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1.
Bone Joint J ; 102-B(4): 470-477, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228076

RESUMO

AIMS: Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. METHODS: We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. RESULTS: The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. CONCLUSION: We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470-477.


Assuntos
Articulação do Tornozelo/cirurgia , Artrite Infecciosa/cirurgia , Artrodese/métodos , Artropatia Neurogênica/cirurgia , Técnica de Ilizarov , Deformidades Articulares Adquiridas/cirurgia , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Artrodese/instrumentação , Artropatia Neurogênica/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/cirurgia , Feminino , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/cirurgia , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Radiografia , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Fatores de Tempo , Cicatrização
2.
AJR Am J Roentgenol ; 214(1): 171-176, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573855

RESUMO

OBJECTIVE. The diagnosis of early prosthetic joint infection (PJI)-defined as within 6 weeks after a total knee arthroplasty (TKA)-can be difficult because of expected postsurgical changes and elevated inflammatory markers. The role of radiographic evaluation in this situation carries unclear clinical significance. This study had three primary aims: first, to determine when soft-tissue gas is no longer an expected postoperative radiographic finding; second, to determine whether soft-tissue gas is predictive of early PJI; and, third, to determine whether the presence of soft-tissue gas correlates with specific patient characteristics and microbiology culture results. MATERIALS AND METHODS. This retrospective study was of patients who underwent TKA from 2008 to 2018 with available imaging between 5 days and 6 weeks after TKA and no interval intervention before imaging. All confirmed early PJIs were included (n = 24 cases; 15 patients). For comparison, patients who underwent TKA but did not have a PJI (n = 180 cases; 150 patients) were selected randomly. Radiographs were reviewed by two readers. A two-tailed p < 0.05 was considered significant. RESULTS. Soft-tissue gas was identified on postoperative radiography of 13 of 24 (54.2%) cases (mean ± standard error of the mean [SEM], 28.3 ± 2.3 days after TKA) with early PJI and four of 180 (2.2%) cases (mean ± SEM, 15.3 ± 7.3 days after TKA) without PJI (p < 0.0001; odds ratio, 52.0 [95% CI, 14.7-156.9]). The presence of soft-tissue gas on radiography 14 days after TKA had a sensitivity of 0.54 (95% CI, 0.35-0.72) and specificity of 0.99 (95% CI, 0.97-1.00) for early PJI. Staphylococcus species were the dominant organisms; cases with soft-tissue gas showed a wider variety of microbiology species (p < 0.01). CONCLUSION. Postoperative soft-tissue gas present on radiography performed 14 days or more after TKA is predictive of early PJI and is associated with a wider spectrum of microorganisms.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologia , Idoso , Feminino , Gases , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo
4.
Rev Soc Bras Med Trop ; 53: e20190328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859955

RESUMO

Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.


Assuntos
Artrite Infecciosa/etiologia , Mordeduras e Picadas/complicações , Vértebras Lombares/diagnóstico por imagem , Osteomielite/etiologia , Febre por Mordedura de Rato/complicações , Articulação Esternoclavicular/diagnóstico por imagem , Idoso , Animais , Artrite Infecciosa/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Febre por Mordedura de Rato/diagnóstico , Ratos
5.
Indian J Tuberc ; 66(3): 422-426, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31439192

RESUMO

A 34 year-old lady was referred for rheumatology review by the orthopaedic team for further investigation of chronic left sternoclavicular joint pain. No preceding event such as trauma, injury or infection had occurred. A rheumatology workup turned out to be negative for an inflammatory arthropathy. After extensive investigations including blood tests, an MRI scan, a CT scan, and a bone scan, and in consultation with the orthopaedic team, the affected joint was biopsied and tested for mycobacterium avium-intracellulare infection. The results came back as positive and the patient was started on anti-mycobacterial treatment. We report the diagnosis, management and 3-year follow-up of this unique case. This highlights an uncommon and often misdiagnosed cause of septic arthritis caused by mycobacterium avium-intracellulare infection. To our knowledge this is the first confirmed sternoclavicular mycobacterium avium-intracellulare infection in an immunocompetent host reported in the literature.


