RESUMEN
OBJECTIVE: Despite the ubiquity of intra-articular and bursal injections for the treatment of joint pain and bursitis, relatively little literature is available on the prevalence of infection after these procedures. The aim of this study was to identify the number of infections recalled by sports medicine physicians who perform injections of large joints and bursae at least once per month. DESIGN: A survey of physician members of the American Medical Society for Sports Medicine identified the reported number of recalled infections for each large joint/bursal location. RESULTS: Of a total of 554 physicians, only 31 infections were recalled by 27 physicians. Only 4.87% of all physicians were aware of an infection after an injection during their career. On average, one infection was recalled of 170 physician-years in practice. No differences in infection rates were observed when comparing primary specialties (P = 0.281). CONCLUSIONS: This study, the largest to date, demonstrates that sports medicine physicians rarely encounter infections after large joint and bursa injections. Though rare, because of their catastrophic nature, risk mitigation strategies should be maintained.
Asunto(s)
Bolsa Sinovial/efectos de los fármacos , Bolsa Sinovial/microbiología , Bursitis/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Inyecciones Intraarticulares/métodos , Artritis Infecciosa/etiología , Bursitis/complicaciones , Humanos , Inyecciones Intraarticulares/efectos adversos , Medicina Deportiva , Resultado del TratamientoRESUMEN
The aim of this study was to report the effectiveness of the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis. From June 2014 to March 2018, we performed the Candy closure technique as a treatment for chronic open infective lateral malleolus bursitis in nine patients without secondary operation. We first performed infectious tissue debridement to control infection, and if primary closure was not possible, we performed the Candy closure technique for small wounds. The duration of the wound prior to surgery varied from 4 weeks to 2 years. Seven cases were due to infection on the bursa and two cases were ulcer-type bursitis. All the wounds were small (average, 3.80 cm2; range, 2.25-4 cm2) and circular. Seven wounds showed complete healing at 4 weeks after surgery, one wound showed complete healing at 8 weeks after surgery, and one wound with infected state was lost to missing follow-up. Of the seven wounds that showed complete healing, one wound recurred 6 months after surgery. The Candy closure technique is a simple method for ensuring healing and coverage of chronic open lateral malleolus bursitis, especially for small wounds with dead space.
Asunto(s)
Fracturas de Tobillo/cirugía , Articulación del Tobillo/cirugía , Bursitis/cirugía , Técnicas de Cierre de Heridas , Adulto , Anciano , Fracturas de Tobillo/microbiología , Fracturas de Tobillo/fisiopatología , Articulación del Tobillo/microbiología , Articulación del Tobillo/fisiopatología , Bolsa Sinovial/microbiología , Bolsa Sinovial/fisiopatología , Bolsa Sinovial/cirugía , Bursitis/microbiología , Bursitis/fisiopatología , Desbridamiento , Femenino , Humanos , Masculino , Persona de Mediana Edad , Colgajos Quirúrgicos , Cicatrización de HeridasRESUMEN
This is the first report in the literature of a sole regional anesthetic for adult craniopagus twins using a supraclavicular block for an elbow incision and drainage/bursa excision procedure. It demonstrates that for these complex medical patients, a total regional anesthesia technique is preferable when possible. There are several known general anesthetic complications in these patients. Anesthetic crossover between the twins can occur and may be variable; furthermore, the incidence and severity of the crossover effects of different anesthetics vary. Positioning of the twins can be difficult with both regional and general anesthesia. However, with regional anesthesia, the twins can position themselves and report any discomfort, which could go unnoticed under general anesthesia, leading to other complications. Craniopagus twins have a high likelihood of a difficult airway due to anatomy or positioning difficulties, which is avoided by regional anesthesia. This case emphasizes the unique challenges that these patients pose and the ability of regional anesthesia to help avoid the pitfalls of general anesthesia in these patients.
Asunto(s)
Anestesia Local/métodos , Clavícula , Bloqueo Nervioso/métodos , Gemelos Siameses/cirugía , Bolsa Sinovial/microbiología , Bolsa Sinovial/cirugía , Articulación del Codo/microbiología , Articulación del Codo/cirugía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.
Asunto(s)
Artritis Infecciosa/microbiología , Bolsa Sinovial/microbiología , Candidiasis/microbiología , Cuerpos Extraños/etiología , Articulación del Hombro/microbiología , Anciano , Artritis Infecciosa/diagnóstico por imagen , Bolsa Sinovial/diagnóstico por imagen , Candida/aislamiento & purificación , Candidiasis/diagnóstico por imagen , Humanos , Masculino , Radiografía , Articulación del Hombro/diagnóstico por imagenRESUMEN
Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.
