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1.
Arch Pediatr ; 27(8): 464-468, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33011034

RESUMEN

BACKGROUND: The foot and ankle are uncommon sites of bone and joint infections (BJIs) in children. The objectives of the present study were to determine the clinical and bacteriologic features of BJIs and to assess any associated complications and orthopedic sequelae. METHODS: We performed a retrospective, single-center study of children treated for foot or ankle BJIs between 2008 and 2018 in a French university medical center. A total of 23 children were included. The median age at diagnosis was 9.1 years. Osteomyelitis was noted in 14 cases; it involved the calcaneus in seven cases, the distal fibula in four cases, the first metatarsal in two cases, and the distal tibia in one case. Arthritis affected the ankle in six cases and the cuneiform-cuboidal joint in one case. In two cases, osteoarthritis of the ankle was associated with distal osteomyelitis of the tibia. Clinical, radiological, and bacteriological parameters, surgical procedures, complications, and sequelae were recorded and analyzed. RESULTS: The median (range) time to diagnosis was 3.18 days (0-10), and trauma was reported in four cases. Fever was present on admission in 18 cases, and the serum C-reactive protein level was elevated in 22 cases. Standard X-rays showed osteolysis in one case and bone sequestration in another. Staphylococcusaureus was identified in 10 cases. Surgery was performed in 17 cases. A subperiosteal abscess that required surgical drainage complicated 10 cases of osteomyelitis. No recurrence was observed. At the last follow-up, the median (range) age was 11.9 years (1.5-19). Sequelae (spontaneous tibia-talus fusion, first metatarsal epiphysis fusion, and varus deformity of the hindfoot) were observed in three cases, all of which were initially complicated by an abscess. CONCLUSION: Physicians should be aware that pediatric BJIs of the lower limb may involve the foot and ankle. S. aureus is frequently involved. In cases of osteomyelitis, complications are closely associated with subperiosteal abscesses justifying an early diagnosis. These BJIs must be treated rapidly, and the risk of sequelae justifies long-term follow-up.


Asunto(s)
Artritis Infecciosa/diagnóstico , Articulaciones del Pie/microbiología , Osteomielitis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Adolescente , Artritis Infecciosa/complicaciones , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Niño , Preescolar , Femenino , Peroné/diagnóstico por imagen , Peroné/microbiología , Peroné/patología , Peroné/cirugía , Estudios de Seguimiento , Huesos del Pie/diagnóstico por imagen , Huesos del Pie/microbiología , Huesos del Pie/patología , Huesos del Pie/cirugía , Articulaciones del Pie/diagnóstico por imagen , Articulaciones del Pie/patología , Articulaciones del Pie/cirugía , Humanos , Lactante , Masculino , Osteomielitis/complicaciones , Osteomielitis/microbiología , Osteomielitis/terapia , Estudios Retrospectivos , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/terapia , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/terapia , Tibia/diagnóstico por imagen , Tibia/microbiología , Tibia/patología , Tibia/cirugía , Resultado del Tratamiento , Adulto Joven
2.
J Orthop Sci ; 25(3): 492-496, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31174967

RESUMEN

BACKGROUND: Osteomyelitis, particularly cases involving the foot and ankle, is a challenging situation that frequently leads to amputations and major sequelae. Targeted antibiotics treating an identified pathogen are key to a successful outcome; however, traditional culture methods for bone tissue have poor sensitivity. This study prospectively compared a novel method for obtaining and processing infected bone tissue with the standard technique. METHODS: 107 patients presenting with a diagnosis of osteomyelitis of the foot and ankle between 2008 and 2017 were prospectively included. Diagnosis was done according to clinical, laboratory and imaging findings. We obtained paired samples of bone tissue from all patients; they were processed through a usual culture method (UCM), but they were also morselized and seeded into pediatric blood culture bottles (PBCBs). We compared the culture yield and the number of agents detected using both the McNemar and the Mann-Whitney tests, respectively. RESULTS: We studied 107 patients (63 with diabetic foot infection and 44 with nondiabetic osteomyelitis). The causative agent was identified in 60.7% of cases using the UCM and in 97.2% of cases using PBCBs (p < 0.001). We detected a mean of 1.05 ± 1.03 bacteria using the UCM and 1.67 ± 0.92 bacteria using PBCBs (p < 0.01). CONCLUSION: Cultures using morselized bone seeded in PBCBs identified the causative agent in a significantly larger percentage than the UCM. Additionally, this method identified a larger number of pathogen agents. A better agent identification method has advantages such as identifying more specific antibiotic treatment in these cases.


Asunto(s)
Articulación del Tobillo/microbiología , Infecciones Bacterianas/diagnóstico , Cultivo de Sangre/métodos , Huesos/microbiología , Articulaciones del Pie/microbiología , Osteomielitis/microbiología , Humanos , Estudios Prospectivos
3.
Foot Ankle Int ; 41(3): 331-341, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31801382

RESUMEN

BACKGROUND: The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). METHODS: Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. RESULTS: No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively (P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 (P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 (P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 (P < .05). CONCLUSION: Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. LEVEL OF EVIDENCE: Level IV, case series.