Assuntos
Artrite Infecciosa/diagnóstico , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Articulação Esternoclavicular , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Imunocompetência , Imagem por Ressonância Magnética , Infecção por Mycobacterium avium-intracellulare/diagnóstico por imagem , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/microbiologia
6.
J Shoulder Elbow Surg ; 28(12): 2317-2325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31377005

RESUMO

BACKGROUND: There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. METHODS: We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). RESULTS: The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). CONCLUSIONS: When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Desbridamento/métodos , Cabeça do Úmero/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/sangue , Artroscopia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Feminino , Humanos , Contagem de Leucócitos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Radiografia , Recidiva , Estudos Retrospectivos , Ombro , Resultado do Tratamento , Adulto Jovem
7.
An. sist. sanit. Navar ; 42(2): 221-225, mayo-ago. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-188883

RESUMO

Facet joint septic arthritis is a rare cause of spinal infection in children with only four cases reported. The transmission pathway is believed to be haematogenous in 72% of cases. The authors present the case of a 13-year-old boy hospitalised for acute lumbosciatalgia, limp and fever, with pain upon palpation of the paravertebral muscles, a positive Laségue signal and elevated serum inflammatory markers. The initial lumbar computerised tomography (TC) scan revealed no abnormalities in the interapophyseal joints. After improving on treatment with analgesics and antibiotics, he was readmitted one month later due to clinical deterioration, and septic arthritis of left facet joint L3-L4 was confirmed by magnetic resonance imaging (MRI). The patient experienced a full recovery after treatment with systemic antibiotics (cefotaxime-cloxacilin) and rehabilitation


La artritis séptica facetaria es una infección raquídea excepcional en niños, con solo cuatro casos publicados. Se cree que en el 72% de los casos el mecanismo de transmisión es hematógeno. Se presenta el caso de un varón de 13 años que fue hospitalizado por lumbociatalgia aguda, cojera y fiebre, con contractura y dolor a la palpación de la musculatura paravertebral, signo de Laségue positivo y elevación de los marcadores séricos inflamatorios. La tomografía axial computarizada (TAC) inicial no mostró anomalías en las articulaciones interapofisarias lumbares. Tras haber mejorado con analgésicos y antibióticos, el paciente reingresó un mes más tarde por deterioro clínico de los síntomas, y la resonancia magnética (RMN) mostró artritis séptica de la articulación interfacetaria izquierda de L3-L4. El paciente obtuvo una recuperación completa con tratamiento antibiotico (cefotaxima-cloxacilina) y rehabilitación. Se requiere un alto grado de sospecha para poder diagnosticar esta localización anatómica como manifestación de lumbociática y/o cojera en niños. Se requiere TAC o, preferiblemente, RMN para confirmar el diagnóstico


Assuntos
Humanos , Masculino , Adolescente , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/reabilitação , Febre/etiologia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem
8.
An Sist Sanit Navar ; 42(2): 221-225, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31219102

RESUMO

Facet joint septic arthritis is a rare cause of spinal infection in children with only four cases reported. The transmission pathway is believed to be haematogenous in 72% of cases. The authors present the case of a 13-year-old boy hospitalised for acute lumbosciatalgia, limp and fever, with pain upon palpation of the paravertebral muscles, a positive Laségue signal and elevated serum inflammatory markers. The initial lumbar computerised tomography (TC) scan revealed no abnormalities in the interapophyseal joints. After improving on treatment with analgesics and antibiotics, he was readmitted one month later due to clinical deterioration, and septic arthritis of left facet joint L3-L4 was confirmed by magnetic resonance imaging (MRI). The patient experienced a full recovery after treatment with systemic antibiotics (cefotaxime-cloxacilin) and rehabilitation. A high index of suspicion is necessary to diagnose this localization as a manifestation of lumbosciatalgia and/or limp in children. CT-scan or, preferably, MRI is mandatory to confirm this diagnosis.


Assuntos
Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Artrite Infecciosa/diagnóstico por imagem , Adolescente , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/reabilitação , Febre/etiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem
10.
J Arthroplasty ; 34(6): 1227-1232.e2, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30905639

RESUMO

BACKGROUND: A sinus tract may be encountered in patients with periprosthetic joint infection (PJI) and constitutes a major criterion for diagnosis. The aim of this study is to identify associated factors for the presence of sinus tract and outcome of 2-stage exchange arthroplasty in these patients. METHODS: We retrospectively reviewed all patients with PJI following hip and knee arthroplasty from 2000 to 2017. Of them, 161 patients with a sinus tract had a minimum follow-up of 1 year following 2-stage exchange arthroplasty. These patients were matched 1:2 with those without sinus tract by using propensity score matching. Treatment success was assessed using the modified Delphi criteria. A multiple logistic regression analysis was performed to determine the effect of sinus tract on the outcome and associated factors for the presence of sinus tract. RESULTS: Factors significantly associated with sinus tract included smoking (odds ratio [OR] = 1.83), hypothyroidism (OR = 1.62), hypoalbuminemia (OR = 1.52), hip joint involvement (OR = 1.43), and prior revision surgery (OR = 1.37). Patients with sinus tract had a significantly higher rate of failure compared to those without sinus tract (OR = 2.94). CONCLUSION: This study demonstrates that the presence of sinus tract in patients with PJI adversely affects the outcome of treatment of these patients. The presence of sinus tract may be a proxy for other issues such as poor periarticular soft tissue, the poor nutritional status of the host, and multiple prior operations. These findings need to be borne in mind when treating patients with PJI and a concomitant sinus tract.