Asunto(s)
Anciano , Humanos , Masculino , Artritis Infecciosa/microbiología , Bolsa Sinovial/microbiología , Candida/aislamiento & purificación , Candidiasis/microbiología , Cuerpos Extraños/etiología , Articulación del Hombro/microbiologíaRESUMEN
INTRODUCTION: Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery. METHOD: We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36 years (23-68 years). The average hospital stay was 6 days (4-9 days). RESULTS: No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18 days (7-22 days). CONCLUSION: We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.
Asunto(s)
Artroscopía , Bolsa Sinovial/cirugía , Bursitis/cirugía , Infecciones por Bacterias Grampositivas/complicaciones , Articulación de la Rodilla/cirugía , Adulto , Anciano , Bolsa Sinovial/microbiología , Bolsa Sinovial/patología , Bursitis/microbiología , Humanos , Articulación de la Rodilla/microbiología , Articulación de la Rodilla/patología , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Rótula , Estudios Retrospectivos , Infecciones Estafilocócicas/complicaciones , Infecciones Estreptocócicas/complicaciones , Resultado del TratamientoRESUMEN
Prototheca is an achlorophyllic alga which rarely causes infections in humans and protothecal olecranon bursitis is remarkably rare. We report a case of a 76-year-old immunocompetent man presenting with pain and swelling of the right elbow secondary to protothecal infection. Initial cultures of the olecranon bursal aspirate revealed no growth; however, repeat aspiration after 2 months grew prototheca species on culture. Prototheca wickerhamii and Prototheca zopfii are the only 2 protothecal species known to cause human infections. Protothecal infection can manifest as skin infections, extremity infections, bursitis and very rarely as systemic infections. Treatment of protothecal infections remains controversial. Amphoterecin B, ketoconazole and fluconazole have been reported to yield a successful outcome. More recently, itraconazole has been found to be curative. Surgical excision of the bursa remains the definitive treatment. Our patient was treated with itraconazole with a favorable response.
Asunto(s)
Bursitis/etiología , Articulación del Codo/microbiología , Articulación del Codo/patología , Infecciones/complicaciones , Infecciones/microbiología , Prototheca/patogenicidad , Anciano , Antifúngicos/uso terapéutico , Bolsa Sinovial/microbiología , Bolsa Sinovial/patología , Humanos , Infecciones/tratamiento farmacológico , Itraconazol/uso terapéutico , MasculinoAsunto(s)
Bolsa Sinovial/microbiología , Bolsa Sinovial/patología , Articulación del Codo/microbiología , Articulación del Codo/patología , Fusariosis/diagnóstico , Fusariosis/patología , Fusarium/aislamiento & purificación , Articulación del Codo/diagnóstico por imagen , Femenino , Histocitoquímica , Humanos , Imagen por Resonancia Magnética , Microscopía , Persona de Mediana Edad , RadiografíaRESUMEN
Trochanteric bursitis, whether septic or inflammatory in origin, is a condition that affects middle-aged patients. Here we report the rare case of an adolescent with septic trochanteric bursitis (treated successfully with intravenous antibiotics), review the available literature on septic bursitis, illustrate the importance of prompt recognition and treatment of this condition in any age group, and describe the clinical presentation and the radiologic findings.
Asunto(s)
Bursitis/microbiología , Fémur/patología , Articulación de la Cadera/microbiología , Infecciones Estafilocócicas/microbiología , Adolescente , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Bolsa Sinovial/microbiología , Bursitis/diagnóstico , Bursitis/tratamiento farmacológico , Quimioterapia Combinada , Floxacilina/uso terapéutico , Articulación de la Cadera/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Penicilina G/uso terapéutico , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/patología , Staphylococcus aureus/aislamiento & purificación , Resultado del TratamientoRESUMEN
Mycobacterium kansasii septic arthritis is rare, most often occurring in immunosuppressed patients including those with organ transplants. We present a case of oligoarticular M. kansasii infection in bilateral ankles, knee, and bilateral olecranon bursae in coexistence with tophaceous gouty arthropathy in a heart transplant patient. There are no reports of M. kansasii infection occurring in joints also affected by tophaceous gout. We contend that gouty arthropathy may alter the joint in such a way as to increase the risk of development of this infection in patients already at risk. In transplant patients presenting with a history and pattern of arthritis consistent with gout, a sufficient level of suspicion should be maintained for this infectious complication, even if monosodium urate crystals are seen on joint aspiration.