Asunto(s)
Articulación del Tobillo/cirugía , Articulaciones del Pie/cirugía , Procedimientos de Cirugía Plástica/métodos , Tuberculosis Osteoarticular/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Articulación del Tobillo/microbiología , Estudios de Factibilidad , Femenino , Articulaciones del Pie/microbiología , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Encuestas y Cuestionarios
4.
J Diabetes Complications ; 30(4): 608-12, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26961279

RESUMEN

AIMS: Charcot neuropathic osteoarthropathy (CN) represents a complication for diabetic patients which involves a progressive alteration of the osteoarticular apparatus with high risk of amputation. The aim of the study was to assess whether the localization of CN and the extent or grading of the osteomyelitis have an influence on the rate of limb salvage and the time to recovery. METHODS: We treated a diabetic population affected by CN complicated by ulceration and widespread osteomyelitic involvement. All patients were treated surgically to eliminate infected tissues, stabilize and correct the bone deformities. Histopathological and microbiological analyses were carried out on the bone specimens. RESULTS: Thirty-three patients affected by CN complicated by large osteomyelitic involvement of midfoot and/or ankle were treated between January 2010 and May 2014. The mean follow-up was 409,35 ± 154,06 days. Thirty patients had complete recovery (90.91%) at the end of follow-up. No difference in limb salvage rate and time to recovery was observed when stratifying the population according to CN localization, extent and grading of osteomyelitis. CONCLUSIONS: In this cohort prospective study we observed a high percentage of limb salvage in patients affected by CN complicated by diffuse midfoot/hindfoot osteomyelitis. The localization of Charcot deformity and the extent/stage of osteomyelitis did not change the rate of limb salvage.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/cirugía , Articulaciones del Pie/microbiología , Recuperación del Miembro/efectos adversos , Osteoartritis/cirugía , Osteomielitis/fisiopatología , Anciano , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/fisiopatología , Estudios de Cohortes , Pie Diabético/complicaciones , Pie Diabético/diagnóstico , Pie Diabético/fisiopatología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Articulaciones del Pie/fisiopatología , Articulaciones del Pie/cirugía , Humanos , Italia , Masculino , Persona de Mediana Edad , Osteoartritis/complicaciones , Osteoartritis/diagnóstico , Osteoartritis/fisiopatología , Osteomielitis/complicaciones , Osteomielitis/microbiología , Pronóstico , Estudios Prospectivos , Recuperación de la Función , Índice de Severidad de la Enfermedad , Factores de Tiempo
5.
J Foot Ankle Surg ; 55(6): 1241-1244, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26190776

RESUMEN

Lyme disease is the result of Borrelia burgdorferi bacterial infection after exposure from a tick bite. A pathognomonic finding in early-stage Lyme disease is an expanding, red macular ring known as erythema migrans. Lyme arthritis is a late-stage manifestation of this disease, affecting the large, weightbearing joints with intermittent pain and swelling. The existing data on Lyme disease and subsequent arthritis have reported manifestations in the lower extremity, primarily in the knee and ankle and less commonly the small joints of the foot. We present a retrospective case series of 11 cases of painful arthritis in the foot and ankle with confirmatory Lyme disease testing.


Asunto(s)
Articulaciones del Pie/microbiología , Artropatías/microbiología , Enfermedad de Lyme/complicaciones , Adolescente , Adulto , Niño , Femenino , Humanos , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
6.
J Med Microbiol ; 58(Pt 1): 65-68, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19074654

RESUMEN

Kingella kingae is an emerging pathogen that is recognized as a causative agent of septic arthritis and osteomyelitis, primarily in infants and children. The bacterium is best detected by rapid inoculation in blood culture systems or by real-time PCR assays. Pathogenesis of the agent was linked recently to the production of a potent cytotoxin, known as RTX, which is toxic to a variety of human cell types. The locus encoding the RTX toxin is thought to be a putative virulence factor, and is, apparently, essential for inducing cytotoxic effects on respiratory epithelial, synovial and macrophage-like cells. Herein, we describe a novel real-time PCR assay that targets the RTX toxin gene and illustrate its use in two clinical cases. The assay exhibited a sensitivity of 30 c.f.u., which is 10-fold more sensitive than a previously published semi-nested broad-range 16S rRNA gene PCR, and showed no cross-reactivity with several related species and common osteoarticular pathogens.


Asunto(s)
Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Kingella kingae/aislamiento & purificación , Infecciones por Neisseriaceae/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Articulación del Codo/microbiología , Femenino , Articulaciones del Pie/microbiología , Humanos , Masculino , Sensibilidad y Especificidad
7.
Clin Rheumatol ; 26(5): 823-4, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-16724167

RESUMEN

Histoplasmosis is an important opportunistic disease to consider in immunocompromised patients from endemic areas. Articular presentations of disseminated histoplasmosis are uncommon. We describe the case of a renal transplant recipient originating from South Africa in whom a suppurative arthritis presented as a manifestation of disseminated histoplasmosis.


Asunto(s)
Artritis Infecciosa/diagnóstico , Articulaciones del Pie/microbiología , Histoplasmosis/diagnóstico , Infecciones Oportunistas/diagnóstico , Artritis Infecciosa/microbiología , Femenino , Histoplasmosis/microbiología , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón/inmunología , Persona de Mediana Edad , Infecciones Oportunistas/microbiología
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