Assuntos
Artrite Infecciosa/terapia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Adulto , Idoso , Artrite Infecciosa/diagnóstico por imagem , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Infecções Relacionadas à Prótese/etiologia , Reoperação/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
11.
Rev Fac Cien Med Univ Nac Cordoba ; 76(1): 52-55, 2019 03 06.
Artigo em Espanhol | MEDLINE | ID: mdl-30882342

RESUMO

Introduction: Septic arthritis by Aggregatibacter aphrophilus is an uncommon entity, so it's important to diagnose it early, to avoid serious consequences. In adults, the knee is the most affected site. Methods: We present a case of a 17-year-old boy, with pain in the left knee since one month ago. It shows an increase in local temperature, erythema and movement inability. A nuclear magnetic resonance (NMR) was performed and empirical treatment was given with cephalothin and clindamycin. A knee arthrotomy was realized, and intramedullary secretion and bone tissue was sent to study. Results: the NMR images were suggestive of an infectious process. In the culture gram-negative coccobacilli were isolated, later identified like as Aggregatibacter aphrophilus. According to this diagnostic, the treatment was changed to ceftriaxone The main conclusions: the rapidity and certainty in the choice of antimicrobial therapy is the most important step for a well evolution of this infection, therefore is very important to emphasize the importance of a correct identification of these rare microorganisms


Assuntos
Aggregatibacter aphrophilus/isolamento & purificação , Artrite Infecciosa/microbiologia , Articulação do Joelho/microbiologia , Infecções por Pasteurellaceae/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/tratamento farmacológico , Ceftriaxona/uso terapêutico , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Infecções por Pasteurellaceae/diagnóstico por imagem , Infecções por Pasteurellaceae/tratamento farmacológico
12.
Vet J ; 244: 104-111, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30825885

RESUMO

Lameness in cattle is a welfare concern and is associated with important economic losses in beef cattle operations. Infection of the distal interphalangeal joint (DIJ) results in severe lameness and if left untreated carries a poor prognosis. Diagnosis of DIJ infection is challenging in the field. The aim of this study was to determine factors associated with septic arthritis of the DIJ in beef cattle. Thirty-nine beef cattle with a complaint of single-foot lameness were used in this study. History and lameness examination data were recorded and analyzed. Radiographic changes and cytology of synovial fluid of the affected DIJ were used to define the presence (cases) or absence (controls) of DIJ infection. Asymmetric swelling at the coronary band of the affected foot and a lameness score of ≥4/5 significantly increased the odds (odds ratio [OR]=63.2 and OR=120, respectively) of diagnosis of septic arthritis of the DIJ in beef cattle with a single-foot lameness compared to cattle with no asymmetry of the coronary band or lameness scores <3. Routine lameness examination findings could be used in the field to rapidly recognize infection of the DIJ in lame beef cattle.


Assuntos
Artrite Infecciosa/veterinária , Doenças dos Bovinos/epidemiologia , Casco e Garras , Carne , Animais , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/epidemiologia , Estudos de Casos e Controles , Bovinos , Doenças dos Bovinos/diagnóstico por imagem , Feminino , Kansas/epidemiologia , Coxeadura Animal/epidemiologia , Masculino , Fatores de Risco
13.
J Orthop Sci ; 24(2): 286-289, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30268355

