Brucella melitensis es un agente de la artritis pediatrica: Serie de casos / Brucella melitensis is an agent in pediatric arthritis: Case series

La brucelosis es un importante problema de salud y, en algunas regiones, es endémica. En ella, es muy frecuente observar un compromiso osteoarticular (20%-60%). En regiones donde es endémica, al analizar la etiología de la artritis, hay que pensar en esta entidad. En este artículo, se informan los casos de 12 pacientes; 11 de ellos eran varones, y la media de edad fue de 12 años (intervalo: de 2 a 17 años). Se determinó el compromiso de la cadera en 9 pacientes; de la articulación sacroilíaca, en 2; y de la rodilla, en 1. Todos los pacientes tenían artralgia; 8 pacientes tuvieron fiebre; y 1 paciente, leucocitosis. A un paciente se lo sometió a un tratamiento quirúrgico debido a artritis séptica. La infección puede derivar en complicaciones graves, especialmente en el compromiso del aparato locomotor. Debe tenerse en cuenta que, mediante el diagnóstico y tratamiento tempranos, es posible prevenir las complicaciones.

Brucellosis is a significant health problem and is endemic in some regions. Osteoarticular involvement is seen most frequently in brucellosis (20-60%). In regions where brucellosis is endemic, it should be considered in the etiology of arthritis. We report the 12 cases, were 11 males with a mean age of 12 years (range, 2-17 years). Involvement was determined in the hip in 9 cases, the sacroiliac joint in 2 and the knee in 1. All the cases had arthralgia, fever was determined in 8 cases and leukocytosis in one case. Surgical treatment was applied to one case because of septic arthritis. Serious complications of the infection may be encountered and particularly in musculoskeletal system involvement, it should be kept in mind that complications can be prevented by early diagnosis and treatment

[Brucella melitensis is an agent in pediatric arthritis: Case series]. / Brucella melitensis es un agente de la artritis pediatrica: Serie de casos.

Brucellosis is a significant health problem and is endemic in some regions. Osteoarticular involvement is seen most frequently in brucellosis (20-60%). In regions where brucellosis is endemic, it should be considered in the etiology of arthritis. We report the 12 cases, were 11 males with a mean age of 12 years (range, 2-17 years). Involvement was determined in the hip in 9 cases, the sacroiliac joint in 2 and the knee in 1. All the cases had arthralgia, fever was determined in 8 cases and leukocytosis in one case. Surgical treatment was applied to one case because of septic arthritis. Serious complications of the infection may be encountered and particularly in musculoskeletal system involvement, it should be kept in mind that complications can be prevented by early diagnosis and treatment.

La brucelosis es un importante problema de salud y, en algunas regiones, es endémica. En ella, es muy frecuente observar un compromiso osteoarticular (20%-60%). En regiones donde es endémica, al analizar la etiología de la artritis, hay que pensar en esta entidad. En este artículo, se informan los casos de 12pacientes; 11 de ellos eran varones, y la media de edad fue de 12 años (intervalo: de 2 a 17 años). Se determinó el compromiso de la cadera en 9 pacientes; de la articulación sacroilíaca, en 2; y de la rodilla, en 1. Todos los pacientes tenían artralgia; 8 pacientes tuvieron fiebre; y 1 paciente, leucocitosis. A un paciente se lo sometió a un tratamiento quirúrgico debido a artritis séptica. La infección puede derivar en complicaciones graves, especialmente en el compromiso del aparato locomotor. Debe tenerse en cuenta que, mediante el diagnóstico y tratamiento tempranos, es posible prevenir las complicaciones

An atypical limping teenager.

A 13-year-old boy presented with a 5-day history of left-sided limp of gradual onset. There was no history of trauma. He developed a fever and rigours a few days before presenting to the paediatric emergency department. On examination, he was tender on palpating the left gluteal area on active mobilisation of the left hip and could not weight bear on the left leg. Pelvic X-rays and ultrasound of the left hip were normal. The blood results showed raised inflammatory markers and normal white cell count. The blood cultures were positive for Staphylococcus aureus. On day 2, a left hip MRI was performed as well as CT-guided drainage. Diagnosis of left sacroiliac septic arthritis was made. After an initial lack of improvement under intravenous ceftriaxone, a drain was inserted and left in situ for 8 days with double intravenous antibiotic therapy instituted. The patient made a full recovery.

Actinomyces timonensis sp. nov., isolated from a human clinical osteo-articular sample.

