Hip osteoarticular complication due to delay in diagnosis and treatment of brucellar hip arthritis: two cases report.

BACKGROUND: Brucellosis is a systemic infectious disease frequently associated with osteoarticular involvement. While sacroiliitis is a common manifestation of brucellosis, septic osteoarthritis is less frequent. Here, we report two cases of septic osteoarthritis caused by Brucella melitensis. CASE PRESENTATION: Both patients had a history of contact with goats before admission. Upon clinical examination, they showed marked pain and limited movement in the hip. Imaging findings revealed obvious osteonecrosis of the right femoral head. Inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein level, were elevated. The tube agglutination test results of both patients were positive (1:160 and 1:200). Real-time polymerase chain reaction analysis of synovial fluid revealed the presence of B. melitensis. We deduced that septic osteoarthritis could explain these clinical and radiological findings. Both patients were followed-up for 12 months. They returned to their normal routine after completing a standard antibiotic regimen, including doxycycline (100 mg, daily) and rifampicin (600 mg), for 6 weeks. CONCLUSIONS: Brucellar hip arthritis is a serious clinical manifestation of brucellosis, presenting mainly as marked joint pain and limited mobility. It is characterized by joint effusion, synovitis, and soft-tissue swelling on magnetic resonance images. Physicians should consider brucellosis as one of the differential diagnoses of arthritis.

Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis.

BACKGROUND: The treatment strategy for evolutive septic arthritis (SA) with coexistent degenerative joint disease is not well established. The purposes of this study were to 1) investigate treatment outcome and potential risk factors of treatment failure in patients with evolutive SA following two-stage procedure, including insertion of an antibiotic-loaded spacer at the first stage and subsequent implantation of a new prosthesis; and 2) determine the performance of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Interleukin-6 (IL-6) in predicting persisting infection at second-stage procedure. METHODS: We retrospectively reviewed 74 patients with evolutive SA of hips and knees who underwent a two-stage TJA between 2008 and 2015. The treatment success was defined according to the modified Delphi criteria and Kaplan-Meier survivorship curves were constructed to determine treatment success. A Cox regression model was performed to identify risk factors for treatment failure. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of ESR, CRP, and IL-6 in predicting persistent infection before second-stage prostheses implantation. RESULTS: Overall, the treatment success rate was 93% for hips and 100% for knees after the first-stage surgery. The treatment success rate was 89% for hips and 84% for knees after second-stage prosthesis implantation with a mean follow-up of 4.7 (range, 2.2 to 10.8) years. Older age (Hazard ratio [HR] [per 10-year increase], 1.20; 95% confidential interval [CI], 1.11 to 1.62), higher preoperative CRP level (HR [per 1-mg/dL increase], 1.15; 95% CI, 1.04 to 1.28) and resistant organism (HR, 13.96; 95% CI, 3.29 to 19.20) were associated with an increased risk of treatment failure. All serologic tests presented limited values in predicting persisting infection, with the area under ROC curve of ESR, CRP, IL-6 and combination of the three markers was 57.8, 61.6, 60.3, and 62.1%, respectively. CONCLUSIONS: Two-stage TJA is an adequate management of infection control in patients with evolutive SA. The three potential risk factors (old age, high preoperative CRP, and resistant organism profile) may predict treatment failure following a two-stage procedure for evolutive SA. Additionally, serum ESR, CRP, and IL-6 had no benefit in predicting persisting infection before second-stage prostheses implantation. These findings may be useful when treating patients with evolutive SA.

30-year survival of a McKee-Farrar hip prosthesis--case report and microscopic analysis of bearing surface.

We report a case of a female patient using a McKee-Farrar prosthesis for 30 years, until revision surgery for aseptic loosening. Electron microscopy analysis of bearing surface of the retrieved implant was performed, and the results were presented in comparison with previously published papers.

Identification of Cartilage Microbial DNA Signatures and Associations With Knee and Hip Osteoarthritis.