RESUMO

BACKGROUND: The diagnosis of periprosthetic joint infections (PJI) in patients with inflammatory joint diseases (IJD) could be challenging. Several tests used for diagnosing PJI may be inaccurate due to baseline inflammatory characteristics of such diseases. We aimed to evaluate the accuracy of several infection biomarkers, in a specific subgroup of patients with PJI and IJD. METHODS: From January 2014 to August 2017, patients with resisting pain at the relevant site, following total knee arthroplasty were evaluated prospectively. A total of 38 patients were undergone revision arthroplasty. Patients were categorized in terms of MSIS criteria: Patients with PJI (Group 1, n = 17) and patients without PJI (Group 2, n = 21). Serum ESR, CRP, Procalcitonin, synovial cell count, percentage of neutrophils in synovial fluid, synovial CRP, Lactoferrin, ELA-2, Thiol - Disulphide levels, BPI and the Alpha defensin test results were obtained. The results of two groups were compared and the diagnostic accuracy of each variable was evaluated. RESULTS: There were 22 women, 16 men with a mean age of 67.8 ± 6.9 years. The differences were significant in all evaluated biomarkers in terms of PJI (p values of all biomarker were <0.001). Alpha defensin, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP were the most accurate tests with area under curve >0.90. CONCLUSIONS: Our results demonstrated that IJD may not affect the accuracy of infection biomarkers in patients with PJI. Alpha defensin test, Lactoferrin, ELA-2, BPI, Procalcitonin and synovial CRP can be used in the diagnosis of PJI in patients with IJD.


Assuntos
Artrite Infecciosa/cirurgia , Artrite Reumatoide/cirurgia , Artroplastia do Joelho/efeitos adversos , Pró-Calcitonina/análise , Infecções Relacionadas à Prótese/cirurgia , Idoso , Artrite Infecciosa/diagnóstico por imagem , Artrite Reumatoide/diagnóstico , Artroplastia do Joelho/métodos , Biomarcadores/análise , Proteína C-Reativa , Estudos de Coortes , Feminino , Seguimentos , Humanos , Elastase de Leucócito/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Estudos Prospectivos , Falha de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Curva ROC , Reoperação/métodos , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Líquido Sinovial/citologia , Resultado do Tratamento
14.
Pediatr Radiol ; 49(1): 23-36, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30225645

RESUMO

Pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome is a rare autosomal-dominant autoinflammatory disease of incomplete penetrance and variable expression. PAPA syndrome is the result of a mutation in the proline serine threonine phosphatase-interacting protein 1 (PSTPIP1/CD2BP1) gene located on chromosome 15, which results in an abnormal overproduction of the pro-inflammatory cytokine interleukin-1ß (IL-1). This syndrome clinically manifests as early onset of recurrent episodes of acute aseptic inflammation of the joints, generally occurring in the first two decades of life, followed by manifestation of characteristic skin lesions in the third decade, after an obvious decline in the joint symptoms. Although uncommon, the potential clinical implications of PAPA syndrome warrant an appropriate diagnosis in a timely fashion.


Assuntos
Acne Vulgar/diagnóstico por imagem , Acne Vulgar/genética , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/genética , Pioderma Gangrenoso/diagnóstico por imagem , Pioderma Gangrenoso/genética , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Síndrome
15.
Skeletal Radiol ; 48(2): 259-266, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29978244

RESUMO

OBJECTIVES: To analyze and identify magnetic resonance imaging (MRI) and clinical findings for the differentiation between infectious arthritis and spondyloarthritis in patients with unilateral sternoclavicular arthritis. MATERIALS AND METHODS: We retrospectively collected and evaluated the magnetic resonance (MR) images of 21 patients diagnosed with unilateral sternoclavicular arthritis, including 12 with infection and nine with spondyloarthritis, between 2004 and 2017. Capsular distension, extracapsular fluid collection, periarticular muscle edema, the prevalence and distribution of bone marrow edema, and the prevalence and size of bone erosions were assessed on the MR images. Clinical data were also reviewed. RESULTS: Capsular distension was more prominent in patients with infectious arthritis than those with spondyloarthritis (p = 0.002); extracapsular fluid collection and periarticular muscle edema were also more common in infectious arthritis than spondyloarthritis (p < 0.001, respectively); moreover, bone erosions were larger in infectious arthritis than spondyloarthritis (p = 0.023). Other findings significantly associated with infectious arthritis included advanced age (p = 0.007), an elevated C-reactive protein (CRP) level (p = 0.001), and erythrocyte sedimentation rate (ESR) (p < 0.001). The prevalence and distribution of bone marrow edema and the prevalence of bone erosions on MRI, the white blood cell count, and sex showed no significant differences between the two groups. CONCLUSIONS: Capsular distension, extracapsular fluid collection, periarticular muscle edema, and the size of bone erosions on MRI, as well as the age, CRP level, and ESR of patients, could be helpful for differentiating infectious arthritis from spondyloarthritis involving the sternoclavicular joint.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilartrite/diagnóstico por imagem , Articulação Esternoclavicular/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos , Estudos Retrospectivos
16.
Intern Med ; 58(6): 865-869, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30449803