Gram-positive, non-spore-forming rods were isolated from a human osteo-articular sample (strain 7400942(T)). Based on cellular morphology and the results of biochemical analysis, this strain was tentatively identified as a novel species of the genus Actinomyces. Phylogenetic analysis based on 16S rRNA gene sequence comparisons showed that the bacterium was closely related to the type strain of Actinomyces denticolens (96.9 % 16S rRNA gene sequence similarity). A comparison of biochemical traits showed that strain 7400942(T) was distinct from A. denticolens in a number of characteristics, i.e. in contrast with A. denticolens, strain 7400942(T) was negative for nitrate reduction and for beta-galactosidase, alpha-glucosidase and alanine arylamidase activities, it was positive for acid production from N-acetylglucosamine, melezitose and glycogen, and it was negative for acid production from turanose. Matrix-assisted laser-desorption/ionization time-of-flight MS protein analysis confirmed that strain 7400942(T) represents a novel species, as scores obtained for its spectra were significant (>2.2) only with strain 7400942(T). On the basis of phenotypic data and phylogenetic inference, it is proposed that this strain should be designated Actinomyces timonensis sp. nov.; the type strain is strain 7400942(T) (=CSUR P35(T)=CCUG 55928(T)).

Sacroiliitis infected with group A streptococcus in a child presenting with confusion and combativeness.

Group A streptococcus-associated severe invasive infection (streptococcal toxic shock syndrome) has been described. Streptococcal toxic shock syndrome occurs when the infecting strain of group A streptococcus produces superantigens. Confusion and combativeness are well known as the common symptoms of streptococcal toxic shock syndrome. We encountered a child who suffered from pyogenic sacroiliitis, with confusion and combativeness. Group A streptococcus was isolated from the patient's blood culture. However, his disease did not fulfill the criteria of streptococcal toxic shock syndrome. Pyogenic sacroiliitis in children is rare, but patients with pyogenic sacroiliitis due to group A streptococcus infection could show confusion and combativeness as clinical signs, similar to the signs in streptococcal toxic shock syndrome.

A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis.

Brucellosis is a systemic infection involving many organs and tissues. The musculoskeletal system is one of the most commonly affected. The disease can present with sacroiliitis, peripheral arthritis, spondylitis, paraspinal abscess, bursitis, and osteomyelitis. A 25-year-old male patient was admitted with fever of 20-day duration, right-sided hip pain, and night sweating. A Brucella standard tube agglutination test was positive at a titer of 1/160. Magnetic resonance imaging (MRI) of the hip joint showed right sacroiliitis and a hyperintense, nodular, lobulated mass within the right iliacus muscle, consistent with abscess. The patient was started on intramuscular streptomycin at a dose of 1 g/day, oral rifampin 600 mg/day, and doxycycline 200 mg/day. On day 20 of treatment, the patient was admitted with swelling and pain over the left elbow for the past week. MRI of the left elbow was performed, which showed fluid edema suggestive of olecranon bursitis. Taking the patient's complaints into consideration, rifampin and doxycycline treatment were maintained for a year. Pain at the hip joint and elbow resolved and MRI findings disappeared. Abscess of the iliacus muscle, which has not been reported before, and the olecranon bursitis that developed during treatment make this case worth presenting.

Sacroilitis por Mycobacterium xenopi en paciente con infección por el virus de la inmunodeficiencia humana / Sacroilitis due to Mycobacterium xenopi in a patient with human immunodeficiency virus infection

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[Septic sacroiliitis with a horseshoe-shaped abscess diagnosed by MR scanning]. / Septisk sacroiliitis med hestesko-absces diagnosticeret ved hjaelp af MR-scanning.

One case of septic sacroiliitis with a horseshoe-shaped abscess is presented. Due to magnetic resonance imaging (MRI) treatment was started the day after arrival to the hospital. Despite relevant antibiotic treatment the abscess did not resolve and after three weeks surgery with drainage was performed with good result. After half a year there was only a slight discomfort. The role of MRI is emphasized.

Propionibacterium avidum sacroiliitis and osteomyelitis.

The anaerobic Gram-positive bacterium Propionibacterium avidum is a common inhabitant of the skin with low pathogenicity. We report a case of P. avidum sacroilitis, psoas abscess and osteomyelitis in a 67-year-old male who had recently undergone surgical repair of an inguinal hernia. The organism was recovered from blood cultures, a bone biopsy specimen and specimens from the abscess. The spectrum of bone and joint infections caused by Propionibacterium is discussed. Infection by Propionibacterium spp. should be considered in patients with bone and joint infections.