OBJECTIVE: Alterations of the gut microbiota have been implicated in many forms of arthritis, but an examination of cartilage microbial patterns has not been performed. This study was undertaken to characterize the microbial DNA profile of articular cartilage and determine changes associated with osteoarthritis (OA). METHODS: We performed 16S ribosomal RNA gene deep sequencing on eroded and intact cartilage samples from knee OA patients (n = 21 eroded and 21 intact samples) and hip OA patients (n = 34 eroded and 33 intact samples) and cadaver controls (n = 10 knee samples and 10 hip samples). Microbial DNA diversity was assessed, groups were compared, and metagenomic profiles were reconstructed. Confirmation was performed in an independent cohort by clade-specific quantitative polymerase chain reaction. Findings in human cartilage were compared to those in cartilage from OA-susceptible C57BL/6 (B6) mice and OA-resistant MRL/MpJ (MRL) mice. Germ-free B6 mouse cartilage was analyzed as a methodologic control. RESULTS: Alpha diversity was reduced in human OA versus control samples (P < 0.0001), and in hip versus knee samples (P < 0.0001). Numerous clades were different in human OA versus control samples, and similar findings were noted in comparisons of murine B6 versus MRL mice. Hip samples were microbiologically distinct from knee samples. OA microbial DNA demonstrated increased gram-negative constituents (P = 0.02). Functional analysis demonstrated increases in lipopolysaccharide production (P = 9.9 × 10-3 ), phosphatidylinositol signaling (P = 4.2 × 10-4 ), and nitrogen metabolism (P = 8 × 10-3 ) and decreases in sphingolipid metabolism (P = 7.7 × 10-4 ) associated with OA. CONCLUSION: Our study reveals a microbial DNA signature in human and mouse cartilage. Alterations in this signature, including increases in gram-negative constituents, occur during the development and progression of human OA. Furthermore, our findings indicate that strain-specific signatures exist within mouse cartilage that mirror human patterns. Further study of the establishment and potential pathogenic role of these DNA signatures is needed.

Treatment of Psoas abscess related coxarthrosis due to salmonella infection in a patient with chronic renal failure. A case report.

INTRODUCTION: The most common microorganisms isolated from septic arthritis are staphylococcus aureus and streptoccocci. Septic arthritis due to Salmonella spp. is extremely rare. PRESENTATION OF CASE: A 55-year-old man, chronic renal failure, is admitted hip arthtritis with newly arised symptoms. The findings were not compatible with primary arthritis. The laboratory findings which include white blood cell count, erythrocyte sedimentation rate (esr) and c-reactive protein (crp) were elevated. In magnetic resonance (mr) imaging there were psoas abscess and septic arthritis of the hip. They were treated by drainage. The culture was confirmed as Salmonella spp. Antibiotic treatment were done. DISCUSSION: Uremia in patients with chronic renal failure is associated with a state of immune dysfunction. In our case, uremia may cause immunosuppressive conditions and hematogenous dissemination of salmonella. CONCLUSION: Salmonella infection in a patient with chronic renal failure may be occured. It must be kept in mind that early diagnosis, administration of appropriate systemic antibiotics and surgical intervention play a pivotal role in successful management. KEY WORDS: Arthritis, Failure, Psoas, Salmonella Renal Abscess.

Burkholderia pseudomallei sepsis with osteoarticular melioidosis of the hip in a patient with diabetes mellitus.

Melioidosis is caused by the tropical soil pathogen Burkholderia pseudomallei Infection, usually in the form of pneumonia, disproportionately affects people with a risk factor for immune dysregulation and mortality remains high even with treatment. Climate change and increasing rates of diabetes render the populations of endemic areas increasingly vulnerable to the disease, which is emerging as a serious global health threat. We present here a case of a 68-year-old man from northern Australia with sepsis and osteoarticular melioidosis of the hip, and explore the links between diabetes mellitus and melioidosis, particularly with respect to musculoskeletal infection.

Campylobacter coli prosthetic hip infection associated with ingestion of contaminated oysters.

This report describes the first reported case of a prosthetic hip joint infection due to Campylobacter coli. The infection presumably resulted from ingestion of contaminated raw oysters. Issues regarding original smear interpretation, culture isolation, and susceptibility testing are presented.

[From tonsillitis to coxitis]. / Fra tonsillitt til koksitt.

We present a 19-year-old woman with a throat infection, increased temperature, a positive mononucleosis monospot test and clinical signs of a lower respiratory tract infection. The diagnosis was thought to be mononucleosis complicated by bacterial pneumonia, but she was later found to have Fusobacterium necrophorum in blood cultures. She subsequently developed metastatic abscesses in her lungs and hip joint and was diagnosed with Lemierre's Syndrome. This case report highlights the importance of close links between clinicians and microbiologists in order to prevent morbidity and mortality in patients with an infectious disease.