Asunto(s)
Artritis Infecciosa/complicaciones , Gota/complicaciones , Trasplante de Corazón , Infecciones por Mycobacterium no Tuberculosas/complicaciones , Mycobacterium kansasii , Complicaciones Posoperatorias , Adulto , Articulación del Tobillo , Antituberculosos/uso terapéutico , Artritis Infecciosa/microbiología , Bolsa Sinovial/microbiología , Quimioterapia Combinada , Articulación del Codo , Humanos , Articulación de la Rodilla , Masculino , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Mycobacterium kansasii/aislamiento & purificaciónRESUMEN
Patients with prepatellar septic bursitis are typically successfully managed nonoperatively with rest, compression, immobilization, aspiration, and antibiotics. Rarely, surgical excision of the bursa may be required for recalcitrant cases. Prepatellar bursectomy, however, has been associated with considerable risk of surgical-site morbidity. Although skin necrosis is frequently cited as a complication of open bursectomy, there is limited information in the medical literature on the etiology and management of this rare but serious complication.
Asunto(s)
Antibacterianos/uso terapéutico , Bolsa Sinovial/microbiología , Bursitis/complicaciones , Piel/patología , Infecciones Estafilocócicas/complicaciones , Bolsa Sinovial/cirugía , Bursitis/microbiología , Bursitis/cirugía , Cefazolina/uso terapéutico , Desbridamiento , Humanos , Articulación de la Rodilla , Masculino , Necrosis/etiología , Necrosis/microbiología , Necrosis/terapia , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Adulto JovenRESUMEN
A 62-year-old male with a history of Wegener's granulomatosis and immunosuppressive therapy presented with chronic olecranon bursitis. A black velvety mould with brown septate hyphae and tapered annellides was isolated from a left elbow bursa aspirate and was identified as an Exophiala species. Internal transcribed sequence rRNA sequencing showed the isolate to be identical to Exophiala oligosperma. The patient was successfully treated with aspiration and intrabursal amphotericin B.
Asunto(s)
Bursitis/microbiología , Articulación del Codo , Exophiala/aislamiento & purificación , Cúbito , Bolsa Sinovial/microbiología , Enfermedad Crónica , ADN Espaciador Ribosómico/análisis , Exophiala/clasificación , Exophiala/genética , Genes de ARNr , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Micosis/microbiología , Análisis de Secuencia de ADNRESUMEN
We present a case of tuberculous greater trochanteric bursitis occurring 51 years after tuberculous nephritis in a 71-year-old man. Radiographs of the affected hip revealed focal osteolysis of the greater trochanter and calcification in the surrounding soft tissues. Contrast-enhanced CT scans and MRI revealed that the enlarged bursa extended into the femoral intermuscular spaces. Bacterial culture of the biopsied bursa grew Mycobacterium tuberculosis. Total excision of the infected bursa, combined with antituberculous therapy, was curative. Tuberculosis of the greater trochanteric bursa should be included in the differential diagnosis of chronic hip pain. New tuberculous musculoskeletal lesions can occur elsewhere in the body many years after primary tuberculous lesions have healed.
Asunto(s)
Bolsa Sinovial/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Renal/diagnóstico , Anciano , Antituberculosos/administración & dosificación , Terapia Combinada , Drenaje/métodos , Estudios de Seguimiento , Articulación de la Cadera , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis Osteoarticular/etiología , Tuberculosis Osteoarticular/terapia , Tuberculosis Renal/complicacionesRESUMEN
We describe a patient whose prepatellar bursa was infected with Sporothrix schenckii. The infection persisted despite itraconazole therapy and cure was achieved only after surgical excision of the bursa. A review of treatments for bursal sporotrichosis is presented.
Asunto(s)
Bolsa Sinovial/microbiología , Bursitis/microbiología , Articulación de la Rodilla/microbiología , Sporothrix/aislamiento & purificación , Esporotricosis/microbiología , Bolsa Sinovial/cirugía , Bursitis/cirugía , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Esporotricosis/cirugíaRESUMEN
OBJECTIVE: To assess the clinical and microbiological characteristics of septic bursitis in those cases that required treatment at the hospital during the past 10 years in a northwestern area of Spain. METHODS: The charts of all patients diagnosed as having septic bursitis at Hospital Xeral-Calde, Lugo, Spain, from October 1987 through September 1997 were reviewed based on published criteria and graded according to severity. RESULTS: Sixty-nine patients diagnosed with definite and 6 with probable septic bursitis met the criteria for severe septic bursitis. Sixty-two were male (82.7%). The mean age at the time of diagnosis was 51 years. The most frequently involved sites were olecranon (47%) and prepatellar (44%) bursae. Among predisposing factors, the presence of prepatellar bursitis was correlated with a job that involved frequent trauma on the bursae. The main clinical and laboratory findings were cellulitis and/or erythema (94.7%), fever (77.3%), and leukocytosis (72%). Noninflammatory synovial fluid (SF, < 2,000 leukocytes/mm3) was observed in 4/32 (12.5%) cases. Positive SF cultures were obtained in 69 of 75 patients (92%). Staphylococcus aureus was the most common pathogen (84%). Blood cultures were positive in 12 of 62 patients (19.4%). Three patients had osteomyelitis. This complication was associated with a longer delay to diagnosis from the onset of symptoms (> 3 weeks vs 9.3+/-13.3 days for the group as a whole). Apart from these 3 cases, overall outcome was excellent. CONCLUSION: Severe septic bursitis is a common disease. Local trauma is the most common risk factor for this infection. Although the most common pathogen is S. aureus, other pathogens such as Brucella abortus play an important role in this infection in our area.
