and a prolonged course of directed antibiotics.
Assuntos
Aggregatibacter aphrophilus/isolamento & purificação , Gastroscopia/efeitos adversos , Infecções por Pasteurellaceae/etiologia , Complicações Pós-Operatórias/microbiologia , Sacroileíte/microbiologia , Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Drenagem , Futebol Americano , Humanos , Masculino , Infecções por Pasteurellaceae/tratamento farmacológico , Infecções por Pasteurellaceae/cirurgia , Sacroileíte/tratamento farmacológico , Sacroileíte/cirurgia , Adulto JovemRESUMO
BACKGROUND: The aim of this study was to improve knowledge of pediatric pyogenic sacroiliitis (PSI) in the pediatric population based on a consecutive case series. METHOD: We conducted a single-center cross-sectional study on 16 patients admitted to the emergency department of our Hospital between January 1990 and December 2015 with a confirmed diagnosis of PSI. The patients were divided into 2 groups by age: infants (6 months to 4 years) and children-adolescents (4-16 years). The features of PSI, clinical signs and symptoms, laboratory tests, bacteriologic investigations, radiologic examinations and outcome were compared among the 2 groups. RESULTS: Patients in the children-adolescent group usually presented with a history of limping and buttock or lower back pain, and methicillin-susceptible Staphylococcus aureus was the most frequent pathogen. We observed a second peak of incidence of PSI in infants with consistent difference in clinical and microbiologic presentation. Infants were more likely to have an ambiguous onset with the refusal to bear weight as the only consistent clinical manifestations, and biologic investigations demonstrated higher erythrocyte sedimentation rate and platelet counts. However, all blood and joint fluid cultures were sterile in the infant group. CONCLUSION: PSI in infants and adolescents may represent 2 different conditions. Although PSI is mainly caused by S. aureus in the children-adolescent group, clinical manifestations and biologic characteristics of PSI in infants suggest Kingella kingae as the etiology osteoarticular infection. Thus, oropharyngeal swab polymerase chain reaction assay for K. kingae and magnetic resonance imaging should be considered for early diagnosis and treatment of this condition in the younger age group.
Assuntos
Sacroileíte , Adolescente , Proteína C-Reativa , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Contagem de Leucócitos , Masculino , Estudos Retrospectivos , Sacroileíte/diagnóstico , Sacroileíte/epidemiologia , Sacroileíte/microbiologiaRESUMO
The sacroiliitis accounts for about 1.5% - 10% of all cases of septic arthritis and it is strongly associated with gynaecological infections, pelvic trauma or drug abuse (3.4% - 12.8% of cases occur during the postpartum period). Early diagnosis is difficult because the symptoms are nonspecific in pregnancy and in the postpartum period, making the delay of treatment a serious risk of irreversible damage to the joint and development of post-infectious complications. The authors describe the case of a 37-year-old puerperal woman presented to hospital, weeks after urgent caesarean section, with endometritis, post-anesthetic epidural hematoma and secondary infectious postpartum sacroiliitis. The diagnosis of sacroiliac joints pathology during pregnancy and puerperium is challenging. The pathogenesis of infectious sacroiliitis results from local contamination by contiguous infection or hematogenous spread of bacterial infections. The prognosis is usually favorable and depends on early diagnosis and treatment.
A sacroileíte representa 1,5% - 10% de todos os casos de artrite séptica e está fortemente associada a infecções ginecológicas, trauma pélvico e a abuso de drogas (3,4% - 12,8% dos casos ocorrem durante o puerpério). O diagnóstico precoce é difícil, pois os sintomas são inespecíficos na gravidez e no puerpério, retardando o tratamento, podendo assim causar danos irreversíveis à articulação e desenvolvimento de complicações pós-infecciosas. Os autores descrevem o caso de uma puérpera de 37 anos que duas semanas após realização de cesariana urgente iniciou quadro de endometrite, hematoma epidural secundário a complicação anestésica e sacroileíte infecciosa secundária. O diagnóstico de patologia da articulação sacroilíaca durante a gravidez e puerpério constitui um desafio. A patogénese da artrite séptica resulta da contaminação local por infecção contígua ou da disseminação hematogénea. O prognóstico da sacroileíte infecciosa do pós-parto é geralmente favorável e depende do diagnóstico e tratamento precoces.
Assuntos
Transtornos Puerperais/diagnóstico , Transtornos Puerperais/microbiologia , Sacroileíte/diagnóstico , Sacroileíte/microbiologia , Infecções Estafilocócicas/diagnóstico , Adulto , Diagnóstico Precoce , Feminino , HumanosRESUMO
Infectious sacroiliitis are rare but they can be complicated by disabling functional sequelae. To describe the clinical and bacteriological characteristics of infectious sacroiliitis among patients treated in Sousse Medical Center, Tunisia. A retrospective, descriptive study, of infectious sacroiliitis among patients hositalized in Sousse between 2000 and 2015. The diagnosis was made on the basis of medical signs, imaging, microbiological indicators. In the study were enrolled twenty five patients, 10 men and 15 women; the average age was 41 years (19-78). Sacroiliitis were due to pyogenic bacteria in 14 cases (56%), brucella bacteria in 6 cases (24%) and tuberculosis bacteria in 5 cases (20%). The mean duration of symptoms was 61, 45 and 402 days respectively. The most common clinical signs were buttock pain (92%) and fever (88%). Standard radiographic evaluation was abnormal in 75% of cases. CT scan and MRI of the sacroiliac joints was performed in all cases. The diagnosis was bacteriologically confirmed in 24 cases (96%). The average duration of antibiotic treatment was 83 days in the pyogenic sacroiliitis, and 102 days in brucellar sacroiliitis. The evolution was favorable in 12 patients (48%), 9 patients (36%) had sequelae of sacroiliac joint pain and 4 patients (16%) died. In our study, time frame of infectious sacroiliitis evolution did not predict the causative bacterium, hence the need for bacteriological documentation in order to prescribe appropriate antibiotic therapy.
Assuntos
Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Sacroileíte/epidemiologia , Adulto , Idoso , Antibacterianos/administração & dosagem , Técnicas Bacteriológicas , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacroileíte/tratamento farmacológico , Sacroileíte/microbiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Tunísia/epidemiologia , Adulto JovemRESUMO
Tuberculous sacroiliitis is rare and of difficult diagnosis. We here report two cases. The first patient was a 40-year old woman with HIV infection; the diagnosis was based on histological evaluation after surgical biopsy. The second patient was a 25-year old man living in prison whose diagnosis was established on the basis of clinical, biological, radiological reasonings and of the effectiveness of the treatment; tuberculin intradermal reaction was phlyctenular. CT scan was essential to establish the lesion diagnosis by showing edge erosion and soft tissue abscess The patients received medical and anti-tuberculosis treatment.