[Neonatal osteomyelitis of the proximal femur: a case with ten-year follow-up and review of the literature]. / Ostéomyélite néonatale du col du fémur avec contamination articulaire.

Acute hematogenous osteomyelitis most frequently occurs in children, generally around 6 to 9 years of age. If it occurs in early infancy, the infection usually involves both the bone and the joint, nearly simultaneously. Neonatal osteomyelitis is another presentation, with an osteomyelitic focus in the metaphysis. We report a case of septic arthritis following osteomyelitis of the hip joint in a neonate caused by a virulent pathogenic organism. Despite late diagnosis and treatment, outcome was very satisfactory with few sequelae for the joint and epiphysis. It should be emphasized that early diagnosis, with prompt and adequate treatment is essential to achieve good outcome. We discuss this case and present a review of the literature.

Analysis of causative microorganism in 248 primary hip arthroplasties revised for infection: a study using the NJR dataset.

INTRODUCTION: This study aimed to describe the epidemiology of the causative organism in a series of primary hip arthroplasties revised for a diagnosis of periprosthetic joint infection (PJI) in England and Wales. METHODS: Patient data from the National Joint Registry (NJR) was linked to microbiology data held by Public Health England (PHE) which identified a series of 248 primary hip arthroplasties revised for PJI between 2003 and 2014. Definitive cultures, isolated at time of revision surgery, were available for all cases. Total hip arthroplasty (n = 239, 96%) and hip resurfacing (n = 5, 2%) were the most commonly performed primary procedures. A two-stage revision was the most common operative management (n = 174, 70%). RESULTS: 202 (81%) cases were infected with a single genus microorganism and the most commonly implicated genus was Staphylococcus species (70% of all single genus infections). Staphylococcus species were also the most commonly identified microorganism in mixed genus infections (74% of patient's cultures). There was a significant difference in microorganism distribution when comparing uncemented vs cement implant fixation, with a higher incidence of Gram-negative infection observed in the uncemented group (p = 0.048, Chi-square). CONCLUSIONS: Both prophylactic and therapeutic antibiotic regimes should be focused on targeting Staphylococci.

Postpartum periarticular hip abscess with later coxitis caused by group B streptococcus.

Intrapartum haematogenous spread of vaginal group B Streptococcus is rare, but it can lead to severe complications like abscesses, endocarditis and meningitis postpartum. We report a postpartum periarticular hip abscess caused by group B Streptococcus. Clinically it caused pain in the hip and a compression of the femoral nerve with motor and sensory component. Diagnosis was made by aspiration under computed tomography control. The only sign of infection was an increased sedimentation rate. After antibiotic treatment the symptoms disappeared and the abscess vanished, but it was reactivated 4 months after delivery, leading to arthritis of the hip joint. Another antibiotic treatment was administered for 8 weeks. 17 months postpartum the patient is well, but a development of a secondary coxarthrosis can not be excluded.

[Active tuberculous coxarthritis in the adult. 2 cases treated by total arthroplasty with a follow-up of 7 and 3 years]. / Coxite tuberculeuse active de l'adulte. Deux cas traités par arthroplastie totale avec un recul de 7 et 3 ans.

Cemented total hip replacements were performed on two patients with active tuberculous arthritis. Chemotherapy was administrated for 3 months pre-operatively and continued for 15 months. Excellent results were observed after 3 and 7 years, respectively.

Trochanteric arthroplasty in the treatment of sequelae after septic arthritis of the hip in infancy.

The authors describe 17 patients submitted to trochanteric arthroplasty between 1979 and 1999 at the Division of Pediatric Orthopaedics and Traumatology of the Rizzoli Orthopaedic Institute. There were 9 females and 8 males aged from 1 to 8 years (mean of 4) affected with the sequelae of septic arthritis of the hip with complete destruction of the epiphysis and of the femoral neck (types IVB and V according to the Hunka classification system). Mean follow-up was 9 years (minimum 1, maximum 23). Surgery is described and indications are discussed: this is the only type of treatment that may be offered in place of conservative treatment.

[Hematogenous pubic osteoarthritis]. / Osteoartritis pubiana hematógena.