Asunto(s)
Bursitis/epidemiología , Sepsis/epidemiología , Infecciones Estafilocócicas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bolsa Sinovial/lesiones , Bolsa Sinovial/microbiología , Bolsa Sinovial/patología , Bursitis/microbiología , Bursitis/patología , Cloxacilina/uso terapéutico , Articulación del Codo/microbiología , Articulación del Codo/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rótula/lesiones , Rótula/patología , Factores de Riesgo , Sepsis/microbiología , Sepsis/patología , España/epidemiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/patología , Staphylococcus aureus/aislamiento & purificación , Lesiones de CodoRESUMEN
We encountered 3 types of subcutaneous bursitis in our patients with scleroderma: dry bursitis characterized by a rub, sterile bursitis characterized by inflammatory effusions without crystals by polarizing microscopy, and septic (staphylococcal) subcutaneous bursitis. The latter, which occurred in 6 of 40 consecutive patients, had a protracted course, was often complicated by fistulas, and tended to involve several bursae particularly in patients with extensive calcinosis.
Asunto(s)
Bursitis/complicaciones , Esclerodermia Sistémica/complicaciones , Adulto , Anciano , Bolsa Sinovial/microbiología , Bolsa Sinovial/patología , Bursitis/microbiología , Bursitis/patología , Cristalización , Femenino , Humanos , Masculino , Microscopía de Polarización , Persona de Mediana Edad , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Between Jan 1, 1984 and Aug 1, 1990, 27 horses were admitted to the veterinary medical center for evaluation of fistulous withers. Nine (37.5%) of 24 horses tested for antibody to Brucella abortus were seropositive. Horses that tested seropositive were significantly (P = 0.046) more likely to have been pastured with cattle that were seropositive for B abortus, and were significantly (P = 0.010) more likely to have had radiographic evidence of vertebral osteomyelitis than were horses that tested seronegative. Five horses that were seropositive for B abortus were administered strain 19 brucella vaccine sc (n = 1) or iv (n = 4). The horse treated by sc injection of vaccine improved during hospitalization, but was lost to follow-up evaluation. Three (75%) of 4 horses treated by iv injection died, but 1 horse recovered within 4 weeks of treatment.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Brucella abortus/inmunología , Brucelosis/veterinaria , Bursitis/veterinaria , Enfermedades de los Caballos/etiología , Animales , Brucella abortus/aislamiento & purificación , Brucelosis/complicaciones , Bolsa Sinovial/microbiología , Bursitis/etiología , Bursitis/terapia , Femenino , Estudios de Seguimiento , Enfermedades de los Caballos/terapia , Caballos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A patient with a Staphylococcus aureus infection of the subacromial/subdeltoid bursa is described. Instillation of radiocontrast dye into the purulent cavity provided evidence that the infection was localized to the subacromial/subdeltoid bursa. The use of bursography/arthrography to define the site and extent of shoulder infections may help to determine the optimal duration of antibiotic therapy and the prognosis for cartilage and/or bone destruction.
Asunto(s)
Bolsa Sinovial/microbiología , Infecciones Estafilocócicas/patología , Acromion , Adulto , Bolsa Sinovial/diagnóstico por imagen , Bolsa Sinovial/patología , Diagnóstico Diferencial , Humanos , Artropatías/diagnóstico , Artropatías/tratamiento farmacológico , Artropatías/patología , Masculino , Nafcilina/uso terapéutico , Pronóstico , Radiografía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológicoRESUMEN
Anthopsis deltoidea was found to be the cause of an olecranon bursitis in a 79-year-old golfer. Serial histological sections of the olecranon bursa showed faintly stained, brown-walled, septate, hyphal elements in the centers of the necrotic debris. The combination of bursectomy and flucytosine treatment cured the infection.