RESUMO

A 53-year-old Japanese man experienced fever/neck pain, and neck magnetic resonance imaging revealed a spinal epidural abscess. The following day, he developed a palpable mass with evident inflammatory signs in the right sternoclavicular joint (SCJ) with severe pain. Ultrasound revealed synovitis with remarkable power Doppler signals in the right SCJ. Blood cultures yielded Streptococcus agalactiae growth. After 12 days, ultrasound showed right distal clavicle bone erosion. His symptoms improved with long-term parenteral antibiotic treatment, but the right SCJ joint destruction progressed for several months. We diagnosed him with sternoclavicular septic arthritis complicated with a spinal epidural abscess and bacteremia.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Articulação Esternoclavicular/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus agalactiae/isolamento & purificação , Artrite Infecciosa/patologia , Diagnóstico Precoce , Humanos , Masculino , Pessoa de Meia-Idade , Articulação Esternoclavicular/microbiologia , Articulação Esternoclavicular/patologia , Infecções Estreptocócicas/patologia , Ultrassonografia
19.
Swiss Med Wkly ; 148: w14669, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30378636

RESUMO

AIMS OF THE STUDY: Paediatric musculoskeletal infections by Panton-Valentine leucocidin (PVL)-producing Staphylococcus aureus constitute a rare, but highly critical event. They are characterised by a rapid course of marked inflammation, worsening under conservative therapy and a high rate of recurrence. This study aimed to illustrate the importance of paediatric PVL-producing S. aureus musculoskeletal infections in western Switzerland. METHODS: Case records, clinical parameters and biological assessments of children with musculoskeletal infections due to PVL-producing S. aureus who attended the University Hospitals of Lausanne and Geneva from 2008 to 2016 were studied retrospectively. RESULTS: Of the nine cases (seven male), four presented with haematogenous acute osteomyelitis, two with septic arthritis, and three with skin and soft tissue infections. Laboratory analysis revealed mean values for white blood cell count of 12,700/mm3, C-reactive protein (CRP) 171mg/l, erythrocyte sedimentation rate (ESR) 62 mm/h and platelet count 241,000/mm3. Notably, fever and laboratory values were higher for osteoarticular infections. PVL was produced by methicillin-sensitive S. aureus (MSSA) in eight cases and by community-acquired methicillin-resistant S. aureus (CA-MRSA) in one case. PVL was identified in blood cultures (six cases), operative samples (seven cases) and an oral swab (one case). Treatment relied on surgical procedures, endorsed by two-agent antimicrobial therapy for up to 9 weeks. Complications included recurrent infections (five cases), pathological fracture (one case) and growth arrest (two cases), as well as an important psychological impact (one case). CONCLUSION: The results of this study highlight the low prevalence of PVL-producing S. aureus musculoskeletal infections in the paediatric population in our region. Nevertheless, given the importance of complications, the recurrence rate and the duration of treatment, clinicians caring for children need to be especially well versed with the peculiarity of this entity. Retrospective case series. LEVEL OF EVIDENCE: IV.


Assuntos
Artrite Infecciosa/microbiologia , Toxinas Bacterianas , Exotoxinas , Leucocidinas , Osteomielite/microbiologia , Infecções dos Tecidos Moles/microbiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Artrite Infecciosa/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Osteomielite/diagnóstico por imagem , Prevalência , Recidiva , Estudos Retrospectivos , Infecções dos Tecidos Moles/epidemiologia , Infecções Estafilocócicas/epidemiologia , Suíça/epidemiologia
20.
Int J Infect Dis ; 77: 23-25, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30273649

RESUMO

Histoplasma capsulatum variety capsulatum (H. capsulatum) is a thermally dimorphic fungus that is endemic to the Mississippi River and Ohio River valley regions. Of the hundreds of thousands of patients exposed to this fungus, less than 1% develop a severe illness most commonly manifesting as pulmonary disease. Septic arthritis from hematogenous seeding with H. capsulatum or from direct inoculation has been reported only rarely in the literature. The first case of septic arthritis of the shoulder due to H. capsulatum occurring in an immunocompromised patient, treated successfully with irrigation and debridement, systemic antifungals, and local delivery of amphotericin B with cement beads, is reported here. Importantly, the addition of local amphotericin B delivery by cement beads to conventional treatment likely led to clinical cure in this patient.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Artrite Infecciosa/terapia , Histoplasmose/terapia , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/microbiologia , Feminino , Histoplasma/efeitos dos fármacos , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico por imagem , Humanos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Metotrexato/uso terapêutico , Ohio , Resultado do Tratamento
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