Pubic osteoarthritis is a little known pathological entity with a very controversial etiology. We present four cases of public osteoarthritis in which the infectious etiology was hematogeneous. The causal germs were: Staphilococcus aureus, Pseudomona aeruginosa, Mycobacterium tuberculosis and Brucella melitensis. In the first three cases, a surgical approach was used, allowing us to establish the etiological diagnosis of the process and to perform the local debridement. In the case of brucellar etiology, an isolated medical treatment was applied, according to the therapeutical guidelines recommended for brucellar bone infections. We have not observed recurrence of the septic process in any of the four cases, with a follow-up period ranging from one to three years.

[Prolonged febrile syndrome as a manifestation of Coxiella burnetii infection, presentation of infrequent clinical cases]. / Síndrome febril prolongado como manifestación de infección por Coxiella burnetii, presentando casos clínicos poco frecuentes.

We present two cases of infection by Coxiella burnetii which developed with sustained fever symptoms. During its evolution, the first case presented granulomatous hepatitis, whereas the second case presented left Cosofemoral Arthritis. We describe the clinical-evolutive characteristics of these clinical forms and within the evolution of the chronic forms of Q fever.

[Heat shock protein antibodies and other chlamydial antigens in various diseases and their occurrence in blood donors]. / Protilátky proti proteinu tepelného soku a dalsím antigenum chlamydií u nekterých chorob ve srovnání s jejich výskytem u dárcu krve.

BACKGROUND: The chlamydial infections are very frequently considered in the causal connection with some diseases e.g. atherosclerosis or chronic joint infections. The evidence of the antibodies against the heat shock protein of chlamydial origin is not the usual part of practical serological diagnostics. The aim of this study is an attempt to identify antibodies against the heat shock protein and other antigens of chlamydiae in the sera of two groups of patients and in the sera of blood donors. METHODS AND RESULTS: The sera of patients suffering from unstable angina pectoris (NAP = 69), sera of patients waiting for the application of endoprothesis due to coxarthrosis (EKK = 49), and sera of 100 blood donors have been examined for antibodies against the heat shock protein, against the major outer membrane protein (MOMP) of C. pneumoniae, and against the chlamydial genus specific lipolysaccharides. The antibodies against the cHSP60 in the sera of patients suffering from NAP have been identified in 41 cases (59.4%), in orthopaedic patients in 21 cases (42.9%) and in 23 of the blood donors (23%). The difference of the antibody-occurrence in the sera of patients is significantly higher than in case of blood donors. The antibodies against the MOMP of C. pneumoniae prevailed in all sera of the persons examined. Their occurrence in the IgG class had a high statistical frequency. The genus specific positive reaction occurred more frequently also in the sera of the probands that reacted positively against the cHSP60 than in those negatively reacting. According to our results, the significance of C. pneumoniae in the genesis of the antibodies against of cHSP60 can be concluded. CONCLUSIONS: The proof of the anti-cHSP60 antibody and of the species-specific chlamydial antibodies may be a useful contribution to the exact diagnosis of the disease with possible chlamydial participation. The C. pneumoniae infection was probably of the main importance for the origin of the anti-cHSP60 antibody in examined persons.

[Primary meningococcal arthritis caused by Neisseria meningitidis. One of the many manifestations of meningococcal disease]. / Primaer arthritis forårsaget af Neisseria meningitidis. En af meningokoksygdommens mange manifestationer.

A case of primary meningococcal arthritis in the left hip of a nineteen year-old female is described. The diagnosis was based on microscopical detection of Gram-negative diplococci and a positive meningococcal antibody-test. Treatment with benzylpenicilline and drainage was instituted. Although she was soon asymptomatic, the X-ray examination showed a slight destruction of the hip joint. One and a half years later the X-ray findings were normal. Attention is directed to the broad clinical spectrum of meningococcal disease.

[Purulent arthritis after blockade treatment]. / Purulent ledinfektion efter blokadebehandling.

Injections of local anaesthetics with or without steroids are widespread in the treatment of muscular pain. Occasionally, however, they are followed by serious bacterial infections. Three cases of septic arthritis, one localised to the hip, one to the knee and one to the sacroiliac joint are presented. One should offer great consideration to the possible complications following injections into or near joints.

[Purulent coxitis after blockade treatment]. / Purulent coxitis efter blokadebehandling.

A case of bacterial arthritis of the hip in a 23 year old male athlete following local injections is presented. The patient was admitted with history of pain in the buttock and femur for 14 days but no fever. The diagnosis was made with bone scintigraphy and needle aspiration. Following surgical drainage and antibiotic treatment, rapid recovery was observed. At four months follow up there were no clinical or radiographic signs of involvement of the hip.